status post everything

Status post my last 30 hour cardiac ICU call.

I have a lot of thoughts.

1. 
First, overwhelming gratitude that nothing truly terrible happened. I came into this month absolutely terrified. These patients are sick: their lives are dependent on balloons and pumps to support their hearts, ventilators to support their lungs, dialysis to support their kidneys, and IV drips to support their blood pressures. I was terrified of making medical decisions for such tenuous patients, and terrified of being alone at night.

But. It was okay.

Sure, there were bad nights (including the now infamous Worst Call Ever) and times I wasn't sure which choice to make. But I learned how to trust my judgement, I learned it's ok to ask for help, and I learned I am never actually alone-- there are always nurses, pharmacists, and respiratory therapists in house, and the cardiology fellow was never more than a phone call away.

Nothing terrible happened, and it was okay.

2.
Which brings me to my second point: I cannot believe how much I learned.

I reviewed a lot of basic cardiology fundamentals. I became way more comfortable choosing medications and way more confident in pulling the trigger to start them. I'm still not a top-notch proceduralist, but I finally got signed off on central lines.

I never thought I'd say this, but cardiology is actually pretty cool. I love how many high-quality cardiology trials there are, and how many best practices are grounded in really solid data.  There will always be uncertainty in clinic medicine, but the vast majority of my decisions were based on good evidence. That's cool.


3.
Finally, I'm just really, really tired. Thirty hours is a lot of hours. I honestly functioned better on zero sleep than I thought I would, but my thinking always felt slow and dull the next day. Like today.

It's not just the physical exhaustion, though. When you take care of really sick patients, you'll sometimes have bad outcomes. I had a lot of difficult conversations and had to break bad news. It was hard, and while I think I always did right by my patients and their families, it left me emotionally tired.

It's been a hard month, y'all, but I helped a lot of people, grew as a doctor, and somehow made it to the other side.