Glancing over the patient list this morning, my eyes lingered on the bolded phrase "NbBoy X, Known Trisomy 21." My stomach sank as the possible complications of that diagnosis began running through my head.
A few minutes later, after we had discussed each patient with the residents, we began our morning rounds in the nursery to perform our newborn exams.
Walking into that patient's room I didn't really know what to expected. Disappointment? Sadness? Fear of caring for a child with disabilities? Whatever angst I was feeling quickly dissipated as we all piled into the room to a grandpa's happy and proud laugh. A dad grinning from ear to ear. And a mom gently holding her new baby, smiling that tired but completely content smile, as only new mom's can.
We spoke with the parents, wheeled over baby boy X in his crib and began examining him. Once we were done we wrapped him up snug and passed him back to mom, who was clearly already completely in love with her new baby.
Later that morning, when we were discussing patient plans, one of the interns asked if the parents were aware of the situation. My resident said yes, and that they had been informed a couple months ago. The two of them began tossing around the idea that maybe the parents were in denial or didn't fully understand the diagnosis.
And, while I am definitely new here, I don't think denial was it at all. Because watching the mom look into the eyes of her new son, I only saw one thing, and it was love.
Monday, October 26, 2015
Wednesday, October 21, 2015
Move over, Clement Clarke Moore
A call light flashing for a room with a 10cm dilated patient is pretty much the best thing that could ever happen on the labor and delivery floor. The nurses jump up, the midwife sets down her coffee, and the super-excited (but totally professional) medical student all rush down the hall, eagerly anticipating the birth of a fresh new little babe. Be still, my uterus.
I just finished up my Ob/Gyn rotation. Part of my rotation included two weeks on the Labor and Delivery floor which meant one thing: BABIES!!! I've seen too many vaginal births to count, and was even allowed to "catch" a few babies myself. Because this rotation will forever hold a special place in my heart, I wanted to write something to commemorate my time with all the excited new mommas and (nervous as all get out) new daddies to-be. In lieu of another list (which we all know I love), I give you a poem...
I just finished up my Ob/Gyn rotation. Part of my rotation included two weeks on the Labor and Delivery floor which meant one thing: BABIES!!! I've seen too many vaginal births to count, and was even allowed to "catch" a few babies myself. Because this rotation will forever hold a special place in my heart, I wanted to write something to commemorate my time with all the excited new mommas and (nervous as all get out) new daddies to-be. In lieu of another list (which we all know I love), I give you a poem...
“'Twas right after the call light flashed”
'Twas right after the call light flashed, when all through
the floor
Not a person was sitting, waiting around was no more.
The nurse jumped up, right out of her chair
And the midwife, mid bite, set down her pear.
The medical student looked up, from her very dull text
And could only hope, she knew what was happening next.
The three of them rushed to the room down the hall,
When they walked in the daddy-to-be looked ready to bawl.
A look of determination swept across the mom’s face.
“Lets do this!” She said, “This baby won’t wait!”
Sterile gowns were tied, white gloves put on,
One last check was performed, that cervix was gone!
The midwife looked at momma, “You know what to do.”
“When the next contraction comes, you push right on through.”
A contraction spike began climbing, on the monitor screen
The poor woman turned red, and started to scream.
She gritted her teeth and moved that baby on down
Straight through the birth canal, until baby started to crown.
“Medical student c’mon! Put your hands right on mine.”
So I bent next to the midwife, and her hands I mimed.
“You can do it!” rang out, the nurse's loud cheer,
"Just one more push, she’s practically here!"
And sure enough, a head started poking through.
The miracle of life – with lots of other goo.
With all the strength she could muster, that momma pushed
When a head popped through, albeit kind of smooshed.
Then one shoulder came, and then one more
And finally a beautiful baby, met by no one before.
Up on momma’s tummy, new baby went
Momma smiled through teary eyes, her energy all spent.
The daddy carefully stayed at the head of the bed,
And bent down and kissed his new daughter’s head.
“You’ve done it,” we cheered. “You are such a champ!”
And I almost forgot, my scrub pants had gotten kind of damp.
The new momma glowed, and she thanked us all
“Baby girl 13:15!” was shouted down the hall.
And as another shift ended, on the L&D floor
That was awesome I thought, I’m ready for more!
I changed out of my gooey scrubs, and replayed it all
I smiled and thought, maybe I'll be an Ob/Gyn, after all.
~The End~
Tuesday, October 6, 2015
Hello, Darlin'
"Hello, Darlin'
Nice to see you.
It's been a long, long time..."
As Conway Twitty's voice rang out from the patient's buzzing cell phone, the very focused intern began inserting a catheter through the abdominal wall where it would drain almost 4 liters of fluid from Mr. X's very distended abdomen.
Just as the catheter tip was reaching our fluid filled money spot, I thought about all the other times that song may have been the soundtrack to moments in this patient's life. Driving a date to the movies. Playing to an empty house after his kids went off to college. Serenading him now when he goes to his favorite local diner for pie. And then I thought about this moment. The one we all found ourselves starring in. The setting: a quiet ICU. The supporting characters: a seasoned attending, a couple of nervous interns, and one third year medical student, trying desperately not to contaminate my sterile gloves. The leading role: a man in his early seventies, currently grappling with the harsh reality of decompensated heart failure.
I originally began this post during my last week of internal medicine. And while there were moments that I absolutely loved working on the floor, there were also many that left me disillusioned. There have been stories that I've wanted to share on this blog, but ultimately chose not to. Mostly because I felt that my writing was inadequate. But also because coming home after ten-plus hours surrounded by sickness, the last thing I wanted to do was write about it.
A lot of those posts, like this one, would start off with a person, their story eventually interrupted rudely by an illness. And that's where it would stop. Because as much as I tried I couldn't find a nice way to wrap it up. A final point or "Scrubs-like" realization to conclude those posts would elude me. It just wasn't there. And I guess that's what made those moments in the hospital, like the one above, so heavy. Those moments remained absent in my writing because they did not exist in real life. Sickness is cruel like that. It so rarely provides the luxury of a satisfactory conclusion.
It is the singular commonality I've found in all the really sick patients I've seen. That no matter how many pack years they've smoked, how severe their coronary artery disease is, or how much their cancer has metastasized, no one ever imagines the hospital is how or where they will end. And when they do find themselves in those moments, faced with the end of it all, it just doesn't seem to fit. Kind of like Conway Twitty in the ICU.
"Thank you, darlin'
May God bless you
And may each step you take
Bring you closer
To the things you seem to find."
Wednesday, August 12, 2015
Dear med school newbie...
A couple weeks ago I posted an open-ended letter to a future patient. A couple days ago one of my dear friends, who I've known forever, started medical school. I like the idea of writing to people I know, but writing to people I don't know is just so fun too. It's in that spirit I give some advice to the brand new med school newbies out there.
Dear med school newbie,
First off, congratulations! Not just for getting accepted to medical school, but for accomplishing the goals that mark that journey. The pre-requisites, and letters of recommendation, and community service projects alone are usually enough to scare the faint of heart from ever even thinking of applying to medical school. (Do I dare even mention the MCAT? Ok, I won't.) But not you, friend. You stuck it out. You figured out exactly how much caffeine precipitates palpitations and walked that fine line like an olympic gymnast. You passed organic chemistry - even if it was with a C. You volunteered your time and parts of yourself and hopefully along the way you realized that helping people is really one of the greatest things ever. Which only made your nerdy little heart chase after a career in medicine that much faster. Go you. :)
Right now I wish I could give you a hug and a high five through the internet (get with it, technology!) I also wish I could tell you that the hard part is over. That once you get that life changing letter cementing your white-coated dreams into reality you can take a breath and relax. (Ok, I guess on the actual day that letter arrives you can chill for a bit.) But if I said the rest of this crazy ride was all downhill after getting accepted, I would be a big fat liar. Which is generally something I try not to be. (People like you more and your scrubs fit better. :) )
The reality is that medical school is like a roller coaster. And some days -- like when you pass an exam you were sure you failed, or you manage not to make an ass out of yourself in front of a faculty member -- you are going to feel so confident and sure of your decision to practice medicine. But other days are going to be low. And the stress and workload and never ending list of things to know and study and review will be overwhelming. You may find yourself questioning this particular life choice and doubting your ability to do this whole med school thing.
I wish I had some advice on how to get through the tough days. All I can say is lean into the people who supported you this far. They're still there. Seek comfort and encouragement in your new med school friends - they're in the academic trenches with you! And remember why you wanted to become a doctor in the first place. Set goals for yourself and chase after them, just like you did when you were still a puny "pre-med." Acknowledge and appreciate your strengths. Work on your weaknesses, but don't beat yourself up over them. And just a couple of med school myth busters for you: Every one struggles with something. No one "barely studies." And no person in a white coat, yes even your esteemed faculty members and attending physicians, will ever know it all.
It's also important to know that medical school is finite. It's not gonna last forever. And, even though I'm only 2 months into clinical rotations, they are so so so much better than the first 2 years. Because those years suck! There really is not use telling you they don't. But again, they only last 2 years. And then they're gone. So learn as much as you can. Say goodbye to the outside world (and your tan. Libraries generally don't have UV lights.), and work your tail off. Because one day you'll walk into a patient's room and lying before you on a hospital bed will be that random disease you read about manifested in a living, breathing person and you will be able to help them. Which is really what all of this med school stuff is about in the first place.
And, when all else fails, and on those days when you "literally can't even," remember PASS = MD/DO.
Now, go put your smarty pants on. We've got some studying to do. :)
Morgan
P.S. This week I really did walk into a room where a patient had one of those "random diseases" we're told as students we'll "hardly ever see." When you get a chance, check out neurofibromatosis. Gotta love those neurocutaneous disorders. :)
Dear med school newbie,
First off, congratulations! Not just for getting accepted to medical school, but for accomplishing the goals that mark that journey. The pre-requisites, and letters of recommendation, and community service projects alone are usually enough to scare the faint of heart from ever even thinking of applying to medical school. (Do I dare even mention the MCAT? Ok, I won't.) But not you, friend. You stuck it out. You figured out exactly how much caffeine precipitates palpitations and walked that fine line like an olympic gymnast. You passed organic chemistry - even if it was with a C. You volunteered your time and parts of yourself and hopefully along the way you realized that helping people is really one of the greatest things ever. Which only made your nerdy little heart chase after a career in medicine that much faster. Go you. :)
Right now I wish I could give you a hug and a high five through the internet (get with it, technology!) I also wish I could tell you that the hard part is over. That once you get that life changing letter cementing your white-coated dreams into reality you can take a breath and relax. (Ok, I guess on the actual day that letter arrives you can chill for a bit.) But if I said the rest of this crazy ride was all downhill after getting accepted, I would be a big fat liar. Which is generally something I try not to be. (People like you more and your scrubs fit better. :) )
The reality is that medical school is like a roller coaster. And some days -- like when you pass an exam you were sure you failed, or you manage not to make an ass out of yourself in front of a faculty member -- you are going to feel so confident and sure of your decision to practice medicine. But other days are going to be low. And the stress and workload and never ending list of things to know and study and review will be overwhelming. You may find yourself questioning this particular life choice and doubting your ability to do this whole med school thing.
I wish I had some advice on how to get through the tough days. All I can say is lean into the people who supported you this far. They're still there. Seek comfort and encouragement in your new med school friends - they're in the academic trenches with you! And remember why you wanted to become a doctor in the first place. Set goals for yourself and chase after them, just like you did when you were still a puny "pre-med." Acknowledge and appreciate your strengths. Work on your weaknesses, but don't beat yourself up over them. And just a couple of med school myth busters for you: Every one struggles with something. No one "barely studies." And no person in a white coat, yes even your esteemed faculty members and attending physicians, will ever know it all.
It's also important to know that medical school is finite. It's not gonna last forever. And, even though I'm only 2 months into clinical rotations, they are so so so much better than the first 2 years. Because those years suck! There really is not use telling you they don't. But again, they only last 2 years. And then they're gone. So learn as much as you can. Say goodbye to the outside world (and your tan. Libraries generally don't have UV lights.), and work your tail off. Because one day you'll walk into a patient's room and lying before you on a hospital bed will be that random disease you read about manifested in a living, breathing person and you will be able to help them. Which is really what all of this med school stuff is about in the first place.
And, when all else fails, and on those days when you "literally can't even," remember PASS = MD/DO.
Now, go put your smarty pants on. We've got some studying to do. :)
Morgan
P.S. This week I really did walk into a room where a patient had one of those "random diseases" we're told as students we'll "hardly ever see." When you get a chance, check out neurofibromatosis. Gotta love those neurocutaneous disorders. :)
Sunday, August 2, 2015
Time Machine
I looked down at my watch and felt a small surge of panic rise in my chest. 6:42am. 18 minutes until morning report. 18 minutes to talk to my patient and examine her before I had to be sitting in a conference room on the other side of the hospital.
Mrs. X, can you tell me how your night went?
Mrs. X, did you get some sleep?
Mrs. X, have you had any headaches?
I began asking my usual battery of questions to a sleepy, semi confused elderly female patient. She interrupted me to say that she needed some water. I hurriedly explained that I would have the nurse bring some in once we were done.
6:47am. 13 minutes.
Any nausea?
Any vomiting?
Again, she asked me for some water.
"I know your throat is dry Mrs. X. We have you on NPO in case we need to do any procedures. I'll have the nurse get you a small cup of water as soon as we finish up here. "
6:51am. 9 minutes.
That time when I looked up from my watch, I noticed Mrs. X gently rubbing her throat, eyes closed. I stopped. I felt like someone had smacked me in the face. Here was an 88 year old female patient, a patient who I had been assigned to follow. A patient who looked remarkably like my grandmother. A patient who was sick and tired and scared. And she was asking me for water. Water. And all I could focus on was getting the information I needed so I wouldn't make an ass out of my self in front of my attending. Here I was behaving exactly like the type of doctor I had sworn to never become.
I paused. Grabbed her hand and said that I was sorry she was so thirsty. I filled up her cup with a little bit of water (NPO is the worst) and patiently waited while she slowly took a few sips. After she was done I took the cup from her and started over.
I was 6 minutes late to morning report that morning. And I though I can't say that I didn't care -- the watchful eyes of my resident stung a little as I took my seat, I was more grateful for a lesson learned. I realized just how easy it is to give in to the endless demands placed on pretty much everyone working in a hospital. I also realized that the choice of giving in to the ever present tick-tock of an over-packed schedule, or taking the time to truly care for the living, breathing human being in front of me will always be just that -- a choice.
Realistically, as a third year medical student, my choices don't impact much right now. Mrs. X would have eventually gotten her water at 7:00am anyways when her nurse came in to administer morning meds. But one day, my choices will have more lasting consequences. And I want them to be positive ones.
Mrs. X, can you tell me how your night went?
Mrs. X, did you get some sleep?
Mrs. X, have you had any headaches?
I began asking my usual battery of questions to a sleepy, semi confused elderly female patient. She interrupted me to say that she needed some water. I hurriedly explained that I would have the nurse bring some in once we were done.
6:47am. 13 minutes.
Any nausea?
Any vomiting?
Again, she asked me for some water.
"I know your throat is dry Mrs. X. We have you on NPO in case we need to do any procedures. I'll have the nurse get you a small cup of water as soon as we finish up here. "
6:51am. 9 minutes.
That time when I looked up from my watch, I noticed Mrs. X gently rubbing her throat, eyes closed. I stopped. I felt like someone had smacked me in the face. Here was an 88 year old female patient, a patient who I had been assigned to follow. A patient who looked remarkably like my grandmother. A patient who was sick and tired and scared. And she was asking me for water. Water. And all I could focus on was getting the information I needed so I wouldn't make an ass out of my self in front of my attending. Here I was behaving exactly like the type of doctor I had sworn to never become.
I paused. Grabbed her hand and said that I was sorry she was so thirsty. I filled up her cup with a little bit of water (NPO is the worst) and patiently waited while she slowly took a few sips. After she was done I took the cup from her and started over.
I was 6 minutes late to morning report that morning. And I though I can't say that I didn't care -- the watchful eyes of my resident stung a little as I took my seat, I was more grateful for a lesson learned. I realized just how easy it is to give in to the endless demands placed on pretty much everyone working in a hospital. I also realized that the choice of giving in to the ever present tick-tock of an over-packed schedule, or taking the time to truly care for the living, breathing human being in front of me will always be just that -- a choice.
Realistically, as a third year medical student, my choices don't impact much right now. Mrs. X would have eventually gotten her water at 7:00am anyways when her nurse came in to administer morning meds. But one day, my choices will have more lasting consequences. And I want them to be positive ones.
Wednesday, July 15, 2015
Dear Future Patient...
Dear future patient,
First off, let me say that it will be a privilege to take care of you. There are a lot of folks in long white coats out there with a jumble of letters after their names, and I am honored that you will one day allow me the privilege of being your doctor. It's something that I am working very hard at, and will continue to do so for the rest of my career.
Because this relationship you and I will have, of patient and physician, is based on honesty, there is something you should know. I did not score exceptionally well on my licensing exams. In fact, like 50% of the other physicians out there, I did not even score in the top 50th percentile. So, if you're looking for that doc who knocked their licensing exams out of the park, I know several and I will get you their contact information and a referral, no charge. :)
You see, reading information out of a medical text book and regurgitating it onto a scantron is not my forte, and never has been. Those questions are two dimensional and more often than not, all they really test is a person's ability to recognize a word they've seen before and match it with another word they've seen before. The exams don't always test how well the examinee understands a concept, just how good they are at a matching game with really big science words. Your disease process, like you, is a multi-dimensional ever-changing entity. So when it comes time to treat you and tailor your care to the unique and complex individual you are, the ability to correctly pick "B" on a multiple choice test doesn't really seem all that helpful, don't you agree?
So, yes, knowing the science behind your ailments and injuries is the foundation of this thing we call medicine. And as I move forward in my training I will continue to learn and strengthen my understanding of the diseases that will one day bring you into my office. But, there is more to providing good quality patient centered care than high exam scores. For example...
While I'm learning about the various kinds of anemias and how they will make you feel like crap, I'm also learning to put you at ease when you tell me about what hurts. And while I need to know what neurological exams to perform if you present to me with stroke-like symptoms, I'm also learning to make asking questions about your bowel movements more funny and less awkward. Should you get admitted to the hospital for acute atrial fibrillation, I'm learning about the medications I need to give you to make your heart stop racing like its chasing after the Sprint Cup. I am also learning how to keep you in the discussion and remember that you are the center of treatment, not your disease. When your concerned wife drags you into my office because you've been coughing up blood for the past week and have a history of unintentional weight loss, I'm learning how to explain the diagnostic exams I want to run to see if it is cancer in a way that empowers and not terrifies you. And one day, when you aren't really you anymore and your body is old and simply no longer capable of doing this "life thing," I am learning how to prepare the people you love and walk them through the difficult process of letting you go.
So no, I did not pass my board exams with flying rainbow colors. I passed them and moved on to learning how to practice medicine. I scored what I needed to so that I could continue to learn how take the very best care of you. Because that has always been my goal - to be an amazing doctor, not an amazing test taker.
Thanks for letting me be honest with you, dear patient. It will still be a few years before we meet, and I promise until we do to continue to to bust my butt and learn the things I need to know to provide you with phenomenal care, the same kind of care I would wish for myself, and those that I love.
See you soon,
Future Dr. Day
P.S. Stop smoking, try to get 30 minutes of exercise at least three times a week, and don't be afraid of those leafy greens. :)
First off, let me say that it will be a privilege to take care of you. There are a lot of folks in long white coats out there with a jumble of letters after their names, and I am honored that you will one day allow me the privilege of being your doctor. It's something that I am working very hard at, and will continue to do so for the rest of my career.
Because this relationship you and I will have, of patient and physician, is based on honesty, there is something you should know. I did not score exceptionally well on my licensing exams. In fact, like 50% of the other physicians out there, I did not even score in the top 50th percentile. So, if you're looking for that doc who knocked their licensing exams out of the park, I know several and I will get you their contact information and a referral, no charge. :)
You see, reading information out of a medical text book and regurgitating it onto a scantron is not my forte, and never has been. Those questions are two dimensional and more often than not, all they really test is a person's ability to recognize a word they've seen before and match it with another word they've seen before. The exams don't always test how well the examinee understands a concept, just how good they are at a matching game with really big science words. Your disease process, like you, is a multi-dimensional ever-changing entity. So when it comes time to treat you and tailor your care to the unique and complex individual you are, the ability to correctly pick "B" on a multiple choice test doesn't really seem all that helpful, don't you agree?
So, yes, knowing the science behind your ailments and injuries is the foundation of this thing we call medicine. And as I move forward in my training I will continue to learn and strengthen my understanding of the diseases that will one day bring you into my office. But, there is more to providing good quality patient centered care than high exam scores. For example...
While I'm learning about the various kinds of anemias and how they will make you feel like crap, I'm also learning to put you at ease when you tell me about what hurts. And while I need to know what neurological exams to perform if you present to me with stroke-like symptoms, I'm also learning to make asking questions about your bowel movements more funny and less awkward. Should you get admitted to the hospital for acute atrial fibrillation, I'm learning about the medications I need to give you to make your heart stop racing like its chasing after the Sprint Cup. I am also learning how to keep you in the discussion and remember that you are the center of treatment, not your disease. When your concerned wife drags you into my office because you've been coughing up blood for the past week and have a history of unintentional weight loss, I'm learning how to explain the diagnostic exams I want to run to see if it is cancer in a way that empowers and not terrifies you. And one day, when you aren't really you anymore and your body is old and simply no longer capable of doing this "life thing," I am learning how to prepare the people you love and walk them through the difficult process of letting you go.
So no, I did not pass my board exams with flying rainbow colors. I passed them and moved on to learning how to practice medicine. I scored what I needed to so that I could continue to learn how take the very best care of you. Because that has always been my goal - to be an amazing doctor, not an amazing test taker.
Thanks for letting me be honest with you, dear patient. It will still be a few years before we meet, and I promise until we do to continue to to bust my butt and learn the things I need to know to provide you with phenomenal care, the same kind of care I would wish for myself, and those that I love.
See you soon,
Future Dr. Day
P.S. Stop smoking, try to get 30 minutes of exercise at least three times a week, and don't be afraid of those leafy greens. :)
Monday, July 6, 2015
Lo siento
"Hey, have you ever heard of benzos causing GI bleeding?" I quietly asked one of the first year interns on my team during rounds this morning.
"No. Why?"
"Dr. X. just said patients on ativan are at high risk for GI bleeds."
"Are you sure he didn't say aspirin?"
"Yeah, he definitely said ativan."
"Hm. Yeah I've never heard of that. He really didn't say aspirin? He has a pretty thick accent. Maybe you misunderstood him."
"Oh no, I'm from AZ and am totally used to listening to people with thick accents," I said, half joking.
Full of third year confidence, I grabbed my phone and opened epocrates to check the adverse effects of ativan.
Later, during a lull in the morning activities, I mustered the courage to ask the attending about this baffling correlation between ativan and GI bleeds. He looked at me, puzzled and said, "no, aspirin. Aspirin causes GI bleeds."
Blank stare. Internal scream. Morgan, you arrogant ass.
"Oh. I must have misunderstood."
I caught a smile creep across the intern's face out of the the corner of my eye, just as our attending began pimping me on aspirin, and other drug classes, that are known to cause GI bleeds. Woo.
Happy Monday, folks! And, if you too were served a tasty slice of humble pie today, I hope you at least learned something from it. :)
"No. Why?"
"Dr. X. just said patients on ativan are at high risk for GI bleeds."
"Are you sure he didn't say aspirin?"
"Yeah, he definitely said ativan."
"Hm. Yeah I've never heard of that. He really didn't say aspirin? He has a pretty thick accent. Maybe you misunderstood him."
"Oh no, I'm from AZ and am totally used to listening to people with thick accents," I said, half joking.
Full of third year confidence, I grabbed my phone and opened epocrates to check the adverse effects of ativan.
Later, during a lull in the morning activities, I mustered the courage to ask the attending about this baffling correlation between ativan and GI bleeds. He looked at me, puzzled and said, "no, aspirin. Aspirin causes GI bleeds."
Blank stare. Internal scream. Morgan, you arrogant ass.
"Oh. I must have misunderstood."
I caught a smile creep across the intern's face out of the the corner of my eye, just as our attending began pimping me on aspirin, and other drug classes, that are known to cause GI bleeds. Woo.
Happy Monday, folks! And, if you too were served a tasty slice of humble pie today, I hope you at least learned something from it. :)
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