Finding Time to Train with Emergencies on the Brain

Finding Time to Train with Emergencies on the Brain

Jul 24, 2012

Finding Time to Train with Emergencies on the Brain
By: Kris Hunt M.D. 

Ms. Smith

It’s 6:00am.  You’ve just come to the eleventh hour of a busy shift.  You’re tired.  Your legs ache from standing and from being on high gear in a busy Emergency Department since 7:00pm the night before.  Only one more hour to go.  You don’t know if you can deal with that one last patient with chest pain who might walk through the door.  You’ve already admitted four people to the ICU, and you’ve already seen 35 patients this shift.  You need to clean up for the next doc.

Instead of a chest pain patient, you, of course, get a severe asthmatic.

“Doc!  Come to the trauma bay!  It’s Ms. Smith, and she’s really, really bad this time!” says a nurse you know and trust very well.  Hobbling quickly toward the trauma bay, you walk in to the room and see a young woman in severe respiratory distress, breathing 40 times per minute and taking rapid, shallow breaths.

The best part of the story?  Before your shift, you did a heavy squat workout.  The lactic acidosis in your legs mimics the lactic acidosis in your patient’s entire body.

“We need to hit this lady with the kitchen sink,” you say as you hear her wheezing from across the room.  “I remember this lady,” you think, “I had her transferred last week for a bad asthma attack to a tertiary care hospital for an ICU bed, and now she’s worse!”  Immediately you ask for five different drugs to try to get this lady to breathe.   You have the respiratory therapist bring down the BiPap machine to force air into her lungs.  The respiratory therapist asks you what dose of albuterol you’d like for the nebulizer solution to try to open up her airways.  “Whatever dose it takes to make her keep blowing smoke at all times,” you say.  You even try a medicine to calm her down a bit.  Anything short of having to knock this gal unconscious and putting a tube in her throat to breathe for her.

A half hour later, she seems to quiet down.  She can talk in two word sentences at least.  You leave the bedside and get started on the discharge paperwork for the remaining folks in the Department.  You get some water to force the lactate out of your body.  You sit.  You try to concentrate and finish.  That lasts an entire fifteen minutes.

“Doc!  Get back here, NOW!” screams the nurse.

Ms. Smith’s breathing is worse.  She stopped talking.  She’s actually falling asleep from the exhaustion of not being able to breathe all night.  She needs to be intubated: to be put on a ventilator and for a machine to breathe for her with a tube in her throat.  She also happens to be a big gal, have a short, thick neck and would, from a quick glance, pose to be a difficult intubation because of this.  It’s fifteen minutes before the end of your shift.  You’re exhausted.  Your cognitive functioning is nearly non-existent.

This is an ER doctor’s worst nightmare.  A difficult intubation when you’re dead tired.

This is when your years of training kick in, when you stop whining to yourself, and when you do what needs to be done.  There are no anesthesiologists in your hospital at this hour.  There is no backup for this.  The only thing that stands between this person and certain doom is your hand.

A bead of sweat drips down your face.  You don’t realize it until it lands on your forearm as you prepare for the procedure.  You ask for meds to put her down.  Your pupils dilate, everything slows.  The monitor in the background, with its buzzing and ringing, you can’t even hear.  You already have a ringing in your own head.  You don’t notice the fact that the monitor reads “LOW OXYGEN SATS” in giant red letters because you already know this patient is damn near dead if you don’t act quickly – it’s irrelevant information now.

She gets the intubation meds.  She’s paralyzed.  In the back of your brain you know that she won’t have a pulse any more if you don’t do this fast.  The only sound you hear now is your own pulse as you hold your own breath.  You put the laryngoscope blade in her mouth, sweep her tongue away as you’ve done hundreds of times before, thrust her jaw upward, and see her vocal cords, something you didn’t think would happen on the first try after looking at her neck.

“Thank God for small favors,” you think.

You put the tube in her trachea.  You use a bag to start breathing for her.  You have her hooked her up to the ventilator machine.  She’s alive.

Shaking, you finalize a few things with her then walk back to your computer.  You finish up with the other patients you had.  The other doc has already come in and started seeing new patients.  An hour after your shift was scheduled to end, you drive a half hour home and fall asleep with your shoes, scrubs, stethoscope, and ID badge all still on your body.  And you wake up in seven hours for a bench workout, followed by another shift.

Medical School

I have been a powerlifter for more than half of my life now.  Somehow, I managed to continue powerlifting throughout medical school.  During my first year of medical school, arguably the most difficult year secondary to the difficult transition that it entails, I squeezed in a third place finish at USAPL Collegiate Nationals.  I continued to compete throughout medical school at the national level.   When we set off for New York in 2008 so that I could begin my Emergency Medicine residency, I had a lot of reservations about what would happen to many facets of my life.  I had just become a husband.  I had also just become a doctor.  I wondered how my parents would be without having me nearby.  I wondered whether I would be able to keep old friendships.   One of the first questions that my old coaches, my new residency program director, and my new wife all asked me was, “What’s going to happen with powerlifting?”

This question came from different people for different reasons.  My residency program director, for good reason, didn’t want it to interfere with my vocational goals as a physician.  My old coaches didn’t want to see me throw away something that became a part of me.  My wife wanted to keep our marriage strong in spite of the chaos that is an ER residency.

Residency

The first year of residency, the intern year, is always the hardest.  Setting aside the transition to becoming an actual physician, this rite of passage is filled with the most work hours as well as the stark realization that these are people’s lives.  During this first year, I continued to train at some level throughout.  I quickly realized that excessive work hours and difficult work outs did not always lend themselves to a balanced life.  This year was pivotal for me in that it made me realize that balance in my respective roles as a husband, a doctor, and a powerlifter was mission critical.  Whenever any part of this balance became excessive is when I began to feel some degree of psychological stress.

Initially, I played around with the idea of not being an athlete any more.  In spite of the thousands of times I stepped under a barbell, I considered in those first few months whether it would be possible to continue doing so and contemplated throwing it away.  I got up, went to work, ate dinner with my wife, and went to bed.  That was, seemingly, that.  However, the stresses of day to day work soon made me realize that powerlifting was an important psychological outlet for me.   It was a release that I needed.  My wife quickly changed her attitude and started telling me to go to the gym.  I had come home after a bad shift too many times angry, upset, and even tearful from the events that transpired that day during my shift as an ER intern.  I needed the iron.

So I went back to the gym.  This was not an easy thing.  I needed to make time for the minimum of four approximately two hour workouts per week that powerlifting often demands.  I had to figure out, between my circadian rhythm being completely screwed up and working sometimes over eighty hours per week, how to fit in the gym and my new bride at the same time.  My wife made part of it easy for me; she started powerlifting.  This was time for us to bond and have no interruptions for a couple of hours per day in light of my work.  It was also a place for us to actually talk between sets: at home, there was always something else to do.

The other difficult part was my work schedule.  Not only were the hours lengthy, they were random.  I may have had two day shifts, followed by a day off, followed by five night shifts in a row.  I used to whine whenever I had to come in any earlier than 3 pm or later than 6 pm to get in a workout during medical school.  Those hours were non-existent to my personal athletic life during residency, and, if they were, it was because I had just woken up after a night shift.  I found that coffee was a good pre-workout beverage, and that protein shakes can sustain one for many hours during a busy shift when there isn’t even have time to urinate.

Halfway through that year, I was back in athlete mode.  I would plan out my workouts for the entire month as soon as the schedule was posted for work.  My wife and I would plan out personal time weeks in advance.  I knew when I was going to work, study, sleep, eat, toilet, shower, shave, drink coffee, go to church, etc., way in advance, to an almost ridiculous degree.  I thought I had this doctor/powerlifter thing figured out.  That was, until I had my first Intensive Care Unit (ICU) month.

The concept of an “eighty hour work week” sort of went out the window that month.  Not to say my residency was performing any form of a violation because, in fact, it would be a violation if I were to work additional hours beyond this.  No, I mean from a standpoint of keeping up on reading, ancillary activities related to work, etc.  Initially, I tried to bull through it and continue the workouts that I was doing.  I had USAPL Men’s Nationals on my mind, and it was only two months away.  I would sometimes start from a night of ICU call then attempt a workout.  A night of call consisted of showing up at 6 A.M. to the ICU, working at all times non-stop for thirty hours straight, barely taking time to drink water let alone eat.  I would try to get three or four hours of sleep after this, then attempt a hard squat workout.

If you’ve ever experienced something that is a waste of time, let me tell you, attempting a squat workout after a night of call is the definition of a “waste of time”.  I tried this twice, and the second time I got through my warm-up and fell asleep, in my scrubs, on a bench in the corner.  I realized that I had to become more time efficient with my workouts while maintaining intensity, and clearly I couldn’t work out intensely after a call night.  I harmonized my call schedule, workout schedule, reading schedule, and marital duties once again, except I had to cut out some “fluff” from my workouts and focus on getting in, getting done what I needed to do, and getting out.

USAPL Men’s Nationals did not go well that year, needless to say.  I did less than well, but I was still in the game.  This is what I kept telling myself throughout residency, to just stay in the game.  I was still never satisfied, but I knew this was only temporary to fulfill my vocational goals.  The balance was tipped toward work, but I knew that once residency was over, it would soon tip back to marital life and lifting.  Year after year during residency, I continued to compete in Men’s Nationals, this being the only meet that I actually had time for, but I was still in the game.

By the end of Residency I was named Chief Resident, and this entailed another tremendous load of administrative responsibilities.  The time management skills that I mastered that first year were again critical toward achieving success in this year.  This threw yet another weight into the balance in my life that I was tediously teetering to achieve.  However, that year ended a success.  The attending physicians in my residency that had taught me for the three years prior had felt I had deserved something for my efforts on our graduation night.  They had named me “Senior Resident of the Year.”  I was honored, speechless, proud, and felt unworthy, all at the same time.  The other physicians that I had trained with had always seemed smarter, more capable, and more put together than me.  Maybe, in some way, the balance that I had achieved, even though it tipped toward work, had meant something.  It also doesn’t hurt to have the most understanding wife on the planet.

Attendinghood and Beyond

The first year of attendinghood is yet another difficult transition; it means that there are no other doctors looking over your shoulder.  Setting aside the fact that I finally became a “for real” doctor, I had my Emergency Medicine Boards to study for.  The growing pains that I experienced that year were quite severe, and it didn’t help that my wife and I were apart for ten months of it while she was finishing Optometry school.  I had to rely on lifting alone to get me through feelings of stress, anxiety, and frustration — feelings which both my wife and lifting had helped with for the last three years.  Lifting also helped with the loneliness that came with not having my wife around.  Granted, I am no soldier, and I have no perspective on what those honorable men and women experience when they go overseas and leave their families, but I do have a great deal more of respect for them now for what they go through.

That first year, I was able to successfully pass my boards, on the first attempt.  I also happened to qualify for the Arnold.  If you ever have a chance to compete in the Arnold, do it and don’t look back.  Dave Ricks destroyed me, but I had a lot of fun.  Since the Arnold, and one month after writing this, I competed yet again at USAPL Nationals.  This time, I placed third, and went 8/9.  I set PR’s in all three lifts.  I also hear that our session was a good one to watch.  I trained hard for it, and I trained efficiently.  I was able to get more hours in at the gym than in residency, but I still maintained the tremendous level of intensity that was required to make my workouts as efficient as they previously needed to be.  It is great to have my wife back, to be finished with my boards, and to have more time to train, but it is, and always will be, a balance.

Accomplishments

Powerlifting:

  • WDFPF 90 kg. Junior World Champion, 2004
  • USAPL Collegiate Nationals, 3rd place 90 kg., 2005
  • Arnold Sports Festival Brown’s Gym Pro Competition 2012
  • USAPL Men’s National Competitor, 90 kg., 2006 – 2012
  • USAPL Men’s Nationals, 3rd place 93 kg., 2012

Medicine related:

  • Named Chief Resident at Beth Israel Medical Center, Manhattan, NY, academic year 2010-2011
  • Received Resident Scholarly Activity Award at Beth Israel Medical Center, academic year 2010-2011 for presentation of “Effect of Creatine on Serum Creatinine” at American College of Emergency Physicians, which also received Newsworthy Abstract recognition at same conference among thousands of presentations
  • Named Senior Resident of the Year at Beth Israel Medical Center, academic year 2010-2011

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2 comments

  1. Hey Kris–you forgot to mention that you broke the barbell at the YWHA while benching. And that you were intubating people while your wrist had pins in it and was wrapped in a cast. Or that you made me food when I was too tired to. Thanks.

  2. Luke /

    I’d love to hear more articles pertaining to powerlifting and being a physician! As a future healthcare professional who loves powerlifting and fitness, I think this would be extremely helpful. Things like “How to train properly while in residency” or “Eating like a powerlifter while working a time intensive clinical rotation” would go a long way in helping healthcare folks keep the professional and personal goals moving forward. Kudos on the article!

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