Hello, blog friends! It has been a while since I've posted here. Part of that was me studying for Step 2, part of it was me binge watching Netflix, and part of that is because I have been blogging for Medscape's student blog, The Differential. I encourage you medically-minded people to go check it out! You need a Medscape account to log in and view the content, but it's free to sign up. :)
I am in the middle of my two month stint in the ER. And while it is exhausting, I do enjoy it a lot - thought it can't compare to the OR. ;) One thing that I've been reminded of recently is how thankful I am that patients agree to let me, a medical student, be involved in their care. I wrote a post earlier today for Medscape where I mentioned that it is our patients, not people standing at the front of lecture halls or writing medical text books, who truly teach us about the art of practicing medicine. And I am so thankful for all of my patients-teachers. I try to approach every encounter with a patient as a learning opportunity, because I am early enough into my career to know just how little I know about medicine. So I try to look for something in each interaction with a patient that I can learn from.
Earlier this week I stitched up a little girl who had been bitten by a dog. And while I was hunched over awkwardly so she could lay comfortably on the bed while watching videos on her iPad, I looked up at her mom. Her mom smiled at me and thanked me for being so gentle and patient with her daughter (who was rightfully terrified - ain't nobody like needles!). I smiled back at her and said it was no problem. But in my head, I wanted to be like, "Ummm, are you kidding? You just let me, a fourth year medical student, literally sew your child back together! I should be thanking you!" And that is the truth. Because patients don't have to let us medical students into their rooms when they don't feel good, and have already been asked a million questions by other (essential) members of their medical team. But they do anyways. And I will forever be thankful to all of my patients for the lessons they have taught me, and for the opportunities to develop into the kind of doctor I always wanted to be.
Tuesday, July 26, 2016
Monday, May 30, 2016
Coffee and Cigarrettes
"Alright Ted, do you remember what you have to look for when you're crossing the street?"
I looked ahead as my resident asked our patient, who was happily puffing away on a cigarette, if he remembered to look for the walk sign before crossing the street.
My last rotation of the year was psych, so I spent my final four weeks as a third year medical student in a state-run inpatient psychiatric facility. And while the first few days, so drastically different from the pristine order and efficiency of the OR, made me long to be back on surgery, that morning I discovered a new found appreciation for psychiatry.
Our patient, Ted, was diagnosed with schizoaffective disorder, and had been at the psych center for a few months. My resident, who had been noticing improvement in his behavior, wanted to take him on a field trip to the Dunkin Donuts a block away as a kind of reward. So that morning, we picked Ted up from the ward, and walked with him to Dunkin Donuts, making a pit stop at the gas station on the way so Ted could get his nicotine fix.
It became clear pretty early on that Ted would not pay attention to street signals and oncoming traffic, and I seriously began to doubt whether our little adventure was a good idea at all. When we finally got to Dunkin, Ted ordered a cup of black coffee and an old-fashioned donut. After myself and the resident ordered our drinks and snacks of choice, the three of us sat there, happily munching away on sugary treats and sipping hot coffee. I looked over at Ted, who smiled and offered me a bite of his donut, and I finally saw the person, not the patient. I was able to see past the diagnosis and disheveled hair and saggy sweater and simply see Ted. I saw the person he was before he was diagnosed, and the person he was trying so hard to become again. The person who was happy because today, for a few brief normal moments, he actually felt like a person again, sitting there sipping coffee and eating his donut, like everyone else.
Everyone who comes into the hospital has a story, granted some stories are harder to see than others. As medical personnel we can get bogged down by diagnoses, especially if that diagnosis is a psychiatric one. But I'm thankful for my time spent with Ted, and all the other patients I had the privilege of working with, for the lessons they taught me. Lessons about compassion, and understanding, and meeting people where they're at. And, the power of a really good cup of coffee.
I looked ahead as my resident asked our patient, who was happily puffing away on a cigarette, if he remembered to look for the walk sign before crossing the street.
My last rotation of the year was psych, so I spent my final four weeks as a third year medical student in a state-run inpatient psychiatric facility. And while the first few days, so drastically different from the pristine order and efficiency of the OR, made me long to be back on surgery, that morning I discovered a new found appreciation for psychiatry.
Our patient, Ted, was diagnosed with schizoaffective disorder, and had been at the psych center for a few months. My resident, who had been noticing improvement in his behavior, wanted to take him on a field trip to the Dunkin Donuts a block away as a kind of reward. So that morning, we picked Ted up from the ward, and walked with him to Dunkin Donuts, making a pit stop at the gas station on the way so Ted could get his nicotine fix.
It became clear pretty early on that Ted would not pay attention to street signals and oncoming traffic, and I seriously began to doubt whether our little adventure was a good idea at all. When we finally got to Dunkin, Ted ordered a cup of black coffee and an old-fashioned donut. After myself and the resident ordered our drinks and snacks of choice, the three of us sat there, happily munching away on sugary treats and sipping hot coffee. I looked over at Ted, who smiled and offered me a bite of his donut, and I finally saw the person, not the patient. I was able to see past the diagnosis and disheveled hair and saggy sweater and simply see Ted. I saw the person he was before he was diagnosed, and the person he was trying so hard to become again. The person who was happy because today, for a few brief normal moments, he actually felt like a person again, sitting there sipping coffee and eating his donut, like everyone else.
Everyone who comes into the hospital has a story, granted some stories are harder to see than others. As medical personnel we can get bogged down by diagnoses, especially if that diagnosis is a psychiatric one. But I'm thankful for my time spent with Ted, and all the other patients I had the privilege of working with, for the lessons they taught me. Lessons about compassion, and understanding, and meeting people where they're at. And, the power of a really good cup of coffee.
Saturday, April 9, 2016
PEG tubes and promises
We were standing next to the nurses station. My senior resident was in the middle of explaining a fairly basic surgical procedure to an elderly patient's wife and daughter. I was standing next to him, trying my best to give reassuring smiles and nods as he answered their questions. When he was done explaining everything and we were about to leave, the patient's wife extended her hand to us. My resident reached out his hand and she took it in hers. Her eyes filled with tears that she didn't try to hide and she quietly said, "Please, do a good job. Do a really, really good job." He firmly, shook her hand and promised that we would, and then we walked away.
That moment has stuck with me. The wife's vulnerability, her pain at the thought of her husband enduring another procedure, the hopelessness she must have felt. The doctor-patient relationship is such a complex thing and I find myself all too often taking it for granted. But in that moment, the true nature of what it means to be a physician was briefly and elegantly on display. And again I was reminded of the contract I implicitly enter into when I put on that white coat. Whether listening to heart beats, writing prescriptions, or cutting open an abdomen, at the foundation of medicine lies a promise to do a really, really good job.
That moment has stuck with me. The wife's vulnerability, her pain at the thought of her husband enduring another procedure, the hopelessness she must have felt. The doctor-patient relationship is such a complex thing and I find myself all too often taking it for granted. But in that moment, the true nature of what it means to be a physician was briefly and elegantly on display. And again I was reminded of the contract I implicitly enter into when I put on that white coat. Whether listening to heart beats, writing prescriptions, or cutting open an abdomen, at the foundation of medicine lies a promise to do a really, really good job.
Sunday, March 13, 2016
Find the one
"Let's find the one."
"What?"
"The one person that we helped today."
I sat across from a tired and overworked family physician (who also happens to be my goofy older cousin) as he scrolled through the day's patient list, looking for the one person he could say without doubt, that we helped. Because that snowy day, months ago, at a suburban family medicine practice in upstate New York, was exhausting. We had seen over 20 patients, almost all of which were complex cases with never-ending problem lists and dozens of meds. Some were sick, most were frustrated, all of them required lots of patience.
Half way through the list, my cousin said family medicine is like golf. You might take ten shots, all of which are lousy. But then you'll have one really great swing. And that's the reason you come back.
So we scrolled through the patient list. Out of 21 patients seen, we figured we could confidently say we helped two. Which, according to my cousin, is twice as many as you can hope for on any given day.
I'm often reminded of that moment when I round on post-op surgical patients in the morning. It's always such a surreal "high-five" moment for me, granted I'm still very new and naive and the symptoms of chronic fatigue have yet to fully set in. But here this patient is, lying in front of you on a hospital bed. When sometimes not even 12 hours before, you were operating on them. Using a camera or your hands to manipulate their anatomy and literally cut out the bad. And I figured out this week why these moments are always my favorite out of the whole day. Granted the patients are still in pain from their surgery (I don't like that part). They are probably annoyed that no less than 5 people that day will ask them if they've farted or pooped while waving an incentive spirometer in their face. (And have I mentioned, it's usually 4:30am?) But, instead of scrolling through a list at the end of the day, trying to figure out who you helped, the patient is right there in front of you. Hopped up on dilaudid and covered in purple skin glue, but nevertheless there. The living, breathing evidence of a person you helped when they needed it most.
So if Family Medicine is like golf, I don't really know what surgery is comparable to. But I've never been much of a golf fan, and there is nothing quite like the smell of Hibiclens in the morning. :)
"What?"
"The one person that we helped today."
I sat across from a tired and overworked family physician (who also happens to be my goofy older cousin) as he scrolled through the day's patient list, looking for the one person he could say without doubt, that we helped. Because that snowy day, months ago, at a suburban family medicine practice in upstate New York, was exhausting. We had seen over 20 patients, almost all of which were complex cases with never-ending problem lists and dozens of meds. Some were sick, most were frustrated, all of them required lots of patience.
Half way through the list, my cousin said family medicine is like golf. You might take ten shots, all of which are lousy. But then you'll have one really great swing. And that's the reason you come back.
So we scrolled through the patient list. Out of 21 patients seen, we figured we could confidently say we helped two. Which, according to my cousin, is twice as many as you can hope for on any given day.
I'm often reminded of that moment when I round on post-op surgical patients in the morning. It's always such a surreal "high-five" moment for me, granted I'm still very new and naive and the symptoms of chronic fatigue have yet to fully set in. But here this patient is, lying in front of you on a hospital bed. When sometimes not even 12 hours before, you were operating on them. Using a camera or your hands to manipulate their anatomy and literally cut out the bad. And I figured out this week why these moments are always my favorite out of the whole day. Granted the patients are still in pain from their surgery (I don't like that part). They are probably annoyed that no less than 5 people that day will ask them if they've farted or pooped while waving an incentive spirometer in their face. (And have I mentioned, it's usually 4:30am?) But, instead of scrolling through a list at the end of the day, trying to figure out who you helped, the patient is right there in front of you. Hopped up on dilaudid and covered in purple skin glue, but nevertheless there. The living, breathing evidence of a person you helped when they needed it most.
So if Family Medicine is like golf, I don't really know what surgery is comparable to. But I've never been much of a golf fan, and there is nothing quite like the smell of Hibiclens in the morning. :)
Sunday, January 31, 2016
Accepted
A couple months ago Sarah Pritzker, writer and blog editor for Accepted, asked me if I would be willing to do an interview focusing specifically on my path to applying and getting into medical school. I was more than happy to oblige and my interview went live on their blog earlier this week! If you're interested in applying to medical school, pop on over to their site and give it a gander. Also featured is this pic of first-year me in my brand spankin' new white. Talk about a throw back! So young...so well rested. ;)
Lastly, I know most of my posts on here are me sharing stories about my experiences as a medical student, but if any of you ever have questions about anything, medical school related or not, please feel free to shoot me an email or comment below!
Happy Sunday, friends. :)
Tuesday, January 26, 2016
Hand and Heart
"Grab a pair of gloves and get in there."
Following my resident's instructions, I put on a pair of blue gloves and pushed my way through the sea of nurses and doctors, to stand in line ready to perform chest compressions on a patient who had coded in the ICU.
Like everyone else crowded into the small patient room, I tried to ignore the blaring sound of the heart monitor and seemingly lifeless body of the elderly patient, all of which confirmed the sinking feeling I had in my stomach. This was bad, and all I could think about was how much I did not want to watch another patient die in the ICU.
Standing beside the patient's bedside, I looked down and saw her hand reflexively reach out. Instinctively, I grabbed it. And while another medical student rhythmically pumped on the patient's chest, I firmly held the old, wrinkled hand and began to softly stroke it with my thumb. I let go when I got the nod from the nurse running the code to begin my compressions. I carefully placed my hands on the center of the patient's chest, amidst the EKG tabs and wires. I pushed down one time and, miraculously, felt a heart beat.
In amazement I shouted that I felt her heart beat. Almost simultaneously the nurse checking the femoral pulse shouted that he had a pulse, too. I looked up at the heart monitor to see a weak, irregular, but definitely present heart tracing. I backed up as the critical care doctor began examining the patient and giving more orders.
I know the science. I know the physiology. I know that it was the electrical conversions and the magnesium and the brilliance of seasoned attendings perfectly managing a critically ill and dying old woman that caused her heart to start beating again.
But I also know that there is power in compassion and hoping, against all odds, that maybe this one time, for this one patient, a code won't end in defeat.
And walking out of the ICU this afternoon I realized something else, too. I have yet to feel something more beautiful than a still heart begin to beat again.
Following my resident's instructions, I put on a pair of blue gloves and pushed my way through the sea of nurses and doctors, to stand in line ready to perform chest compressions on a patient who had coded in the ICU.
Like everyone else crowded into the small patient room, I tried to ignore the blaring sound of the heart monitor and seemingly lifeless body of the elderly patient, all of which confirmed the sinking feeling I had in my stomach. This was bad, and all I could think about was how much I did not want to watch another patient die in the ICU.
Standing beside the patient's bedside, I looked down and saw her hand reflexively reach out. Instinctively, I grabbed it. And while another medical student rhythmically pumped on the patient's chest, I firmly held the old, wrinkled hand and began to softly stroke it with my thumb. I let go when I got the nod from the nurse running the code to begin my compressions. I carefully placed my hands on the center of the patient's chest, amidst the EKG tabs and wires. I pushed down one time and, miraculously, felt a heart beat.
In amazement I shouted that I felt her heart beat. Almost simultaneously the nurse checking the femoral pulse shouted that he had a pulse, too. I looked up at the heart monitor to see a weak, irregular, but definitely present heart tracing. I backed up as the critical care doctor began examining the patient and giving more orders.
I know the science. I know the physiology. I know that it was the electrical conversions and the magnesium and the brilliance of seasoned attendings perfectly managing a critically ill and dying old woman that caused her heart to start beating again.
But I also know that there is power in compassion and hoping, against all odds, that maybe this one time, for this one patient, a code won't end in defeat.
And walking out of the ICU this afternoon I realized something else, too. I have yet to feel something more beautiful than a still heart begin to beat again.
Sunday, January 17, 2016
A little help
I had been yelled by one of the senior residents for not scrubbing in on surgeries I was repeatedly told by other residents to not scrub in on. During the middle of one surgery a nurse, who was worried my glasses would fall into a patient's open abdomen, taped my glasses to the middle of my forehead with a giant piece of surgical tape. And then I got kicked out of the OR because I didn't know the answers to the surgeon's questions. Needless to say, last Wednesday was rough. Walking out of the OR I could feel tears burning my eyes as I walked into the bathroom. After I had a good cry I went to the library to research the surgery I had just been asked to leave. I sat down at a computer, my face puffy and tear stained, closed my eyes and willed myself not to cry again. When I opened them, I saw that three of my med school buddies had pulled up chairs, literally surrounding me with friendly and understanding faces. They let me vent, made me laugh, and quickly pulled me out of the dark hole I was trying desperately not to sink into.
Last week was my first week of surgery. There were parts that were AMAZING (I seriously think I could just live in the OR), and as mentioned above, there were also some parts that were not so amazing. And it's in times like those that I'm unbelievably thankful for my med school friends. We run around the hospital, in short white coats, and every time we see one another, it's a relief. Because we know our battle buddies aren't going to pimp us, or ask us to drain anything gross, or yell at us for not doing something. Often our camaraderie manifests in dorky faces across the wards, goofy greetings as we pass each other in the stair wells, and sometimes simply being there when one of us is having a really rough day. But without these people, and those moments, I don't know how I would survive rotations. Because as I have found time and time again, those famous words ring true, "I get by with a little help from my friends."
Last week was my first week of surgery. There were parts that were AMAZING (I seriously think I could just live in the OR), and as mentioned above, there were also some parts that were not so amazing. And it's in times like those that I'm unbelievably thankful for my med school friends. We run around the hospital, in short white coats, and every time we see one another, it's a relief. Because we know our battle buddies aren't going to pimp us, or ask us to drain anything gross, or yell at us for not doing something. Often our camaraderie manifests in dorky faces across the wards, goofy greetings as we pass each other in the stair wells, and sometimes simply being there when one of us is having a really rough day. But without these people, and those moments, I don't know how I would survive rotations. Because as I have found time and time again, those famous words ring true, "I get by with a little help from my friends."
Tuesday, January 12, 2016
Square One
I've been on surgery for all of two days now. And, while I absolutely love being in the OR, it can be intimidating to say the least. In and of itself, the OR is like a whole new world, with unspoken rules and sterile fields that cannot be broken. That, coupled with the vast amount of knowledge the surgical residents are able to rattle off at a moment's notice, is enough to make the most confident medical student break into a cold sweat. During the past two days I've been reminded of the (relatively) little amount of clinical knowledge I've mastered in my seven months in the hospital. While most of the time, I use this fact to motivate me, sometimes it has the opposite effect, and I can feel the realization of everything I have yet to learn weigh me down.
I experienced one of these moments yesterday morning. It was 5:07am and I was on my first ever surgical rounds. Myself, and the entire team of surgical residents were standing outside a patient's room when my fellow student and I found ourselves in the middle of a particularly bloody session of pimping (a style of questioning all medical students fear to our very core). While questions, that I did not know the answer to, were whizzing past me like bullets in a WWII period film, I remembered something a preceptor on my previous rotation told me about surviving medical training.
I was sitting across from her desk at the end of the day reviewing the cases we had seen. It was my final day working with her and we got to talking about medical school and its challenges. At the end of our conversation she gave me this final piece of advice:"Discover what you like about yourself. Hold on to that. And if you do, no one will be able to touch you. Promise me you'll do that?"
Medical student, how do you repair a spigelian hernia?! As I was jolted back to reality by the quizzical stare of my senior resident, I could feel the heaviness already gathering in my chest. But then I made a choice. And, after taking a deep breath I calmly replied, "I don't know, but I'll look it up."
So c'mon 2016, bring it. :)
I experienced one of these moments yesterday morning. It was 5:07am and I was on my first ever surgical rounds. Myself, and the entire team of surgical residents were standing outside a patient's room when my fellow student and I found ourselves in the middle of a particularly bloody session of pimping (a style of questioning all medical students fear to our very core). While questions, that I did not know the answer to, were whizzing past me like bullets in a WWII period film, I remembered something a preceptor on my previous rotation told me about surviving medical training.
I was sitting across from her desk at the end of the day reviewing the cases we had seen. It was my final day working with her and we got to talking about medical school and its challenges. At the end of our conversation she gave me this final piece of advice:"Discover what you like about yourself. Hold on to that. And if you do, no one will be able to touch you. Promise me you'll do that?"
Medical student, how do you repair a spigelian hernia?! As I was jolted back to reality by the quizzical stare of my senior resident, I could feel the heaviness already gathering in my chest. But then I made a choice. And, after taking a deep breath I calmly replied, "I don't know, but I'll look it up."
So c'mon 2016, bring it. :)
Subscribe to:
Posts (Atom)