Today I am trying to fit New York City appropriate clothes into a suitcase so that
tomorrow I can fly across the country in preparation for my psych core that starts Monday.
Life is busy. I will update soon, promise!
9.23.2011
9.11.2011
"for the dead and the living, we must bear witness." — Elie Wiesel
Today a patient died. I met him in the ER just five short days ago. At that time he was talking, breathing, living. But then he got sick.Very sick. And surgery and medicine and a stay in the ICU could not fix his failing organs or return him to health. His family watched in disbelief as each day he got sicker and sicker... And today they had to say goodbye.
As a doctor in training I am privileged to be with patients all stages of life and sometimes even death. Today is a day to remember and as such I am reflecting on all the patients that I have met whose lives I glimpsed before they were over. I will remember... the smiles, the jokes, the lives of my patients.
I will remember them because to remember is to bear witness, and this is something I can do.
---
This day in September, ten years ago started normally enough for most people. Preparing for work, boarding a plane, going about their day to day business... no one knew what unimaginable things the day would bring. I was in Boston at college, in class and not privy to the first tower being hit.... but as the news started to make its way around campus and throughout the world my would be husband came to meet me and as class ended I walked out to see him standing in the hall, waiting and in the instant I saw him, I knew. I didn't loose a family member and I only vaguely knew people affected by the attacks, at least at that time.... However we later moved to NYC and then I met countless people who had been there, witnessed the towers falling, walked over a bridge to safety or fled the city afterwards. I know families that decided they could no longer live in NYC and I know people who never-not in a million years- considered leaving.
New Yorkers have solidarity when it comes to 9/11. So today I partially feel like I'm on the wrong coast.
People still talk, people still remember, but the events are not quite so raw, not quite so close to home... Of course those that lost their lives on 9/11 were not all New Yorkers. And really it doesn't matter where one is today or where one was ten year ago. What matters is that we remember for those affected by 9/11 and especially for those who lost their lives.
It has been a decade, but we still remember. It is one thing we can do.
8.31.2011
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!
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!
8.20.2011
"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...
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...
8.16.2011
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.
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.
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