2:15am

And of course, I'm wide awake. Hello insomnia, you really aren't a friend of mine. May as well blog a little, not anything else going on in the middle if the night. Tomorrow is my last long call/admit day for Medicine. Wednesday is post call and my oral exam. And then I'm down with third year. Kind of crazy how fast it went. Seems just like yesterday when I was standing in the OR and pondering how little I knew. Now I'm almost a real big grown up MS IV. The plan? Napa first and foremost. See family. Drive South. See more family. Settle and study for Step 2. Head to New York. Do a peds sub-I... somewhere, this part is difficult to schedule. But sub-I. Somewhere. Get amazing letter. Head back to Cali. Do some medicine electives. Apply for residency. Yada, yada... Anyhow, it's all good. Napa is in sight, just two days to go... Cheers!

swimming pools and spoons

Sometimes you just need a swimming pool. They are doing construction on the hospital and I snapped this picture on my way in today.

The pools were filled with gravel and dirt and I have no idea where they are taking these... You would think they there would be a more sophisticated way to move around the excess dirt and gravel but the plastic pools seemed to be doing the job.

Which reminds me of the spoons, way back in my first rotation, during Neurosurgery. Let me explain. If a patient had a subarachnoid hemorrhage and we needed to remove the clotted blood from the brain we used... a spoon. Again you'd think there would be some tool or special device made for such a procedure but if there is I have no idea what it looks like because we always used spoons. Just plain, regular tea spoons.

This post has no real purpose I don't have anything profound to say. I'm just reflecting on simple things that somehow get the job done. I'm 10 days away from being done with third year and I just emailed my final patient write-up to my preceptor. It feels good.

Now if you excuse me I'm going to enjoy a glass of wine and ponder the simple things in life. Like swimming pools and spoons.

no words

I never considered myself as having a problem with words. I love to write, and it has always seemed to come easily for me. But then I get to IM and my H&Ps seem on the skimpy side. For someone who was regularly told her emails were too long and that the essay only needed to be 500 words not 2000 this is an odd place to find myself. I should be able to write paragraphs about my differential diagnosis but I tend to focus on the most likely and leave out the obvious details because I think they are obvious, or written two sentences above in the labs, or I just talked about it in the HPI but I guess repetition is okay if it is important. I think I'm just modeling what I've read but just because your resident does it doesn't make it right. So I'm working on this. Also, I don't know if I just have an extra attentive Attending or if my pronunciations have been awful lately but I've been corrected when I say words too.
Random examples:
-Rhales is British so the a is an ah not a hard a.
-Triamcinolone (antibiotic) in my head has an extra syllable. And why is this called tack cream? I really don't get it.
-Petechiea (the ch is pronounced as k not a ch)

So I vow to be more thorough, more verbose and work on my pronunciations. And maybe learn some medicine while I'm at it.

I was reflecting on the patient's I've seen so far and I think I've hit all the major organ systems.
Here is the short list:
HTN (only essential)
CHF (right and left sided)
Valvular Heart Disease
Afib vs Aflutter
CAD r/o ACS
COPD
Asthma
Pneumonia
Renal Failure (acute and chronic)
Liver Cirrhosis
Hepatitis (Hep C, Viral, Tylenol OD)
Stroke
Alzheimer's
DM (but all type II so far)
Psoriasis
Reynaud's Syndrome
Panic Disorder
Depression
Bipolar Disorder
Substance Abuse (cocaine, alcohol, narcotics)

Not bad for one month into IM... I wonder what I'll see today? Whatever it is, I'll try to use my words.

*On an completely unrelated note- Happy Match Week to my SGU colleagues and other MS IVs that are anxiously waiting for Friday. Here is a link to the list. Right now it only has pre-matched students but the Canadians will be added soon and then everyone else on Friday or as soon as SGU updates it... Fingers crossed for everyone. I feel nervous this year, I can't even imagine the suspense of next year.

the zebra that wasn't

what if your patient has the worst diagnosis. not because it is something rare and horrible but just because it is.  my patient from day one of IM is still in the hospital and if he's lucky he'll leave tomorrow but still... he walked into the hospital and although he'll walk out his life has drastically changed. i'm sad for him. sad for his family. i was there. he was my first H&P of IM. i won't forgot him... he taught me not just about medicine but about being there. and about how the nicest patient's have the worst diagnosis.

IM is a quarter over which is kind of amazing. tomorrow is the last day with my resident and she's taught me a lot. i've gotten to work with three different attendings and they all had different styles. i've seen a variety of patients. mostly the basics but some interesting cases too.

i'm feeling reflective but its a good feeling. third year is winding down and mostly i feel like i still have so much to learn. but every day i hope i'm making progress.

I'm not taking this for granted

"This" being medicine.

"This" being a chance to be a medical student. Which if you really think about it, is a pretty awesome job. I get to spend my days learning about things I find interesting. I'm on my feet, talking to patients and practicing skills I hope to spend the rest of my life doing. I am not really responsible for anything. Nothing is expected of me beyond being interested and showing up.

"This" being a part of patients' lives when they are at their most vulnerable. As a medical student I have time so I can spend an hour talking to and educating my patient about whatever disease and treatment is relevant. I have time so I can talk about life or anything really... and I like this time.

I can spend half the day in the library reading. Or I can spend it in the cath lab, or GI suite or wherever else my patient may need to go. I get to see medicine from the perspective of someone who knows a little but has the time to absorb it all.

I'm only 10 days in but so far I've see the textbook come to life.
Ascites with a fluid wave. Gout with tophus nodules. Stephenson-Johnson Syndrome. Hypertensive retinopathy complete with arteriovenous nicking, cotton-wool spots and flame-shaped hemorrhages.

This is medicine and this is me getting to do it.

I love this time in medical school. Third year is nearly over and I'm just happy to be here. This is good.

Day 2 and my (first) zebra = I heart medicine

So I'm only two days into medicine and so far I have a very interesting patient. I can't go into details because HIPPA and stuff but he's younger than I am and in multi-organ failure without a known cause. The obvious and regulars have been ruled out so now we are looking for something more exotic. Sucks for him, cool for me. He's an ICU patient and being only an MS III we are not suppose to follow ICU patient's but somehow I got him anyhow and I'm so glad I did. I actually want to be at work and am reminded of why I went into this, medicine is interesting, the human body is downright amazing and I am SO LUCKY to be living my dream.  I just hope that my patient's zebra is something reversible and/or treatable and that he will go on to live his life and I'll learn much in the process.

Yesterday was also interesting as it seems the "flavor de jour" was cocaine abuse. Maybe it was the patients tribute to Whitney's passing as my Attending postulated... but whatever it was we had no less than three admits for some type of cocaine related complication. Lesson of the day, love your heart, don't do cocaine and happy Valentine's Day.

Also the residents are great. We have noon conference and/or med student lectures pretty much every day and we get to do stuff but are still told to go home early/ go study and given minimal scut work. So all in all, I'm two days in and very happy to be here. Medicine rocks. San Francisco is great and I live in the same state as Dr. Boyfriend once again. All in all, life is good!

Anatomy of a 6 week Rotation

Week 1: excitement, meeting new people, figuring out who's who. this is going to be great.
Week 2: still excited to be in a new rotation, settled and ready to learn, call is fun.
Week 3: tired. time is going by so slowly....i can't believe i'm only half way done. call is exhausting.
Week 4: omg. am i still on this rotation? very tired. call is dreaded. did i mention tired.
Week 5: the end is near. i kind of like this rotation. i'm sad i only have two weeks left.
Week 6: exams, done. that was great! i can't believe how fast time goes by....

I'm just about done with OB/GYN. It was fine. I liked the OB part and tolerated the GYN... clinic and L&D were great. The OR, not so much.... but then again I already knew surgery wasn't for me. It was a good experience and I'm glad to have another rotation behind me.

IM is up next and while I'm ready to learn and excited to be going somewhere that I have autonomy and actually contribute to patients care I'm a little apprehensive about working 6 days a week for 3 months on the wards. But regardless I'm going. And then fourth year will be here so ready or not, here I go...

Cali is just 8 days away, so long New York!

Oh, yeah, I write a blog....

Hi dear readers !I didn't forgot about you, although my lack of posting may make you think otherwise. Insert normal excuses here- busy, nothing interesting, blah, blah, blah. Anyhow, I hope you enjoyed the Holidays, Happy New Year to you!

So, what have I been up to? If you are keeping track at home I'm in my second to final rotation of third year. I just have four weeks of OB/GYN left and then I'm headed back to Cali for IM and then I'm a grown up MS IV! Crazy how time went by so fast.... Of course things are not quite THAT easy because I do have to take those little things called the Step 2 CK and CS, and arrange my schedule for next year, etc, etc. But I'm marching on....

Peds was amazing and everything I could have wanted in a rotation.  Great teaching, interesting cases, cute kids, good diversity and basically confirmation that I was born to be a pediatrician. Every day was fun. I heart babies, teenagers and all those in between. I was even able to spend several days in peds neruo clinic and that was amazing too. So all in all I am happy and ready to get to fourth year already so I can hang out with those kids again! Last night I was on-call on L&D and just down the hall from the nursery so I made a few trips (to check on the deliveries of course) and just because babies are way cuter and more fun than moms' in labor. Or at least I think so.

So OB/GYN. Well I started with clinic so I've gotten to see a little bit of everything and then last night on call I scrubbed for one section and helped with one NVD so all in all I'm getting to see what I'm suppose too. I feel like I'm missing the gene that makes one wax poetic about the miracle of life and witnessing a birth. I suppose I am more upset by how cold the anesthesiologist is to the patient in the C-section, how scared she seems and how horrible it must be to have a baby brought into the world this way. The patient was alone, Spanish speaking and clearly scared. Not a single person in the OR spoke Spanish, or if they did they kept quiet. It broke my heart to see her sitting there, her eyes trying to hold back tears and her entire body shaking (from cold or fear or both). I held her hand before I scrubbed in and a caring nurse or two did the same but during the actual C/S it was only the anesthesiologist behind the curtain with her and he most certainly wasn't comforting her.... but the baby was fine and patient's family appeared shortly thereafter to be with the patient and see the new baby so maybe I'm getting more upset about this than I need to be.

Of course normal vaginal delivery doesn't look like a piece of pie either. Oh my goodness, the crying, the screaming, the mess, the (seemingly) never ending labor. The vaginal delivery I saw was a bit better in that mom got to breastfeed and hold baby within five minute of the actual delivery and the family was in the room, cheering, and celebrating. So maybe magic for them, not so much for me. But babies were born and life begins anew so I'll try to focus on that positive as I sign off today.

Hopefully I'm back to regular scheduled blogging in this new year.

blame it on the kids

HPI: female medical student with sore throat x 3 days, non-productive cough developing over last 24 hours along with hoarse voice and headache, possibly a subjective fever
sick contacts- numerous kids with strep, RSV and all other sorts of viruses seen and examined in the last week courtesy of her time spent in the Peds ER
cough drops and Advil has been mildly effective. no change in appetite. recent difficulty sleeping due to nasal discharge and cough.

PE: pt looks tired and miserable but not that sick. throat is mildly erythematous and adenoids are visible but without purulent discharge. cervical LNs tender.

DDx:
URI/Laryngitits- unspecified viral, top contenders include:

• Rhinoviruses
• Parainfluenza viruses
• Respiratory syncytial virus
• Adenoviruses
• Influenza viruses

Steptococcal Pharyngitis - (pt has had strep throat no less that 50 billion times in her life and blames her sensorineural hearing loss on all the antibiotics she took as a kid trying to get rid of the same. pt can swallow without too much difficulty and lack of real fever, appearance of the throat are less suggestive of this dx)


A/P: Most likely viral so therefore no treatment warranted.

Rx: Take the morning off to stay home, drink tea and study. (Pt would not want to get the healthy kids coming for well-visits sick, after all!)

10 fingers, 10 toes...

I just finished my two weeks of inpatient floor work and next I have a full week of newborn nursery. We had an intro lecture on Thursday and I'm quite excited. How cool is it that I will get to check a newborn and perform physical exams for the very first time for these little ones? Plus they are cute even if there heads are molded into some interesting shapes from the delivery process. And I am sure I'll learn a ton too. Time to brush up on causes of neonatal jaundice.

Peds soldiers on and I'm loving it. Show me the babies!

this is it

peds is here, i'm 1.5 weeks in and have seen plenty of asthma and RSV... plus a few interesting cases, rare and otherwise. the teaching is great. the hours are okay. the patients are wonderful. so really, no complaints except that i feel like i know nothing. there is so much to read and study but every day i'm learning.

i love the population and the diversity. one minute a 7 day old baby and the next a 17 year old teenager. parents of all varieties. play is part of the job. i heart it all!

links galore

Just a few recommendations if you are looking for something psychiatric tinted to enlighten/entertain or distract you.

LISTEN
Real 'Sybil' Admits Multiple Personalities were Fake
An NPR Segment that I stumbled upon yesterday...


READ
for the moment/hour/day-
The NY Times Lives Restores Series- Parts 1-3 now available, here is the link to the first article

for the week/month-

"Sybil Exposed" by Debbie Nathan (I'm reading this now, 1/3 the way through and so far I'm intrigued and saddened. I guess the original Sybil work is up next.)

"The Center Cannot Hold" by Elyn R. Saks (I haven't yet read this but it is on my list as well.)

"The Bell Jar" by Sylvia Plath 

This is a classic and if you haven't read it, you should. 

WATCH
In case you would rather a video, this one and the prior two in the Lives Restored Series are well done and get my recommendations as well.

---

That's all for now. Two more weeks of psychiatry. My goal is to prepare for the shelf and stay interested in all of it. Now, back to my book!

how to bribe your patient into compliance?

answer: with coffee and tea. No joke!

Geriatric psychiatry is a lot of things... however holding my interest is not one of them. I tried to give it a fair shake. And for about a week I was intrigued and pleasantly surprised by just how much I liked it. But it must have been the newness, or the fun patients I had that week because my enthusiasm quickly wore off.

 Last week was rough. I didn't really want to go to work and once I was there I just couldn't wait to leave. My patients were belligerent, agitated, hostile and demented. I feel bad for them. But not bad enough to make myself bribe them to take their medications like my Attending does. I mean I guess if getting a cup of tea or buying a cup of coffee is all it takes for a patient to become compliant why not do it? But in my short experience it only works for a limited amount of time. And even if patient complies for the moment/day/week then what? Even if the patient is discharged it is not like we won't see the same patient back next week or month for the same thing.

Medication non-compliance is real. Psychiatry is a revolving door. I wish this were not the case or there was something else I could hang my hat on. But so far that is all I've got.

I only have two weeks left. And it is bearable but not exactly fun. Now the admission notes and discharge summaries just feel like scut work. Write this. Dictate that. Go talk to a patient that is laying in bed naked and refusing to take any medications or put on any clothes or eat any food. Wait for said patient to decompensate to point of needing IM meds or become so dehydrated or hypoglycemic that she qualifies for medical transfer. Type up discharge summary for transfer. Repeat.

Did I mention, I only have two weeks left? But on the upside I do have a whole entire weekend (off) to study in NYC so I'll survive. One latte at a time. Maybe I need to be bribed just like my patients. Oh my...

the good, the bad and the crazy

 -day 4 and so far inpatient psych is

good - I have a wonderful attending that let's us pretty much do everything. Admission notes, interviews, MMSE, discharge summaries, etc. Some of the other teams are still on "needs supervision" to talk to their patients or write a progress note but we have full reign which I appreciate.
- Our weekly lecture series is going to be great if today is any indication. There is a full time pharmacist that works on the unit and he gave us a great lecture on antidepressants today. Yay for learning pharm!
- I have a favorite pt that likes to compliment me in another language and dances in his wheelchair whenever there is music or mention of the same. You can't be sad when your pt is dancing in his wheelchair.
-Did I mention 9-5, no weekends, no call?

bad - Psych is depressing. Pt's have no insight, poor hygiene, hear voices and scream at you. Treatment is medication (sometimes forcefully) and structure. But a reading room without books and a place that smells like urine half of the time is not exactly my cup of tea.
-I hate the old fashioned keys needed to get into anything on the unit. The entrance is key coded but the rest of the until requires keys. And of course none of the keys fit well so it can take 5 sec or 15 min to open a door. We have computers that are fingerprint access enabled but we need a key to get into the nursing station. Does this make any sense?

crazy-  enough said. Stories will follow.

Pscyh, The Big Apple and Life as I know it-

So, today will mark day three of psychiatry. I'm at an inpatient geriatric psychiatric hospital so my experience is thus limited. However in just the first two days I've gotten to see and do quite a bit and my schedule is strictly 9-5 with no call or weekends so I'm not complaining. And of course I'm in NYC so I'm going to live up these next six weeks.

Museums, broadway, apple picking upstate- check, check, check! Shopping, eating out at super yummy and fancy restaurants, fun runs in Central Park- Yes, yes please and sign me up!

In any case. I'm back in THE City and I'm ready for whatever, whenever and lots of it. And I'm pretty sure psychiatry will keep me entertained during the day at a minimum. Bring it!

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!

Revelations!

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.)

My happy/celebrating patients...

Best news ever?
-How about telling a patient (and her family) that she doesn't have breast cancer. The biopsy was negative and the mass is benign. Yes there was a party in the clinic and yes I laughed and celebrated with the patient. And yes, I got to tell her the good news myself.

2ne best news ever?
-One of my first patient's from neurosurgery, a patient that was at one time in a drug induced coma -went home. I thought he was going to die, but despite the complicated surgery, new-onset seizures and hospital acquired pneumonia he somehow got better. Medicine is amazing!

My crying/scared patients...

Waking up from surgery can be scary. I have never had major surgery but I imagine that waking up in an unfamiliar room with what seems like a million people staring at you musts be a little unsettling. Today my patient woke up and she looked scared. I met her last week in clinic when I did her H&P and I had talked to her before the surgery so she knew that I would be present in the OR. She was having an elective surgery and the complication rate is low. She did well during surgery but it was slightly more difficult that anticipated and so her lengthened surgery status earned her an overnight admission. I held her hand as she woke up and her eyes told me she was scared. I went with her to recovery and told her that we would be keeping her overnight for observation. Or maybe the nurse mentioned this to her, but in any case I had to explain it to her. She didn't want to let go of my hand so I offered to stay. For half an hour I stayed by her bed and answered questions about her surgery. I tried to reassure her and I offered the only thing I could think of my time and my self. Eventually I tracked down the attending to come reassure her and I continued to check on her throughout the day. She will be fine. I was told by a resident that I wasn't acting like a surgeon. But you know- I am okay with that.

Being newly diagnosed with cancer. Being alone in the the hospital over a Holiday weekend. Being in pain. These are depressing things. So understandably my patient was minutes from tears when I entered her room this morning. She felt forgotten about. A simple procedure and biopsy of her mass were put on hold over the long weekend. As she talked and cried I offered her a tissue and she said they were bigger and softer the the hospital issued ones. She most likely has terminal cancer (and she knows this) and yet she thanked me for giving her a kleenex and listening to her. As a medical student I don't have much power, I can't make decisions and my knowledge of actual important medical information is tiny. But I can provide kleenex, hold a hand and lend an ear. Maybe these aren't behaviors of surgeons but they sure make me feel like I'm doing something.

Today was one of the most fulfilling days I've had in surgery. I went to the OR but it wasn't what I did in the OR that I am reflecting upon, it is all of the stuff I did beforehand and afterwards. Patients by their very nature are going to be scared, anxious, neglected. Isn't it our job as physicians to notice this and do our best to help them cry, accept and move on? Isn't it our job to comfort them?