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. :)
Saturday, December 19, 2015
Agape
Thank you for endless slices of German chocolate cake, and for proving that you really are never to old to jump on a trampoline.
Thank you for making Christmas magical, and for patiently letting my tiny hands remove and replace every single piece of silver tinsel my 6 year-old self could reach on your Christmas tree.
Thank you for proving that a smile really is the best accessory.
Thank you for teaching me how to climb trees, and for helping me hide the evidence of scraped knees and scuffed shoes.
Thank you for teaching me that love is selfless and can be given long after a person stops being able to receive it.
For these lessons, and so many more, I will always will be so thankful. Oh, how I will miss coming home to your hugs and our conversations spent holding hands and each other. Losing you will forever leave a hole in our family, one that we will do our best to fill with sweet memories and your legacy of love.
Tuesday, December 15, 2015
Out of the Woods
"Code Team, to the CT Scanner. Code Team, to the CT Scanner."
As the voice of the hospital operator echoed the familiar call to action, myself and one of the radiology residents jumped up from our chairs and dashed out of the resident reading room and across the hall to the CT scanner.
When a code is called in a hospital, organized chaos quickly follows. Within seconds, swarms of white coats pour through stair well doors. Nurses with crash carts run through halls. The urgency is palpable.
When myself and the radiology resident got to the patient, the code team was already there (I swear they can apparate) assessing the situation. An ICU patient sent for imaging had semi-consciously pulled out his ET tube and NG tube. He was now in the process of desatting as all of the oxygen molecules dissociated from their hemoglobin chaperones, with no new recruits coming from the lungs.
Last block I did an elective in radiology. Which means I was out of the medical trenches for the past few weeks, safely tucked away in dimly lit reading rooms aglow with the light of high definition monitors. While I am not considering a career in radiology, I did learn a lot and it was interesting to explore a field of medicine I have never really learned much about before. But whenever I toyed with the idea of not going into clinical medicine, something (like a code being called) reminded me which side of healthcare I want to play for.
Pulmonology and anesthesia soon showed up and the patient was reintubated. I sat back and watched intently as the emergent situation was quickly resolved. As we walked back into the reading room after the patient was stable, the radiology resident mumbled, "Man, I sure don't miss that." I smiled, realizing just how much I did.
As the voice of the hospital operator echoed the familiar call to action, myself and one of the radiology residents jumped up from our chairs and dashed out of the resident reading room and across the hall to the CT scanner.
When a code is called in a hospital, organized chaos quickly follows. Within seconds, swarms of white coats pour through stair well doors. Nurses with crash carts run through halls. The urgency is palpable.
When myself and the radiology resident got to the patient, the code team was already there (I swear they can apparate) assessing the situation. An ICU patient sent for imaging had semi-consciously pulled out his ET tube and NG tube. He was now in the process of desatting as all of the oxygen molecules dissociated from their hemoglobin chaperones, with no new recruits coming from the lungs.
Last block I did an elective in radiology. Which means I was out of the medical trenches for the past few weeks, safely tucked away in dimly lit reading rooms aglow with the light of high definition monitors. While I am not considering a career in radiology, I did learn a lot and it was interesting to explore a field of medicine I have never really learned much about before. But whenever I toyed with the idea of not going into clinical medicine, something (like a code being called) reminded me which side of healthcare I want to play for.
Pulmonology and anesthesia soon showed up and the patient was reintubated. I sat back and watched intently as the emergent situation was quickly resolved. As we walked back into the reading room after the patient was stable, the radiology resident mumbled, "Man, I sure don't miss that." I smiled, realizing just how much I did.
Thursday, December 3, 2015
Shiny and Bright
It's been one of those weeks where my to-do list seems endless and it's left me wishing there were more hours in the day night (for sweet, sweet sleep). At this point in my life, it seems that there are medical students who know exactly what they want to be when they grow up. And then there are those of us running around in short white coats who still don't have a clue. I, for now, am solidly in the latter category.
In between studying and making pro and con lists for every medical specialty known to man, I remembered this quote a classmate and I used to always say to each other (usually at 2am in moments of exhausted exasperation, hunched over biochem notes):
In between studying and making pro and con lists for every medical specialty known to man, I remembered this quote a classmate and I used to always say to each other (usually at 2am in moments of exhausted exasperation, hunched over biochem notes):
One day, when I'm all grown up and all the unknowns that currently keep me up at night are known, I'm sure a part of me will miss the mystery of not yet knowing what will be. So for now, I'll make another cup of cocoa, start a new list, and try to be grateful for a future full of shiny and bright possibility.
Wednesday, November 18, 2015
More than you know
During rounds I made a mental note to go back in and check on the patient. Something about the way our attending examined him without even saying hello rubbed me the wrong way. When I walked back in I introduced myself, went over and said hi to our patient, and then turned and began speaking with his grandmother, the primary caregiver.
I then began to listen to his heart, lungs and abdomen. I looked over at his grandmother while I palpated his belly, careful not to disturb the feeding tube protruding from his abdominal wall. She was smiling at me and at her grandson, with a look of relief across her face. I finished up my exam and shook her hand. While I was walking out she began explaining to me that she was concerned that his G-tube had a hole in it, but that it wasn't scheduled to be replaced for 5 more days. I told her I would speak with my resident and see what we could do.
The remainder of Mike's hospital course was uneventful. After some arm twisting/begging, I got interventional radiology to replace his G-tube and he went home on a course of antibiotics to kick the nasty respiratory infection that landed him in the hospital in the first place. As we were discharging him, his grandmother thanked me for taking such good care of her grandson and we joked about how he was quite the ladies man, since all the nurses loved him.
Truthfully, I get why my (very intelligent and seasoned) attending didn't bother to say hello to Mike every morning. The kid has cerebral palsy. He looks different, acts different and can't speak. And most physicians really just don't know exactly how to interact with severely disabled patients. But that's the thing, patients are people. And even severely disabled and nonverbal people have personalities and needs, they just can't communicate them in the same way most of us are able to. But I've learned, and am continuing to learn, that so much about medicine is more than what you know - anyone can look up facts and treatment plans on UptoDate and clinical judgement comes with time. At it's core, medicine is about showing people, and their families, that you care. It's about taking extra time to speak with a concerned parent about their sick child - even when the attending and resident have already explained the situation three times. It's making funny faces back when your stethoscope is cold and your patient makes a silly face. It's about calling other departments and stressing the fact that something for your patient needs to be done and no, it cannot wait. And sometimes it's simply smiling at a patient even when you know they can't smile back.
I then began to listen to his heart, lungs and abdomen. I looked over at his grandmother while I palpated his belly, careful not to disturb the feeding tube protruding from his abdominal wall. She was smiling at me and at her grandson, with a look of relief across her face. I finished up my exam and shook her hand. While I was walking out she began explaining to me that she was concerned that his G-tube had a hole in it, but that it wasn't scheduled to be replaced for 5 more days. I told her I would speak with my resident and see what we could do.
The remainder of Mike's hospital course was uneventful. After some arm twisting/begging, I got interventional radiology to replace his G-tube and he went home on a course of antibiotics to kick the nasty respiratory infection that landed him in the hospital in the first place. As we were discharging him, his grandmother thanked me for taking such good care of her grandson and we joked about how he was quite the ladies man, since all the nurses loved him.
Truthfully, I get why my (very intelligent and seasoned) attending didn't bother to say hello to Mike every morning. The kid has cerebral palsy. He looks different, acts different and can't speak. And most physicians really just don't know exactly how to interact with severely disabled patients. But that's the thing, patients are people. And even severely disabled and nonverbal people have personalities and needs, they just can't communicate them in the same way most of us are able to. But I've learned, and am continuing to learn, that so much about medicine is more than what you know - anyone can look up facts and treatment plans on UptoDate and clinical judgement comes with time. At it's core, medicine is about showing people, and their families, that you care. It's about taking extra time to speak with a concerned parent about their sick child - even when the attending and resident have already explained the situation three times. It's making funny faces back when your stethoscope is cold and your patient makes a silly face. It's about calling other departments and stressing the fact that something for your patient needs to be done and no, it cannot wait. And sometimes it's simply smiling at a patient even when you know they can't smile back.
Sunday, November 8, 2015
Mouth to Mouth
Our COPD screening event at the local town mall was well underway. If you think people try to avoid that annoying guy at the random phone kiosk (seriously, has anyone ever bought a phone there? Ever?), then you should see 'em try to dodge a bunch of over enthusiastic medical students and residents in white coats. ;)
I had finished explaining to an older gentleman how the spirometer works and he had just taken a very deep breath and attempted to expel all of his air into the mouthpiece. He was red in the face, wheezing hard, and basically about to fall out of his chair at any moment.
Me: Sir, it's ok! Let's take a few deep breaths before you use the machine again. I don't want you to pass out! *Half jokingly*
Man: Are you kidding?! That's what I'm banking on! If I pass out, you have to give me mouth to mouth!!!
Me: Oh, yeah? That's a clever little plan.
Man: You can't trust me, I'm a dirty old man, hah!
I continued with the screening test, to the soundtrack of the male residents' laughter. By the end of it, both my new friend and myself were red in the face - him from chronic lung disease, me from embarrassment.
Forget about kids, in my experience it's the OLD people who say the "darndest" things.
Happy Sunday, folks. :)
I had finished explaining to an older gentleman how the spirometer works and he had just taken a very deep breath and attempted to expel all of his air into the mouthpiece. He was red in the face, wheezing hard, and basically about to fall out of his chair at any moment.
Me: Sir, it's ok! Let's take a few deep breaths before you use the machine again. I don't want you to pass out! *Half jokingly*
Man: Are you kidding?! That's what I'm banking on! If I pass out, you have to give me mouth to mouth!!!
Me: Oh, yeah? That's a clever little plan.
Man: You can't trust me, I'm a dirty old man, hah!
I continued with the screening test, to the soundtrack of the male residents' laughter. By the end of it, both my new friend and myself were red in the face - him from chronic lung disease, me from embarrassment.
Forget about kids, in my experience it's the OLD people who say the "darndest" things.
Happy Sunday, folks. :)
Monday, October 26, 2015
Metrics of Affection
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.
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.
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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