Tuesday, January 8, 2013

There are no sick days in residency

Of the numerous sucker punches residency has to offer, I think the most baffling is the way we deal with falling ill. As in, the residents themselves being under the weather.

I know! That happens? Bunch of pansies...

It's okay for our patients to get sick, I mean, they kind of have to in order to eek a living out of this popsicle stand, but we, as care providers, can not. 

Our daily zigging and zagging of snot is irrelevant. Our very job description of promoting health, wellness, and recovery, doesn't apply to us. We must defy the principles of communicative disease, be the commander of our own physiology, make ways to rest/hydrate/exercise within our 80hr work week, and not get sick.

Okay. Let's be fair. That might be a bit extreme. There is a contingency plan in place if you are delirious or in a coma. 

Or, if you are a weakling who doesn't want to bring your virus laden wet rag of a self to the oncology ward because you're "concerned" about the "vulnerability" of patients "without an immune system," then you can fall back on the a fore mentioned contingency. It's called Jeopardy.

Jeopardy. Sure it may refer to the Alex Trebeck themed monologue running through your head -  "You chose this career you nincompoop for 100", "Nut jobs in charge of scheduling for 200," or, today's daily double, "Schadenfreude," - but in reality it refers to the word's dictionary definition:

Jeopardy [jep-er-dee] noun 
1. harzard or risk of or exposure to, loss, harm, death or injury
2. peril or danger
3. the danger or hazard of being found guilty, and of consequent punishment, undergone by criminal defendants on trial

Synonyms: See Danger; menace, threat
Antonyms: Security

So, see? You're totally covered! 

Vomiting, immobility, fevers, explosive uprisings of rebel recruits in your sinuses? Nope! Doesn't sound like death to me! Walk if off you whiner.

If you really are in peril, you can call in a jeopardy person. Go ahead. See what happens.

Who is the jeopardy person, you ask? One from a shiny cavalry of good hearted souls on call to be our back-up? Close... it's a fellow resident.

365 days a year there is a resident on jeopardy call. Actually, three. One for each year -- there's an intern jepo person, a 2nd year jepo person, and a senior jepo person. If you can't come in on a given day -- your grandmother died, you're in a car accident you can't leave the scene of, you've just found out you have two months to live -- then you call the jepo person in to cover whatever shift you're going to miss. 

Am I the only one who finds this sketchy? Cause, I mean... yeah you get a break, but you're screwing over your counterparts by succumbing to your body or circumstance, you lame-o.

It gets lamer.

If you DO call somebody in to cover your shift because you're dying, what do you get in return? Sympathy? Chicken soup? Nah, how about a healthy serving of guilt and immediate e-mails asking when you're going to PAY THAT PERSON BACK.

If you're sick, and someone has to cover for you, even though you're miserable and are making what is probably a considerate decision for anyone working with you who might pick up what you've got, you need to pay whoever covers you back.

Not with money, mind you. With another, comparable, shift. 

Last February I was hypoxic (low oxygen in my blood) and dyspneic (short of breath) and physically unable to walk from my couch to the kitchen (sooooo sick). I'd worked four 12hr ED shifts in as many days with a waning voice and a progressively looser grip on reality, taking care of angsty teenagers and snotty kids who weren't half as sick as I was, and finally said, ENOUGH. 

Well, my husband did. He said enough. He thought I was dying and forced me to stay home.

I had to jepo someone for the first time in 22 months of residency. Because GOD FORBID the ED would be down one resident for 12 hours (when there are always at least 3 residents in addition to 2 mid-level providers and 2-3 attendings)(plus med students).  

While it was great not having to go in that day, and probably best for the health of everyone involved, I then had to work with the covering person to find a time when I could cover a 12 hour shift that they had in the future. So I ended up covering the PICU, NICU, and peds ward at the city hospital overnight on Thanksgiving, because that's the only time we could find that jived.

Be ye warned. There are no sick days in residency. And in fact, you get insult to injury by having to cover another shift for that person in the future.

While I get that the payback expectation is largely to discourage people from abusing the system, why on Earth isn't there a better way? A medical diploma didn't make us superhuman. Why does the system expect us to be? 

Sunday, January 6, 2013

A firm decision to do or not do something.

My resolutions for 2013 are straightforward:

1) Take better care of my teeth.
2) If I wear make-up during the day, I must wash it off before going to sleep.

And by "straightforward" I evidently mean "peepholes into my true life as a slob and possible redneck."

I forget how messy I was am. Throughout college, my roommate, Disturbingly Potent, was meticulous and very upstanding when it came to home making. Think pastel hued gingham with navy madras accents carrying a book on manners whilst wielding an acerbic wit and you have the jist of her persona. So of course she was tidier than a 1950s housewife.

In an effort to make up for the fact that I was am incapable of getting up when my alarm goes off and therefore ruined the majority of her mornings with my snooze hitting, I tried to keep my areas in check. No clothes on the floor. No dirty dishes.

At least, no dishes dirty enough to grow things.

As soon as I got to med school and had a room of my own again, the clutter came screaming back, albeit a little reigned in because Manhattan isn't a place too conducive of hoarding, at least not on the amateur level. I certainly rivaled the pros in terms of incapacitation due to mental illness, but even though I couldn't get out of bed in the morning, by God I could still aim and throw things in the trash.

Having said all that I don't think my hygiene has ever been out of check, save for the few years in elementary school when I was the smelly kid.

It had to have been around fifth grade after we moved 3 hours away from the only home I'd known and I implemented a bathing strike to make my displeasure known. Malodorously.

But I've found that when your time is crunched, like say, if you're enduring an on-the-job equivalent of water boarding and come home after an 80hr week unable to function in society, non-essential things go by the wayside. And now that you realize teeth brushing and face washing fall into the "non-essential" realm of life, you can see what dire straits we are dealing with here.

Residency: don't let it happen to you.