Not quite dead yet

Surgery is going OK entering the 4th week. I've come to realize that I've had my head up my ass for the past 3 weeks and was putting my energy into the wrong areas. Now I get to spend the next 5 weeks trying to make up for that...hooray. I've got a few half finished posts that I'll finish and put up some time in september...but for now the beatings will continue until morale improves.

For the unofficial Blogger record, I was in the hospital for about 90 hours last week as a medical student...you can imagine what the resident's lives are like!

Oh and I'm probably colonized by VRE, MRSA, TB and C. diff at this point. If I don't post in the next week or so, no worries...i'm in the ICU with IV abx.

The hidden curriculum of medical education

On the surface, medical education appears to be a fairly simple venture: with deductive reasoning, apply a heap of basic/clinical science in the venture of diagnosing and treating disease. Sounds easy enough once you have 6 years of post-secondary education under your belt, and have been selected from the heap of bright people throwing their applications at American medical schools, right???

Like so many things in life, numerous other things get in the way of that plan. Like chief residents who are too busy to acknowledge your existence because they are busy holding the hospital together. Like interns who disappear half way through the day because they're post call and have to attend to the human weakness of sleep. Like clerkship coordinators who are too disorganized to schedule a doctor to run a mandatory lecture and leave you sitting around for 45 minutes while they "work on it". Like having to break scrub in the middle of closing a patient for a BS preceptor meeting that you skipped the day before and having the resident you were assisting give you crap because of it for the second day in a row. Like having to make 3 different people aware of the intimate comings and goings of your every second of every day with the reprisal of a dirty look and sarcastic comment during a 10 minute lunch break before having to wait for the mandatory conference.

There is a hidden curriculum within third year medical education, where you are the lowest
person on the totem pole. Where you are wrong, almost no matter what you do. Where happenings that are beyond your control are assumed to be your fault. Where you must ask to ask a question, and then ask your question. Where you have no true goals defined for you, no defined schedule, no defined role, but have a series of unwritten expectations that are being continuously evaluated silently by your superiors...to be placed in your record and follow you around for the remainder of your life.

If you couldn't guess from my sunny disposition, I had a rough day where I stood around for too long, probably made some bad impressions with my actions and have fucked my evals up. Nothing bad happened, no one said anything to me, but I just feel like I'm making an ass out of myself while I stand around in the hospital and do nothing for hours on end. But when I'm busy and have a required activity, I get crap for having to go to it. Firmly planting my foot into my mouth at least twice this week with one of the chief residents didn't help...so when he informs everyone in the program that I'm an ass, that's probably not going to be good for my grades either. Working around miserable, tired people without a lick of positive feedback has sapped my energy and made me more critical of myself...but guess who gets to spend another 13 hours in the hospital again tomorrow with a smile on his face and a positive attitude? Yours truely.

Board scores came out today...I was at the national average, which is what I expected. It would be nice to make myself stand out this year, but it's probably not going to happen.

PM&R in Alabama is looking like a true possibility... here I come!

Surgery Experience- Week 1

I'm post call right now and have an ENTIRE weekend to sleep, read about my patient (singular) and every other patient on my team's census and possibly even meet up with my family for a few hours!!! I had the first 24 hour call of my hospital's surgical clerkship for the year. I got to see some pretty complicated surgical cases down in the ED and to watch one BS trauma work up, but then I got to watch the residents on call yell at peds nurses, and then sat around reading Surgical Recall from about 2-4:45. I slept for about half an hour and got permission to leave half an hour early since NOTHING was happening in the entirety of the hospital.

As I alluded to a few days ago, I'm discovering that the hospital is a horrible place to learn how to be a doctor. I say this for a number of reasons:

1. I was given a set of expectations from my clerkship director that apparently only I know about.
   
2. My clerkship director's expectations differ from my preceptor's expectations, which differ from my chief resident's expectations, which differ from my intern's expectations, which differ from the expectations on other teams as well as from that of the teaching resident on call. I have approximately 20 bosses and no defined job description!!
   
3. The words "educational opportunity" is loosely defined as "get the fuck out of my way and go watch X with Dr.Y in the Z" where X, Y, and Z are unknown variables. By the way, if you have not defined X, Y and Z on your own, you are worthless. Thank you janitor for pointing me to OR10...you saved my self esteem for the next 10 minutes until I was pimped again...by the anesthesiologist.
   
4. Trying to get caught up on your work as a surgical intern is a lot like being a dog trying to chase it's own amputated tail. You go around and around and around and around but you'll fall over from exhaustion before you catch it.
   
5. I don't want to be an intern...but it's about $180,000 too late for that one. I've been asked exactly 5 times if I'm sure that I still want to be a doctor...how's that for job satisfaction
   
6. Being pimped in the OR or on rounds is rather benign because it serves a purpose. Unless you're the intern presenting morning sign out at your 24th hour in the hospital with 6 more hours of catch-up work before you can go home and your chief resident is angry at life.
7. My feet hurt.
8. It is possible to wash your hands for 5 minutes straight.
   
9. Don't fuck with the pancreas.
   
10. Eat, sleep, pee and blog when you can.

I don't want to like surgery, but surprisingly I'm having a good deal of fun on surgery...but the novelty is starting to be tarnished more than a little bit. I've scrubbed on 3 cases and gotten to do some fun stuff on my service, but I've never felt more useless in my life. All I can really do is try to be enthusiastic and work hard enough to live up to the expectations of everyone above me, which again are rather nebulous. I've only been scolded like a child once in the past four days, so I'm doing better than I thought I would.

My plan is to get up to speed this weekend on what I should know for my service and then to actually define my place next week, if I'm not reshuffled onto a different team again by one of the chiefs. For now...my bed is calling

Figured out where I stand...

Tuition to east coast medical school: $45,000/year
Inflated NY cost of living: $20,000/year
Books, supplies, etc: $ 1,000/year
Years of higher education: 4 undergraduate, 2 medical

Realizing that you're at the absolute bottom of the totem because meticulous details laid out in your your orientation were wrong thrice, you were ignored by every nurse in the hospital while trying to remedy the SNAFUs and it took one attending about 10 calls to various residents to find someone to teach us to scrub in after a nurse reamed him a new one:
Priceless

Some things in life money can buy, for everything else there's surgery.

And so it begins

In about T-8 hours, I'll officially begin third year. Not going to lie...I'm a little nervous because it's surgery and I'm still a bit hazy on exactly what I'm supposed to do on a daily basis. It seems to be a learn as you go sort of thing, so that looks like the plan for now.

Anyway, I celebrated my nation's independence from the land-grubbing Brits with copious amounts of alcohol, unhealthy food and precious little sleep. I'm quite relaxed, but about 3/4's of the way to my first MI...I think my cholesterol is pushing 400 right now.

I'll let you know tomorrow how orientation goes