Yesterday I saw a 9 year old girl with abdominal pain. As I examined her abdomen I asked if it hurt when I pushed. She said yes. I said, Okay, scale of 1 to 10, how much does it hurt? She said 8.
She was completely well-appearing so I then backed up and said, Okay, scale of 1 to 10 with 1 being a paper cut and 10 being a train just sliced off your legs.
She got wide eyed and said 3.
Her mom asked if the real doctor could come in then.
Knowing my life I’m going to be asked about rectal carcinoma in my oral exam today and will be unable to stop myself from saying (not for the faint of heart):
It will be an experience not unlike the time I accidentally wore sequined shoes to an Ivy League medical school interview.
One of the most difficult things about buckling down to study for an exam, besides “not wanting to” and, my personal favorite, “crippling self-destructive tendencies,” is when the exam in question is widely characterized as ridiculous, non-representative and altogether impossible to predict. Classmate upon classmate who took the surgery shelf (a timed, nationally standardized final exam of sorts which are administered at the conclusion of each rotation) has relayed their feeling of utter defeat following this exam. And again when the results arrived.
I do have one Meddie Friend who rocked the socks of her surgery shelf, but she also kicks all sorts of ass in general. I reiterate, she kicks ass. That is where she and I largely differ.
Evidently the surgery exam focuses primarily on the medical management of surgical patients which by and large is NOT what I gave my attention to these past twelve weeks. When we weren’t being scutted out (e.g. “Here, run this blood to the lab,” or “Hey, can you write discharge summaries for the 28 patients on our service? Today?” or “So would you mind stopping by my apartment to take my dog around the block? Here’re my keys.”) we as medical students were expected to be in the OR to serve as retractors and mute sounding boards for surgeons’ misplaced disappointment in their lives.
Standing there watching a ten hour Whipple, willing my ankles not to roll so I wouldn’t accidentally drop the small intestine into the area the surgeon was focused on, it was hard to feel I was learning about medical management. The hierarchy of medicine and the staggering capacity for arrogance within human emotion? Sure, I learned plenty about all that. But how this patient was worked up and the different approaches to evaluating their presentation? Not so much touched on, at all, ever, even though we had plenty of quality time standing there and standing there and standing there.
Now, I suppose that’s where the responsible med student would make it a point to go home and read up on pancreatic neoplasms (one of the main indications for performing a Whipple), but, Dude. I’ve been standing in an OR for ten hours (WITH ONLY ONE PEE BREAK) and was probably awake by 4:30a this morning with the expectation of waking up that early again tomorrow. I want to go home and mainline cheese cubes before collapsing into bed.
The even more responsible med student, perhaps even the good med student, would have read about all that pancreas stuff the night BEFORE the operation. In my world that’s made difficult by all the persuasive excuses my incredibly imaginative internal monologue produces railing against that possibility: You need your sleep for the big procedure tomorrow! It will probably be cancelled! Someone will surely want to scrub into the case and relieve you of its infamous horror! I bet an agent will hear you whistling Christmas tunes en route to the hospital tomorrow morning and immediately enlist your talents for the Radio City Music Hall Spectacular!
So, yes, whine-ity whine whine whine. Bottom line, I have little to no motivation to bust my buns studying for an exam I am anticipating to be a medical quagmire.
Had I learned medicine the first time around, you know, at any point in the previous two years or during my 12 week internal medicine rotation this year, I may not feel so resigned to mediocrity… or if I had any modicum of motivation I might be able to use the defeateds’ complaints to better equip myself for the showdown… but that would be what the good, responsible, kick ass medical student would do. And if we’ve learned anything about anything, we all know that that med student I am not.
Five more days. Let’s see what we can do.
The other day we had a seminar that attempted to introduce us to what happens when a patient leaves the hospital. Specifically, elderly, chronically ill patients. Where do they go when we’re done patching them up? Back home? Rehab? The curb?
One of the essential skills the lecturer highlighted was performing a functional assessment in order to determine just what our geriatric charge can or can’t do for themselves. Part of that includes testing their hearing. Makes sense.
The lecturer went on to say that when older people are hard of hearing, it really isn’t helpful to start shouting at them. Not only do you up the HIPAA ante of broadcasting their health status, but raising your voice tends to elevate vocal pitch. This is troublesome since higher tones are the first to go as human hearing degenerates, so even though you’re louder, you may not be any more intelligible.
The lecturer suggested instead of yelling into the patient’s face we, especially us women, consider lowering our voice.
The rest of the seminar was lost on me. All I could do was imagine interviewing my patients in this voice (heard between 1:17-1:20):
Excellent news, readers. Until last night I wasn’t exactly sure how I would pass this medicine shelf today. But thanks to the illustrious example of a potential vice-presidential nominee, now when I happen upon a question I can’t answer I will just tell my course director I’ll try to find specific examples and bring them to him later.
Brilliant.
Today we had to meet in small groups with the chief of internal medicine whose office is literally larger than my apartment. He was very welcoming and gave us each a chance to relay our spiel to him about where we came from and why we chose medicine.
I told the chief of internal medicine that I kind of wanted to do something important sort of once and because I didn’t know what else to do I wound up at medical school. And now that I’m here well, I don’t really know what to go into since I hate science to my very core and I’ve found I don’t like working with sick people, so that seems to limit my options and oh yeah, I want to have a family someday too. But I do know I’d like to do something that enables me to pay off my loans sooner rather than later by practicing as little clinically as humanly possible.
I said that, aloud, and did so far more inelegantly than I’ve typed it out just now.
To the chief of internal medicine.
To the chief of internal medicine at my very self-important school and perhaps actually important affiliated hospital.
It was kind of liberating to feel that bullet fire through my foot.
In the sixth grade our gym teacher made us warm-up before each class period. Presumably so we wouldn’t wreck our lax little tendons overzealously chasing a kickball or while diving under the parachute or sustaining whatever injury doing whatever stupid thing I didn’t want to participate in because sports were stupid and I’d rather be reading a book.
I was so worked up about the prospect of having to stand in front of thirty of my peers, charged with leading them in STRETCHING no less, that each day we had gym class I skipped out on cereal and Power Rangers early to go through a routine. I’d sit down in the living room and make a mental check-list of all the stretches I’d lead the group in were I called to do so.
I’d make sure not to do anything too hard like the splits or push-ups, largely because oh oh, I physically COULDN’T, and I’d try to formulate an order so that I wouldn’t forget anything or be left standing there agape with no stretch to offer.
The final check of course was to make sure my pants didn’t have any holes in the crotch as the black stretchy pants of yore were prone to developing. Sitting to lead a straddle stretch would be infinitely more mortifying than it already was if I unknowingly displayed a window to my undies.
I was never called on to lead gym stretch. I’m fairly confident the gym teacher only picked the pretty girls to lead the class or at least those who would willingly make eye contact at the time of choosing.
I don’t know what happened to that neurotic little girl. The one who would check and double check and RE-double check and then plan and then plot and then maybe even ask their Dad for stretch recommendations, JUST IN CASE. I used to always be prepared… even for things that were rather inconsequential in the long run.
My marathon of a 12 week medicine rotation ends on Friday. And of course, it culminates in an exam covering oh, you know, all of internal medicine.
I don’t feel prepared. I can’t bring myself to study anymore. I think the nerd in me has finally, FINALLY burned out. And this time, I don’t think it’s so inconsequential. Blech.
“Patient X, I’m very sorry, but I’m going to have to pull this needle out and try for a different vein.”
“You’re a very bad nurse.”
Many varied things have held me back from blogging of late. Not least of which is the fact that as of July and the onset of my third year of medical school, my world has turned upside down and inside out. Sometimes very literally.
I now routinely place my finger into the anus of patients. I have cracked ribs and mushed viscera in an effort to save my patient’s life. I have realized that more often than not, I’m paying $70,000 to perform the tasks of a glorified secretary. All of this in exchange for the promise of a career I’ve never been entirely sure I want.
The past few months have been surreal. From finishing my time in the classroom in April to taking The Boards in May to entering the hospital every single day as if I belong there… it’s been a whirlwind. I’m trying to figure out how to process it all.
It’s been a long time since I’ve been engulfed in something completely and wholly unfamiliar. Nineteen years in a classroom will do that to you. But I’m experiencing something unique and, fine, I’ll just say it: precious, and I think it warrants documentation. If for no one else but my future self.
My future, God help us all, physician self.
One of the things I’m learning is how quickly and abruptly one has to desensitize and compartmentalize in order to handle the day to day dealings of life and death. I’m scared of becoming a robot. Or worse, a Republican.
I’m scared that if I don’t remind myself of who I was when I started all this that I’ll lose sight of the trepidation and awe medicine usually deserves. We’re dealing with human lives. There are people attached to these lab values and diagnoses.
Right now I think I’m closer to being a patient than a doctor and I’m hoping that keeping a log of the transformation from one to the other will enable a coexistance of both rather than a dissolution or sacrifice of the other.
I’ve been cautious in approaching the interweb with all of this beacuse oftentimes I want to come home and CAPS LOCK SENTENCES ON HOW ANNOYING THIS PATIENT WAS or HOW ANGRY THIS ATTENDING MADE ME or WHY ON EARTH DID I EVER THINK THIS WHOLE THING WAS A GOOD IDEA FOR CRYING OUT EFFING LOUD. Also, HIPPA. Also, my own privacy. Also, my free time should probably be geared towards oh I don’t know, learning the practice of medicine.
So… we’ll see. I’m here now. I’ve missed this.
When the Bough Breaks
December 10, 2008 by PantsYesterday I was gloriously excused for a few hours from my (minimal)(laughable)(let’s face it, largely fake) responsibilities in the neurosurgery OR for a good ole fashioned GYN appointment. Anymore when I see a physician for any reason I find myself in an odd position: I’m the patient. It seems spending the past six months on the other side of the drop sheet has afforded me new insights into my own health care. Specifically, I am now determined never to be sick or require medical attention ever. Ever ever ever. I don’t want to be in a hospital EVERRRRR, MY GOD. And doctors on the whole frankly freak my shit out. But! The root of these notions are stories for a different HIPAA laced day.
So anyway, the times when I do have to suck it up and go to the doctor I find myself surveying things with a short white coat sized grain of salt (AKA I can probably convince you I know what’s going on while having absolutely no idea).
My doc’s waiting room is arranged such that a whole host of chairs forms a U shape facing a central wall. On said central wall there are four or five large bulletin boards teeming with pinned up baby face snapshots, all staring out with empty baby stares in a kind of an eerie way, eliciting a creepy feeling from passerby not unlike the spook I imagine supermarket employees get walking down the Gerber food aisle after the customers have gone home.
I couldn’t help but… question… the decor from a, I suppose, social sensitivity standpoint. I mean, really? Baby faces? Obviously they are the cooing mugs of past deliveries, but… they’re the successful deliveries.
Am I being a freak thinking that such a display might alienate or off put patients who came in uncertain about their pregnancy? Or even less politically/socially/religiously charged, an infertile patient coming in for consultation? Or the patient who comes in for an anatomy ultrasound and learns the fetus has been lost?
I just… I don’t know… was surprised.
Some of you I’m sure will commence eye rolling, but others will maybe understand why I think doctors can be a little too focused on the science sometimes. Detrimentally so.
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