When It Rains, It Pours

First off, it is raining here in Nome. On January 30, 2014. And it has been raining lately. The other day we got up to a balmy 53 degrees, while Hawaii was just over 10 degrees warmer at 65 degrees (normally the average temperature in Hawaii in January is 85 degrees warmer than the average Jan temperature in Nome)! The Sea is not frozen like it usually is at the end of January–parts of the beach are back to liquid!

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I haven’t posted in a while, because I’ve been super busy. And when it rains it pours. I worked on call on Thursday, the overnight Saturday night call, the Monday call and had ~12 inpatients. After Monday, one way or another, landed with 7 patients. I know that is a small number for a hospitalist, but it’s different when you’re the ED doc, fielding calls from all the villages, and the hospitalist (and partly the travel arranger, the counselor, the referral coordinator, the case manager, wound care person, nutritionist…etc)! Plus the hospital medicine is in addition to the regular clinic on Monday through Friday. A few of the hospital patients were really sick (which means you get called on them throughout the days), and after practicing my getting-rusty critical care medicine (which pressor do you use when someone has critically low blood pressure with a stretched out heart with a fast rate, heart failure, and kidney failure again?), they got sent to Anchorage. There are also a few social/behavioral health intensive patients.

For the most part, it’s rewarding. But lately I’ve had days where I just feel overwhelmed with how much more there always is to do. No matter how much you give, there’s always more you see, and feel like you should be doing/giving. It’s hard to know where to draw the line, because most people in this type of work do it to help others. It feels impossible to not help out when you see it is needed, and it goes against the nature of a healthcare provider. But you could go forever, 24 hours a day, and still not do enough. And there isn’t always a system to help get it all done–there are some awesome systems here, with great people making them work–but not always. Often there are not always the resources.

So then you have to choose–how much you can help and when and whom. And it feels so terrible to have to make choices that feel like you aren’t doing everything for each patient. And I’m not very good at it. In fact, I suck at it. So what I end up doing instead is working 14-16 hours every day, because the only way to do more is just add on more.  I’m starting to feel a little bit  frazzled (even though I’m so fresh out!). Honestly I don’t know how the older doctors do it, because I know they’ve been doing this for decades, and they are still going strong–they work so hard. I need to learn from them their secrets. But I do know that if someone says something discouraging, and/or asks me to do more (or implies that I’m not doing enough), it’s enough to make me lose any control that I had of maintaining my “just-keep-going” course, and in the last couple of days I have lost it. A discouraging word can go a long way. But so can an encouraging word.

To add to that, it seems like the way Life goes, when it rains it pours. This week has had lots of other little struggles–my internet just stopped working, and I have no business hours to figure it out (pretty much every business in Nome is open from M-F 9am-5pm). Also not long ago, the storm blew all that snow into my container, I had to dust all the snow off of each item, move it all out and clean it up. And all of it has been sitting in my apartment, filling up the entrance, blocking my doorways and cluttering the place up, because I haven’t really had a day off since then. But, that happened to be the time when the landlords decided my house is due for an inspection, so I carried it back at 11pm, after working a few long days. And I was trying to plan my Continuing Medical Education (CME) and it seemed like all my attempts at planning kept on failing…among other things. Sometimes you just feel like you’re in a vortex of overwhelming things to do, and everything comes around at once.
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Anyway, things are looking up (like they always do). I have internet for the first time in days! And I’m pretty sure I’ve figured out my CME–I’m going to Hawaii!!! Plus, I have received the most amazing support from my coworkers, all the time, but especially when they saw how overwhelmed I’ve been getting. And I know everything will be alright when this passes–even when it pours.

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