Last Day

Some impressions from my last day of clinicals:

We brought treats in for the staff this morning. As we sat around eating donuts, we heard about the chaotic night shift--a patient had come in obviously high but refusing to admit that he was using drugs and later that night, after a trip to the bathroom, he coded and they did CPR and other unpleasant things and he died anyway.  Drug guy was not the only patient who died in the night. The other was more expected (she got dose after dose of morphine to keep her comfortable and she died quietly in the night) so all the talk was about dead drug guy. The stories about it started out serious but by the end people were joking and laughing about it, necessarily.

After hearing the stories, another student told me about her rotation last term when she walked into a room to check on a patient shortly after giving her a dose of fentanyl, a massively potent opioid. The student found her struggling to open a bottle of oxycodone--another potent opioid--that she had brought from home. The student took the bottle of oxy away from the patient of course, and left the room only to be  told that next time (there will always be a next time, I'm finding out) she should hit the call light and have another staff member come in and count the drugs so that the patient can't later claim that there were more.

Later in the afternoon, I had just finished talking a reluctant patient into downing the last of a bottle of nasty tasting contrast medium when the scan he was scheduled for is cancelled.  No one agreed with the decision, of course, but the surgeon is king.

I had the same patient as yesterday, a man who should have given up smoking a long time before he did. You can see on his x-ray that his lungs look packed with cheesecloth. I put my stethoscope to his chest and I hear crackles. He is exhausted from the work of trying to breathe and from a recent surgery and from getting no rest. (The hospital is the worst place to try to get any sleep.) He's developing bedsores and I try to position him to take the pressure off the worst parts, but he refuses to budge. His brain isn't getting enough oxygen and he's confused but he still has the right to refuse anything he wants to refuse. He just wants to sleep, so I pull down his shades and turn off his lights and leave him to it.

The day went on and on and on. It was slow on the unit so I borrowed another student's psych textbook and made copies of the reading for Monday's class. Whenever I have a free moment, I sit and read.

While I'm reading in the break room, one of the other students comes in. He's a quiet man in his 30's who works at another hospital as a tech. He tells me to google "Philly sidecar," so I do. He tells me they had a patient at the other hospital with that. "He was kind of a gross guy," he says.

The other students have gotten their assignments for their final rotations. Two of them have snagged coveted places on baby-related units but the kicker is that neither of them wants to go there. I understand. I hope I don't end up with a labor and delivery or mother-baby assignment. I've asked for something surgical or post-op and beyond that in a specialty clinic. We'll see.

I give a Starbucks gift certificate to the med tech who I've gotten along with really well and she hugs me goodbye. Then as we are leaving the unit, she hugs everyone else goodbye. My instructor also hugs me and every other student goodbye. I watch the Muslim student try and fail to get out of hugging. He won't touch women in general outside of work or, I guess, marriage.

I come home and try and fail to sleep. I put my scrubs in the washing machine and I surf the 'net until David comes home and we feed the pups we are sitting and then run out the door to the theater to see Black Panther (which I really, really like). We came home and made a couple of sandwiches and called that dinner.

I'm so exhausted that I don't know how I'm standing up even.