To be or remain in a specified place or situation, typically one perceived as tedious or unpleasant

-also defined as the theme of family medicine inpatient (FMI). Well, at least this week.

Patients are "stuck" at the hospital while waiting for placement into a skilled nursing facility or rehab center. They are not longer acutely ill and there is nothing that we are doing for them each day, other than a courtesory exam and progress note. But still they cannot go home and insurance or lack thereof dictates placement, or lack thereof, so they stay in the hospital. Day after day. But what is a good learning experience on day 1 or 2 or even 5 becomes a bit tedious on day 12, 18 or 23. When nothing changes and all labs are normal and meds adjusted. Everyone is bored. Even the nurses pleadingly ask, "when can Mrs. Smith go?"

Patients are "stuck" at the hospital because they need a consult from a service that is MIA or because they need cardiac stress testing but it is the end of the month and the pharmacy is out of persantine or it is the weekend and they must wait until Monday for pathology to give an official reading or for some  non-weekend working dept to sign off.

I am "stuck" in the hospital because my rotation mandates that I am there 12 or 13 hours each day and while these hours make sense for my resident who is covering all the patients and overseeing all the admissions they hardly make sense for me when there are four other medical students on the team and I only get every 5th admission. Especially when we have finished rounding and I have seen all my patients, the same patients that are also stuck at the hospital, and there is absolutely nothing to do while I wait for the hours to pass. So far I've successfully snuck into the OR, slept, hung out in the ER, offered to go to Starbucks for the team, and a dozen other non-FM type things.  I think I may give my patient a manicure tomorrow (because she is stuck, she asked me to, and because that way at least I'll be productive, though knowing my luck there is some hospital regulation again this.)

Yay to being half way done with FMI, almost.

*Oh, and yes I realize I could and should study (and I do) but FM is considered an elective and so there is no shelf exam or test.  Plus the rotation is Pass/Fail and right now Step 2 seems far away....  But if you have any other suggestions for passing time in the hospital, please share!


"Just you wait...."

These words seem to be a running theme lately. If you are newish medical student, or just starting off resident, chances our you know what I'm talking about.

Are these words of warning? Are you trying to save us? What makes other, older, wiser nurses, residents, attendings want to deflate the bright-eyed and bushy-tailed Bambis' of their idealistic views? Why do you need to tell me it won't last? Why shouldn't we be as eager as a toddler to get a new toy?

Three examples:

-My friend Beth is one week from being done with her training and she has a job lined up to work as a PA in the ER. While rotating one day in her future ER, a nurse, and soon to be co-worker tells Beth that she will become like all the others soon enough, JADED. Beth denies this. The nurse insists. She has seen it happen, time and time again. It isn't clear why she is telling Beth this but it makes an impression.

-During my first week of surgery rotations I happened to work a long day. I arrived to the hospital around 4am and happened to talk to one of the nurses about a mutual patient of ours. The RN was working the night shift and remembered me,  so 18 hours later when I was back on the floor checking on a patient before I left for the day she made sure to tell me that my enthusiasm was temporary. She also told me I should go home. And while she was right and maybe I did need to go home I remember in that moment thinking to myself, I hope this lasts, I hope I always care this much about each patient I take care of, this is my job to be devoted.

A classmate started her rotations this week and she is on my FM team. When she got her first patient to admit she did a celebratory dance, complete with clapping and jumping up and down, right in the middle of the ER. I laughed (I can recall my own enthusiasm and the joy one feels when she is finally seeing a patient, by herself.) The resident gave her a funny look as she skipped  happily away. "What is up with her?" the resident asked me. "It is her FIRST patient!" I replied. The resident sighed, "I wish I was still so excited to admit a patient, I don't remember ever being that eager."

And yet, I am sure the resident was. At one time she was an idealistic, eager, enthusiastic doctor in training. Just like we all start out as... Bambis.

And I'm sure those nurses are right. Over time, in a few years, or maybe a decade my friend Beth may become jaded. The ER is a tough place to work. ER staff deals with sick, scared, patients. People can be at their worst and burnout in the ER field is real. But does that mean we have to try and take the idealism away before it wears off?

I did tire of 16 hour days. And note to self-seeing the same nurse separated by two shifts signals it is time to go home. But it will continue to happen. Even if I'm not always happy about it. And I should stay so devoted.

And yes, my classmate will stop dancing every time she gets assigned a new patient to admit. However my hope is that we continue to remember that feeling of enthusiasm from time to time.

Idealist, devoted, enthusiastic. Sure we all still Bambis but you know what, we wouldn't change it for the world, being a Bambi is a pretty cool thing! Go ahead, call me Bambi, I'm proud to be!

(Now where is my nurse like Carla?)

And because we all need some music in our day and not because this has ANYTHING to do with my post...



So, I'm only two day into my Family Med* rotation so I'm not sure if that is really enough time to come to any conclusions. But I'm going to anyhow because I have the time to blog and because in just two days time I've come to realize a few things about myself... First a quick comparison, which is probably not fair to either field but its my blog and I'll compare if I want to!

Going from Surgery to Fam Med feels like running a marathon to strolling in the park. Everything moves a whole. lot. slower. Everyone is nice. The attending bakes you homemade chocolate chip cookies (literally), the resident apologizes for not having time to teach and for being so busy. You are asked repeatedly each day if you need to eat and then given ample time to do so. All patients are seen by the attending, every day! It is like an alternate universe. And I'm not sure what to make of it.

All of this is good. And nice. But it kind of bores me. In two days I've only gotten a single patient to myself. I did help another student with her H&P and co-wrote a single note this morning. Plus I got the priviledge (a.k.a. intern too busy so asks me to do it) of updating our team's entire patient census list which was grand total of 6 patients. But back when I was a surgery student I saw 6 patients/ wrote 6 notes in a single morning.

Okay, so my patient. I did his admission H&P on Monday and today I got to present him to the attending and help her with the A/P so he's mine until discharge.  Except that not tomorrow morning because our team switches to night float for two nights so another team covers our patients (I don't know how that makes any sense but that is how it is). Anyhow, maybe by the end of the week I'll have two whole patients. That's the hope anyhow.

Oh, so my discoveries. Well while we were busy waiting for rounds to start, then later munching down chocolate chip cookies, then later at lunch, then later waiting for rounds to resume and then end, I realized that I did not like that attending had to run off to deliver a baby in the middle of my presentation. Or that the 11am weekly lecture was canceled because of the same. I know, it is medicine and things happen. But I think I need a schedule, a plan. I don't get stressed when plans change per se. I'm okay improvising or adjusting but I do like having structure. And surgery had that going for it. Cases were scheduled. When one finished another started. There was some predictability of what days were clinic versus OR versus just rounds.

Family Med is the embodiment of unpredictability. In the next six weeks I never get more than one day off at a time. My schedule changes every week.  Actually it changes ever day or two. As a medical student on a rotation this is not a big deal. But I cannot imagine a life of this. So I guess that means inpatient Family Med is off my list... which is too bad because the people are SO nice. Maybe it is the laid back nature and the I can deal with anything, at any time mentality that makes these people so cool. So I hope that they can be my friends.  But I guess I'm too uptight for their field.  Surgery vs Medicine: It is the classic do versus think. And come to think of it, I've always imagined myself somewhere in the middle. Child Neurology is a middle ground, right?

*Disclaimer, at my hospital the Family Med rotation is all inpatient so it is really more like an IM elective and probably not wholly reflective of FM

** This post is not to slight either Surgery or Family Med. I met some brilliant surgeons that were quite capable of thinking and even treating the whole patient. I learned a lot of medicine from my attendings during surgery. And it is important that we have people who love Family Med and do it all, it is SO needed.  I just don't think I'm one of them.


Three Months Later

Patients seen: 88
Surgeries scrubbed into: 26
Lives lost: 7
Goodbyes said: 1
Hands held: 15

Surgery is over and I don't think I'll miss the ER/traumas or sad stories that bring the patients to the hospital. I'd rather not have to contemplate skin grafts for the women who fell asleep while smoking causing her bed to catch on fire and burn 30% of her body. Neither cup of noodles nor sparklers should never be given to children to children under 7. Gas stoves or BBQs and unsupervised cooking for children- please no. And just in case you didn't know: grandma driving while on amphetamines,  uncovered empty pools without water, holding a boiling pot of beans in your lap = very bad ideas. I use to think hang-gliding sounded like fun, but after seeing the results of landings that didn't quite work out maybe I'll rethink that. I have had my fill of gun shot wounds and stabbings. Pneumothorax, appendicitis, cholelithiasis - check, check, check!

The OR was actually quite fun most of the time. I can see the appeal, and I even liked about half of the surgeons I met. I'm crossing surgery off my list but am so thankful for the long rotation (even if I wasn't always thrilled during it.) I will probably never see brain surgery or even a lap appy again, but I'm so glad I got to experience them.

(Next time I post I'll be on inpatient family med. Stay tuned.)