Trust No One

There is a montra that a staff physician taught me on one of my first inpatient hospital rotations as a resident: Trust No One.  (Her other big soap box was: always do a rectal exam, but I wasn't too found of that rule.)  At first "trusting no one" seemed rude and inefficient.  Afterall, we are a team of nurses, doctors, pharmacists, and even patients.  If I can't trust the patient's story, the nurse's evaluation, the ER doctor's opinion, or the pharmacist's recommendation, how can I be a team player?  More importantly, how can I get anything done?

Well, long, long ago, I learned that patient's are not always trustworthy.  "I quit smoking," from the guy who you could smell before you saw.  "I've never had sex," from the pregnant teenage girl.  "No, No.  I would never do drugs," from the patient with pupils the size of dinner plates.  "I've been sober for a long time," from the guy who goes into alcohol withdrawal seizures two nights later.  While, yes, most diagnoses can be made from the patient's history alone, there are still some times you have to take their history with a grain of salt.  So, I guess the montra holds true.

However, when it comes to my own medical community, I am a very trusting person.  It is true that if you treat the nurses well they will make your life easy (and, although I haven't experienced it, they also can make your life miserable if you don't).  There have been so many things I've learned from nurses along the way.  The amount of time they spend with the patients, their personal experience, and their thoroughness are huge helps.  However, there have also been times it has led me astray.  There were a few examples even just this week that I wish I would have asked more questions, gotten more details, and trusted my instincts and training more when the nurses were anxious, stressed, and frantic for the doctor's orders they wanted.  Instead of taking a step back and reigning in the situation, I caved and ordered more tests, started more medications, and skipped steps I should have taken.  Thankfully, the patient's didn't suffer, and it ended up just being a waste of precious healthcare dollars and a blow to my ego.  But, now the montra is a little louder when my pager goes off.

Now, to be fair, the same holds true for people with "Dr." in front of their name.  The number of times is growing where the story from the other doctor is not the same story that I come up with when I go to see the patient myself.  I've gotten a patient with an "anxiety attack" from the emergency room that ended up being a heart attack.  I've gotten someone who "just needs to be watched until a spot in a nurshing home opens up" in rhabdomyolysis.  It wasn't me, but I heard a story about an intern who asked the pharmacist with help changing someone's IV steroids to oral and ended up giving 3x the amount they wanted.  Can you say - 'roid rage.  Montra true once again.

I realize that this might be unintentionally sounding arrogant or elitist.  In all honesty, as much as I try, I haven't always been worthy of that level of trust either.  We all are doing our best, but eventually when I'm the one solely responsible for someone's health, and ultimately someone's life, I don't want to have anyone else to blame.  So, with all due respect, don't mind me if I verify the patient's story, question the nurse's evaluation, reexamine another doctor's patient, or look up a medication dose one more time.  It's just my montra: I trust no one.

Just me?

Hopefully, everyone feels like this sometime.  Hopefully, it isn't just doctors.  Hopefully, it isn't just moms.  Hopefully, it isn't just me?!

Four days ago, I felt... yuck.  I felt like I was a bad doctor.  I felt like I was a bad mom.  I felt inadequate.  Overwhelmed.  Tired.  Attacked.  Insecure.  Unappreciated.  I felt like quitting.  What a terrible day.  What a terrible way to start a very busy four day stretch.  Whew, thankfully, now it's today, and it's over.  That feeling is fading.  It's amazing what trusting your instincts, Diet Coke, and some sleep can do.

Dear Oof-oof,

Here's to my son's little, limp, blonde stuffed best friend.  Who knew that a lifeless toy could have such a personality and such a bond with a boy who has enough life for the both of you.

You began as a gift, and your soft fuzz made for the perfect newborn photo-shoot backdrop.  Then you quietly took your perch on the shelf and kept your dark brown eyes protectively on my baby sleeping in the crib below.

However, it didn't take long for Owen's own brown eyes to spot you on that shelf.  A friendship was born.  Soon after he said the sweet words: "mama" and "dada," "oof-oof" rolled off his tongue.  (It might have come first, but I'm too proud to remember that.)  Unseparable.

As much as you've been through, it's no surprise there is a little less fluff in your stuff.  Your neck has been formed to the shape of Owen's loving elbow.  Your tail is bald from loyal tugs.  Your eyes are scuffed due to a few run-ins with the cement.  And your fur is well worn from being first of the scene to soak up tears, blood, boogers, and other unmentionable bodily fluids.

Thank you for being there for my sweet, soft-hearted little boy.  He turned to you for comfort during his first nap at daycare, when he woke up scared in the middle of the night, and whenever mommy isn't there to kiss his "ouch".  You also provided your undivided attention when our attention was needed for another little boy in our house.  Now, Owen happily shows you off his little brother, but don't worry, he isn't about to let you become a hand-me-down.  You are his.  Always.

Some day you two won't be together.  Maybe Owen will out grow you.  Maybe it will be the washer that is your demise.  Maybe you'll be lost or left.  But until then, keep up the good work.  Owen loves you.  We all love you.

Sincerely,

Owen's Mom

P.S.  You smell much better after your bath today.

Day Light Savings

Seriously.  This daylight savings stuff is not cool.

Ten years ago the extra hour was great because it meant an extra hour of sleep.

Five years ago the extra hour was good because my intension was to have an extra hour of studying.

Today the extra hour was terrible because two people in our house didn't know what they (or their nap schedule) was in for.  This morning lunch, nap, and church all collided on the same hour.  We chose the nap.  God, forgive us.

Maybe in the spring I'll be a little more prepared and break the boys in slowly the few days before.  Or, maybe we should all get together and petition to end this crazy daylight savings crap all together.  I mean really, just pick a time already! 

(But on a positive note... at least I wasn't on call last night.)