I make probably hundreds of decisions a day. We all do, some bigger and some smaller than others. The last 2 weeks I have spent my days in the hospital and for the next 2 weeks will spend my nights in the hospital - learning to be a doctor.
My attending doctors slowly giving us more autonomy to make our own decisions, to figure out how to practice medicine and feel that we are managing our patient's care. It started out small last week, with how to make my patient's poop. "What's your favorite treatment for constipation?" Options include - Milk of Magnesia, Colace, senna, Magnesium Citrate, lactulose, and a variety of suppositories. So I picked one, no poop, next day try a different one. There you go that's what I'm learning :) Hey, all decisions matter the faster I can get my patients to poop, the happier they'll be?!
My little decisions and slowly advancing to other parts of patient care. Learning from watching the decisions my attendings make in their choice of bedside manner - when to play tough and try to scare the patient and when to sit down and really talk out the situation. As doctors, I am still learning much like a 2 year old, through mimicking. I watch and then I do - picking and choosing which pieces of my attendings I want to mimic. Taking those little pieces to make me into a doctor.
I am able to see the consequences of many of my patient's decisions. Deciding to be an IV drug user and blowing out all of your veins may buy you a central line in order to be able to draw blood or give you fluids. You also will likely get stuck umpteen times in an attempt to get a peripheral line before heading for the big guns.
Shooting up into your external jugular vein may cause a life threatening abscess in your neck that may actually scare you enough to come clean. Or perhaps you'll be admitted to the hospital with what I learned is called "cotton fever." Apparently when shooting up heroin or crushing up pills, then dissolving it in a liquid in order to shoot up - during this process at some point they filter it through cotton, but oftentimes it is a cigarette filter - well sometimes microfibers from the filter get into the bloodstream when shooting up and the body has an inflammatory response which causes high fevers. Apparently if you go to the needle exchange program in town you can also get clean cotton which will prevent the likelihood of cotton fever.
And working in a hospital makes it inevitable that end of life decisions will be made. When is the proper time to send your mentally handicapped brother to hospice rather than try to prolong his life with feeding tubes? Rather to let him enjoy eating whatever he likes, but knowing ultimately he will likely die from aspiration pneumonia. Apparently, I have learned that pneumonia is not such a bad way to go, because the brain becomes hypoxic and there is not much pain. They know this from patients who were nearly there and came back from the edge.
What decision would you make if you were able to choose your death. I watched from the sidelines, as she was not my patient, a late 90 year old lady make the decision on whether or not she wanted to go to surgery for an incarcerated hernia. Take a chance to die on the operating table from a MI or other complication versus dying from your bowel dying inside of you, a likely very painful death. Hospice is a wonderful service and provides great care to those in their last moments for both themselves and their families. I cannot imagine making that last decision - being rolled into the OR knowing there is a good chance that I would not come out of those doors, that this was it. Or if I do make it out who knows how long or horrific the recovery would be. It was a decision I could see going either way - both sides equally difficult to choose between.
Decisions, decisions, decisions - all day everyday we face 100s of them. Many are decided without even realizing we've made a choice. I guess just keep practicing, find out what works or makes poop and hopefully when those big time decisions roll around we'll be prepared.
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