http://www.pushfluids.com/blog/

Push fluids walks the delicate line between self-pity and self-parody. It is written by three 3rd year medical students at a New York City school.

sample entry:

i discharged a patient today who is a teenager and has a terminal disease that is going to kill her in the next few years, if not sooner. medically, her condition is far beyond anything that i could help with. she has many, excellent specialists on board to make sure that her treatment is optimized and that she recieves the most up-to-date medicines. as the med student assigned to her it was my job to talk to her more than anyone else, to really learn what was going on with her complicated social situation and her serious depression, and, along with the other team members, to be her advocate in the hospital.

i fucked it up.

i was too afraid to confront her medical condition to really try to find out how she understood what was going on and what her feelings were about it. i refused to see beyond the somewhat surly, very flamboyant girl before me. i wasn't able, until today, to really think about what happens next, and how her life is going to change when she goes home. most importantly, i was too timid with the various teams that were managing her care to really fight for the services that i knew she needed.

as a medical student you walk a very fine line. you advocate for your patients, but you MUST respect the hierarchy of the hospital and not get too loud. you know your patient the best, but you know the hospital the least which often leaves you helpless when trying to make things happen. you're made to feel responsible for someone, only to realize that you are largely dispensible, and are often left out of important decisions.

i realize, through all of this, that i am still learning. i am learning how to confront terminal illness in a child. i am learning that i need to be more firm in my suggestions about management options, and i am learning who will listen to me and advocate with me, and who will dismiss me.

it's just really hard when you realize that you have learned at the possible expense of someone else. this is not to say that all is lost. the child went home with hoards of people commited her care and her well-being, but it was a lost opportunity with other people who may have made the transition from chronic illness to terminal illness more smooth. and it was a lost opportunity for me to really sit with a patient that i knew well and help her begin to grapple with her illness.

interesting stuff.