Case presentations are one of my favorite things about Internal Medicine, apart from patient care. They're essentially a patient's entire hospital course compressed into one hour. A resident, intern, or medical student presents a particularly interesting or educational patient to the entire group. The chief resident moderates the discussion, pausing at certain points to allow the group to further investigate the case. The idea is for the group to collectively "work up" a patient as we would in real life.
I enjoy thinking through the case in my mind, figuring out what questions I would ask or what other labs I would order, then comparing that to what the group comes up with. As a medical student, I find this exercise invaluable in using the interns and residents as models for how I should approach a patient. Plus, I feel so actively engaged in the case presentation that the clinical lessons seem to stick almost as well as seeing a real patient.
Case presentations are generally similar at PSL compared to DHMC; their differences are mostly due to individual personalities of the faculty moderators. At PSL, the faculty moderators tended to give the chief resident and the group discussion more free reign, adding to the discussion only when an experienced opinion was needed.
At Denver Health, though, the faculty moderator is an old-school personality locally famous for his chest x-ray readings and his bow-ties. He takes more control over the discussion, explaining his diagnostic approach step-by-step. Every piece of information you gather should inform your next question to the patient, he says. He also reinforces a systematic approach to thinking about all possible causes of a given set of signs and symptoms. I feel smarter just listening to him.
I hope other clerkships have case presentations, or something like them.
Thursday, July 28, 2011
Friday, July 22, 2011
Realities of working at a safety-net hospital
One of the patients I'm following managed to put together quite the interdisciplinary team. We consulted: infectious disease, GI, neuro, psychiatry, nutrition, speech therapy, social work, physical therapy, and occupational therapy.
Despite so many people and so many resources devoted to this patient, she still insisted on returning to the poor lifestyle decisions that landed her in the hospital in the first place. She understood how her actions negatively impacted her health and that she would likely wind up back in the hospital with the same problems, or worse. "Why change now?" I had a dozen answers to that question, but none of them mattered. She didn't want to die, yet she also seemed to accept early death as a consequence of living the rest of her life on her own terms.
I think what I'm feeling now is the prodrome of disenchantment.
Despite so many people and so many resources devoted to this patient, she still insisted on returning to the poor lifestyle decisions that landed her in the hospital in the first place. She understood how her actions negatively impacted her health and that she would likely wind up back in the hospital with the same problems, or worse. "Why change now?" I had a dozen answers to that question, but none of them mattered. She didn't want to die, yet she also seemed to accept early death as a consequence of living the rest of her life on her own terms.
I think what I'm feeling now is the prodrome of disenchantment.
Wednesday, July 20, 2011
A familiar face on my team
I got really lucky with my team for the first two weeks of my Internal Medicine clerkship at Denver Health. My attending just happens to be one of my favorite professors from my pre-clinical years! He teaches biochemistry and endocrinology (nutrition and metabolism). Aside from being an excellent teacher, he's also just an all-around nice guy. He has a calming demeanor; just talking with him, you get the sense that he is fully listening and truly cares about what you're saying.
This is particularly helpful since I have been struggling a bit with some anxiety surrounding oral presentations. Over the past few days, I think that my oral presentations have been much better than they were last month at PSL. This is partly because I have more confidence stemming from more experience and exposure, though I also attribute this improvement in part to decreased performance anxiety in this new learning environment. It's not really what I was expecting from Denver Health.
Both my resident and intern are also excellent, but I'm only with them through the end of the week before they rotate to a new team. I wish that I had more time working with them, too.
This is particularly helpful since I have been struggling a bit with some anxiety surrounding oral presentations. Over the past few days, I think that my oral presentations have been much better than they were last month at PSL. This is partly because I have more confidence stemming from more experience and exposure, though I also attribute this improvement in part to decreased performance anxiety in this new learning environment. It's not really what I was expecting from Denver Health.
Both my resident and intern are also excellent, but I'm only with them through the end of the week before they rotate to a new team. I wish that I had more time working with them, too.
Sunday, July 17, 2011
Internal Medicine clerkship schedule at PSL
Presbyterian St. Lukes Medical Center
Call: When your team admits new patients.
Call is every fourth day ("call q4") at PSL. Residents and sub-interns (fourth-year medical students) are there for the full 30 hours; the two interns per team split the call day in two 12-hour shifts; third-year medical students stay until they get their 2-3 patients, but no later than midnight.
Rounds: When your team talks to the attending physician about current patients.
Rounds can be a bit confusing because they're held at different times depending on the day in the call cycle. Post-call rounds are usually at 7:30am, and the attending usually invites the team to eat breakfast in the physicians' cafeteria. Rounds are held at 8:00 and 8:30 on the second and third days after call, and they're held at 9:00 on call days.
Pre-round: When you visit with your patients in the morning and collect all new information (e.g. labs, studies, significant overnight events, physical exam).
I usually gave myself around 2 hours to pre-round on 2-3 patients. The earliest I got to the hospital over the past month was at 5am, and that was on a post-call day when I had 3 patients to pre-round on before rounds at 7:30.
My pre-round looks something like this:
1) Talk to the night nurse about overnight events.
2) Look in the patient's chart (both physical and electronic) to check for new orders or follow-up notes.
3) Start filling in my own follow-up note with the information I got from the overnight nurse and objective data like morning labs or any studies done since the previous morning's rounds.
4) Visit with my patient: get their perspective on how they did overnight.
5) Do a targeted physical exam.
6) Finish writing my follow-up note before rounds.
Classroom learning
In addition to clinical duties, I also had to attend various lectures and seminars. We had Morning Report every day from 10:30-11:30 and Noon Conference every day from noon-1pm. On Thursday afternoons, we also had to attend the Chief Resident Lecture Series from 2:30-4:00.
The end of the day
I got lucky that both of the residents who I worked with over the past month were laid-back and considerate of my time. They usually told me to go home rather early in the afternoon, sometimes even as early as 2pm. I didn't really know what to think about this, at first, especially given all of the horror stories I've heard about Internal Medicine being one of the hardest clerkships.
Typically, when my resident told me to go home earlier than 4-5ish, I would go find one or both of my interns and see if there was anything I could do to make their life easier. This amounted to scutwork, yes, but these were the kinds of tasks and chores that I'll have to be doing myself when I'm an intern. Plus, I know that both of my interns appreciated my scutwork services because it helped them get out of the hospital earlier. If both of my interns sent me home, too, I'd either study for the shelf exam in the hospital's library (I'm not exactly a procrastinator) or I'd actually go home and relax or go for a run.
Overall, I had a few 18-hour days and a few 8-hour days, with most of my days falling somewhere around 10-12 hours. It'll be interesting to see how my schedule at Denver Health compares.
Call: When your team admits new patients.
Call is every fourth day ("call q4") at PSL. Residents and sub-interns (fourth-year medical students) are there for the full 30 hours; the two interns per team split the call day in two 12-hour shifts; third-year medical students stay until they get their 2-3 patients, but no later than midnight.
Rounds: When your team talks to the attending physician about current patients.
Rounds can be a bit confusing because they're held at different times depending on the day in the call cycle. Post-call rounds are usually at 7:30am, and the attending usually invites the team to eat breakfast in the physicians' cafeteria. Rounds are held at 8:00 and 8:30 on the second and third days after call, and they're held at 9:00 on call days.
Pre-round: When you visit with your patients in the morning and collect all new information (e.g. labs, studies, significant overnight events, physical exam).
I usually gave myself around 2 hours to pre-round on 2-3 patients. The earliest I got to the hospital over the past month was at 5am, and that was on a post-call day when I had 3 patients to pre-round on before rounds at 7:30.
My pre-round looks something like this:
1) Talk to the night nurse about overnight events.
2) Look in the patient's chart (both physical and electronic) to check for new orders or follow-up notes.
3) Start filling in my own follow-up note with the information I got from the overnight nurse and objective data like morning labs or any studies done since the previous morning's rounds.
4) Visit with my patient: get their perspective on how they did overnight.
5) Do a targeted physical exam.
6) Finish writing my follow-up note before rounds.
Classroom learning
In addition to clinical duties, I also had to attend various lectures and seminars. We had Morning Report every day from 10:30-11:30 and Noon Conference every day from noon-1pm. On Thursday afternoons, we also had to attend the Chief Resident Lecture Series from 2:30-4:00.
The end of the day
I got lucky that both of the residents who I worked with over the past month were laid-back and considerate of my time. They usually told me to go home rather early in the afternoon, sometimes even as early as 2pm. I didn't really know what to think about this, at first, especially given all of the horror stories I've heard about Internal Medicine being one of the hardest clerkships.
Typically, when my resident told me to go home earlier than 4-5ish, I would go find one or both of my interns and see if there was anything I could do to make their life easier. This amounted to scutwork, yes, but these were the kinds of tasks and chores that I'll have to be doing myself when I'm an intern. Plus, I know that both of my interns appreciated my scutwork services because it helped them get out of the hospital earlier. If both of my interns sent me home, too, I'd either study for the shelf exam in the hospital's library (I'm not exactly a procrastinator) or I'd actually go home and relax or go for a run.
Overall, I had a few 18-hour days and a few 8-hour days, with most of my days falling somewhere around 10-12 hours. It'll be interesting to see how my schedule at Denver Health compares.
Friday, July 15, 2011
Loose ends
I left loose ends at PSL.
The most important loose end is a patient who we admitted quite awhile ago. This patient has a rare disease with a very poor prognosis, and there were several times over the past month when we thought that he might pass away. I have observed with great interest the dynamics between the medical team and my patient's family and how those dynamics have impacted his process of dying.
I care very much for this patient. The last time I saw him awake, I held his hand to comfort him. There really wasn't anything else I could do to help. He looked up at me and whispered "Thank you." I could barely hear his words over the noise of the breathing machine and the mask over his mouth. The meaning was in his eyes. A single tear rolled down his cheek, and I caught it with my finger.
Then I squeezed his hand one last time and left. It was so much more difficult for me to leave him than to hold his hand.
The most important loose end is a patient who we admitted quite awhile ago. This patient has a rare disease with a very poor prognosis, and there were several times over the past month when we thought that he might pass away. I have observed with great interest the dynamics between the medical team and my patient's family and how those dynamics have impacted his process of dying.
I care very much for this patient. The last time I saw him awake, I held his hand to comfort him. There really wasn't anything else I could do to help. He looked up at me and whispered "Thank you." I could barely hear his words over the noise of the breathing machine and the mask over his mouth. The meaning was in his eyes. A single tear rolled down his cheek, and I caught it with my finger.
Then I squeezed his hand one last time and left. It was so much more difficult for me to leave him than to hold his hand.
Thursday, July 14, 2011
Preparing for the Hereafter
My resident came to me with a new patient who he wanted me to follow: “This is an elderly lady complaining of dizziness and fatigue [details changed]. On a scale of 1 to cute, she’s cute.” He was right. I immediately made a connection with Alice [pseudonym]. Even through her pain and discomfort, she was always pleasant and smiling and quietly encouraging me as a student of medicine in her gentle Southern twang. An aura surrounded her that she had experienced a lot of life and had perhaps learned some of its secrets.
When it came time to discharge Alice, I was selfishly sad that I would no longer have the pleasure of her company. That was when I decided that I would ask her if I could visit her in her home as part of a required assignment for this clerkship.
The point of this assignment is to emphasize the human component of the patients we see. My perception of my patients is very much colored by the only environment in which we have interacted, the hospital. I may have had some enjoyable conversations with Alice, and I may have met some of her family and friends, but my perspective of her throughout her hospitalization was necessarily one-dimensional.
What is her home environment like? I knew that her son was taking care of her, but what is the exact nature of that relationship? How does she manage her medications? How does she get around the house? What does she do for fun?
Alice and her son welcomed me into their home. It’s a small house located on a busy street, and it’s equally busy inside bursting with plants and pictures. Alice was in the living room when I arrived; I watched her get out of her chair and make her way to her motorized wheelchair 10 feet away, assisted by her walker. The whole process took about 2 minutes.
Alice explained that she likes to move about by herself, but her son is usually nearby to help her if she needs it. She further explained that her son does all the chores around the house, including managing her medications and preparing food. I noted the dozen or so medicine bottles perched on a tray built into her walker and the smell of an early dinner coming from the kitchen, where her son was humming and cooking away.
I asked her about her hobbies and what she does to keep herself busy. Without trying to hide her disappointment, she described how she had previously been very active in her church community but is now unable to get out and socialize. She doesn’t leave her house much at all. Even getting to her doctor’s appointments is a big deal.
Then she voiced her biggest concern: “My son is getting tired. It’s a big job taking of caring of me. I don’t know when I’m going to have to move into a nursing home.” I realized that this issue must weigh heavily on her mind. I didn’t have any easy answers for her.
We spent the rest of our visit together looking at pictures on the walls and talking about the people from her past who she has loved. Then it was time to leave.
“Goodbye, Alice. Thank you for your hospitality.”
“There ain't no goodbyes, honey. I’ll see you in the Hereafter.”
When it came time to discharge Alice, I was selfishly sad that I would no longer have the pleasure of her company. That was when I decided that I would ask her if I could visit her in her home as part of a required assignment for this clerkship.
The point of this assignment is to emphasize the human component of the patients we see. My perception of my patients is very much colored by the only environment in which we have interacted, the hospital. I may have had some enjoyable conversations with Alice, and I may have met some of her family and friends, but my perspective of her throughout her hospitalization was necessarily one-dimensional.
What is her home environment like? I knew that her son was taking care of her, but what is the exact nature of that relationship? How does she manage her medications? How does she get around the house? What does she do for fun?
Alice and her son welcomed me into their home. It’s a small house located on a busy street, and it’s equally busy inside bursting with plants and pictures. Alice was in the living room when I arrived; I watched her get out of her chair and make her way to her motorized wheelchair 10 feet away, assisted by her walker. The whole process took about 2 minutes.
Alice explained that she likes to move about by herself, but her son is usually nearby to help her if she needs it. She further explained that her son does all the chores around the house, including managing her medications and preparing food. I noted the dozen or so medicine bottles perched on a tray built into her walker and the smell of an early dinner coming from the kitchen, where her son was humming and cooking away.
I asked her about her hobbies and what she does to keep herself busy. Without trying to hide her disappointment, she described how she had previously been very active in her church community but is now unable to get out and socialize. She doesn’t leave her house much at all. Even getting to her doctor’s appointments is a big deal.
Then she voiced her biggest concern: “My son is getting tired. It’s a big job taking of caring of me. I don’t know when I’m going to have to move into a nursing home.” I realized that this issue must weigh heavily on her mind. I didn’t have any easy answers for her.
We spent the rest of our visit together looking at pictures on the walls and talking about the people from her past who she has loved. Then it was time to leave.
“Goodbye, Alice. Thank you for your hospitality.”
“There ain't no goodbyes, honey. I’ll see you in the Hereafter.”
Wednesday, July 13, 2011
Reflections on Internal Medicine at PSL
My internal medicine clerkship at Presbyterian St. Luke's hospital comes to an end tomorrow. Reflecting on the past month, it has overall been a good experience. I have learned a lot, very quickly. The steep learning curve has at times been frustrating, but I've been fortunate to have been surrounded by co-workers and teachers with a lot of patience and who also seem to enjoy teaching. It makes a huge difference. I'm sad to leave PSL but am excited for new Internal Medicine adventures at Denver Health.
My two principal goals for the coming month at Denver Health:
1) Continuing to improve my oral presentations
2) Improving overall efficiency
My two principal goals for the coming month at Denver Health:
1) Continuing to improve my oral presentations
2) Improving overall efficiency
Thursday, July 7, 2011
Neurological Care at The Children's Hospital
I got the e-mail today telling me that I will be doing my Neurological Care clerkship at The Children's Hospital. I have mixed feelings about this.
Four hospitals take students for neurology clerkship: The University Hospital, The Children's Hospital, the VA, and Denver Health. I ranked the VA first and TCH dead last.
This might not make sense at first if you know that I have been researching careers in pediatric neurology. My thought process was to gain a solid adult neurology foundation during my clerkship then do a pediatric neurology elective during my fourth year. That's obviously not going to happen now. Instead, I'll just do an adult neurology elective early in my fourth year.
So, while I'm somewhat disappointed that I didn't get my first choice of site, and while I had to shuffle around my plan for neurology, I'm still looking forward to working at TCH. It's one of the top pediatric hospitals in the country (20th in neurology), and I've heard only great things about the Neurological Care clerkship at TCH.
I talked with a classmate of mine who did his neurology clerkship at TCH, and he loved it. When I told him about my concerns of not gaining a basic foundation in adult neurology, he said that he felt he learned the neurological exam extra-well because he also had to learn all the little tricks of getting the kiddos to cooperate. Good point.
So overall I'm very excited. I think Neurological Care at TCH will be a great learning experience and a boat load of fun.
Four hospitals take students for neurology clerkship: The University Hospital, The Children's Hospital, the VA, and Denver Health. I ranked the VA first and TCH dead last.
This might not make sense at first if you know that I have been researching careers in pediatric neurology. My thought process was to gain a solid adult neurology foundation during my clerkship then do a pediatric neurology elective during my fourth year. That's obviously not going to happen now. Instead, I'll just do an adult neurology elective early in my fourth year.
So, while I'm somewhat disappointed that I didn't get my first choice of site, and while I had to shuffle around my plan for neurology, I'm still looking forward to working at TCH. It's one of the top pediatric hospitals in the country (20th in neurology), and I've heard only great things about the Neurological Care clerkship at TCH.
I talked with a classmate of mine who did his neurology clerkship at TCH, and he loved it. When I told him about my concerns of not gaining a basic foundation in adult neurology, he said that he felt he learned the neurological exam extra-well because he also had to learn all the little tricks of getting the kiddos to cooperate. Good point.
So overall I'm very excited. I think Neurological Care at TCH will be a great learning experience and a boat load of fun.
Internal Medicine Intern Guide
My intern gave me a present today: her old copy of a guide for Internal Medicine interns. The chief resident was passing out new editions today, so my intern didn't need the old printing that she had herself inherited from someone in a previous class. From the way she gave it to me, I got the impression that this would prove to be a very valuable gift; I didn't realize just how valuable until I heard one of the fourth-year students ask if there were enough copies for the sub-interns to get one, too. There weren't.
Flipping through the booklet this afternoon, it looks like there's a lot of general advice for new interns (e.g. how to stay sane, how to work efficiently, how to act professionally) as well as "the experienced approach" to a spectrum of disorders and diseases commonly encountered on the Medicine service. Most of this advice can be equally well applied to third-year medical students. Just like interns, we are also experiencing one of the most dramatic transitions in our careers.
Here are some words of wisdom that I think are especially useful for third-year medical students:
Flipping through the booklet this afternoon, it looks like there's a lot of general advice for new interns (e.g. how to stay sane, how to work efficiently, how to act professionally) as well as "the experienced approach" to a spectrum of disorders and diseases commonly encountered on the Medicine service. Most of this advice can be equally well applied to third-year medical students. Just like interns, we are also experiencing one of the most dramatic transitions in our careers.
Here are some words of wisdom that I think are especially useful for third-year medical students:
Always at the forefront of our minds has to be the patient. They are the reason we all have jobs, and caring for them in a compassionate, professional, and intelligent manner is our ultimate endpoint. ...
Your patients will come to you scared and looking for answers. Your mission... is to learn to help with these two things. The diagnosing and treating can be tricky and time-consuming without always being fruitful. Sometimes you will find the cause and realize that there is nothing to be done to cure it or halt its course. This is why it is the second most important thing you can do for your sick patient. The first is helping to alleviate the fear that comes with being ill. When done right, this goal can be accomplished almost every single time, in almost every single patient.
Make an effort to see your patients for who they really are: people, just like you, with families, goals, dreams, and desires, who see all those things being thrown into disarray and peril by a gnawing pain in the gut or a sudden flash of pain across the chest. Every "interesting" or "cool" case for you is a potential threat to their existence. Be mindful of this. While we have come here to learn and expand our knowledge, it is only because of the patients and what they are going through that this is possible.
So be respectful of patients and their families. Understand that anger and irritation on their part is not directed at you, and do your best to not take it personally. When you take the time to understand that a patient's anger might actually just be one of the stages of loss or dying, this becomes much easier to accept. Learning to step outside yourself and think in terms of the patient first will help to bring all of these things into perspective.
...Your time in the hospital over the next few years is going to be an incredible life-changing time for you. Understanding that it is the same for your patients will make it all that much richer, and you will become a better doctor for it.
Monday, July 4, 2011
A bad interaction with a nurse
I had a nurse tell me recently that I "need to figure out how things work around here." My offense: I interrupted her when she was talking with another nurse because I needed my patient's vitals. It was 5 minutes before rounds, and the most recent vital signs in my patient's chart were from 7pm the previous evening. I was polite about it ("I'm sorry for interrupting..."), but it would have been very bad showing up at rounds that morning without my patient's vitals.
Later in the afternoon, I went to check up on my patient before she was sent down to surgery. My patient wasn't allowed to eat or drink anything since breakfast, so it was no surprise that she asked for some water when I asked if there was anything I could do for her. Yeah, nice try. That same nurse happened to be in the room during this exchange. Before I could reply, the nurse jumped in: "You might be able to fool him because he's new here, but I've been working here for 20 years, and you can't fool me!"
I felt belittled and undermined. Realistically, my patient most likely didn't catch any hidden meaning in the nurse's comment. I probably wouldn't have thought twice about it, either, if it weren't for her icy response to my interrupting her earlier in the morning.
This nurse's behavior in my opinion was both unprofessional and unacceptable. So what did I do about it? Nothing. Just vent to my friends and on this blog. I have been fortunate up until now in that almost all of the people with whom I have interacted on the wards have conducted themselves professionally. Medical students (mostly third-years) tend to get a lot of flak because we're thrown into the world of medicine with little practical experience. We have to start somewhere.
If this nurse continues to undermine me in front of my patient, I will talk to my resident about it and ask him what he thinks I should do to fix the situation. This is what I would say to the nurse:
Later in the afternoon, I went to check up on my patient before she was sent down to surgery. My patient wasn't allowed to eat or drink anything since breakfast, so it was no surprise that she asked for some water when I asked if there was anything I could do for her. Yeah, nice try. That same nurse happened to be in the room during this exchange. Before I could reply, the nurse jumped in: "You might be able to fool him because he's new here, but I've been working here for 20 years, and you can't fool me!"
I felt belittled and undermined. Realistically, my patient most likely didn't catch any hidden meaning in the nurse's comment. I probably wouldn't have thought twice about it, either, if it weren't for her icy response to my interrupting her earlier in the morning.
This nurse's behavior in my opinion was both unprofessional and unacceptable. So what did I do about it? Nothing. Just vent to my friends and on this blog. I have been fortunate up until now in that almost all of the people with whom I have interacted on the wards have conducted themselves professionally. Medical students (mostly third-years) tend to get a lot of flak because we're thrown into the world of medicine with little practical experience. We have to start somewhere.
If this nurse continues to undermine me in front of my patient, I will talk to my resident about it and ask him what he thinks I should do to fix the situation. This is what I would say to the nurse:
I respect the work you do as a nurse and your 20 years of experience - in fact, I rely on your experience as I'm learning how to be a good doctor. But I need you to respect my role as a student and the process of my medical education. I felt undermined when you highlighted my inexperience in front of my patient. Please don't do that again.
Friday, July 1, 2011
Guest Writer: Thoughts on General Surgery
--Greg, University of Colorado School of Medicine, Class of 2013
I'm two weeks into my general surgery rotation. We are up pretty early taking care of patients and luckily get a lot of surgery time during the day. It’s hard being a third year medical student in the hospital. We have to be at certain locations throughout the day, but they don't give us the clearance to get into a lot of the ORs and other places we need to be. This makes it quite frustrating at times and we have to be creative in navigating around the system.
Today in surgery, my attending allowed me to close up a couple of the incisions. For a third year medical student, closing up the incisions is a big deal, it’s exciting and we actually feel a little bit useful. In reality, closing up the incision is not a big deal at all, but we take what we can get. The whole time I was closing, a scrub nurse stood behind me looking over my shoulder, ridiculing my every move. "I can't believe how slow he is", "Oh my God, you're wasting so much suture," "This is ridiculous, its going to take him an hour to throw four stitches!" "This is bullshit, I want to get out of here," "If you want to learn, GO TO DENVER HEALTH!", etc.
Finally when it was all done and we were cleaning up, she came over looked me in the eye and asked if I was going to need therapy, in a poor baby sort of voice. I held my own the entire time, trying to focus on the task and not let my emotions get to me. Even though she made a big stink the entire time, I think I did a reasonable job, and it didn't take an eternity like she would like me to believe.
Comments like those experienced today are frequent events, but they are not usually that harsh or direct. I've come to find that there is this unwritten rule that the third year medical student is a living punch dummy, free to be abused by everyone and anyone associated in the hospital. Surprisingly, the surgeons are the least likely of all the staff members to be mean to us. They poke a lot of fun at us, but in a respectful, often humorous sort of way.
I seem to be able to brush off the humiliation completely when in the hospital. Unfortunately when I get home, nonproductive thoughts enter my mind. Thoughts questioning my abilities, questioning if I will ever find a niche and be successful in a career in medicine. Sometimes I question the whole profession altogether. How can such a beautiful thing, taking care of the ill, be laced with such arrogance, animosity and uncooperative behavior? The medical students may be a burden to the nursing staff, as we often don't always know what to do and we frequently just get in the way, but I wish they understood the pitted feeling of anxiety held within our stomachs throughout the entire day. We want to be useful, we don't want to be in the way, and most of all we don't want to make anyone angry at us.
I entered medicine because I felt it was a special profession, one where everyone was held to the highest standards and mutual respect and collegiality were not only encouraged, but demanded. I guess every profession that holds a human element is not exempt from the fallacies of our species. It was naive of me to think otherwise.
Looking at the big picture though, I am able to realize that this is just one small hiccup in my training. Tomorrow is a new day. I'll probably get yelled at and made to feel inadequate, but it takes a strong person to get to this level and I will persevere through this as I've demonstrated in the past.
I will probably not be a surgeon. I like procedures, but I do not enjoy the culture that has become ingrained in the OR. I like the idea of working in a small clinic where I can have more influence in setting the standards of behavior and developing the culture of my practice. We will see though; feelings and interests seem to change rapidly in this training. Two weeks ago I was thinking orthopaedics, today of all things I'm considering outpatient skin cancer surgery as a sub-specialty of dermatology!
I'm two weeks into my general surgery rotation. We are up pretty early taking care of patients and luckily get a lot of surgery time during the day. It’s hard being a third year medical student in the hospital. We have to be at certain locations throughout the day, but they don't give us the clearance to get into a lot of the ORs and other places we need to be. This makes it quite frustrating at times and we have to be creative in navigating around the system.
Today in surgery, my attending allowed me to close up a couple of the incisions. For a third year medical student, closing up the incisions is a big deal, it’s exciting and we actually feel a little bit useful. In reality, closing up the incision is not a big deal at all, but we take what we can get. The whole time I was closing, a scrub nurse stood behind me looking over my shoulder, ridiculing my every move. "I can't believe how slow he is", "Oh my God, you're wasting so much suture," "This is ridiculous, its going to take him an hour to throw four stitches!" "This is bullshit, I want to get out of here," "If you want to learn, GO TO DENVER HEALTH!", etc.
Finally when it was all done and we were cleaning up, she came over looked me in the eye and asked if I was going to need therapy, in a poor baby sort of voice. I held my own the entire time, trying to focus on the task and not let my emotions get to me. Even though she made a big stink the entire time, I think I did a reasonable job, and it didn't take an eternity like she would like me to believe.
Comments like those experienced today are frequent events, but they are not usually that harsh or direct. I've come to find that there is this unwritten rule that the third year medical student is a living punch dummy, free to be abused by everyone and anyone associated in the hospital. Surprisingly, the surgeons are the least likely of all the staff members to be mean to us. They poke a lot of fun at us, but in a respectful, often humorous sort of way.
I seem to be able to brush off the humiliation completely when in the hospital. Unfortunately when I get home, nonproductive thoughts enter my mind. Thoughts questioning my abilities, questioning if I will ever find a niche and be successful in a career in medicine. Sometimes I question the whole profession altogether. How can such a beautiful thing, taking care of the ill, be laced with such arrogance, animosity and uncooperative behavior? The medical students may be a burden to the nursing staff, as we often don't always know what to do and we frequently just get in the way, but I wish they understood the pitted feeling of anxiety held within our stomachs throughout the entire day. We want to be useful, we don't want to be in the way, and most of all we don't want to make anyone angry at us.
I entered medicine because I felt it was a special profession, one where everyone was held to the highest standards and mutual respect and collegiality were not only encouraged, but demanded. I guess every profession that holds a human element is not exempt from the fallacies of our species. It was naive of me to think otherwise.
Looking at the big picture though, I am able to realize that this is just one small hiccup in my training. Tomorrow is a new day. I'll probably get yelled at and made to feel inadequate, but it takes a strong person to get to this level and I will persevere through this as I've demonstrated in the past.
I will probably not be a surgeon. I like procedures, but I do not enjoy the culture that has become ingrained in the OR. I like the idea of working in a small clinic where I can have more influence in setting the standards of behavior and developing the culture of my practice. We will see though; feelings and interests seem to change rapidly in this training. Two weeks ago I was thinking orthopaedics, today of all things I'm considering outpatient skin cancer surgery as a sub-specialty of dermatology!
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