I think the dictionary should be revised. Next to "overwhelming," the definition should be changed to read, "a third year med student's first day in the hospital."
I can't say I've been in very many hospitals, so I don't have any basis for comparison... but I'm pretty sure they imported the Labyrinth straight from Greece, put some hospital beds in it, and called it Hospital. I'm convinced that any one of these days, I'm going to make a wrong turn going from South Building to 4-West and run into the Minotaur himself. My greatest daily embarassment (actually, come to think of it, a ritual) is getting out of the elevators in the morning, walking purposefully forwards, realizing I'm going in the wrong direction, and making an abrupt 180. I think the fact that I'm wearing a white coat (and thus look like I actually know what I'm doing) makes it only more comical. I hope it will get better.
But the overwhelmingness doesn't stop there. Never mind that there are 30 residents per year, 4 teams, one cardiology teaching service, an utterly confusing calendar involving A, B, C, and D, call on every 4th day, P which stands for goodness only knows what on the calendar, different levels of hierarchy between interns, residents, and attendings, and only 1 day off per week. Never mind the 7 am sign-outs (and what the hell is a sign out?), pickups (huh?) and "caps" on admissions. And DEFINITELY, never mind that I look like an idiot as soon as I open my mouth and ask, very innocently, "what the hell is a sign out?"
Tuesday, August 28, 2007
Thursday, August 9, 2007
Family Medicine: The Happy Ending
My last day of Family Medicine. I should be cramming for my shelf exam tomorrow, but I just wanted to take a moment to make note of all the things I will miss after today. Yes... miss. I can't believe I'm actually getting nostalgic about a workplace, but these are the people I've been seeing day in and day out for the last six weeks, and for a person with utterly no life (a. k. a. med student), that's a big deal. They were like a second family! I'm going to miss the lady from the front desk who is perpetually asking us if we've eaten because she's seen med students hit the floor in dead hypoglycemic faint before. I'm going to miss the PA at the charity clinic who speaks Spanish so that even I can understand it. I'm going to miss the kooky attending, the attending who accused me of being in Slackers Med School, and the jaded (but jolly) fellow.
My preceptor was something else-- literally taking my hand and pushing it toward instruments while he performed procedures, holding onto my hand with the instruments until I was confident enough to do it myself. I sat in the hot seat and performed a cryo on cervical neoplasia in an HIV+ patient today, something I only wish all my other student colleagues could have the opportunity to do. I'm going to miss that teaching. I'm going to miss the nurses: sweet, crazy, caring, always prepared with coffee. I'm going to miss the little flags on the walls next to each exam room that made me feel so included-- red for patient, blue for nurse, yellow for doctor... and white for student (yes, student! we get our own flag!) in the room. I'm going to miss the schedules taped up at the nurses' station. I'm even going to miss the clock on the wall near the computers. OK, now I'm going a little overboard, but still... the place has its own rhythm and I had finally fallen into step, but now it's time to move on.
On a lighter note, I actually volunteered to do a rectal exam yesterday. You're probably wondering why a sane person wouldn't run screaming away from the opportunity to stick a digit up someone's ass. First of all, you've probably already figured out that I'm not sane, so that cat's out of the bag. More importantly, though, I was doing it for the patient's sake. You see, I was seeing a patient with Dr. Sausagefingers, and if you could just have a look at Dr. Sausagefingers' digits and then compare them to mine, you might see how compassion would move the heart of a young medical student to take mercy upon the sick and ailing, even at the cost of having poopy fingers.
OK, I'm done grossing you out.
My preceptor was something else-- literally taking my hand and pushing it toward instruments while he performed procedures, holding onto my hand with the instruments until I was confident enough to do it myself. I sat in the hot seat and performed a cryo on cervical neoplasia in an HIV+ patient today, something I only wish all my other student colleagues could have the opportunity to do. I'm going to miss that teaching. I'm going to miss the nurses: sweet, crazy, caring, always prepared with coffee. I'm going to miss the little flags on the walls next to each exam room that made me feel so included-- red for patient, blue for nurse, yellow for doctor... and white for student (yes, student! we get our own flag!) in the room. I'm going to miss the schedules taped up at the nurses' station. I'm even going to miss the clock on the wall near the computers. OK, now I'm going a little overboard, but still... the place has its own rhythm and I had finally fallen into step, but now it's time to move on.
On a lighter note, I actually volunteered to do a rectal exam yesterday. You're probably wondering why a sane person wouldn't run screaming away from the opportunity to stick a digit up someone's ass. First of all, you've probably already figured out that I'm not sane, so that cat's out of the bag. More importantly, though, I was doing it for the patient's sake. You see, I was seeing a patient with Dr. Sausagefingers, and if you could just have a look at Dr. Sausagefingers' digits and then compare them to mine, you might see how compassion would move the heart of a young medical student to take mercy upon the sick and ailing, even at the cost of having poopy fingers.
OK, I'm done grossing you out.
Tuesday, August 7, 2007
Family Medicine: The Talkers
This morning, the Talkers came in droves to my humble outpatient care facility (the nurses would have a bitchfest followed by withdrawal of all tetanus immunization privileges if they heard me calling it a clinic).
Who are the Talkers? Talkers are just like other patients, but they are afflicted with a special condition which makes them entirely unable to shut up. Quite apart from that, they may be either incredibly nice people or horrible jerks; sick, sick puppies or perfectly well. Dealing with them simply takes a different tactic from what our training teaches us.
In school, we learn to elicit a detailed history from the most stubborn patient. I have an armory of talking points to force every piece of information out of any patient who doesn't want to tell me what's wrong-- from simple compassion to dead silence. We are taught that the first 2 minutes belong to the patient, how to ask only open-ended questions ("describe your pain" vs. "is your pain sharp or dull?"), and how to normalize any potentially embarassing disclosure-- no matter how bizzare it may be. Yes, many of my other patients have diarrhea after eating boiled peas; please do tell me if yours is bloody.
How to make someone with verbal diarrhea focus on what I'm trying to deal with in my patient encounter, however, is a proficiency I am apparently sorely lacking. I tried asking only closed-ended, yes-or-no questions, only to be foiled into derailment from "do you have palpitations?" to "I feel like I'm going to fall, especially on concrete." "Does your pain radiate down the arm? Please answer yes or no," turned into "You know, this one time, 5 years ago, I had shooting pains in my foot and it went away after a week." Patient after talkative patient, I was helpless in the face of torrential verbiage rushing my way. 15 minute patient encounters became 20, even 25 minutes. Problem lists grew from 2 to 3 to 5 long. The waiting room got crowded. My hungry stomach begged for mercy.
My preceptor and I saw Talker number 3 together, and it was then that I was relieved to realize that focusing an interview with a gregarious patient is not only difficult for me. But I am happy to say that I've learned a few tips along the way-- and Talker 3 leaned in conspiratorially near the end of his interview to say, "I know I like to talk a lot." At least he's not in denial.
Who are the Talkers? Talkers are just like other patients, but they are afflicted with a special condition which makes them entirely unable to shut up. Quite apart from that, they may be either incredibly nice people or horrible jerks; sick, sick puppies or perfectly well. Dealing with them simply takes a different tactic from what our training teaches us.
In school, we learn to elicit a detailed history from the most stubborn patient. I have an armory of talking points to force every piece of information out of any patient who doesn't want to tell me what's wrong-- from simple compassion to dead silence. We are taught that the first 2 minutes belong to the patient, how to ask only open-ended questions ("describe your pain" vs. "is your pain sharp or dull?"), and how to normalize any potentially embarassing disclosure-- no matter how bizzare it may be. Yes, many of my other patients have diarrhea after eating boiled peas; please do tell me if yours is bloody.
How to make someone with verbal diarrhea focus on what I'm trying to deal with in my patient encounter, however, is a proficiency I am apparently sorely lacking. I tried asking only closed-ended, yes-or-no questions, only to be foiled into derailment from "do you have palpitations?" to "I feel like I'm going to fall, especially on concrete." "Does your pain radiate down the arm? Please answer yes or no," turned into "You know, this one time, 5 years ago, I had shooting pains in my foot and it went away after a week." Patient after talkative patient, I was helpless in the face of torrential verbiage rushing my way. 15 minute patient encounters became 20, even 25 minutes. Problem lists grew from 2 to 3 to 5 long. The waiting room got crowded. My hungry stomach begged for mercy.
My preceptor and I saw Talker number 3 together, and it was then that I was relieved to realize that focusing an interview with a gregarious patient is not only difficult for me. But I am happy to say that I've learned a few tips along the way-- and Talker 3 leaned in conspiratorially near the end of his interview to say, "I know I like to talk a lot." At least he's not in denial.
OB/GYN: Mami
Once upon a time, mami was simply a pet name in my book - you know, something along the lines of hunny or sweetie that a guy calls his girl. It's cute, try it out. Next time your girlfriend calls, pick up the phone and say "Ay mami!" and listen to her smile.
So what does it really mean? I babelfished it and found no exact Spanish to English translation, but I'm pretty sure that it means mommy. Now you might be thinking, "What the hell? You want me to call my girlfriend mommy?" Because 1.) You're not interested in getting all Oedipus rex on anyone and 2.) You're not thrilled about knocking anyone up either. Yet in a typical day's work on this rotation, I often hear women being called mami or mamita.
Without having to look at the patient's chart, I already know a few things about her. She is a young Latina who speaks no English and is having her third or fourth child, has only had free clinic prenatal care (if at all), is simultaneously grateful for and terrified of medical attention, and she'll deliver vaginally without complications, and not complain about any discomfort. All this I know because med school trains us well in pattern recognition; she is another mamita.
And now that sweet title becomes bittersweet to me, because I wouldn't want that life for myself. But maybe I'm just being all judgey and ignorant. Who knows? She might see me as another medical student, which means that I'm a young adult who speaks no Spanish and is in my third or fourth year of school, has only had free time on weekends (if at all), is grateful for and terrified...wait no, I'm getting off track here.
All I'm trying to say is that I want to know that she chose this path for herself. And if she didn't, I want to know what she wants her life to be. And if we can, I want to know how we can help her. Most of all, I want for us to know her and her name, so that she is no longer just another mamita.
So what does it really mean? I babelfished it and found no exact Spanish to English translation, but I'm pretty sure that it means mommy. Now you might be thinking, "What the hell? You want me to call my girlfriend mommy?" Because 1.) You're not interested in getting all Oedipus rex on anyone and 2.) You're not thrilled about knocking anyone up either. Yet in a typical day's work on this rotation, I often hear women being called mami or mamita.
Without having to look at the patient's chart, I already know a few things about her. She is a young Latina who speaks no English and is having her third or fourth child, has only had free clinic prenatal care (if at all), is simultaneously grateful for and terrified of medical attention, and she'll deliver vaginally without complications, and not complain about any discomfort. All this I know because med school trains us well in pattern recognition; she is another mamita.
And now that sweet title becomes bittersweet to me, because I wouldn't want that life for myself. But maybe I'm just being all judgey and ignorant. Who knows? She might see me as another medical student, which means that I'm a young adult who speaks no Spanish and is in my third or fourth year of school, has only had free time on weekends (if at all), is grateful for and terrified...wait no, I'm getting off track here.
All I'm trying to say is that I want to know that she chose this path for herself. And if she didn't, I want to know what she wants her life to be. And if we can, I want to know how we can help her. Most of all, I want for us to know her and her name, so that she is no longer just another mamita.
Saturday, August 4, 2007
Medicine - BM Bx
Yesterday I got to watch a BM Bx - the heme/onc fellow's abbreviation for bone marrow biopsy. Our pt had been in the hospital about a week before our service took over - 1st of the month phenomenon - and in the 3 days we had her, we could still not figure out why she had had multiple embolic strokes without a single risk factor, and eosinophilia up to 45% of WBCs. But in those 3 days the heme/onc fellow managed to convince her to let him take a little piece of her bone to try to figure out why she's got all those damn orange/pink-staining cells in her blood.
I happened to be on the floor when the heme/onc fellow arrived, 6pm on a Friday evening, which seemed an odd time to biopsy a woman's hip. I walked into her room while he was prepping her lower back with iodine, looking up as I stuttered the question "Can I watch?" I quickly added, "I'm the medical student who's been following her this week," mostly so that the pt, lying face-down-in-a-pillow and getting an IV ativan push, might recognize me.
She gave her muffled consent to me being present, and I realized that I was the least of her concerns. I know she had been nervous about the procedure and I tried to think of a way to help console her, coming up short. Instead I tried to imagine what she was going through: multiple strokes that put her in the hospital for 10 days, a slew of tests including a lumbar puncture that took 3 tries, and now going through the painful-sounding procedure that might diagnose her with cancer. And only 50. No, I couldn't even imagine it.
I couldn't help her right now, but I could help him: I rolled her pajama bottoms down from the biopsy site with my gloveless hands, to keep the fellow's gloves sterile. Her pj's kept rolling back up, so I had to expose most of her butt, apologizing silently to the back of her head. The fellow set up his slides and made small talk to the nurse assisting, who shamelessly flirted back to him. The fellow was young enough that I found myself glancing at his ring finger (as I've only started doing since starting in the hospital) though of course his hands were covered with gloves. The patient liked him too, a day ago she was dead set against the biopsy but, as she put it, "he seemed nice."
And he was. While he numbed the area and injected more anesthesia, he continued to talk to her with his soothing voice, explaining what he was doing but also frequently asking if she was doing ok. Observing his bedside manner, I decided that he could have a piece of my hip bone marrow too, if he smiled at me like that.
It wasn't until it was time for the biopsy that there was a problem. The fellow's procedure was perfect. He progressed a long needle into the sit, continually asking the pt if she could feel anything and giving more anesthesia accordingly. My eyes were glued to the skin, the indentation of the needle, and the slow rotating motion of the fellow's hands screwing the needle further and further into bone. I started to feel funny. The pt gasped a few times, but did not speak, tensed the upper half of her body but did not pick up her head. And the fellow continued digging into bone. I had to sit down.
I silently ducked into the next bedside and sat down, leaning back and trying to recover from my vasovagal reaction. All the associated symptoms were there: dizziness, palpitations, diaphoresis, blurry vision, and nausea, and I damned my weak stomach. How embarrassing. I hoped that the fellow didn't think I was bored and just left.
Once I felt well enough to stand I returned to the bedside, in time to watch the fellow make it to the marrow and draw a vial of it. He told me, "It looks like blood, but it's called 'marrow,' it's where blood cells are first made before they go into the blood." I wondered if there was a polite way to tell him that even though I look 16, I did in fact pass step 1 and he didn't have to simply so much.
For the end of the procedure he progressed a hollow needle into bone once again this time to take a biopsy of tissue. I had to leave to sit two more times. Man. I don't know how he could do it. He wasn't one of those surgeons we hear about who can depersonalize the patient and just cut, he was interacting with her personally, checking in with her and explaining each step of the way. He could watch her struggle through the anxiety and pain and continue drilling into bone, all the while consoling her and explaining to me how blood cells start in the marrow.
I wonder if this is what humanism in medicine is. I had thought that by trying to put myself in the patient's place, that I was being humanistic, but by doing so I couldn't even stand through the procedure. If it were me, as much as the patient would have liked me holding her hand, she would have had to console me to get through the biopsy.
After the procedure, I followed the fellow and fetched the chart and a progress note for him, getting rewarded by one of those smiles. "How was it?" he asked me. "I was getting a little vasovagal, sorry I had to keep leaving to sit down." "Really?" he answered, looking confused. Pause. Then his brow furrowed, and he solemnly continued, "Yeah, I remember the first one I did, it was hard." Apparently after 500 procedures he was able to perform a biopsy while attending to the patient humanistically, but I can only imagine how "hard" that first biopsy was.
I happened to be on the floor when the heme/onc fellow arrived, 6pm on a Friday evening, which seemed an odd time to biopsy a woman's hip. I walked into her room while he was prepping her lower back with iodine, looking up as I stuttered the question "Can I watch?" I quickly added, "I'm the medical student who's been following her this week," mostly so that the pt, lying face-down-in-a-pillow and getting an IV ativan push, might recognize me.
She gave her muffled consent to me being present, and I realized that I was the least of her concerns. I know she had been nervous about the procedure and I tried to think of a way to help console her, coming up short. Instead I tried to imagine what she was going through: multiple strokes that put her in the hospital for 10 days, a slew of tests including a lumbar puncture that took 3 tries, and now going through the painful-sounding procedure that might diagnose her with cancer. And only 50. No, I couldn't even imagine it.
I couldn't help her right now, but I could help him: I rolled her pajama bottoms down from the biopsy site with my gloveless hands, to keep the fellow's gloves sterile. Her pj's kept rolling back up, so I had to expose most of her butt, apologizing silently to the back of her head. The fellow set up his slides and made small talk to the nurse assisting, who shamelessly flirted back to him. The fellow was young enough that I found myself glancing at his ring finger (as I've only started doing since starting in the hospital) though of course his hands were covered with gloves. The patient liked him too, a day ago she was dead set against the biopsy but, as she put it, "he seemed nice."
And he was. While he numbed the area and injected more anesthesia, he continued to talk to her with his soothing voice, explaining what he was doing but also frequently asking if she was doing ok. Observing his bedside manner, I decided that he could have a piece of my hip bone marrow too, if he smiled at me like that.
It wasn't until it was time for the biopsy that there was a problem. The fellow's procedure was perfect. He progressed a long needle into the sit, continually asking the pt if she could feel anything and giving more anesthesia accordingly. My eyes were glued to the skin, the indentation of the needle, and the slow rotating motion of the fellow's hands screwing the needle further and further into bone. I started to feel funny. The pt gasped a few times, but did not speak, tensed the upper half of her body but did not pick up her head. And the fellow continued digging into bone. I had to sit down.
I silently ducked into the next bedside and sat down, leaning back and trying to recover from my vasovagal reaction. All the associated symptoms were there: dizziness, palpitations, diaphoresis, blurry vision, and nausea, and I damned my weak stomach. How embarrassing. I hoped that the fellow didn't think I was bored and just left.
Once I felt well enough to stand I returned to the bedside, in time to watch the fellow make it to the marrow and draw a vial of it. He told me, "It looks like blood, but it's called 'marrow,' it's where blood cells are first made before they go into the blood." I wondered if there was a polite way to tell him that even though I look 16, I did in fact pass step 1 and he didn't have to simply so much.
For the end of the procedure he progressed a hollow needle into bone once again this time to take a biopsy of tissue. I had to leave to sit two more times. Man. I don't know how he could do it. He wasn't one of those surgeons we hear about who can depersonalize the patient and just cut, he was interacting with her personally, checking in with her and explaining each step of the way. He could watch her struggle through the anxiety and pain and continue drilling into bone, all the while consoling her and explaining to me how blood cells start in the marrow.
I wonder if this is what humanism in medicine is. I had thought that by trying to put myself in the patient's place, that I was being humanistic, but by doing so I couldn't even stand through the procedure. If it were me, as much as the patient would have liked me holding her hand, she would have had to console me to get through the biopsy.
After the procedure, I followed the fellow and fetched the chart and a progress note for him, getting rewarded by one of those smiles. "How was it?" he asked me. "I was getting a little vasovagal, sorry I had to keep leaving to sit down." "Really?" he answered, looking confused. Pause. Then his brow furrowed, and he solemnly continued, "Yeah, I remember the first one I did, it was hard." Apparently after 500 procedures he was able to perform a biopsy while attending to the patient humanistically, but I can only imagine how "hard" that first biopsy was.
Thursday, August 2, 2007
Family Medicine: Time to Pap a Paraplegic
Actually... it's a quadriplegic, but I thought the alliteration between Pap and para was pretty cool. I'm about to go in and do it... this should be interesting. Do not EVER assume that just because a person is disabled, he/she is not having sex. That would be called NARROWMINDEDness (a long, but appropriately descriptive word for the mental condition in describes).
Wednesday, August 1, 2007
Medicine - Thank you, Doctor.
For this new round - err, new month - in the hospital, I've been assigned to the cardiology service and today met my new team. I began the day by hitting "off" instead of "snooze" and waking up at 7:05 this morning, and made it to the hospital late and disheveled. (M, are you sure you weren't talking about me??) ;) Trying not to obsess about this great first impression I'd be making on my new team (and cry about losing my last team), I paged my senior resident and found her on the fourth floor. My resident is an R2 instead of an R3, so this would be her first shift on floors as the senior resident on the team. We would be her first student and intern.
Spending the morning listening to the resident orientation, I realized that as my resident and intern both spent the last month on elective and night float shifts, I could actually help them find their way around hospital, figuratively and literally. I spent some time after the orientation (which was NOT meant for me) showing the intern how to find labs and vitals on the computers, and by now I'm actually feeling that I'm a seasoned part of the team. Except that its 9:30 and I have to pre-round on two pts and write their notes in the next half hour.
I scurried through the hospital, running into the new fourth year on my old team, who asked me some questions about a pt I had been following. I insisted that he and the new team not hesitate to page me for any other questions that come up. I found my pts' charts and copied the pertinent information, starting my notes and feeling efficient. A unit secretary made some copies for me without me asking her (I later found out that her nephew is in our class). Then I saw my first cardiology pts.
One of my pts spoke only portugese, and his granddaughter translated. Later that morning I would correct my resident about 3 times in the pronounciation of his name, and my attending would get it wrong when addressing him. Later that morning I would also insist that my attending go back to talk to the granddaughter who was still confused about the treatment plan, and end up bringing her out of the room to talk to him. But for now I just noted his lower extremity edema and that I could not hear his S4, try as I could.
My other pt was a filipino lady in her 70's who told me that she couldn't sit up or eat a full meal because her blood pressure would go up into the 200's, but that she wanted to go home. Later that afternoon as I was at my outpt clinic, she would be discharged. But while I examined her, I just noted her PERRLA and other normal physical findings. I told her I would talk to the doctors and that we would be back that afternoon.
As I walked out of the room, she said, "Thank you, Doctor." I don't know why, but I didn't correct her.
Spending the morning listening to the resident orientation, I realized that as my resident and intern both spent the last month on elective and night float shifts, I could actually help them find their way around hospital, figuratively and literally. I spent some time after the orientation (which was NOT meant for me) showing the intern how to find labs and vitals on the computers, and by now I'm actually feeling that I'm a seasoned part of the team. Except that its 9:30 and I have to pre-round on two pts and write their notes in the next half hour.
I scurried through the hospital, running into the new fourth year on my old team, who asked me some questions about a pt I had been following. I insisted that he and the new team not hesitate to page me for any other questions that come up. I found my pts' charts and copied the pertinent information, starting my notes and feeling efficient. A unit secretary made some copies for me without me asking her (I later found out that her nephew is in our class). Then I saw my first cardiology pts.
One of my pts spoke only portugese, and his granddaughter translated. Later that morning I would correct my resident about 3 times in the pronounciation of his name, and my attending would get it wrong when addressing him. Later that morning I would also insist that my attending go back to talk to the granddaughter who was still confused about the treatment plan, and end up bringing her out of the room to talk to him. But for now I just noted his lower extremity edema and that I could not hear his S4, try as I could.
My other pt was a filipino lady in her 70's who told me that she couldn't sit up or eat a full meal because her blood pressure would go up into the 200's, but that she wanted to go home. Later that afternoon as I was at my outpt clinic, she would be discharged. But while I examined her, I just noted her PERRLA and other normal physical findings. I told her I would talk to the doctors and that we would be back that afternoon.
As I walked out of the room, she said, "Thank you, Doctor." I don't know why, but I didn't correct her.
Medicine - This month . . .
Today is the first of the month. It's the point when somewhere in the hospital there is a bell that DING!s and all the residents, interns, attendings, and even students, all stand up from their chairs, move one spot over, and sit back down for another round of the hospital's version of speed dating.
Since we've now been on this rotation for a month, I'd like to take a chance to reflect. Over the last month I've experienced -
getting lost trying to find the cafeteria, getting locked between two swipe-only doors, and getting trapped trying to exit the building (no ... damn ... exits!!!).
nearly fainting when my super nice actually-gave-us-the-leture-on-humanism attending asked me again what the symptoms of uremia are (we had gone through them the day before, and bless his soul, I can't remember what the I and U of AEIOU stand for).
having my pager go off without knowing it and needing a nurse to gently tell me that that sound is actually coming from my pocket (me: "but they said they wouldn't be paging me!" nurse: "oh sweetie, they lied to you.")
walking into a pts room and not once thinking the pt would be annoyed with my presence.
not being able to sleep because I wasn't sure whether my resident really wanted me in an hour early the next day or if she was being sarcastic. (She was.)
going from following 1 pt to following 2.
seeing a classmate I've never said two words to and being so excited to see a familiar face that we got into a 10 minute conversation about how our respective rotations were going.
feeling that my intern was being a bit possessive when referring to me as his medical student.
finding that I was never eager to leave the hospital and go home after a long day, actually meaning it when asking my residents what else I could do and not using code for "please let me go home!" . . . and being surprised about this.
noticing that my angry psych pt is actually more sarcastic then angry, and that she's started to say "thank you" when I'm done pre-rounding on her every morning.
going from following 2 pts to following 3.
getting called 18 yrs old by a nurse who wasn't kidding.
getting called "that 4 yr old med student" by a pt's daughter, who was.
finally feeling comfortable taking care of the handful of patients that are mine, all mine! and feeling wronged when my resident changed the dosage of a beta blocker without telling me.
not nearly crapping myself on rounds and actually answering questions and getting the compliment from my attending "sorry to keep directing these questions towards you, but you seem to be on a roll."
deciding from the above that I would go into medicine, open a private practice with that attending, and babysit her children on weekends because I am that excited about this rotation.
joking to my angry/sarcastic psych pt that when she gets that transfer, she's going to miss waking up to me shining my pen light in her eyes every morning.
feeling pride that I'm not only being useful to my residents, but also lightening their work load and helping them get out a few hours earlier.
actually thinking that maybe they could use that time to hang out with me and tell me what its like to be a resident. (But not daring to suggest it!)
having an elderly pt report to me that she's only on ambien and listening to her insist for an hour that she's the healthiest woman in her nursing home and everyone envies her health, only to go out to her chart and find that she's actually on 21 medications, has severe AS and is in CHF.
going through pre-test with my resident and making her depressed because she wasn't getting the questions right either. then my intern insisting he try the same questions, with the same result.
wishing that my intern would just tell me how he takes his coffee instead of insisting he can't scut me because he looks so stressed out and tired that I want to take care of him.
not thinking that last line was possessive at all.
getting so excited to get the news that my two psych pts (in PsychBuilding) had received transfers that I ran into their rooms and told them myself. then, saying good-bye to each of them on the same day, and telling them that I'd better not see them again!
seeing a pt in the ER whose chest pain is obviously musculoskeletal (it hurt when he pressed on it) but insisting we admit him because he reminded me of my father and though, like my father, he only has 1 or 2 risk factors for MI and is in near perfect health, I was afraid that he could clot any day now.
being able to tell that pt and his wife that we ruled out every possible serious cause of his chest pain and that he could rest easy now (but don't forget to follow up with your doctor!) ... though really I'm the one who can rest easy.
going from following 3 pts to following 4.
finding out that my team had spent the morning meeting to evaluate me . . . and still working my ass off for rounds even though they were done grading me.
hanging around the last day of the month with my team and finding every excuse not to leave even though the work was done and we had put in 12 hours. Feeling that my resident actually considers me a friend and that she meant it when she said I can call her anytime. Knowing she meant it when she said I'd better not like my next resident more than her.
Well ok I didn't know I had that much sap in me, but there it is.
Since we've now been on this rotation for a month, I'd like to take a chance to reflect. Over the last month I've experienced -
getting lost trying to find the cafeteria, getting locked between two swipe-only doors, and getting trapped trying to exit the building (no ... damn ... exits!!!).
nearly fainting when my super nice actually-gave-us-the-leture-on-humanism attending asked me again what the symptoms of uremia are (we had gone through them the day before, and bless his soul, I can't remember what the I and U of AEIOU stand for).
having my pager go off without knowing it and needing a nurse to gently tell me that that sound is actually coming from my pocket (me: "but they said they wouldn't be paging me!" nurse: "oh sweetie, they lied to you.")
walking into a pts room and not once thinking the pt would be annoyed with my presence.
not being able to sleep because I wasn't sure whether my resident really wanted me in an hour early the next day or if she was being sarcastic. (She was.)
going from following 1 pt to following 2.
seeing a classmate I've never said two words to and being so excited to see a familiar face that we got into a 10 minute conversation about how our respective rotations were going.
feeling that my intern was being a bit possessive when referring to me as his medical student.
finding that I was never eager to leave the hospital and go home after a long day, actually meaning it when asking my residents what else I could do and not using code for "please let me go home!" . . . and being surprised about this.
noticing that my angry psych pt is actually more sarcastic then angry, and that she's started to say "thank you" when I'm done pre-rounding on her every morning.
going from following 2 pts to following 3.
getting called 18 yrs old by a nurse who wasn't kidding.
getting called "that 4 yr old med student" by a pt's daughter, who was.
finally feeling comfortable taking care of the handful of patients that are mine, all mine! and feeling wronged when my resident changed the dosage of a beta blocker without telling me.
not nearly crapping myself on rounds and actually answering questions and getting the compliment from my attending "sorry to keep directing these questions towards you, but you seem to be on a roll."
deciding from the above that I would go into medicine, open a private practice with that attending, and babysit her children on weekends because I am that excited about this rotation.
joking to my angry/sarcastic psych pt that when she gets that transfer, she's going to miss waking up to me shining my pen light in her eyes every morning.
feeling pride that I'm not only being useful to my residents, but also lightening their work load and helping them get out a few hours earlier.
actually thinking that maybe they could use that time to hang out with me and tell me what its like to be a resident. (But not daring to suggest it!)
having an elderly pt report to me that she's only on ambien and listening to her insist for an hour that she's the healthiest woman in her nursing home and everyone envies her health, only to go out to her chart and find that she's actually on 21 medications, has severe AS and is in CHF.
going through pre-test with my resident and making her depressed because she wasn't getting the questions right either. then my intern insisting he try the same questions, with the same result.
wishing that my intern would just tell me how he takes his coffee instead of insisting he can't scut me because he looks so stressed out and tired that I want to take care of him.
not thinking that last line was possessive at all.
getting so excited to get the news that my two psych pts (in PsychBuilding) had received transfers that I ran into their rooms and told them myself. then, saying good-bye to each of them on the same day, and telling them that I'd better not see them again!
seeing a pt in the ER whose chest pain is obviously musculoskeletal (it hurt when he pressed on it) but insisting we admit him because he reminded me of my father and though, like my father, he only has 1 or 2 risk factors for MI and is in near perfect health, I was afraid that he could clot any day now.
being able to tell that pt and his wife that we ruled out every possible serious cause of his chest pain and that he could rest easy now (but don't forget to follow up with your doctor!) ... though really I'm the one who can rest easy.
going from following 3 pts to following 4.
finding out that my team had spent the morning meeting to evaluate me . . . and still working my ass off for rounds even though they were done grading me.
hanging around the last day of the month with my team and finding every excuse not to leave even though the work was done and we had put in 12 hours. Feeling that my resident actually considers me a friend and that she meant it when she said I can call her anytime. Knowing she meant it when she said I'd better not like my next resident more than her.
Well ok I didn't know I had that much sap in me, but there it is.
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