Changes

I don't know when it happened.  In the blink of an eye 3rd year clerkships have ended, fourth year sub-internships are done and residency applications have been submitted. 

The thing that scares me the most is I can see myself becoming one of "them". The type of people that I had so much disdain for when I began medical school, when I was full of optimism and excitement about my future career.  I found myself identifying with the gripes of my interns, 2nd and 3rd year residents and even attendings. 

Conversations that before rolled over me about the realities of medical practice now stick with me, ruminating in my mind.

I truly hope this is a passing phase.  The stress of passing boards and the endless waiting for interview offers to roll in are hopefully to blame. 

I want to be sure that I love medicine that way I had always envisioned that I would without all these extra hoops and traps we're always mucking through. 

Notable Quotables: A.D.

"The basics are the most important thing you will ever learn.  You will never rise to the occasion, you will always sink to the level of your training" 

- A.D. [Trauma Surgeon]

I had the opportunity to see a Grand Round lecture done by a prominent Trauma Surgeon who is nationally renowned.  At the start of his lecture he did a brief overview of the basic physiology that is associated with "doing the ABCs" (I'll get to that in another post but in short the first things that need to be assessed in a trauma patient are A: Airway, B: Breathing and C: circulation).  This one liner from him really struck me.  It reminded me not to cut corners in my training because this is the time to meticulously go through every single step.  In the event of a true emergency I can rely on myself and know that no matter what there is a certain algorithm that I can trust that was followed.

The Long Call

all names used in this blog are fictional, any resemblance to real persons is purely coincidental

Tick, tick, tick.  Every call night the second hand crawls along.  I twirl slowly in my rolling office chair, from side to side.  My foot gently catching my weight and lurching me back the other direction.

I swiftly slide my phone out of my pocket and watch as the time flashes across the screen 5:48 AM and let it drop back into my pocket.

Just twelve minutes, then freedom.  The bottom dropped out of my stomach.  Another name had just popped up on the board.

JACKSON, CECILA

Maybe if just sit here, very still, not making any noise my resident will forget I'm here.  Maybe he'll just let me leave.

The exhaustion I had been ignoring all day was slowly creeping its way down my body.  Hour number seventeen.  I wanted to scream.

A fleeting moment of solitude after I had finished my notes and patiently stood behind my resident as he painstakingly entered all the orders required for the last admission.

Request for bed.  Request for change in level of care.  Restart home meds.  Request records from outside hospital.  So many requests.

He quickly scanned his patient list, swiftly struck through a scribbled note and was once again hunched over his keyboard

To a passerby it simply looked like a messy sheet with some nebulous comments hastily jotted down.  A more seasoned eye quickly sees this single sheet of paper was the lifeblood on the medical team.

Through the tangle of notes, strikethroughs, patient stickers and various sets of numbers and letters there emerged a well crafted document that provided a tracking sheet for the entire roster of patients the resident was responsible for overlooking.

Without this sheet the team fell apart.  The senior resident meticulously keeps track of the goings on of every patient on their service, overseeing the work of theirs juniors while maintaining communication with their main attending physician while somehow making sure patients are taken care of in between.

He refreshed his list and noted the new name.  He swiftly opened up the paging software undoubtedly to inform the intern of the new admission.

Click. Scroll. Click click.  Scroll.  Click.

Quickly scanning through the patient's admission note and the scant past records already in the system.  Suddenly he was up and on his feet and halfway down the hallway before I registered that if I didn't follow I was not going to be able to find him for quite some time.

Notable Quotables: SC

"You have to decide and ask yourself. Am I starting from scratch with this patient or am I merely laying a hand as they pass by ?" 

- S.C. [Psychiatrist]

An amazing attending I had an opportunity to work with during my inpatient psychiatry rotation once mentioned this in reference to a new admission that came in.  He made this distinction which really opened my eyes up to evaluating your role as a physician, I hadn't realized how much this can vary based on the context in which you are seeing a patient.  The outlook and management you would exercise in a patient who is routinely yours, one that you see in the office once a month who happens to be hospitalized for acute stabilization will be 180 degrees different from a patient that was brought to your hospital because thats where the ambulance came and usually receives care from an outpatient doctor 80 miles north of where you are.  

One Man's Trash is Another Man's Treasure

I was hesitant to use the title I did for this post, because it sounds disrespectful.  I wanted to address the fact before I delved into this post.   The title really captures the essence of the message I am trying to deliver and that is why I put it there.  On to other things . . . 

One of the greatest parts of third year--for me at least--has been how each of us is starting to carve our own path.  As M1s most of us started out with either no clue what we wanted or a vague idea of what that might be. Slowly we began collecting little nuggets of advice and experience that have further nudged us down a certain path.

The divergence really begins to come to a head as everyone has a few rotations under their belts.  I am astounded at how diametrically opposite peoples experiences and reactions to those experiences have been.  Arguably the most interesting part of third year thus far has been seeing people develop their own passions and interests.

Conversations with my peers about any certain speciality is sure to produce a chorus of "Oh I thought it was awesome", "I could never . . . " and "meh" all around the table.  I can't get enough of it.  Its fantastic to see that inner curiously and passion being rekindled in us as we are finally making this final trek through med school.

With match day just around the corner for the M4s I'm ecstatic to see what they all pick.  I know its still a year off for us but seeing the class just one year senior to us match is mind blowing.  They're students we actually know, people we have come to for advice about classes and rotation sites; friends.  Now they're going to be real life doctors, hoping for the next 12 months to go by lightning speed.

Notable Quotables: Sir William Osler

"One of the first duties of the physician is to educate the masses not to take medicine" 

- Sir William Osler 

If you haven't heard of Dr. Osler yet I would recommend clicking here to read a little bit.  He basically invented the idea of residency training and was the first guy who thought maybe medical students should get some bedside training and get out of lecture halls.  I think the sentiment of this quotation is fantastic, it really drives home the core of practice which shies away from the idea of overmedication and really medication at all.

Code 52

Names and other identifiers have been changed to protect the identity of all involved

"Code fifty two, Emergency Room.  Code fifty two, Emergency Room," blared over the loud speaker in the hospital.  Simultaneously a chorus of beepers went off, like crickets on a sticky summer day.

I glanced down at my pager that echoed the same message "CODE 52, EMERGENCY ROOM".  The same message flashed across the screen three more times as I ran quickly down the main hallway.  Code 52 meant trauma.  I was about to partake in my first trauma ever.  Dr. Shyer suddenly appeared from a small tributary hallway leading into the main one that led to the ER.

"Come with me," he said and I stepped in line behind him as we continued swift down the hall.  Dr. Shyer waved his ID card up to the scanner--this was followed by a quick beep and mechanical whir as the automatic door lurched open.  I felt the tail of my white coat brush up against the barely half opened doorway.

A small army had assembled near trauma bay one.  Slightly blurred through the sliding glass doors of the entrance I saw a flickering red and blue light quickly grow in size.  The sound of sirens broke me out of my trance, instead of the usual dopplering of the sound as it zoomed past, the sound grew from a distant whine to a persistent and ear shattering level as the ambulance pulled into the drive.

EMTs clad in all black uniforms with yellow block lettering brought him in on a stretcher.  A coordinated heave transferred his limp, seemingly lifeless body onto the ER bed.  A flurry of activity commenced.  Two large bore IVs were stuck to continue adequate fluid resuscitation.

"Single motor vehicle accident.  Car was wrapped around a telephone pole," I overheard a woman in all black say.

"We need a chest tube, now, " Dr. Shyer calmly stated, with the slightest thread of urgency stringing along behind his request.

"Someone get shears. I need shears now," a trauma nurse barked at her colleague.  There were hands coming from all directions, working on multiple things all at once.  Suddenly a tentacle shot out and sheared through what remained of his clothing.

"You! Have you put in a foley before?," Dr. Shyer glanced in my direction.  Of course I'd put in a foley, it was a requisite job of the medical student on a surgery rotation.  But in a fast paced environment where it might actually matter, no absolutely I had not.

Before I had time to respond a nurse threw a sterile foley kit at me.  It was like my body switched to a survival instinct driven place and I was on autopilot.  The countless times of gingerly placing the sterile glove pack on the table and practicing gloving without breaking sterile field paid off for me as I effortlessly gloved myself.

Break seal.  Sterilize with iodine. Lubricate piping.  Advance until a flash of urine.  Inflate balloon.

A stream of pale yellow slowly snaked its way through the piping.

Pete, the other student and I exchanged glances as I weaved out of the way and traded spots with him.  Just one beat was missed as I took over the rhythmic chest compressions, on a sardonic note, to the beat of 'Stayin' Alive' in my head as we had been instructed in CPR training.

The ER attending took a step back.

"Is there anything that we have not tried that anyone would like to try?" he glanced around the room and continued "I believe we have done everything we can.  Time of death 1346."

And suddenly the room  was empty.  We donned our white coats that had unceremoniously been thrown over the nearest chair back as we had rushed into the room.  I slowly reaffixed the flat, pearlescent buttons on the front of my coat, redraped my stethoscope around my neck, clipped my pager to the waist of my sea foam blue scrubs and waived my ID card to let myself out.