Archive | January, 2012

jackass moment

15 Jan

I just finished my first “sub-block” of my medicine clerkship.  I met with my attending on the last day to get feedback for the next block and to touch on areas where there’s plenty of room for improvement.  When she got to the area of “Professionalism” and “Patient Care,” she shook her head and said, “I honestly have nothing to add here.  If you can try to keep some of that humanity through residency and into your career, you will serve your patients well.”

The fact that she used the word humanity struck me, and I couldn’t help but look at her sheepishly and say, “I have to confess to something…”

No more than two days prior, my resident had sent me to have the “first crack” at a patient on whom we were asked to consult.  For me, it was challenging.  She had a very long history of chronic conditions and transplants, the last one complicated by an odd aberration (“odd aberration”…redundant?).  Essentially, one of her glands was so used to compensating for a failing organ that, when the organ was replaced, the gland kind of went haywire.  Anyway, I was sitting at the nurse’s station in a completely foreign area of the hospital, frantically pouring over this patient’s chart, which was several binders thick, when someone approached me: “How do I get to room 4xxx?”

I was so engrossed in the patient’s story-line, I nearly jumped out of my skin.  I looked up and said, “I’m not in this department.”

As soon as the words left my mouth, I regretted them.  And then I heard a kind voice behind me, “How can I help you sir?”  Shit.  Not only was I a total ass, but I was an ass in front of one of my superiors (for lack of a better word).

A few minutes later, she lightly tapped me on the shoulder, “When you’re studying and working hard to become a physician, try to maintain your humanity.”

She was right, and this sent me into a tizzy over whether or not I’m only nice when people are watching.

So, after my attending patiently listened to my little confession, she kind of smiled and said, “Yeah…that’ll happen; it happens to the best of us.  Doesn’t change my opinion of you, but adorable that you felt compelled to tell me about it.”

doc

13 Jan

There’s a sweet security guard who works the night shift at the biomed library.  (As I found out when I offered him a cookie one day, he’s “got the sugars”…must be from Pittsburgh.)  Every time one of us enters or exits, he excitedly waves at us with a huge grin stretched from ear to ear, an whispers (so as not to disrupt others), “Okay, Doc, hi there, Doc.”

I recently found out that he calls us as such so that he can say, when we graduate. that he was the first one to call us “Doctor.”

work-life balance: hunh?

12 Jan

It’s a topic that’s emphasized a lot at Penn, which I love.  Right now I get to work with a phenomenal, brilliant attending who truly seems to have it all.  She’s even a great model of compromise, taking a year off med school to have her first child, purposely choosing a supposedly less time-consuming field and opting not to do a competitive fellowship in order to spend more time with family and loved ones.

Yesterday she told me that she hasn’t seen her children since Monday morning, and that they feel more comfortable going to the nanny with their problems than to her.  When I said that I felt like I was sucking as a spouse, she commiserated: “Yeah, I’m sucking as a spouse, a mother, and a physician.”

Oy.  Guess this feeling of complete inadequacy never goes away, does it?

the stench of medicine

11 Jan

Today I got my first whiff of the rotting flesh of a diabetic patient.  It’s been ten hours, and I’m no longer within the hospital’s four walls…and I can still smell it.

immersion

10 Jan

Today I tried to explain to a patient my position on my med consult team.

His understanding: “So, it’s like language immersion?  You know, where you just jump right into a country where you can’t speak the language, and you come out fluent?”

I’m hoping for proficient.

my white coat

9 Jan

Well, it’s definitely not this white anymore…

I used to hate it.  I hate the reputation, what it symbolizes.  And, after receiving permission from my preceptors, I would often hang my coat on the back of a chair while interviewing a patient.

Now I only sorta dislike it.  What they don’t tell you on day 1 of med school is how much those deep, wide pockets come in handy for holding anything and everything from a stethoscope, tuning forks, reflex hammer, patient notes, study cards, and the ever essential Pocket Medicine.  Forget the weighted vest, going running in my white coat would give me the work out of a lifetime.  I might look like the freakin’ Michelin Man by the end of my shift, but you can’t beat the convenience.

the first day

8 Jan

To preface, I’m going to err on the side of caution with regards to what information I can share about my clinical experiences.  I don’t think I’ve crossed the line yet, but I’ve been warned by my colleagues and have heard horror stories about bloggers getting nailed for violating patient confidentiality (and, of course, I don’t want to be unfair to the patients I see).  Unfortunately, this means that I probably can’t share many if not all details regarding some of the more audacious, humorous, touching, terrifying cases of which I get to take part in the care.  Looks like we’re in for some pretty truncated stories, decidedly lacking in fairy dust.

Day 1:

My resident and attending are happy to throw me into patient rooms before they get a chance to see them.  I love it.  The first patient I interviewed was a seasoned physician who developed a pretty nasty infection, and we were consulted regarding an incidental finding on one of her scans.  We’re in the kind of uncomfortable position in which the patients we see are not really “our” patients.  Of course, we’ll step in when appropriate, but it’s not our place to give a lot of information.  Basically, the patient had no idea about the finding, and I was supposed to get as much information out of her as possible.  I came across a piece of family history that was hugely relevant, and subsequently got a “Good catch,” from my attending…A little pathetic, I know, but so much of the value of my day hangs in a two-word affirmation of my educators.  Guess my 1st-grade teachers should have thought twice before initiating the gold-star policy.  We’re all entirely dependent on praise as motivation.

And then I made a patient cry.  She is a sweet little elderly woman who had a couple horrible months of deteriorating health and neglect from the medical profession (not at Penn).  She and her daughter were telling me about their faith in God to help them through, and then her daughter said, “Mom, did you notice the doctor’s name tag?”  (I swear, I tried really hard to communicate that I was a student…)  And the mother lost it.  “I knnnnnnnnnnoooooooooowww!”  I think I need to prod John for more information on how not give patients false hope with a last name like Jesus.

the clinics

7 Jan

I give up.  I keep telling myself this week will be different, that I’ll actually post consistently and remember all those gems of  moments…the ridiculous thing a delirious patient said to me, the original and completely unoriginal comments made regarding my last name, my “endearing” moments of idiocy, inspiring words of wisdom and moments of complete lack of filter by my physician educators, all the times I got lost in like a 100-yard radius, etc.  It’s been a week.  I love it.

My time is very tight, so I think the next year is going to be an exercise in succinctness–clearly not my forte.  I got off my “shift” a bit early today, so I wanted to at least jot a quick note before starting what will be my second abbreviated work-out of sorts in a week.  I’m spending my first two weeks on “Med Consult.”  Basically, I’m on a team with only a third-year resident and his attending–both of whom totally rock my socks!–and we are called by other services in the hospital (like surgery, OB, neuro, trauma) to consult on complicated patients.  For the most part, it’s evaluating whether or not a patient can undergo a surgery safely if they have a preexisting condition (often multiple) and what addition evaluation or care they should receive.  It’s pretty fascinating, really variable, and it’s forcing me to figure out my way around the hospital.

One of the best parts–and this is going to sound horrible–is that I’m the only student on my team.  Not that I don’t love my classmates–I do!–but I actually think this is great way for me to build confidence and be honest with myself about what I do and don’t know.  I am not the loudest.  I am not the quickest.  As a result I have frequently felt completely inadequate in comparison to my peers.  The clinics…well, they make me feel inadequate in a totally different way (like when a physician asks me how long I’ll want to wean a patient off a drug I’ve never heard of…who knows, maybe he’s making it up?  yeah…I’ll just tell myself that for now…).  But it’s refreshing to get a chance to demonstrate what I know, and to be openly honest about what I don’t.  Also–shocker!–physicians actually appreciate it when you’re honest about what you don’t know.  English grad school was a time when it paid to “baffle them with bull” (…when one couldn’t “dazzle them with brilliance” –W. C. Fields).  Not medicine.

SO many wonderful things that make clinics SO much better than power-point!  Another plus: I see the stunning sunrise of Philadelphia from Founders 14 every morning.   You know you’re jealous.

and so it continues/begins…

2 Jan

I’ve been a neglectful blogger.  This has been both a usual and an unusual vacation for me(–by the way, can someone explain to me why it’s grammatically correct to say “a usual”??).  Usual in the sense that it’s included wonderful  celebrations and gatherings with old and new friends and family, far too much food and alcohol consumption, the requisite watching of classic and silly holiday features, intentions of productivity slashed by hours of mindless television, and, of course, travel at breakneck speed through the cities we once called home.  (For the record, John and I have become champs at the game of “you sleep, I drive–and switch!”)  Unusual in that this vacation has come with an odd amount of exhaustion and sadness.

I have a reputation among family and friends for having a loud love of all things Christmas–funny especially because I’m not even an authentic Christian.  It’s trite, but there’s just something about the season…I love the magic and warmth that surrounds the holidays, the smell of crisp winter air with burning cherry wood, pine leaves, and citrus, the coming together of the people you love, and the music (I might be able to listen to Christmas carols for at least three months a year).  It’s hard to admit, but I kind of see it as part of becoming an adult: you still cherish the joy of the holiday, but there is a sorrow present, I think, for most people.  You can’t help but think about those who have mattered most in your life, and miss those with whom you wish you could still celebrate.  And then I think there is a kind of pressure to put aside stress, anxieties, and disappointments and simply “be merry.”  Alcohol helps.  And sleep…sometimes at 18-hour stretches.

And so, at this time of year, I have felt so much love, happiness, fulfillment, energy, and excitement, punctuated by short bursts of loneliness, self-doubt, and dread.  Clinics start tomorrow–the part of med school I’ve been waiting for since day one.  Everyone’s a little wound tight.  We know nothing, and we don’t know what to expect.  I think tomorrow will be better, once things are set in motion.  I think I will have to work more diligently than I know, but I do believe I can be decent at this.  (It’s also helpful to put into perspective my level of responsibility in comparison with everyone else involved in patient care…)  Tomorrow’s 10 hours of orientation/training…then I’m on two weeks of Med Consult (I’ll figure out what that means tomorrow?), followed by two weeks of GI, four weeks at the VA, then four weeks of family med in Bucks County.

Have I mentioned that our street does this thing called “Luminaries”?  Above is our block on Christmas Eve.  Each house was responsible for lighting ten candles set in bags of sand.  John and I let our little seven-year-old pyro next door light ours right before John left for his overnight.  I then finished up Christmas presents to White Christmas, got a few hours of zees, picked up John at the hospital at the break of dawn, and drove to Virginia.  My heart literally skipped a little when I caught sight of the “OPEN CHRISTMAS” sign draped across the Starbucks’ entrance off 95.  Tomorrow might be a two latte day as well.