Remember in the Velveteen Rabbit? How you know when things become real because the get all beat up and whatnot? Yeah, I'm pretty sure that's what it's like when one becomes a "real" doctor.
It's been a hard 6 days (only 6? yikes...). But I'm starting to get it. A lot of the struggles are systems based: who to call for what, what I'm expected/allowed to do without an attending/who's nice/who isn't, etc.
Yesterday, a nurse paged me:
"Dr. G, I'm calling about Patient X. Dr. F came up earlier today to evaluate her bleeding. She gave Pitocin. But the patient is bleeding again. A lot. Gushing."
My stomach jumped to my throat. I pulled it together, asked about her vital signs, asked if she had an IV and what was running. And then I said I'd be right up.
When I walked into the room, the nurse gave me a run down of the patient's bleeding. She'd had a Cesarean section 11 hours earlier, and she'd been alternately trickling and gushing ever since. She was tired, pale, and still bleeding. I took a breath, and reached for a pair of gloves while asking for a fluid bolus and a stat CBC. I did an internal exam and found a few small clots, which I removed. Suddenly, I felt something shift inside me, and the "real doctor" in me came out. I turned to the nurse manager who had joined us, and asked for 2 mg of morphine, because I knew that whatever I was going to do next was going to be painful. Because the patient was "stable," I knew I could wait for pain relief. But I also asked for more meds, some of which I planned on inserting in the patient's rectum (yeah, no one likes that, but it works). Once the morphine was in, I did the most aggressive exam I've ever done, medicated the patient, inserted a speculum, and removed about 200 ml of clot from the uterus. Then I watched the cervix, saw that it truly wasn't bleeding, and felt the uterus contract into the firm ball that we love.
I'm still not sure how I knew what to do. It was almost an out of body experience. I kept communicating with the nurses and the patient, telling everyone what I was going to do and why. I know that I told the patient over and over again that we were going to take care of her, that she was going to be fine. I heard my voice, calm and steady, even though my thoughts were frantic: please stop bleeding pleasepleasepleaseplease. But she did. I did the right things, and she stopped bleeding. And she didn't even need a transfusion.
And later, in my inbox, I found an email from the nurse manager to me, my chief, and my program director, telling us that I was very impressive, both "professional and patient centered in a somewhat hectic situation." And I felt like a real doctor.