Junior Mints

Hrrm.

Watching 3rd years brings back memories of surgery clerkship – walking around in groups, thinking you’re a bad ass while the residents do everything, and not knowing what the hell you’re doing but acting like you do – yeah, I remember those days well.

I’m still living them.

But in all seriousness, the juniors have been putting in some serious work this week. Many of the ICU patients are surgical, sicker than snot, and require a lot of interventions/ management/ follow up, leaving the juniors arriving throughout the day trying to find some data that's needed. Most are here well past 6 pm on a regular basis.

Yet, despite these hours and the conditions they've been launched into in the last 1.5 weeks, I still can’t fathom why anyone would walk into a patient’s room whose on contact precautions, touch them with their bare hands, and get huffy at the nurse who tries to stop you. I get that you’re tired, man, but is the extra few minutes of putting on a cover and gloves really worth risking infection? Plus snapping at the nurse will only get you on a shit list that you don’t want to be on. Trust me.

Overall though, the thing that bothers me the most about them (not that they bother me in and of themselves) is the fact that they have to change into nice clothes as soon as they leave the OR. One girl had to leave and change before she could help out with a chest tube the other day (which was subsequently completed while she was gone). It floored me.

Gone are the days of walking around in scrubs – like I was allowed – and being able to deal with the fluids and contaminates since you could just get another clean pair from the OR. That was one of the great things about the surgery clerkship – not having to wear a tie and iron your damn clothes or worry about destroying them.

And there were great days on that clerkship. But I mean, do you really have to avoid wearing the scrubs altogether? The residents still walk around in theirs, why can' t the students?

Chips

I've noticed that there are a lot of people in health care that take shots at medical students and younger residents while they can. As a resident gains more seniority these people begin to behave differently and almost cower from their gaze. Being one of these students who has received harrassment from various nurses, techs, and assistants I can understand how one might get riled up when you're the object of another's fun.

But that's just how it goes during this process. We have almost no power over anyone, can't really get on someone for being a jerk, and have to simply suck it up. Or get flustered, let the person know they got the best of you, and realize that you've now become the "joke bitch" for that floor.

A friend of mine has been given a rather hard time during her Sub-I from just about everyone. The latest was from a tech who prodded her into anger by insinuating that she wasn't cut out for medicine after a comment she made. My advice, had I given it, would be to just suck it up, ignore the insults, and try to keep the chip on her shoulder from getting bigger.

Because if we were to allow every instance of humiliation at the hands of "lesser people" get to us then we'd be demon asses and bitches by the time we're finished with residency.

Part of training to become a boarded physician is to learn limits. When those above us do it, they do it in hopes of keeping us grounded, well aware of our limitations, and more vigilant the next time. When it's done by those below us (like techs, MA's, and the like) they're doing it while they can, because they know in a few short years they won't be able to say one negative word without being severely castigated.

So let the fuckers make fun and just continue to improve. Reacting simply makes them feel more justified and makes you appear insecure about your level of knowledge.

Fresh Fish

The new crop of 1st years have arrived. Hurrah!

I can hear the fellas now: running over to the fence, yellin' and hollerin' whilst the new prisoners make their way through the entrance gate. They're trying to not show they're scared, but their feet shuffling in hurried, small steps always gives them away. That and their new black doctor's bag purchased by mommy and daddy in hopes that they can buy buy some favors with it and to lessen the initial pain.

"Fresh Fish, we're realing them in!" A cellmate of mine yells as he mimicks the universal sign for angina pectoris.

"Hey Fish! I got some biochem love for ya, right here! What's tha matter? You don't like oxidation reactions? Ahahahaha." Laughs a hypomanic prisoner ending his 2nd year of incarceration with only the hurdle of testing for work release to get through.

Yeah...kinda like a scene from any prison movie the new meat has made their way to the penitentiary AKA med school and has begun their processing. Soon they'll be known as The Bitches of P=MD block... 'er...I mean Class of 2011.

“Like lambs to the slaughter.” I said to myself, grinning as I walked past them while they milled about, anxiously chattering in the atrium of the basic sciences building. “They’ve no idea what they’re in for.”

I don't know what to think of them, other than being rather obtuse about keeping quiet in study rooms while others are working, but I'm sure I'll really never know. It's not like I'll have much contact with them as a 4th year, but whatever.

All over the United States people are making the transition from real life to medical student with Doe-eyed dreams and ideals of what medical school must be. I hope that they've done their homework because this ain't no fairy tale. People get hurt and we all don't live happily ever after...Bambie fucking dies.

But, with that being said:
Good luck to all you freshies out there! It’s gonna hurt, but stick to it and you’ll make it through – eventually.

Selfish Love

Scutmonkey has a great post about the trials of being medical student. I’ve only recently uncovered his blog and believe it to be a great asset and hope that he finds the readership he deserves. His post got me thinking about something I’ve discussed in the past, but are now lost to that damn delete error a while back.

Training to be a physician has got to be one of the most exciting, excruciating, and mind-numbing processes out there. In order to succeed through this mess known as medical school one must be inordinately self absorbed. It takes a true narcissist to look at the time commitment, mountains of books and information requisite, the destruction of personal enjoyments, and the numerous physicians who warn against applying to medical school and still believe they’ll get through it smelling like roses. Frequently a feeling of "being the best student in the school" pervades the egos of students.

Often there is someone with you as you traverse this system, either from pre-med school or they arrive sometime during. If they are not embroiled in this system they are too often lost to it. Casualties of the war between professors, peers, administration, nurses, attendings, and oneself.

Marriages seem to be the harder battle to lose, but all too often a once happy union is dissolved as one of the partners navigates the storm-tossed waters of medical training. Infidelity often is a reason, but far more common is the complete loss of self. The fact that the partner has changed and is no longer recognizable to someone who once loved them unconditionally.

Personally I think there should be adjustments to wedding vows once someone enters medical school: Till death or medical training do us part.

The demands of the profession allow for nothing short of a life of solitude. Expectations of superiors are of the self-less, ubiquitous, omniscient resident and/ or student. A life outside the hospital is for the weak. Your own loved ones are secondary to the “call of medicine” and therefore are not your primary concern. I have actually heard an attending say that family comes second to patient care.

To increase the discord between partners is the fact that many people will never understand the process, failures, victories, and absolutely demanding nature of medical training. It is an enigma to many: how can you be tired after sitting on your butt for 9 hours when I worked hard all day long?

Anytime there is a partnership where one person takes on a task that becomes incredibly demanding of their time you can expect failure. It’s natural to want to be appreciated, loved, touched, and have feelings reciprocated. It’s also natural to feel wrath and disgust towards anyone who, once so willing, no longer exchanges emotional currency.

BMI Discussion and AWOL

OK. In response to the comments about the last post related to the “patient” I must admit something: that was me. Way to go Liz...you nailed it.

That’s right. I had you guessing about what kind of shape I’m in, what I might look like, and what you, my avid and voracious readers, thought MSG's fitness level is based on numbers because I'm an incredibly vain person. Happy?

The result? Well, basically most of you had me fairly well described: slightly overweight with a muscular build, often mistaken for weighing far less than I actually do (usually 40 pounds or so). I do not, regrettably, have legs of steel or “guns of nazarone”. Yet. So thanks for playing.

I was thinking about using this as a BMI discussion since I honestly feel I'm not "close to being obese" as the BMI suggests, but I think I’ll hold off on it. Afterall, most of us understand that this particular tool is useful but is clearly subject to interpretation.

******

Yesterday Stepson had his elementary school graduation. I was given a reprieve for the morning, but was supposed to return to the Army base afterwards. Instead I just didn’t go. I was essentially AWOL.

What's interesting to me is the fact that I’ve never done this before – completely forgoing my responsibilities because I despise a rotation. But here it is…I missed a day for no real reason. I just didn’t want to drive that far to deal with that crap.

Do I feel guilty? In some ways, yes, I do feel guilty. But in an abundance of others I feel completely OK. I had a great day with my family and enjoyed a picnic with his classmates. I spent some quality time celebrating Stepson's accomplishments and this movement into a new phase of his life. Hell, in one year we might be moving several thousand miles from him and his asshole dad, so taking time to enjoy these moments is even more important.

The only issue is whether I'll receive a reprimand on Tuesday for not returning. Either way - whatever. I really don't care anymore. I've got a couple more weeks and then 3rd year's over.

Croc

Well, I finally went and did it. I joined the millions of medical professionals who wear plastic and cheap looking footwear to work and purchased a new set of Crocs. I just couldn't take the smell my sneakers were giving off after this last month. It was getting really bad.

So now I have the "outdoor type" that's all manly looking and burly. I kept tripping on them yesterday. Damn near fell down some stairs, but hopefully I'll get better at walking. I've only been doing it for 29 years now.

And the best thing? My feet remained relatively comfy and rather non-malodorous throughout a 13 hour day. Awesome. My residents of the past are thanking me right now.

Where Have All The Flowers Gone?

Something is happening in the medical blogging world. People are dropping like flies. I took a brief hiatus after I inadvertently deleted my past posts. I can only hope that these missing bloggers will do the same and return to us. Many of these are some of the first medblogs that I read and were inspirations as well as teachers in getting me to start my own.

So, for now, a fond farewell with hopes that you will soon return:

Flea

Fat Doctor (invite only)

FifeMe (invite only)

VitaminK

Barbados Butterfly

Hospital Phoenix (who turns up again and again only to disappear again and again)

It’s scary to wonder what’s happening here. Censorship, either self induced or forcibly mandated, is continuing its strangle hold of a profession who’s sanctity is quickly slipping away. Where have all the bloggers gone? Sad days indeed.

3rd Year - Tale of 2 Truths

With a new crop of 3rd year medical students making their way through their final exams and getting prep’d for Step 1 I’ve thought about what 3rd year truly entails. Essentially it involves 2 things: confusion and humiliation.

First, confusion occurs based on your concrete belief in what you’ve learned from your books, what you’ve inculcated for Step 1, and the honest-to-God belief that you know what field you want to enter. 3rd year throws all of this out the door. I remember wanting to be an ER physician. I remember believing I knew a lot about congestive heart failure and treatment.

Then, Internal Medicine, my first rotation, completely turned my world upside down. ER was suddenly despised due to the patient aspect, CHF was complicated, and patients scared the hell out of me. Everyday I just hoped that I could answer enough of someone’s questions to not get yelled at. Answers that had been satisfactory for Step 1 were no longer "current treatment regimens". I was frustrated and confused.

The second is humiliation. And by this I mean the humiliation that accompanies the medical student as they traverse the harrowing halls of hospital wards, talk to patients without betraying the forbidden secret that they are scared to death of them, and attempting to maintain some semblance of your pride as much as possible while being humiliated by every aspect of hospital employee.

“Do you know how to draw blood? No? What a tool!”

“Do you know how to put in a foley catheter? What? Even my grandmother knows how to do that!”

"Can you find a mop and clean that up? What? No?! Fuck you!

In some parts of the hospital the phones are complicated, thus relegating you to asking how to answer your resident’s call as they return your page.

“What a dumbass you must be – how’d you get to be a medical student?”

You wonder why the nurses yell, attendings scoff, and residents roll their eyes. You’re trying, but it’s never enough. And just as you begin to feel comfortable and start to appreciate your surroundings your rotations end, your month schedule changes, or your attending/ resident changes. The confusion and humiliation remain as constant as the smell of ripe feces and sterile scrub on the internal med floor.

So, tread softly oh ye brave soon-to-be 3rd year medical students. It’s not always bad, but it’s definitely a trip.

Hands Tied

I have a presentation to give for a CME weekly course related to a case report that I’ve been working on with a surgeon. The presentation has me quite worried since there will be physicians who are experts in this area and I’m supposed to provide them with some medical education. OK. No biggie. Right?

Ummm…wait. Scratch that.

Did I forget to tell you that the presentation needs to involve various specialties of medicine that are involved in the patient's care? Have I also informed you that it needs to be around 45 minutes in length? I haven't? Well, here's something else to chew on while you consider the enormity of this proposal.

The surgeon I'm supposed to be working with has remained quite clandestine. On Monday, while I spoke with him in the holding room of the OR, he got a little upset that I took it upon myself to ask a specialist (who is also a very well known physician in his field and would make a great person to have write me a letter of recommendation) about some information he can provide on the topic. He told me to only be in contact with him and that we'd talk later in the week. Since then I’ve e-mailed and attempted to contact him several times to get his feedback, the patient’s current status, etc. only to have no replies. I can't find him in his office and he won't return my phone calls. At this point I’m essentially flying blind.

So what would you do?

Here’s what I did: I enlisted that specialist’s assistance anyway in critiquing my power point slides, but not providing me any information. I figured that if the person who signed me up for this presentation wasn’t going to assist me then I’ll go to someone who will at least let me know if what I've got is crap or not.

Now, certainly some concern is warranted at this point. It might make this surgeon mad and he could theoretically try to damage my chances of residency (not very likely, but certainly it's possible). However, he’s right out of residency, still has to take his boards, and has made it rather clear that he’s too busy to actually do this himself. I think that’s part of the reason he drafted me into presenting and I think he feels that I've made him look bad by asking for help. Personally I just want to do a good job and waiting until the last minute is not the way to go.

Take a Number

“What’s her name?”

This thought crosses my mind as I head towards my patient’s door. It’s 5:45 am and I’m dragging. I don’t want to be here. I don’t want to walk into a stranger’s room and feel them up (not truly, but checking for breast tenderness and discharge as well as vaginal exams seems an awful lot like it – especially at this ungodly early hour).

“Shit. I can’t remember. Can’t go calling her senora 4104 now, can I?”

I head back to the census sheet, taking a few extra moments to talk with my friend. I then head back to the door. Stopping tentatively at the door, hand poised to knock and shatter the stillness within the room.

“Goddammit! What’s her name again!?”

This plays out more often than you would like to think. I’ve read the chart, understood what transpired overnight, know where she and her newborn child stand amongst the new admissions, and know exactly what phrases to employ in order to get my SOAP note complete. I just can’t remember her name.

This is medical education. Patients begin to loose their identities to us as we try and get through rotations alive. The pressures placed on our shoulders, already weighed down by the heaviness of our short white coats overloaded with multiple tools to assist our "brains", lend themselves towards our thought blocking. It's the only defense mechanism we have left.

Patients stop existing as people and become numbers, diseases, diagnoses, and procedures to be added to the ever growing patient encounter log in my right pocket. They’re just not people. That impedes my daily progress. That notion cannot be considered - it will delay me.

Why do you want to be a doctor? I can no longer answer this question without wondering if the reason(s) I had entered medical school have been completely abandoned; lost along the way during the inculcation of my medical knowledge. Maybe next year I’ll pick it back up and patients won’t be just a number. But I fear that this won't transpire. After all, I've got things to do and people (numbers) to see.