Life on clinics

The transition back to clinics has been partly better and partly worse than I thought. The evenings are always late, to the point that I usually get home between 8 and 9, H has already been given a couple of bottles, and I nurse him to sleep which takes about 20 minutes. He's already sleepy and quiet, and not interested in making eye contact, singing songs, playing little finger games, smiling, or really interacting at all. So I feed him until he falls asleep, and then I rush around washing all of his bottles from that day (unless it's MM's turn to wash them), refilling them with pumped milk for tomorrow, washing the pump parts, maybe pumping again depending on how much he ate, packing my lunch for the next day, making coffee, possibly updating my progress notes or SOAP for one of two patients, and then falling into bed as soon as all of that is done. So, I barely spend any time with him during the week, most of what I do spend is not quality time, and I'm always tired because I have all that stuff to do when I get home instead of just going to sleep.

I can actually FEEL myself getting stupider as the week goes on! On Monday, if I only worked a few hours over the weekend, I'm pretty on my game. I can intelligently examine a patient, formulate a problem list, come up with a decent list of differentials, and decide on an initial diagnostic plan. I can think through mechanisms when the clinicians pimp me, and I get things done relatively efficiently (although I've always tended more toward the chicken-with-its-head-cut-off style of doing things rather than a smoothly efficient manner. I wish I could think of some way to be more organized about what I need to do! I've been like that my whole life, and I've recognized it as a problem for years, and nothing I do seems to help much. It's a real liability as a clinician, so I'd really like to fix it.) By Thursday, I'm a total disaster. You would think I was actually a completely different person! This Thursday, for instance, I had trouble deciding whether serum bile acids would be high or low in a dog with a portosystemic shunt. I decided they'd be low, since they're made by the liver, which isn't functioning properly. Since that's wrong, the clinician tried to get me to start over with the mechanism, and I thought she was saying I was wrong about where bile acids are made . . . . . .  . so I ended up telling her they're made in the pancreas.

The pancreas.

Bile acids.

In the pancreas.

I cringe even thinking about it! And Friday was similar.

Anyway, I was off this weekend, except for being on call last night 8P-8A, and having to go in around 7 both mornings to SOAP my patient in ICU. I only have one patient in the hospital right now, and he was in ICU for the past couple of days so I didn't have to do his treatments, just examine him and update the problems list, diagnostics from the day before, and plan for the current day. Yesterday that was fine, I finished around 8:45 and went home. Today, he had improved enough to move out of ICU and back to the wards! That was super cool (he was really sick, I thought he was going to either die or be euthanized) but also a pain in the ass since a) I had to do the transfer, b) now all his AM treatments were my responsibility, and there was a list a page long (literally) of treatments that I was ordering for him, and c) since he was on the wards he couldn't be on IV fluids anymore, so all his meds had to go PO and the doses and intervals had to be recalculated and everything had to be ordered from the pharmacy. Oh, and since he was feeling so much better, he no longer stood inert while I measured his blood pressure, took his temperature, applied his topical medications, and drew blood -- instead he was wriggling and twisting all around trying to get away from me, so I needed help with everything and everyone else was busy trying to get their own treatments taken care of so they could leave.

So, at 8:15 I texted MM (who had to leave for work at 9) that he was going to have to drop H off at the vet hospital on his way to work. Which he did, and it was no big deal since we only live half a mile away and had discussed the possibility beforehand. And MM fed him right before they came over, so theoretically he'd be fine for awhile while I finished up all my stuff for my patient and wrote his magnum opus of a discharge.

But he started fussing as soon as I got up to the wards. So I had him in the Bjorn trying to shush him, while everyone who hadn't met him yet wandered by, saying hi to him and asking about him, and one of the really nice nurses (probably the nicest I've met at this hospital, actually) hung out, chatting about when her daughter was a baby, and he was fussing, and crying, and I finally put him back in his carseat, but then I had to lug it everywhere with me. And every time I sat down to try to update the discharge (THANK GOD I started it ahead of time!!!) he would start fussing again, and everyone else was trying to concentrate so I couldn't just let him be noisy.

In the end, my resident ended up basically finishing all of my work for me, while I shushed H. I literally got nothing done once M dropped him off, except for filling samples of prescription diets to go home with the dog, and dropping his bloodwork off at the lab. My RESIDENT did the rest of my work, including deciding which drugs to send him home on, writing all the directions for the owner, filling the prescriptions, and finishing my discharge. So, that was a pretty massive fail. :( Luckily she's really nice and didn't seem to hold it against me. But it was still unprofessional, whether it upset anyone or not.