It's not just good things that must come to and end

Bye, bye, 2008. Please be sure to let the door hit you in the ass on your way out.

This year has had a few nice points for us, but overall, it can go straight to hell. I have a very optimistic eye trained on 2009, and that eye is looking through the laser sight of a powerful rifle, so you'd better watch your step, 2009. It's time to pony up and be good to us.

In other news, I'm all done, and it couldn't have come a day too soon. PICU was definitely the most difficult rotation of medical school for me. I would like to say that unconditionally, without the qualifier of what was going on in my personal life during that time, but I can't. After all, to be fair, the second most difficult rotation was probably OB/Gyn, due not in small part I'm sure to the fact that I had a miscarriage right smack dab in the middle of it (stupid 2008). So, clearly, personal issues cannot be put aside here.

However, I must say that even without the whole husband with cancer thing and the being pregnant thing, PICU is amazingly difficult. I have a whole new level of respect and awe for critical care physicians, particularly those in PICU. There is a new dimension added to critical care when you have children involved.

It's very feast or famine; my first week, we mostly had kids that needed a lot of very careful care but would almost certainly be okay. Then we had weeks where we lost three patients and an additional 30% of our service was about to die.

It blindsides you. There's the kid who comes in with headaches and is found to have terminal brain cancer; the kid who was totally healthy until infection led to meningitis led to stroke; the kid who came in for a simple, common operation and died three days later from massive cardiovascular collapse. I couldn't put it aside like I could with older adults. Losing patients has always hit me hard, but this was something new. The grief of parents of young children is somehow much harder to bear than the grief of adult children of elderly patients.

Then, you add in my current personal situations. Having to go see a family awaiting biopsy results for their child's brain mass every day, for days and days, without having an answer for them--and then having to deliver bad news--was heart wrenching. I had just waited for those results for my husband, and it was the longest and most horrible two weeks of my life (and we got relatively good news at the end). We still have scary waits--PET scan results, blood culture results, etc. etc.--and every minute still kills me.

I was waiting to have our 20 week ultrasound during the majority of the rotation, and seeing a parade of tragic lethal congenial malformations being desperately, and unsuccessfully, treated kept in fresh in my mind just how many things can go wrong with a baby. I went from being excited about the scan to being terrified. Luckily, everything looked great. It didn't stop my obsessive worry, but it took it down a few decibels.

Intellectually, it was always challenging. These are the most complicated patients around, with multiple life-threatening medical issues balanced against each other like a house of cards; every day you were trying to shift one of the bottom cards without having the whole thing collapse. I never felt that I developed a good grasp of the sickest patients. Yet, looking back, I am somewhat disappointed that I couldn't find within myself the usual regret to be moving on from something before I felt I really understood it. When I finished the rotation, I felt nothing but relief.

I was exhausted, in every sense of the word. At one point my husband spiked his first fever--luckily, he was not neutropenic (Go Go Gadget Neupogen!) but it was still terrifying. Having to be away from him so much was really agony, worse than it had been since his diagnosis, if that's possible.

What got me through it was 1) my deep, deep desire to never, ever, ever ever ever have to go back and do it again; 2) my husband's constant encouragement; and 3) my fantastic residents. Thanks a bunch guys--literally couldn't have done it without you.

And now I'm done, done, done. Though I'm technically on vacation it doesn't feel like it; at least, not yet. Hubby got very very sick a few weeks ago and we had to postpone his chemo. It was the worst week since after we got rolling on the treatments. I was terrified. He had high fevers, night sweats--it was a perfect example of how horrible it is to be newly minted MD when something like this goes down. We knew every possible bad thing that could be going on, but we both lack the practical experience to offset those fears with less frightening possibilities. The one thing I hadn't thought of was relapse, and when the doc pointed out that possibility, I well nigh had a meltdown. There were several nights I just laid in bed next to his sleeping, sweat-drenched form and cried. But he got much better, and today the doc informed us he thinks it is much, much more likely to have been a virus than anything else; sometimes, a little reassurance is magical.

We also found out that one of our doggies has a cancerous mass--can you believe that @)%&@? She has to go back in for a wider excision, and get an ultrasound of her spleen to see if there are any mets. This is the kind of tumor that if her spleen is clear, she will almost certainly be fine; if she has mets to her spleen, she's a goner. So, that has certainly added to my current Climate of Frenzied Panic.

Once I finished, I had about eight metric tons of random life chores to get done, the holidays, the family in town, blah, blah, blah... and I have a solid week of interviews starting Monday.

So, vacation, but not really. Looking ahead I think things will become substantially more sane towards the end of the month, but I've been saying crap like that for a while. Hubby only has three more treatments, then a PET, and if that sucker's clean, it will be the best thing ever (of course we have to await the 3 month PET...). The doggie gets her scan next week and if that looks good it will be a big relief (and if not... LALALA, I CAN'T HEAR YOU!). End of Feb I have to take--and pass, unless I want to cough up an additional thousand clams--Step 2 CS. Then comes the rank list and match. Baby looks awesome, still kickin' me with a vengeance.

So that's it for now. The long update. I am thinking of some ideas for future posts, perhaps about interviewing and ranking, exciting stuff like that. Until then I hope everyone had a wonderful, safe, happy and healthy Holidays, and that you remembered all of the wonderful things you have in your life. They are too precious and delicate not to be treasured.

Except for 2008. That sucker can go into concrete shoes at the bottom of the Hudson.