“You ready to change your first diaper, daddy? I’ve been waiting to record you!”
Grandma jumped out of her seat, phone clutched in her hands. The hot pink glitter case gleamed, ready to capture this momentous occasion.
Halting my physical exam of his 12 hour old baby, I looked up at dad’s terrified face as he looked down at the black mess I revealed when I undid his daughter’s diaper.
“Oh my God. That’s not natural.”
“This is called meconium. As she starts eating more, she’ll clear this tarry stuff out in a few days. But in the meantime, it’s really sticky and takes a lot to clean up. Here, let me get you some baby wipes and a new diaper.”
Stepping aside to collect the necessary supplies from the bassinet drawer, I could feel the tension radiating off dad on his approach. As I handed him the baby wipes and diaper, he whispered,
“I’ve never changed a diaper before.”
Grandma’s dry cackle filled the room.
“This is going to be good!”
Shooting him a reassuring smile, I stepped back and watched the show. Dad gingerly took hold of her feet with his massive thumb and index finger, afraid to squeeze too tightly for fear of breaking her little bones. As he reached out for a baby wipe, I shook my head.
Rookie mistake, man. At this rate, I’ll be here waiting forever for you to change her diaper.
“There’s a lot of meconium there – it’ll be easier if you wipe as much off as possible with the diaper before you start using the baby wipes.”
Concentration breaking, dad lost his pincer grasp on his daughter’s feet. Horrified, he grimaced as her right heel bounced into the black tarry goo glued to her little bottom.
“We’re waiting! Say hi to the camera!”
Hazel eyes turned to mine as if to silently plead: Save me!
“You got this. Next time try holding at her ankles or knees – it’s more stable that way. You won’t break her.”
Realizing I wasn’t going to swoop in and take over, his gaze returned back to his daughter with determination. Slowly but surely the process started all over again.
This time he clasped her ankles with his whole hand. Grandma, mom and I watched as he wiped away the first layer of meconium. Then again, and again and again, confidence growing with each pass that he wasn’t going to tear away her skin. Once satisfied that every fold was adequately clean, he fiddled with the velcro fasteners, adjusting and readjusting the tension to make sure it wasn’t too tight or too loose. Tucking the front part of the diaper down, he took special care to make sure her umbilical stump wasn’t getting caught.
After completing the longest diaper change known to man, dad looked up triumphantly.
“There! I did it!”
Laughing, I took a spot next to him by the bassinet.
“Looks good! But unfortunately I’m going to have to undo the diaper to get a good look at everything. You did good work, though!”
“I’m surprised you stayed in there for as long as you did,” the nurse said to me as we stepped out of the room. “You were so patient.”
Shrugging, I gave a non-committal reply with a deflective smile, per my usual.
“I had time.”
As I walked down the halls of the nursery to finally hopefully eat lunch at 2 pm, my response echoed in my head.
You didn’t have the time, M. But you needed to MAKE the time for this.
How else was I going to drown out the cries of my 90 year old patient from this morning?
“Why hasn’t God taken me yet? I can’t bear this anymore!”
Or refuel from the taxing pep talk I had to have with my patient who refused to work with physical therapy?
“When are you letting me go home?”
“Well, you can’t go home until you’re able to sit through a 4 hour session of dialysis because the dialysis units outside of the hospital don’t allow you to lay down. You have to physically sit for 4 hours which means you need to build up your strength. This is why it’s important that you work with physical therapy today.”
“… maybe tomorrow.”
“You must be so frustrated. I know you’ve been in the hospital for 3 weeks and you want to go home…”
“That’s not even my home! That’s where my kids put me so they didn’t have to take care of me. Just… just get out of here, ok! Everyone just leave me alone!”
Or how about the conversation in which I had to set expectations for my stroke patient’s son?
“The nurse told me you put in an order to not let my father eat. I want to know why.”
“Yesterday during lunch, I saw him have a choking episode and I felt he wasn’t safe to eat. He’s still too drowsy.”
“Well, I want to feed him. He’s hungry!”
“He has a G tube – we’re giving him what he needs through his tube feeds. Right now it’s not safe to give him food by mouth or he might choke, but I assure you, we’re not starving him.”
“This is no way to live.”
No, it’s not.
None of this is.
And yet here we are day in, day out, fighting the inevitable.
Just saving lives…
I should have gone back to the hospitalist office to eat after that discussion.
But I didn’t.
Instead I wandered through the halls until I found myself in the newborn nursery.
A place where dreams are born. Where hope still lives. Where the ugliness of the end of our days are light years away.
The vulnerable moments here are encased in meconium and tears and joy.
They are captured by phones wrapped in pink glitter cases in order to be shared with anyone who will stop and listen.
They are from where I draw strength to continue on with my 12+ hour days, watching dads awkwardly change their first dirty diaper while my stomach grumbles in protest.
I needed to MAKE the time.
This was more for me than it was for them.
What’s the point of eating if your soul is running on empty?
***
Picture taken of the Mount Fyffe mountain range in New Zealand.
Wow M. I was hoping that you leaving your prior position and coming into a hospitalist role may re-spark the passion of medicine that drew you to being a doctor in the first place.
Sounds like you are still running on empty and I am not sure what advice I have to give. Dealing with newborns etc definitely sounds like it recharges you (and anyone for that matter), maybe there is opportunities where that is where you spend most of your time.
Anyway, I hope things do get better. Trading one hot frying pan for another is not going to cure burnout.
I totally agree. I’m trying to figure out what my next steps look like but am allowing for another 4 months of this to see if it improves.
It’s been fascinating to see how the hospital environment has changed in the last 4-5 years. The patients are definitely sicker and at a much higher volume than the typical patient load where I trained. At first I thought I would be thrilled by the prospect of doing “actual” medicine, but now I realize what I’m actually doing is performing hail mary’s on people who are likely going to die in the next 6 months regardless of what we do. I just get to condemn them to SNF’s and LTACH’s until they do.
This is the reality of hospital medicine. It’s hard when I know these outcomes could have been avoided by good preventive medicine 30 years ago… I guess I’m still a preventive medicine doc at heart.
I’m sorry it isn’t going as well as you hoped and I hope everything improves. A lot of what you described is how I feel about medicine. I’ve struggled with pushing away the naive ideas of “saving people” and settling with the every day realities of hospital medicine.
So fascinating how we’re making such a distinction between what we do in hospital medicine and actually “saving people”. In training, I actually enjoyed my inpatient rotations for the most part – there was so much to learn, so many interesting pathologies and I felt like this was where one could be on the cutting edge of medicine.
But after the shiny luster is gone, you can’t continue to blind yourself to the aftermath of all this saving. The saving is glorious, without a doubt. But what we condemn people to afterward is something I’m having a hard time with as I keep signing all the paperwork to the long term care facilities they’ll never come home from.
Hi M-
Apologies for giving unsolicited advice… If you decide that hospitalist medicine is not for you, but you still have a passion for preventive medicine… Can I humbly suggest contraception medicine? My Intrauterine Contraception Clinic completely resuscitated my Gyne career. The young girls (and all patients really) are so appreciative, and having a first pelvic exam by another female who is compassionate and patient is such a relief to them. It gives me such a sense of accomplishment and I really feel like I’m making a difference. Check out my YouTube channel “Talking IUC with Dr. D”. If you ever wanted to have more exposure to this area of preventive medicine, would love to have you visit my clinic!
OK- end of unsolicited advice!
(But one last thought… you SERIOUSLY could be a professional photographer, your photos are amazing!!!!)
:)Kristina
Thanks! The trick to taking great pictures is going to beautiful places! Haha.. all I do is push the other tourists out of my way, point and click 🙂
Anyway, please don’t apologize for the unsolicited advice – I appreciate it! I am exploring ways of how to pivot back into the outpatient setting, but on my own terms. Similar to you, I remember what it was like to walk someone through their first pelvic exam/pap smears and their relief at the end when they told me, “Oh, that wasn’t as bad as I thought it would be!” I also really enjoyed inserting/removing Nexplanons but never had the courage to do any IUDs, especially since the clinic wasn’t outfitted with pelvic US, I didn’t even know how to use that machine AND I’m pretty sure I’d perf someone on my first try. So there’s that 🙂 Maybe if I had someone like you for backup, it would work (btw I watched your video a while ago so I could make sure I was counseling my pts the right thing when I referred them over to GYN)! At any rate, I’d love to find an excuse to go visit the old T.O.
I actually think I need to do something with lifestyle medicine/ACLM and be the doc who gets people off their meds through diet and exercise in an evidence based way, but I don’t know how that works logistically, especially since I have zero interest in dealing with insurance again. If you have any insight to that, please let me know!
M
I’m both flattered and embarrassed that you actually watched one of my IUC videos! Do you know that I had almost zero training in residency to insert IUD’s? (Insert #1: MFM clinic- I asked the staff consultant to show me how, he said “Kristina, I haven’t inserted one of those in 20 years!” Spent 20 minutes frantically reading the instructions that came with it, attempted insert, of course it fell out! Insert #2- a Mirena, the staff was “kind” enough to show me what to do. That was it! Now I do almost a thousand a year lol. Of course lots of D&C’d helped build confidence for sounding etc, but otherwise I learned in my own practice). I don’t use ultrasound but send my tough ones to a colleague who does them with sono HSG assistance. Thankfully the perfs are so rare, but I now have to send them (hat in hand…) to my ex-colleagues at the hospital to deal with. 😑 Always mortifying. No matter how “low risk” we try to make the job, there are still risks. The joys!
Wish I knew more about lifestyle medicine/ACLM… but I do have a friend from med school who left her family practice to do nutrition medicine (but this is in Canada, and I’m not sure how remuneration works…) I would be happy to put you in touch with her if you were interested.
I’ll have to try the push-tourists-then-click trick myself (somehow my photos don’t seem to turn out as spectacular as yours, even with the Rockies as backdrop!)
:)Kristina
I’m an adult hospitalist and recent residency grad. Love this post and the previous one about the futility of it all in modern medicine.
I’ve had this idea for a study on admitted medical patients. A randomized control trial where half the patients are treated like regular hospitalized patients. For the other half we do nothing. Continue home meds and give 3 meals a day, say hi every morning . I think the latter half may do better.
I’m also trying to figure out my next steps. Feel free to email me if you’d like to chat. Misery loves company.
I think they’ve already done that study – people who enter hospice/palliative care tend to live longer than if they continue to be medical-ized by the system. But of course, we keep intervening simply because we can, not because we should.
Misery does love company 🙂 Just emailed you.
M,
Do listen to Kristina, she knows from whence she speaks!
As for career resuscitation, have you considered working less, and could you pull it off financially?
Lots to be said for the therapeutic benefits of cutting back…
CD
Cutting back is definitely on the table. I’m going to try to at least rearrange my erratic schedule to see if that helps because I’ve been essentially going into the hospital q3 days without a significant amount of time off.
If that doesn’t work, I will either be cutting back or handing in my resignation from medicine altogether. We’ll see what happens…