First night shift tonight. The switch to night shift? Brutal. . This is probably not helped by the fact that last night was Purim and, despite my attempts to not drink too much, I drank too much. I wouldn't call it a full blown hangover that I woke up with this morning, but the drinks were certainly saying, "hello, remember me?" My plan was this. . go out, stay up as late as I could, sleep today. Parts 1 and 2 went well. Part three hasn't gone so well. Turns out despite being tired, sleeping during the day is hard. Also turns out "waking up" at 5:30 pm to get ready for work is even harder.
You know what this calls for? It calls for diet coke - first one in months. Sigh, ER, you may beat me down yet.
I do have some stories for y'all, but didn't get to writing them tonight. Hopefully soon.
Sunday, February 28, 2010
Tuesday, February 23, 2010
Coming to America
The 67 year-old Ethiopian man did not speak a word of English. Well, that's not entirely true. At various times in the conversation, he would interject with, "And what is your name?" (I had already told him about 5 times).
He also knew thank you. And although he used it appropriately, it was a bit uncomfortable when he said, "Thank you," after I finished doing a rectal exam. In my fluster of not knowing what to say, I said "thank you" back, which compounded the awkwardness (for me, not for him). I slowly exited stage left.
With the interpreter on hand, things got a bit easier, but not as much as one would expect. When I asked him if there was anything else that was bothering him, he grabbed his belly with his hands. "This," he said (through the interpreter), shaking his belly furiously. "This is wrong. This was not here 3 months ago. This came on since I moved here. Now I do nothing and my belly has gotten big. The doctors tell me to lose weight, but I don't even eat that much. Like today, I have eaten nothing." The interpreter giggled a little, "I want this to go away; can you make this go away?"
Sigh. . welcome to America, I suppose.
He also knew thank you. And although he used it appropriately, it was a bit uncomfortable when he said, "Thank you," after I finished doing a rectal exam. In my fluster of not knowing what to say, I said "thank you" back, which compounded the awkwardness (for me, not for him). I slowly exited stage left.
With the interpreter on hand, things got a bit easier, but not as much as one would expect. When I asked him if there was anything else that was bothering him, he grabbed his belly with his hands. "This," he said (through the interpreter), shaking his belly furiously. "This is wrong. This was not here 3 months ago. This came on since I moved here. Now I do nothing and my belly has gotten big. The doctors tell me to lose weight, but I don't even eat that much. Like today, I have eaten nothing." The interpreter giggled a little, "I want this to go away; can you make this go away?"
Sigh. . welcome to America, I suppose.
Tuesday, February 16, 2010
A few days ago I was speaking with someone I had just met who asked me what I do. The conversation went something like this:
Her: And what do you do?
Me: I am in school.
Her: What kind of school?
Me: Graduate school.
Her: What are you studying?
Me: Medicine.
Her: Oh. . nursing school?
Me: No, medical school - I am studying to become a doctor.
This is a common conversation. I have it frequently and it made me think that, in a bit over a year, the conversation will be different:
Her: And what do you do?
Me: I am a resident. I am a doctor.
That's a big difference. . "becoming" versus "am."
This is going to happen to me very soon. In one day, I will walk up to the podium and receive a diploma and suddenly "I am becoming a doctor" will change into "I am a doctor." And yet it won't. Because getting the MD after my name won't make me any more skilled, competent, secure in my knowledge, or successful at healing patients. It's experience that does that (or so I am told). And skilled, competent, secure, and successful aren't points that you reach like mountain peaks. Instead they are paths that you travel on. Through experience you become more skilled, competent, secure, and successful.
Becoming. It may seem like a silly, or even obvious point to harp on, but I think it's an important one. Except in a few fields (the trades being some of them), in our modern-day society, we seem to have a binary approach to professions and careers. What I mean by this is that you aren't something, then you go to school to learn about becoming something, and then you get a degree and you are something. In many areas, we have lost the idea of apprenticeship. Without a doubt, school (especially the long road to the Ph.d. or the shorter road to becoming a teacher or therapist) serves as a sort of apprenticeship, but it seems like we have lost a structure for learning on the job. Everyone says that the most important learning occurs when you actually do something, so why don't we have any formalized structure for that?
Once you get your teaching degree and land a job, you are a teacher who is given as much responsibility and evaluated with the same criteria as a teacher who has been teaching for 30 years. No one expects you to be as successful as the teacher with more experience, but there is no allowance for that built into the system (except perhaps through pay). We suffer from the absence of mentorship. Pretty much everyone would benefit from a mentor, especially one who can evaluate your skills and say, yeah. . I think you are ready to try this.
One of the things that is often criticized in medicine is it's hierarchical nature. I am not 100% convinced that it is a bad thing. Doctors with more experience have seniority and are treated as such. Younger doctors should be able to speak up (and they are with more volume with the changing times), but in a field like medicine, experience should carry significant weight. It's a field where hierarchy appropriately refuses to die. It's a field that that seems to acknowledge that one is eternally becoming a doctor.
Her: And what do you do?
Me: I am in school.
Her: What kind of school?
Me: Graduate school.
Her: What are you studying?
Me: Medicine.
Her: Oh. . nursing school?
Me: No, medical school - I am studying to become a doctor.
This is a common conversation. I have it frequently and it made me think that, in a bit over a year, the conversation will be different:
Her: And what do you do?
Me: I am a resident. I am a doctor.
That's a big difference. . "becoming" versus "am."
This is going to happen to me very soon. In one day, I will walk up to the podium and receive a diploma and suddenly "I am becoming a doctor" will change into "I am a doctor." And yet it won't. Because getting the MD after my name won't make me any more skilled, competent, secure in my knowledge, or successful at healing patients. It's experience that does that (or so I am told). And skilled, competent, secure, and successful aren't points that you reach like mountain peaks. Instead they are paths that you travel on. Through experience you become more skilled, competent, secure, and successful.
Becoming. It may seem like a silly, or even obvious point to harp on, but I think it's an important one. Except in a few fields (the trades being some of them), in our modern-day society, we seem to have a binary approach to professions and careers. What I mean by this is that you aren't something, then you go to school to learn about becoming something, and then you get a degree and you are something. In many areas, we have lost the idea of apprenticeship. Without a doubt, school (especially the long road to the Ph.d. or the shorter road to becoming a teacher or therapist) serves as a sort of apprenticeship, but it seems like we have lost a structure for learning on the job. Everyone says that the most important learning occurs when you actually do something, so why don't we have any formalized structure for that?
Once you get your teaching degree and land a job, you are a teacher who is given as much responsibility and evaluated with the same criteria as a teacher who has been teaching for 30 years. No one expects you to be as successful as the teacher with more experience, but there is no allowance for that built into the system (except perhaps through pay). We suffer from the absence of mentorship. Pretty much everyone would benefit from a mentor, especially one who can evaluate your skills and say, yeah. . I think you are ready to try this.
One of the things that is often criticized in medicine is it's hierarchical nature. I am not 100% convinced that it is a bad thing. Doctors with more experience have seniority and are treated as such. Younger doctors should be able to speak up (and they are with more volume with the changing times), but in a field like medicine, experience should carry significant weight. It's a field where hierarchy appropriately refuses to die. It's a field that that seems to acknowledge that one is eternally becoming a doctor.
Monday, February 15, 2010
Day One
So here I am. the ER. The ER and I. It's been six weeks since I've talked to a patient, 10 weeks since I've been invested in a patient's care (and that was a psych rotation), 5 months since I've really touched a patient, and over a year since I've been expected to manage a patient. In other words, it's been a damn long time since I've felt like a doctor, or even a student doctor.
I've been told that rotation through the Hospital X (HX) ER* will cure even the most reluctant medical student. There is no shallow end there, it's all deep. It is a "kick you out of the nest, watch you hit the ground, then roll you to a cliff and push you off again" sort of rotation. Fly dammit, now.
The anticipation - horrible. I've been fretting about this rotation since I signed up for it. And the fretting became physical about a week ago. . culminating with my last 2 days of "freedom" being spent mourning the fast encroching loss of my freedom and worrying about how may days into the rotation I will be kicked out of medical school for my lack of knowledge, skill, and all-round un-doctorlyness. Needless to say, I was spinning a wee bit the night before. For example, at 10:00 at night I decided it would be a great idea to make not some not-so-important cheat sheets I've been meaning to make for a year. It shouldn't be a surprise to anyone that I did not sleep so hot that night.
The introductory lecture of the rotation only added to my anxiety. I thought the rotation director would be gentle and smiley and welcome us to HX with big hugs and words of reassurance. Instead she was more than a little manic (tip to SR) and spoke so fast that I'm still not really sure of about half of what she said. I left the room even more wide-eyed and petrified. I ran through the list of probable alternative jobs in my head: teacher, sign language interpreter, singer, farmer, lab rat, dog trainer, whale tank cleaner, balloon animal maker .. . really, anything. ANYTHING would have been less stressful than this, I thought. What the F was I thinking? If I could go back to that 23 year old and talk to her, I would shake her. . . a lot. . and say you stupid, naive girl. Stress. . .it sucks, I promise you that by 29, you will realize it's not even close to what it's cut out to be. That's what I was thinking as I speed walked across the street to the ED, trying desperately to keep up with the clerkship director who apparently also walks manically.
So day 1 started, and day 1 continued, and then day 1 ended and I didn't die OR cry once. (Of course with 17 days left, there is plenty of time left for that).
The ED Green (where the less acute patients are seen - think urgent care) has a fast pace and you tick away your time there by patients rather than hours. We work "12 hour" shifts, but they end up being more than that since you have to tack time on for the patients that are essentially ready to go, but not out the door, when your shift ends. The responsible doctor and med student doesn't just hand those patients off to his/her replacement. . nope, he/she finishes what he/she started. You discharge those patients, and that's a lot of paperwork and a bit of time. Plus you have to finish any and all charts that you might not have had time to complete during the day. This took me 2 extra hours my first day. . .I'm hoping I can trim that time down a bit.
Somehow, in an ED that sees few to no pelvic exams, I ended up doing 2 today. This morning during our tour, we walked by the pelvic exam room and the clerkship director pointed at the room and said. . "There's the pelvic exam room, but you probably won't ever see it. We really don't do pelvics here." (On a side note, I found this statement rather odd. . really, any woman coming into the ED with abdominal pain and/or vaginal bleeding should probably get a pelvic exam). But despite that statement, it was like the Gods of irony and the Gods of Gentle Introductions to Scary Rotations were holding hands and blessing me today. Female problems and pelvic exams are a homecoming from me. I'm not saying I was perfect, but at least I can understand the gynecological language.
The high point of the day was the young female (from jail) who presented with abdominal pain and thought she was 3 months pregnant. Her uterus was just too big for her reported gestational age so I thought, she has to be further along. Turns out we were both right. A quick bedside ultrasound showed us a head, an arm, a leg, a heart. . then we moved the ultra sound probe and saw the heart again. . but then we also saw a different heart. . and then the first heart. . and then the 2 hearts side -by-side. Twins, with a gestational age of about 4 months! An exciting moment for the ED.
And the look of surprise, fear, and joy on the girl's face was, well, heart warming and heart wrenching. She flashed the first smile I'd seen on her face all day.
*In order to keep these posts somewhat confidential, I will be changing identifying characteristics of patients, including the name of the hospital, which I have changed to Hospital X, or HX for short.
I've been told that rotation through the Hospital X (HX) ER* will cure even the most reluctant medical student. There is no shallow end there, it's all deep. It is a "kick you out of the nest, watch you hit the ground, then roll you to a cliff and push you off again" sort of rotation. Fly dammit, now.
The anticipation - horrible. I've been fretting about this rotation since I signed up for it. And the fretting became physical about a week ago. . culminating with my last 2 days of "freedom" being spent mourning the fast encroching loss of my freedom and worrying about how may days into the rotation I will be kicked out of medical school for my lack of knowledge, skill, and all-round un-doctorlyness. Needless to say, I was spinning a wee bit the night before. For example, at 10:00 at night I decided it would be a great idea to make not some not-so-important cheat sheets I've been meaning to make for a year. It shouldn't be a surprise to anyone that I did not sleep so hot that night.
The introductory lecture of the rotation only added to my anxiety. I thought the rotation director would be gentle and smiley and welcome us to HX with big hugs and words of reassurance. Instead she was more than a little manic (tip to SR) and spoke so fast that I'm still not really sure of about half of what she said. I left the room even more wide-eyed and petrified. I ran through the list of probable alternative jobs in my head: teacher, sign language interpreter, singer, farmer, lab rat, dog trainer, whale tank cleaner, balloon animal maker .. . really, anything. ANYTHING would have been less stressful than this, I thought. What the F was I thinking? If I could go back to that 23 year old and talk to her, I would shake her. . . a lot. . and say you stupid, naive girl. Stress. . .it sucks, I promise you that by 29, you will realize it's not even close to what it's cut out to be. That's what I was thinking as I speed walked across the street to the ED, trying desperately to keep up with the clerkship director who apparently also walks manically.
So day 1 started, and day 1 continued, and then day 1 ended and I didn't die OR cry once. (Of course with 17 days left, there is plenty of time left for that).
The ED Green (where the less acute patients are seen - think urgent care) has a fast pace and you tick away your time there by patients rather than hours. We work "12 hour" shifts, but they end up being more than that since you have to tack time on for the patients that are essentially ready to go, but not out the door, when your shift ends. The responsible doctor and med student doesn't just hand those patients off to his/her replacement. . nope, he/she finishes what he/she started. You discharge those patients, and that's a lot of paperwork and a bit of time. Plus you have to finish any and all charts that you might not have had time to complete during the day. This took me 2 extra hours my first day. . .I'm hoping I can trim that time down a bit.
Somehow, in an ED that sees few to no pelvic exams, I ended up doing 2 today. This morning during our tour, we walked by the pelvic exam room and the clerkship director pointed at the room and said. . "There's the pelvic exam room, but you probably won't ever see it. We really don't do pelvics here." (On a side note, I found this statement rather odd. . really, any woman coming into the ED with abdominal pain and/or vaginal bleeding should probably get a pelvic exam). But despite that statement, it was like the Gods of irony and the Gods of Gentle Introductions to Scary Rotations were holding hands and blessing me today. Female problems and pelvic exams are a homecoming from me. I'm not saying I was perfect, but at least I can understand the gynecological language.
The high point of the day was the young female (from jail) who presented with abdominal pain and thought she was 3 months pregnant. Her uterus was just too big for her reported gestational age so I thought, she has to be further along. Turns out we were both right. A quick bedside ultrasound showed us a head, an arm, a leg, a heart. . then we moved the ultra sound probe and saw the heart again. . but then we also saw a different heart. . and then the first heart. . and then the 2 hearts side -by-side. Twins, with a gestational age of about 4 months! An exciting moment for the ED.
And the look of surprise, fear, and joy on the girl's face was, well, heart warming and heart wrenching. She flashed the first smile I'd seen on her face all day.
*In order to keep these posts somewhat confidential, I will be changing identifying characteristics of patients, including the name of the hospital, which I have changed to Hospital X, or HX for short.
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