Epilogue

So it's over. I talked to my replacement program director (my program director took very unfortunately-timed vacation this week) after half day yesterday, and they have decided to pull me from the rotation, citing 'medical reasons'. So I'm now home. And happy. And rested. And the annoying cramping I'd been experiencing for the past few days that I attributed to being on my feet for too long has completely stopped. And my feet look like human feet, not Shrek feet. And I even have an appetite again. Life is good.

As for trauma, I'll be making up the time with extra trauma call here. Which is fine with me. Hell, I'll carry the trauma pager for the rest of the freaking year if it means never having to go back to the Centre of the Universe. Which I haven been assured I won't. :-)

Best of all, the trauma rotation from hell is now being reviewed. It seems that after the replacement program director got my e-mail he started asking around, starting with the two new staff hires in the ED who finished our training program last year. It seems my experience was anything but unique. And one emerg doc expressed surprise that I'd even attempt to do it 6 months pregnant. Um... yeah. Clearly I had NO idea what I was getting myself into.

Then, however, I had to tell the people at the COTU that I was leaving. In the first stroke of phenomenal luck that I've had since this awful rotation started, Mr. Old-School-Gruff-Intimidating-Trauma-Surgeon who is usually the postgrad education guy is on vacation this week. So instead, I had to deal with the guy who just happened to be the sweetest, friendliest and most approachable of the 6 trauma surgeons on the service. I had only met him once, but he actually took the time to learn my name (a stark contrast from the other staff trauma surgeons). His exact words to me?

"Couz, the two most important things in life are your health and your family. Right now, you need to think about those two things. Work will always be there. And work should never come before taking care of yourself. So go home and take care of yourself and your baby. Don't worry about anything else."

How sweet (and totally unexpected) is that?

My senior resident was also pretty unfazed, but now that there is a second junior resident that joined our team this week I'm sure she's just relieved that my leaving will be unlikely to disrupt her OR time. No doubt whomever gets stuck with my last two nights of call will be less than thrilled, but I'll be long gone by that time.

Having dealt with the rigid rules and hierarchy that is medical education, I am actually completely blown away by how accommodating everyone has been. Thank God that medicine can actually be human and sympathetic occasionally.

And as of Monday, I'm back in the emergency room. And feeling like the old Dr. Couz. And that's a good thing. I missed me. :-)

P.S. Thanks again to everyone for all their support over the past couple of weeks. Particularly to my blog readers and friends in the COTU who actually offered such things as air conditioned places to sleep and home-cooked meals delivered to the hospital for me. You guys rock. And an extra thank you goes out to my uncle Andy-- until this week, I didn't realize how closely you followed my blog and my life. Although it's been one helluva rough couple of weeks, I feel very loved.

Thank Freaking God.

I'm coming home. I love my program.

Another Damn Update...

In spite of my current predicament, I have been really touched by the outpouring of support. Phone calls from my nearest and dearest (which I've been mostly avoiding since the slightest show of sympathy can make me burst into very un-Couz-like tears), posts to this blog, Facebook messages and e-mails from both long-lost friends (who knew they read my blog) to near-strangers offering me respite from my situation (thanks again, Kate!). It makes a girl in a desperate situation feel very loved.

But the week got no better after my post. In fact, my night of call was beyond brutal. By 11pm that night my feet were so swollen (in spite of my TED's support stockings) that I couldn't get my Nikes back on. I had to unlace them and leave them unlaced. The night was a blur, I never did figure out where my call room was (a moot point, since I didn't get a chance to sit down until about 5:30am) and I STILL didn't see any good trauma. I felt so sick on my post call day (nauseous, swollen and prone to fainting) that I ended up being sent home at a reasonable time (not long after noon-- so only 30 hours or so of nonstop work on my feet). There were literally no high points to my week. I drove myself home on Friday after work, in spite of the long weekend traffic, and was greeted after the long drive by my sister and her significant other who made me eat and rubbed my feet. It was nice.

The next morning (after about 12 hours of sleep interrupted only by disturbing dreams of people crashing on the floor and visions of my pager going off) I wrote a carefully worded letter to my program director. Thankfully, she is a very approachable ER doc who has been through a few pregnancies of her own, and has already been a great mentor for me through this experience. Here is the letter I wrote (some details have been changed, obviously):

Dear Emergency Medicine Program Director:

I'm really sorry to interrupt your long weekend, but I'm having some serious problems with my trauma rotation.

This rotation is not meeting my educational objectives in any way. Having already completed two months of general surgery as a PGY-1, I am honestly not finding this rotation helpful at all. I am the junior resident on the team, and my role does not extend past running the floor. Making this more difficult is that fact that no one at any point has explained to me how the hospital works, what exactly is expected of me or even things as simple as how to access x-rays. In fact, many of my duties are only identified as such the following day when they haven't been done and I am berated by various senior member of 'the team'.

My day starts at 6am, when I am expected to pre-round on the team's patients before the senior resident comes in at 6:30am. At that time, I will be quizzed on lab results, urine output and vital signs. A quick round are preformed before the senior heads to the OR, and I am left to run the floor all day. This leaves me running from one end of the hospital to the other for an average of 12 hours a day without breaks. Even my half day is not necessarily 'protected' time, as the other juniors are very hesitant to relieve me of the duty of covering my team's patients and holding the trauma pager. The policy in this centre is that it is your responsibility to find someone to cover for you and if you are unable because the other juniors are unwilling or unable, you simply don't get to attend half day. On Wednesday I was paged out of half day an average of every 5-10 minutes throughout the afternoon, and heard next to nothing of the teaching. Since this is quite clearly a service-based rotation as a opposed to one that values teaching, the Wednesday afternoon was my only chance to get any formal (or informal) teaching and it was a bust.

The only change from this routine comes when the trauma pager goes off. This happens anywhere from 0-2 times a day (in spite of the fact that this is supposed to be the 'busy' time of year for trauma, ironically). I respond, along with about 10 other people, and fight for room near the patient along with the team from anesthesia, the team from the emergency room and the team from orthopedic surgery. My 'role' in the trauma is restricted to doing the secondary survey (the primary is mostly handled by anesthesia), and waiting around while the patient is scanned to see what team the patient will be admitted under. Although in theory I am supposed to be the one to do the procedures, that has been restricted to inserting foley catheters. Honestly, I felt I was getting much more out of traumas in my home centre, where the ER doc would allow me to run through the entire trauma from start to disposition. In addition, I actually found that I had more opportunities to do procedures in the ED in my home centre than I do on this rotation. This experience has been extremely disappointing, and I find that I'm not actually getting anything out of it.

Ordinarily, I would probably suck up the experience and push through it, just to have it behind me. But in light of my current physical limitations, I am having a really difficult time meeting the physical requirements of this rotation. Between the swelling, the back pain, the GERD-associated vomiting that sneaks up on me at embarrassing moments and the pre-syncopal episodes that happen when I spend too long on my feet, this week has been really rough on me. I'm not sure what to do at this point. I honestly don't think I can physically complete the rest of this rotation, but I am concerned about the repercussion of taking leave. I am willing to explore any number of options-- doing extra TTL call during my ortho-plastics and elective rotations, doing a trauma rotation as an emerg resident (as opposed to a gen surg resident) at this teaching centre or elsewhere... I am open to pretty much anything. I think there are many other ways I can get the exposure the trauma I am looking for, because I'm really not getting it on this rotation.

I would be more than willing to discuss this with you as soon as you can. I am hoping there will be another way I can fulfill my trauma requirement for the program and another way I can spend the rest of this month. You can reach me at home this weekend or by e-mail.

Again, I have to apologize. I am in no way a quitter, and debated a long time about addressing this with you. As I said, my first instinct in this situation would be to suck it up and finish for the sake of having it behind me, but between my somewhat compromised coping skills and my concern about the actual educational experience itself I don't think that simply going through the motions for the sake of completing the rotation is my best option at this point.

Thank you for listening, I look forward to your reply.

Couz

Unfortunately, I am still waiting for that reply. I suspect she may have gone out of town for the long weekend. Since I don't feel right bailing on a rotation without the blessing of my program director, I may end up heading back to the scene of the crime tomorrow in order to report to work at my usual 6:15am on Tuesday morning. Sigh. Just when the foot swelling has gone down...

Quick Update

I know I promised more uplifting posts, but it's just not going to happen. Not anytime soon, anyway.

After being spoiled by starting my EM year by actually doing a month of emergency medicine (astonishing, I know), I am now in hell. I have been shuttled down to Large Teaching Hospital in major Canadian city also known as the Centre of the Universe (or COTU, semi-affectionately). So in my fragile emotional state (for more illustration of this, see last post) I have been sent to a sterile little apartment far from my home, my husband, my fur-babies and everything familiar to me to be overworked, belittled, abused, demoted and generally made miserable. Why is this happening to me? Because I'm reliving some of the darkest days of my medical education... my days as a junior surgical resident.

This is allegedly my 'Trauma' rotation. Bullshit. If this was a true trauma rotation, I'd be working with the TTL (trauma team leader) running the trauma from start to finish. Instead, I respond with the trauma team to all incoming traumas and traumettes (little traumas, or minor injuries that might require a chest tube or something), do a quick primary and secondary survey and then sit around and pick my ass until the patient has been scanned. Then after all of the injuries have been identified, I define which ones are directly relevant to the general surgery team and report back to the staff. Not too bad, right? Particularly since I get first dibs on some of the more invasive stuff (chest tubes, femoral pokes, art lines, etc.). So why am I miserable?

You'll be sorry you asked. My day starts at the hospital at about 6:15am. I am expected to pre-round on patient results and conditions for all of the team's patients (both trauma and regular general surgery patients) before the senior comes in. To add to the fun, the ward is often locked that early in the morning and I have to buzz the intercom for a good 10 minutes before someone will let me in. Which then makes me behind, and I get yelled at for not knowing everyone's Tmax (maximum temperature, indicating fevers and such) over the past 24 hours. My days last about 12 hours long. That's an average. On my feet. Spent running around from one corner of the hospital to the other, mostly completing scut while my senior is in the OR. I rarely have time to eat, and I don't really have the urge to anyway. I am nauseous most of the time, whether it's from being exhausted or stressed I don't know. Thanks to pregnancy hormones, I am quick to cry-- and considering the number of times a day I'm frustrated or overwhelmed, I have had to choke back humiliating displays of emotion more times than I can count. I save it for the 2-3 hours between the time I get home and the time I go to bed to have a hope in hell of waking with my 5:15am alarm.

Doing this pregnant was the stupidest idea ever. My feet are swollen by 8am, thanks to a combination of being on my feet constantly and the 40 degree heat. My back and abdomen cramp constantly, again probably thanks to the time spent on my feet. I've started having those lovely pre-syncopal episodes again, probably in part due to my ongoing blood pressure issues and part due to the fact that I'm back to minimal food intake.

Pregnant or not, this rotation sucks. I am the whole team... just me and the chief resident, who just stays in the OR. I'm trying to do everything, but no one will tell me what 'everything' is or how I'm supposed to get it done in a hospital system that is completely foreign to me. There is no one to answer my questions, and the only time I find out that I was supposed to have done something is the next day, when I'm being yelled at for not doing it.

And to add to the fun, my 'protected educational half days' (teleconferenced lectures from my home school) are anything BUT protected. Today for half day I had to beg someone to take the trauma pager, and he wouldn't cover my call for the afternoon. So I barely even heard any of today's lecture because I was too busy answering pages every 5-10 minutes. Then I got yelled at by my senior for sending a med student to do a consult-- she was placated when I explained that I had already seen all of the urgent consults and assessed them for the OR, and that this consult was VERY non-emergent and the staff requesting the consult admitted on the phone that the patient wasn't likely a 'surgical candidate'... but still.

I've done this already. I've put in my time as a surgical scut monkey. I'm not here to be anyone's lackey, I'm here to learn to run trauma. And I'm getting very little of it. It would have been MUCH more useful to do this as an EM/Trauma rotation. I'd still see the same stuff, but from a perspective that is pertinent to my role as an emergency physician.

Now any other time in my life I probably would have sucked this up and just counted down the days until I was done. But my coping skills have already been recently taxed to their maximum. I'm doing my call tonight, working a full day tomorrow (going home at noon post-call is not an option here on this service... particularly not when your staff surgeon has booked a clinic with 42 patients on your post-call day), back on Friday, then I'm going home. Home to my husband, my dogs, and my crazy sister who is visiting for the weekend with her significant other. There I will carefully construct a letter to my program director explaining my case, my issues, and how difficult this has been. I will emphasize how little I am getting out of it. I will offer to do extra Trauma call during my easier rotations, or even over my maternity leave. But I want to come home.

I just can't do this anymore.

I'm not even reading this post over. Excuse the disjointedness. I might regret posting this later, but what the hell-- you want an insider's look at medical education, here it is. Often, it sucks. And I am too tired to keep sucking it up right now.