Then I woke up

The verdict is in. The worst part of being a third year med student is the getting yelled at part.

Let me rephrase. The worst part of being at the absolute bottom of the totem pole is getting a whole bunch of crap crapped on you, and having to sit there, smile, and take the abuse.

Especially when you totally don't deserve it, because you didn't do anything wrong.

Yeah. If you couldn't tell, today was not a good day at the hospital.

I have a patient who gets her blood drawn every morning at 4am. Yes, she gets woken up every morning at 4am for her blood to be drawn so that by the time the medical team gets to the hospital, results will be waiting. That way, we can figure out our plan of attack for the day.

For the past two weeks, those results have always been there. And my patient is a very smart lady, so every morning when I go see her, I bring in her daily results, and we sit there and add another data point to her growing graph.

Today, there were no results at 6:30am. There were still no results at 7:03am when my intern walked in the door, no results at 7:29am when I left for morning report, no results at 8:35am when I came back from morning report, and no results at 9:15am when we were standing outside her door as I updated the team on her condition before we went in to examine her.

ME

Good morning Ms. Prince!

PATIENT

Hey there Michelle - is my bloodwork in yet?

ME

No, it doesn't seem like it..but don't you worry - I'll be in and let you know what they are as soon as they pop up on my chart!

PATIENT

Okay...just as long as I don't need that biopsy.

ME

Nope, I think you're good for now...but we'll wait for those results to make a definite plan.

At 11:30am, when rounds finally ended, some of her other lab work started to trickle in. A sputum culture had grown out some stuff, antibodies for a couple of bugs were negative, and some cancer markers had come back negative. But her bloodwork was still missing. So I worked on my notes and waited for stuff to come back. Except it never did. And at noon, I had to go to class.

And at 2:45pm, right before class ended, my pager started buzzing.

Patient's husband found blood tubes in room - apparently never sent to lab. Btw, family very angry with care team. - Nurse

Oh shit.

So there was lots of yelling over that. Even though I had absolutely nothing to do with blood draws and making sure those things got to the lab. Apparently I should be checking under beds and in bedpans for vials of blood. Who knew?

Then, later that evening, because the aforementioned patient had fired her Infectious Disease team, I had to call and arrange for the other ID team to come see her.

ME

Hi, I'm calling regarding a consult for Ms. Prince.

MEAN RESIDENT

This better not be about treatment, because you know you can look that stuff up right? Don't waste my time.

ME

Oh no sir --

MEAN RESIDENT

Sigh. What's the one liner on her?

ME

She's a 55 year old female with a past medical history of leukemia presenting with fever of unknown origin.

MEAN RESIDENT

She had leukemia?

ME

Diagnosed in 2000.

MEAN RESIDENT

IF SHE HAD LEUKEMIA, YOU CONTACT THE OTHER TEAM, NOT ME.

ME

Oh, see, the thing is, she fired --

MEAN RESIDENT

[dial tone]

Fabulous. So then I went back to my team room to finish up my notes, and my intern - as he was leaving - remarked slyly about how the recycling bin was getting awfully high and that it ought to be taken out...by a med student.

So knowing my cue, I got up to go empty it out.

Only, the new interns had thrown their lunch and gum and other sticky things into the bin.

So I stood there, throwing away the papers coated in cottage cheese into the trash, and feeding the others into the Shred-N-Recycle bin.

SOMEONE IN CHARGE OF SOMETHING

Are those patient files?

ME

Yeah.

SOMEONE IN CHARGE OF SOMETHING

Why are you throwing those into the trash? They need to be shredded. Privacy rules, you know.

ME

Yeah, but they have food on them and I didn't want to mess up the shredder.

SOMEONE IN CHARGE OF SOMETHING

So you'd rather have patient information be leaked?

ME

Well no...I'm sorry, I'll put them in the shredder bin.

SOMEONE IN CHARGE OF SOMETHING

Ah, finally a smart idea! Maybe your first!

Then I stand there trying to rip just the piece of the paper with gum on it off, and feed the rest into the shredder. And he finally walks away.

SOMEONE ELSE WHO THINKS THEY'RE ALL THAT

WHAT are you doing?!?! There's FOOD on that!

ME

I know I know...but I'm trying to rip off just that section...

SOMEONE ELSE WHO THINKS THEY'RE ALL THAT

You're going to ruin the machine. Sigh. Please. Stop. Just step away please.

There was no winning this battle. I ended up shredding it myself with a pair of scissors and I scattered them among 3 trash bins. Hopefully that was enough to appease the higher-ups.

Ugh.

Like I said, it wasn't a good day at the hospital.

The thing is, I had been loving it up until today. I get lectured at every day, but it's typically about stuff that I can be doing to improve patient care. Constructive criticism. Slow down when you're talking. They still have a PIC line in? Uh...that's high risk for bacteremia. You probably shouldn't give a patient a whole bucket of ice chips if they're NPO.

But today? Today's lectures were unnecessary. I didn't need to be lectured at as though I were a five year old - [sing-song voice] So then, after blood work is drawn, what do you do? Yes, you put the label on it...good girl.

Especially when I don't even do that stuff.

I keep waiting for someone to pinch me and tell me that today was just a big bad dream.

The remedy (I won't worry)

On the wards, the only way a medical student can really impress an attending is via the oral presentation.

Every morning, I try to get to the hospital about an hour before the rest of the team arrives, so that I can run around and try to find the overnight nurses for my patients and get the inside scoop from them about things that might have happened to our patients. Fevers, desperate pleas for pain meds, or even stuff like frequency of bowel movements.

Yeah. The life of a medical student. It's real glamorous.

Anyhow, after we get all that info, we go into the patient's room to see how they're feeling, and do a quick physical exam, to make sure there weren't any crazy changes to their heart rate or lung function since we've last seen them.

Then, we ROUND.

At first it's fine. I normally stand in the back of the crowd, nodding my head as the team visits new patients. And then, before I know it, it's my turn. My turn to present. And I stand there in front of five people who definitely know way more medicine than I do, and probably know that all this information I'm giving them is just stuff I'm regurgitating from the article I read last night.

But, if you can stand there, using big medical terms and exuding confidence, without having your knees knock together, you'll get high marks. Even when you're sweating like a pig and have no idea what you're talking about.

After all, you gotta fake it til you make it.

Yet, for some odd reason, no matter how many times I practice or how many articles I read, my oral presentation always degenerates and turns into a three minute comedy routine.

Yesterday, I admitted a homeless man with severe anemia. He didn't have any obvious trauma or bleeding sites, so we decided to send him for a colonoscopy. So this is what I presented:

Mr. Carlson is a 53 year old man who presents with severe anemia. While there were no adverse events overnight, the nurse reports that the patient was resistant to his overnight colonoscopy prep, alledgedly throwing his goly-tely down the toilet instead of drinking it to clear out his system.

Here, my resident cracked a smile. But I continued.

His vitals were stable overnight and physical exam is unremarkable. So for today, the plan is to consult the floor pharmacist and see if there is a suitable pill form alternative to goly-tely.

Here, my intern stifled a giggle. But still, I continued.

After rounds, I intend on going back into the room to discuss the importance of goly-tely to the patient, and will consult GI to see if we can reschedule his colonoscopy for later this afternoon.

Effectively at the end of my presentation, I paused and held my hands behind my back, proud that I had been able to memorize a presentation in front of my attending - the oral presentation master. Heck, I did a pretty good job, I thought.

At the end of all of our presentations, my attending would discuss our plan for the patient (such as whether or not he agreed with the colonoscopy), pimp us on all things related to the patient (in this case, everything you should know about anemia and more), and then critique our presentation and tell us what we could do better tomorrow.

Well, I think a colonoscopy is definitely needed in this case, since we can't find another site of bleeding. And while your presentation was good, I think the patient might be more amenable to the GoLytely if it were pronouced as such, and not goly-tely.

The team burst out laughing.

And I blushed so red, I could take over Rudolph's job for Santa.

Goly-tely. GoLytely. So much for trying to impress the team.

At least I've never mispronouce it ever again.

Free falling

That's not my name

ME

How was your night out yesterday? Are you making new friends? :P

J

Eh, it was okay.

ME

Find anyone to replace me and Lisa yet?

J

Who?

ME

Ha. Ha. Ha. You think you're so funny.

Keep breathing

I can't believe it's been a week already. And another part of me can't believe that its only been a week. I am definitely not the same med student I was a week ago.

I started working in the hospital last Monday on the inpatient medicine floors.

People who have gone through this already talk about how this is similar to being thrown into the swimming pool to learn how to swim, but wow. I wasn't learning how to swim, I was trying to figure out how not to drown.

Like I said, my first day was Monday. But what I didn't know, until I got to the hospital on that beautiful Monday morning, was that my first call day was also Monday. Meaning that my team would have to take care of the bulk of new patients being admitted into the hospital. Meaning that while everyone else got to spend their first day getting to know their team of residents and interns and figure out protocol for different things, I got to meet my team in 5 minutes, listen to an outside hospital's report of an incoming patient in the next 5, and then run off to meet the patient to get their story, because there was no time for how do you do's and a cup of Starbucks coffee. So while everyone else was getting to dip their toes into the water, I was getting pushed off the diving board.

Problem is, I don't know how to swim.

But there was no time for self-doubt, so I ran off to meet my patient, running through my history and physical template in my head - she was complaining of chest pain Michelle...don't forget to ask about onset, location, duration, characteristics, aggrevating/alleviating factors, radiation of the pain, self-treatment - and everything I possibly remembered about cardiovascular disease, which in that moment of stress and anxiety was...well, not much.

I took a couple of deep breaths outside the room, trying to get my heart rate to stop beating in my ears, and then after plastering a fake confident smile on my face that belied how I was truly feeling inside, I knocked on the door and walked in.

Hi! I'm Michelle and I'm a third year medical student, and I'll be taking care of you today.

Sweaty palm met sweaty palm, and we were treading water. I could do this, and my confidence in the past two years of classes on patient communication and physical exam skills returned.

Until I finished my spiel and she looked at me and said, "Espanol?"

No, no espanol. None at all except for me llamo Michelle and no comprendo, which I repeated about ten times as she tried to tell me her story.

But all's well that ends well. Her son walked in the room five minutes later and told me the gist of what had happened, and was able to translate questions and answers for us. Yes it hurts when I breathe. No I wasn't doing anything, I was sleeping. No nausea or vomiting, but I was sweating. No, the pain hasn't gone away. 8/10 on the pain scale - giving birth to that one was worse.

In the end it all worked out. She had pneumonia, and so we kept her for a couple days to figure out what it was, and then treat it, only to find that diagnosis was wrong, send her for another procedure to figure out what the true diagnosis was, treat that...and then yesterday, she was finally discharged.

She had been in the hospital for exactly the same amout of time that I had been.

So today is my day off. My day to recharge and study frantically only surely to get all the questions asked of me wrong. And then tomorrow, I go back in and start this whole process all over again.

Stars and stripes forever

Season of a lifetime

It's been one week since I've become an official third year medical student. One week.

But because of this week, I am now equipped with all the tools that I'll need as a third year. Supposedly.

This week I learned how to access patient charts and put in orders. I learned how to place an IV and draw blood. I was taught the minute details and changes to the oral presentations that the various rotations require. I was declared to be tuberculosis-free. I practiced how to put foley catheters in male and female pelvic models. I finally received my shiny new badge, and my own personal pager. We had lectures on how to read xrays and learned how to write the perfect history and physical.

And tomorrow, I'll recite the Geneva Oath all over again, and receive my brand new white coat. Still short to signify my bottom-of-the-totem-pole status, but now embroidered with my name! Yes!

I would say that I can't wait, but I kinda can. I can wait, and I wish I could wait.

And that feeling? It doesn't make any sense. Technically, I've been waiting for this moment for a long time. I've groaned and whined about it for the past two years, complaining about things like 'if it's an outdated drug, why do I need to know the side effects? It's not as though my patients on the wards are going to be on it.' Furthermore, this is the cliched reason why we all came to med school. Not to study medical textbooks for two years, but to help people. To care for patients. Real patients.

So why is it that three days before the official didactic-to-clinical transition, I feel totally incompetent and want to run in the opposite direction as far as I can? And as fast as I can?

I'm guessing it's just fear of the unknown. When I step into that hospital on Monday morning, I will have no clue what's going to happen. No idea if I'll be given a heart attack patient or someone with pulmonary emboli, or maybe someone with just some abdominal pain. And because of that, I can't really prepare. And so it's fear of not knowing how much I'll know and recall in the spur of the moment. It's fear of not knowing how confident I'll be in coming up with a differential diagnosis, or placing an IV. It's fear of not knowing if I'll be putting in catheters correctly. It's the fear of not knowing if my inherent awkwardness will be laughed off by patients. It's the fear of not knowing how to act in my bottom feeder role.

Being in the hospital as a second year student was fun. I got to shadow an attending and see patients, and it was fun and exciting. Because I was a shadow. I knew exactly what I was supposed to do, who I was supposed to see, and what I was supposed to say. It was easy, because I just parroted whatever my attending did.

And now it's all gonna be me. No more training wheels. No more bumper guards. No more practice runs. It's all me.

I just have to trust in my education. Trust that I learned a lot these past couple of years. Trust that I have the skills. I just have to trust myself.

Technically, I've been taught everything that I'll need to know. I just need to review it. Practice it. Use it.

I can do this. Because everything in my life has been leading up to this moment. To this transition. And so, I can do this, because I have the tools and the knowledge base to do this.

Supposedly.