Monthly Archives: August 2023

Night Float

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The hospital is 24-7 all year long so there are always staff who care for patients overnight. I was the doctor on a night medicine crew for a few weeks recently. That stretch, I worked in a veterans hospital which meant all my patients had two things in common: they were in the hospital and had served in the military.

Here are some snippets from my nights:

  • “Let us know if anything changes,” I said as I left the room having been called there because the patient’s heart rate had dipped for a few minutes. They were in the hospital because their heart was beating too slowly. Therefore, any time their heart went even slower it was concerning and I went to evaluate them. On this visit to their room, the patient’s symptoms were unchanged from earlier that night and the night before. They were stable, though lightheaded. How to best manage their heart was being explored by the day team. The patient had insomnia even when not in the hospital. I was holding the sleeping medication they’d used for months because it could make their heart slower. It was our second night together, the patient and I, and we were doing our best to get through it. They watched TV because they couldn’t sleep and I answered pages (yep, in healthcare we still use pagers and faxes), saw patients, and ordered medications as the need arose.
  • I stopped by a patient’s room early in the night because they were a “watcher” (someone who was on my “watch carefully list” because they were more likely than others to take a turn for the worse). They had recently turned 80 and were chatty. They glanced up at the news on the TV in the room, “Politics in this country is in a terrible state,” they said. I expressed my agreement. “We got shot at for this,” the patient said, shaking their head and nodding at the TV. Six million responses flashed through my mind; none expressed what I wanted to say. None made the gravity of their statement less.
  • I was called to a patient’s room multiple times over several nights. Every time they were writhing in abdominal pain. Every time they had their blanket over their head. What kind of trauma had this grown-up person survived to feel it necessary to hide under their blanket in the hospital? Our workup, so far, was negative. No explanation for their pain. We tried treating constipation and urinary retention. We tried nausea medicine. None of that helped. Tylenol wasn’t working. What else should I try? Should I give this patient another small dose of opioid medication like they got during the day? Were they seeking out opioid medication because they were addicted to opioids or were they just in pain? Did it matter if they were drug seeking because of addiction if their pain was real? Was their pain real? If their pain was real, was an opiate the best tool I had to help lessen it?
  • I walked briskly. A patient who was admitted for a small stroke had an evolving headache. Maybe it was just a headache, but I wasn’t going to just give Tylenol and not examine the patient. It would be terrible to miss a second stroke we might be able to do something about. Head and neck pain. Their neuro exam was normal – no weakness or sensation changes. I examined their neck. My heart jumped with joy. There under my fingertips was a good old regular muscle knot. We have great medications for muscle pain. Besides, hospital beds are uncomfortable. When this patient got home (especially if they stretched) their knot would surely go away. Finally, a fixable problem!

There’s something surreal about starting your shift when the sun is setting and driving home to sleep after the sun rises – driving in work traffic going the opposite direction as everyone else on the work-home axis. Some nights in the hospital seemed to move backward and other nights zoomed by. I don’t recommend the night shift and I never will – this wasn’t my first rodeo as we used to say in the ED where I first worked night shift. Yet, this was my first time on nights as a doctor. Night float afforded me more independence than I’d had previously. I grew as the nights trudged on. As I drove home on the morning of my last night shift, I felt a little bit more like a physician than I ever had before. And though tired and excited to transition back to days, the feeling of growth was rewarding.

In the Quiet Presence of Plants

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“Some people look for a beautiful place, others make a place beautiful.”

~Hazrat Inayat Khan

I’m a keeper of plants. Some might call me a gardener but, having grown up in the rural US, I reserve the term “garden” for plants that root in the ground. And so, I’m a keeper of plants because all my plants are rooted in pots.

I have over 75 plants in my smallish apartment. Some of them have followed me through 6 moves. Some joined just this month. The only common feature among them is that they prefer Virginia to any place we’ve lived before. I attribute this to the sparkly sun here which was a key feature that drew me to the state in the first place.

My plants are as diverse as Richmond. There’s the Norfolk pine I’m growing as my Christmas tree. There are begonias adding their clashing leaf patterns to the balcony-dwelling jade plant, banana plant, snake plant, umbrella tree, and palm. On my desk is a battalion of orchids, most of whom bloom in spring. There are calatheas, peperomias, and bromeliads mixed in with the succulents and cacti. The coffee plants, passion fruit vines, and lemon trees are some of the newest additions. A dear friend got me a money tree for luck, around the time I got a lucky bamboo – it was a period of much change, so luck was needed. These lucky plants keep on growing. My crown of thorns hasn’t stopped blooming since I got it 5+ years ago. The fig, rubber, and dragon trees all were recently decapitated to encourage side branches (so far these experiments have been fruitful).

The plants sit along the windows and in layers such that those that need the least light live in the middle of my apartment and those that need the most are on the balcony for the summer or reside on the wide windowsill between my bedroom window and the blackout curtains necessary for daytime sleeping when I’m on nightshift. I know each plant’s light and watering preferences. I have a strategy for keeping each one alive when I leave for vacation.

Sometimes I wonder if it’s silly to have so many plants because I work such long hours outside of my home. However, when I come home to find a new flower bud or a fresh leaf unfurling, I’m reminded that it’s not silly but genius to have so many plants. The plants add a different beauty to the apartment than art (I have that too) and their quiet company is something I enjoy. With my plants even the most frustrating day can be softened when, upon sitting on my couch, I notice just how much the peace lily likes its new spot or how much the Chinese evergreen has flourished since we arrived in Richmond only months ago. And when I see the plants that I’ve potted up at least 3 times threatening to outgrow their current pots, I remember how we all change and grow with time. Sometimes our process of growth is too slow to see from day-to-day and only can be realized when we compare month-to-month or year-to-year. Yet, just as surely as my plants are renewing their roots and leaves, I’m also growing as the days of residency pass.

Hey Doctor!

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I got in the hospital elevator. One person was already in it – a maintenance guy by his uniform and the fact that he had a ladder in hand. Before I’d decided if I was going to say “hello,” he declared joyfully “Hey doctor!”

I glanced down at my badged (“doctor” was written on it in capitalized black letters on a yellow background larger than anything else on the badge). I looked around the elevator…yep just me and him…he was definitely talking to me. I said, “Hi!”

“Did you have to look at your badge?” he asked in a voice cracked in the way voices are when a laugh is bubbling up. We both burst into laughter.

I’ve been a practicing doctor for 5 weeks. While I feel ready and excited to be a doctor, the title is still new and I’m learning the role. Some patients and non-doctors take the title seriously and some don’t; however, when you ARE a medical doctor, the title comes with some weight as you know exactly what responsibility is behind it.

As part of my residency training, I work in a primary care clinic where I have a group of patients for whom I’m their sole primary care doctor for the duration of my residency. This means I’ll see them when they have a new issue and I’ll also manage their health maintenance. Primary care is about tackling health challenges before they become health issues and preventing people from experiencing life-threatening events and worsening health if possible. It’s arguably the most important part of the healthcare system even though it gets the least recognition, compensation, and emphasis in our corporate/profit-focused US healthcare system.

My first week as a primary care doctor I ordered a cholesterol panel (a blood test) for one of my patients. They had obesity and chronic pain. They hadn’t had their cholesterol checked before and at their age and BMI (body mass index) I wanted to see if we needed to start a cholesterol-lowering medication to reduce their risk of heart disease. During our appointment, the patient and I had a lovely conversation about their life and the changes they’d made to improve their health. I was inspired by them because it was clear that they were motivated and dedicated to their health – they had made diet changes and were finding ways to fit exercise into their routine despite having housing insecurity and struggling to make ends meet. 

The cholesterol panel came back several hours after the patient’s appointment had ended. I looked at the numbers and panicked. How do I interpret these numbers? I asked myself. This patient was relying on me to evaluate their lab results and provide recommendations on lifestyle and medication use. It was a big burden. I read some medical resources then, based on what I read, decided that their cholesterol was okay given their other heart risk factors. They didn’t need to start a new medication. I sent them a letter with the normal result.

Even after I sent the patient a letter about their cholesterol, panic lingered in my toes. Had I interpreted the results correctly? Would I need to call them back and tell them I was wrong, and we needed to do something different? Had a missed an opportunity to help them protect their heart?

Over the next week I researched more about cholesterol panels and then talked to my supervising doctor about the topic. In the end, I confirmed that I had made the right decision for this patient. I also learned there is a calculator I should use to determine patients’ risk of heart disease and the benefit of starting a cholesterol-lowering medication.

Soon interpreting cholesterol panels will be easy and fast. But the first time I did it for a real patient (a real person) was exciting and nerve-wracking. Just like being called “doctor” in the elevator this week required a little extra processing to realize that I was the doctor being referenced. I know I won’t have to check my badge for much longer to confirm my profession. I’m excited to grow into the person who can respond without pause to “hey doctor!”