Finally LEARNING medicine

Up until this year, medical school has been a long series of arduous memorization tasks with the ultimate goal being passing an exam at the end of the course and moving onto the next exam and getting into the hospital. Then you get onto the wards and you're stuck trying to figure out how to write a note on one patient while your team has rounded on about 30 others. Slowly over a few days you figure out how to get things done and you get comfortable in that role...but then it's over and you're onto another service or specialty and essentially back to square one.

So much of third year of medical school has been an absolute waste of hours. It's incomprehensible to anyone that hasn't been through it that I could complete a total of 20 minutes of work in a day and do nothing else with the remainder. On surgery, I'd stand around in the OR holding a retractor for three hours staring at the back of someones shoulder because it was an interesting case just to spend 10 minutes writing an op note. I spent peds writing the same note on the same patient every day for a month straight. I've stood around for hours on rounds talking about the consistency of patient's stool, phlegm, nasal discharge and every other bodily fluid just because there's a teaching point burried beneath the pile of excrement. I've introduced myself to the same demented little old lady every day this week, and said goodbye as she begs me not to leave her...breaks my heart every time still. Today was the perfect example of medical educational inefficiency: 8AM-8PM Sunday call...I wrote 2 notes and one admission note, ate 2 meals, had 4 small cups of coffee and stood around watching my residents enter orders, answer pages and take admission histories for about 10 hours. Atleast my new team throws around some decent pimp questions that are clearly worded in English and logically extension from the discussion we were having on the patients...so I atleast feel less frustrated.

A funny thing is starting to happen though, something's starting to click. I'm able to answer a good portion of the pimp questions, I'm nailing down my treatment plans for alot of the more common ailments and I'm actually able to keep up with the majority of the discussions. Moreover, I feel like I can pick out and retain the pertinent parts of a history without forgetting anything too huge. I finally feel like I'm a part of the team rather than a lead weight dragging the whole process down. While I haven't really mastered my differentials, nor have I been allowed to see patients on my own, I feel like I'm getting to the point where I have a level of knowledge that allows me to eventually operate as a bumbling sub-intern.

Unfortunately, I'm going to be that bumbling sub-i running around the EDs of programs that I want to match in JULY...a mere 8 weeks away. Crap...this is all coming up waaaaay faster than I thought it would. Before you know it, I'm going to be Dr. Bostonian, PGY-1 EM resident...::gasp of horror::


Medicine...the last frontier (clerkship)

I've been in the hospital consistently since July 7th of last year...and now 5 weeks into my medicine rotation and I'm ready to gouge my eyes out with my stethoscope (I'll find a way). It seems that the more I grow as a medical student, the more I stay the same.

It's not that I'm disinterested in the material, I'm just burnt out. There's only so many months that I can go through the motions of writing patients' notes without actually synthesizing any of the decisions contained within them. Sure they let me throw in my 2 cents with regard to diet and how I think the patient is tolerating their treatment and what the lab results mean...but in the grand scheme of things, the residents do EVERYTHING. That includes saving the patients from horrible attendings who may be actively trying to kill patients (if it weren't for the Hippocratic Oath...sometimes I wonder whether they really knew what they were vowing).

Truth be told, I actually am enjoying medicine in terms of the breadth of patients that I'm seeing and the opportunity to finally flesh out my basic medical knowledge. But rounds are possibly the most painful exercise invented in the history of man. I mean really...why do I have to see the patient if we're all going to then go visit him a few minutes later and find the same findings that I did and repeat the same exact exam that I did and come to the same conclusion that I presented to you because it was what we said the plan was yesterday.

And to make things worse, why are you pimping me during hour 11 of my 12 hour weekend call day, in the middle of the emergency department on differentiating pre-renal and renal azotemia in the acute setting? No I haven't gone over the causes of acute renal failure yet because half of my patients chronically run a BUN in the 70's and a Creatinine in the 4's. Yes, this is the first healthy patient that with acute renal failure that I've ever seen that may have a slim hope of recovering function. no I still get mixed up calculating FENa ((Una/Sna)/(Ucr/Scr)???). Oh yeah, asking your indirect and vaguely worded question in broken English is not making life easier for me. Yes, I'm still going to say "I don't know" because I'm a third year medical student and I really haven't ever encountered alot of things in my clinical career because my clinical career has only been months long. And yes I still hate the kidney...despite my attendings insistance that all medical students love nephrology because it makes sense. I'm sorry, when you have 4 types of RTA numbered I thru IV where IV is not actually a tubular problem and type III is as common as a unicorn, I have already given up hope because so have most nephrologists. Sure I'll give a presentation on monday...it's not like I had other plans for my sunday like catching up on my write-ups.

Anyway, I have no idea how I'm doing thus far and I'm living for my one-week vacation before I start up with my Massachusetts-based EM electives this summer. Oh the little things in life that get me through the hours of standing there staring off into nothingness trying to look interested. ...:).

Fun with old ladies

I have a strange talent. Now I'm not going to pretend that I'm a sex symbol or anything, but old ladies seem to like me. We're talking the butt-pinching, candy-giving, giggle-inducing kind of old lady crush that I'm hoping other male medical students have induced. It must be my towering 5'8" physique with the 158 lb recreational distance runner/beer drinker buld...gets em every time. Generally these cougars are something around age > 65 and/or BMI > 40. Yeah...I'm a stud.

We had the crotchetiest old woman on our service who hated EVERYONE...my residents, my attending, the nursing staff, the food-delivery people...everyone! She kicked my resident out of the room the morning before when he went in to say good morning. The nurses put her on contact precautions so that everyone would leave her alone...I think she had C. diff in the 90's, but wasn't a really compelling case. Of course she was old and obese...s/p gastric bypass 2 years ago. Lo and behold, my married, male resident is talking to her about her medications while I'm in the room.

Old Lady: Well I'm not taking the plavix AND this blood thinner...they do the same thing!!
Resident: Well...not exactly, the lovenox is prevent you from getting another PE like last time you were here and the plavix is for the stents in your heart.
OL: I don't care I'm only taking one!!!
R: Ok then, but we need to put some other sort of DVT prevention...will you wear the thromboguards?
R: Ok, I'll go put in those orders in
::we both head towards the door and start pulling off the isolation gowns as quickly as possible to move on to the next patient::
OL: Dr. Bostonian...I didn't say that you had to go (with that creepy trying to be coy/seductive voice)
::shudder...swallow vomit...try not to laugh out loud...turn to face her::
Bostonian: Can I help you with anything Mrs. OL?
::I can hear my resident outside running down the hall to tell the rest of the team::
OL: I just wanted to talk to you for a bit...are you married?
B: Nope, but I have a girlfriend. She's a lawyer.
OL: That's nice...blah blah blah...stories about when she wasn't sick or morbidly obese...try to not look at the clock on the wall that says I have 15 minutes to see my other 2 patients before rounds...now isn't that a hoot?
::Smile politely...swallow vomit again because it really smells like C. diff in here::
B: Alrighty Mrs. OL, I have to get going to see my other patients, but I'll stop by later to say hi
::Move quickly towards door and hope to escape unscathed::
OL: Bye Dr. Bostonian...I can't wait to see you later...

Anyway, it happens time and time again on this service. Today I got some candy from a 73 year old who wanted to talk to me about my plans for having children in the future...uggggh. Atleast if I moonlight at a nursing home, I'll do alright...;)


Don't believe everything you read

Dictations tend to be rife with errors in the midst of the technical and precise language used to create a historical record of a patient's health care and to bill insurance companies for services rendered. I actually laughed out loud when I read this one today

Past Medical history:
"blah blah blah....and the patient is deceased. blah blah blah."

Um, no he's not. He's sitting here in the ED on a stretcher very much alive. I just talked to him like 2 minutes ago.

PS-and to drum up hits: Swine flu, Tamiflu, H1N1...that ought to get the hit counter spinning. More to come.