This morning was a whirlwind of surgical experience minus the part where I scrubbed in for every operation and ended up touching nothing but my own hands in all of them. I did get a little more used to the way the operating room works with all of its crazy rules. I had less awkward moments, slipped my hands in a few gloves properly the first time and only got scolded once for almost touching something that was not sterile when I was sterile (to be fair, I wasn’t going to touch it all, I just put my hand near it, and it was a piece of surgical cloth so I didn’t think too much of it and the surgeon wanted it moved so he could see a monitor and I can never freakin figure out who he’s talking to in the OR with his surgical mask muffling everything anyway).
I like lists so here are the surgeries in order:
1. I don’t know what it’s technically called but what happened was, four months earlier this woman was defecating out of her vagina (crazy!!!). There was a fistula (unnatural connections of two organs) between her colon and vagina so my LCE surgeon separated the two, ran some tests to make sure nothing else leaked in her GI tract, then essentially pushed a piece of her small bowel through the wall of her abdomen so that nothing could get past it anyway. So this woman didn’t poop for four months (don’t ask me what happened to all her poop during that time, I have no idea). Then today, the surgeon undid what he did to the small bowel in the previous surgery and pushed it back inside of her belly so things should work properly again.
2. A standard gallbladder removal. This time I knew a thing or two about bile ducts because I had studied them over break but I wasn’t prepared to recall all of the arteries and what they were branches of. But still, the pimping wasn’t too bad in this one. Sure I felt dumb but not too dumb.
3. Total thyroidectomy (a removal of the entire thyroid). This was a surgery I had never seen before and even though I had studied the thyroid the night before, the surgeon hammered me with questions that I didn’t know the answer to 9.5 times out of 10. I felt really, really dumb. But I also felt like some of the powerpoints I studied contained different information than what the surgeon said for some things so I partially felt cheated. But mostly dumb. I need to brush up on every artery in the human body apparently. This surgery was a lot different than the other surgeries I had been in on the account that everything was so small. It seemed like the surgeon was putting a pound worth of metal staples into this lady’s neck to clamp off all of her vessels. It took longer than the other operations and everything was so hard to see (especially through the fog on my eye shield) that I almost got nauseous. I welcomed the early exit I was able to make when the surgeon told me to follow the pathologist back to his lab and examine the thyroid under the microscope.
In between all of this, I made mini-rounds with the surgeon during which he expounded greatly on the history of surgery, telling tales of the cocaine snorting, cold war fighting, fathers of surgery and the advent of cat gut sutures, staple guns and rubber gloves.
Despite all his demanding questions and remarks about how he delivered 30 babies in his third year of medical school and performed an appendectomy in his fourth effectively making me feel like a future failure, the surgeon was kind enough to show me how to tie knots for sutures for a little bit. Granted, the guy is a machine when it comes to tying knots. They’re as natural to him as turning a door handle. So I couldn’t really follow his method of doing it but I did remember a little bit of the method I learned after the suture clinic I took a while back. I also scored a couple suture kits of my own to practice with in my car.
At the end of the morning, I honestly couldn’t wait to get out of there. The more I do general surgery the more I find myself missing pediatrics. LCE definitely isn’t my favorite part of the week anymore. I’ve always loved surgery but if I had to do it 24/7 like this, I don’t know if I would love it anymore. I miss seeing kids on a regular basis. Even if the medicine was less interesting.
I’m exhausted.
December 2010
30 posts
November 2010
31 posts
Today we hit the ground running with six hours of lecture on female genitalia and the proper ways to examine them for disease. I can’t say it was enjoyable. I feel bad that women have to go through all that we put them through in order to make sure they are healthy. I’m glad that the penis is external and that there is no need to stick giant metal contraptions in there to see if it’s diseased or not. Wednesday I do my first vaginal exam on a real woman. I feel bad for the woman.
We had another CPS session today in which we determined that the patient had exactly what we discovered she had at the end of the last CPS session. So it goes.
Editing is so frustrating. Especially editing video. There’s so much that I want to do. So many small technical pieces of knowledge that are holding me back. I hung out with my friend Trey tonight and tried to get some music software to work. It wouldn’t. I am having all kinds of bad luck with technology lately. The only successful thing that happened was that Trey taught me how to play “Hallelujah” by Leonard Cohen. It’s a really beautiful song and I’m thinking about covering it with a few friends.
I captured about half a tape of footage of the last Outwatch the Bear shoots that I did on my computer tonight. I figured if I can’t work on The Culprit Life stuff I might as well work on this.
Reading a few chapters of The House of God while waiting in line for black friday shopping. I’m about half way through the book now. Too bad I wont finish it till Christmas break.
Over Thanksgiving dinner, I met a new friend who told me the solution to my guitar recording problem was most likely a device called a tube compressor. I had never heard of it but it’s the first piece of real advice anyone has had to offer for me on this issue so I’m going to do everything I can to get a hold of one.
Polley and I went to the photography museum downtown today. It’s small but they often have intriguing exhibits, especially black and whites. The one we saw was all old photos of people in the city, mostly New York City, black and whites with a lot of detail. There were some urban landscape shots I found interesting as well, but then again, I’m kind of a sucker for those, even ones from the 1920’s.
At night, I saw part 1 of the 2 part, final Harry Potter film(s). The last few Harry Potter films have contained great cinematography and this one was no different. The only thing that was lacking from this film was a true climax and closure but I think the filmmakers did the best job they could considering it is the first half of a single book. The acting was good and the effects were fantastic as usual. I have read all the Harry Potter books and so I was skeptical that this film would even make a good film since the three main characters spend the majority of it simply traveling from camp site to camp site but again, I think the filmmakers did a good job with the material they had and made the plot move along well.
Above Everything
Basically I worked on this all day. It’s a mixed media piece I made for Polley for our one year anniversary. This is only my second painting. You see the thing is, I can’t really paint. But I like mixed media a lot anyway so I use it to my advantage and I think it turned out decently. I used scraps of street maps, a Chinese newspaper, nutrition facts from a cereal box, a museum gift shop bag, old schematic drawings, and the cover of a piece of sheet music for the hills. I used actual sheet music I ripped out of an old book for the clouds and a brown paper bag for the balloon’s basket. The only things that are only paint are balloon and the sun/sky. I like the texture that results from decoupaging the scraps of paper to the canvas. I also like that from far away you notice the basic colors and picture but when you get close you can see the details of the paper I used because I only painted a thin coat of acrylic over them. It’s not a masterpiece but it was fun to make and Polley likes it so that’s all matters.
I finally watched Inglorious Bastards for the first time tonight as a conclusion to my goal to see every Quentin Tarantino film this year. It was funny and gory and generally great. It is definitely his most mainstream film. I think that I liked the actual direction in some of his other films better. For instance, this movie was very linear in its storyline while a lot of the other Tarantino films cut in and out of the normal time line. The characters in this film were just as memorable as anything else he’s ever done though. I’m interested to see what his next feature will be like.
City Streaks
My friends Paul and Valerie helped me take these photos from the corner of a rooftop downtown. I just got a good tripod and wanted to try out some long exposure photography, something I’ve only done for light writing. I liked how these came out. Hopefully I’ll get to do some more soon.
The test this morning was difficult, especially about 20 or so questions toward the end. As predicted, the faculty still apparently don’t give a crap about the computer’s freezing and cutting our time short so I think I lost about 10 minutes because of that. Meanwhile, since the school started construction on the histo and path labs where the other students usually take their tests, they had to take them in a couple of lecture halls which came with their own difficulties. One of them was freezing cold and in the other you could here all the noises from the construction crews working. Plus I heard they could here lecturers for the first years on the other side of their rooms as well. Maybe it’s just me but it feels like the faculty are either utterly terrible at organizing and conducting exams or they really just don’t give a crap about the students concerns. Either way, we’re screwed.
You know how little girls will pick a flower’s petals off one by one repeating “He loves me, he loves me not”? That’s how I feel the last couple of days before a test. I know this. I don’t know anything. I know this. I don’t know anything. I know this. I don’t know anything.
Right now it feels more like I don’t know anything.
Growing up, my father would always tell me that, although he graduated from law school and became an attorney, he had mediocre intelligence. I thought he was being modest. You have to be one of the smartest people in your generation to be in a grad program like that. But now I see why he said that. Going to med school (and I assume law school in my dad’s case) is a huge reality check to whatever bit of self-confidence you have. Being around these people who memorize things by the second time they see them, these people who quickly recall minute facts they learned months ago, these people who find importance in bits of information I never even knew existed, these people who can diagnose a patient when given less than a dozen syllables, being around these people has made me realize that I will be reluctant to ever state I possess anything more than mediocre intelligence. Passion? Yes. Imagination? Often. Creativity? Sometimes. But intelligence? No. Not I. Not unless I’m lying to myself and others. Not unless I’m acting. Not unless I fall prey to an amnesia that makes me forget everything that has happened for the last 16 months.
I believe medical school has vaccinated me against ever contracting that subtle disease of the human heart commonly known as arrogance. If I can one day approach my patients with all the knowledge and nimbleness of mind of one who possesses mediocre intelligence, I will consider my life a success.
I had a fantastic time studying with my friend Amy downtown for a bit this afternoon. She helped me memorize everything I need to know for antiarrythmic drugs. Not bad for a television production major.
Imagination > Science
It’s hard to study when all you’re thinking about is the six day break you’re about to have for thanksgiving. I was recently asked what I wanted for Christmas. The answer to that is more days off of medical school. There isn’t a better gift anyone could possibly give me right now. And I know I’m not the only one in the class who feels this way. Maybe that’s why this thanksgiving seems more like Christmas.
Studying medicine is a funny thing. It makes you see diseases everywhere. Some see them in themselves. Others see them in people around them. Lately, I have acquired a curiosity about the health of my family members. When you study diseases every day with vignettes that feature a 50 something year old man or woman you start thinking about the 50 something year old men and women in your own life. For me, that means my mom and dad and aunts and uncles. Then it spread to wondering what all those elaborate pill cases (you know the ones with the days of the week on them) my grandparents used to have actually contained. Pretty soon, if you even hear that someone you’ve only seen a few times in your whole life has some kind of cardiac condition you start interrogating the one who mentioned it, trying to feel around for a diagnosis through the six degrees of separation.
My dad mentioned to me on the phone tonight that most of the people he knows that are his age are in pretty good shape. I guess I tend to forget that there are a lot people out there, maybe even most, who don’t have some kind of chronic condition or congenital abnormality. Who would have guessed?
We had a good joint review session today where several different people, including some fellow students, walked us through a complete case of a patient who suffered an MI. I thought it was pretty well done. Then I studied in the undergraduate library with some undergraduates. How I envy them.
I felt very awkward. All morning.
Having observed many surgeries in the OR before, I thought I would feel at home. But today, I scrubbed in for the first time and it was a truly uncomfortable experience.
Scrubbing in for surgery includes first turning on a faucet by banging your knee against a big metal basin. Second, you open a package containing a scrub brush and a pick that you use to clean under your nails. Third, you squirt an obscene amount of soap on your hands using a foot pump, lather, and then continue to scrub each finger nail, the front, back, and each side of each of your fingers literally ten times. Fourth, you wash the front and back of your hands and your entire forearm to the elbow. Fifth, you rinse off everything starting with your fingers and ending at your elbows and turn off the faucet by banging your knew against the basin again. Sixth, with your elbows bent and hands up in front of your face, water dripping from them, you somehow maneuver through the big wooden door into the operating room without touching anything with your upper extremities. Seventh, once in the operating room, one of the assistants gives you a sterile cloth to dry your hands, once again, fingers to elbows, one hand then the other, then you have to find some random surface to put the cloth on or get another assistant to take it. Eighth, the assistant will have you stick your arms into the sleeves of a sterile gown that is closed in the front and open in the back. Ninth, the assistant will open a pair of thick surgical gloves for you to put your hand in. They are big and green and you would perhaps feel like a superhero in them if it wasn’t for the fact that every time you plunge your hand into the hole being held open by the assistant, you end up displacing one of your two end fingers into a finger slot they’re not supposed to be in. Seriously, EVERY TIME. So you feel a lot less like the super hero you imagined you would feel like and more like one of the countless dumb minions the super hero has to knock off to get to the real villain. Minion #53. The writer didn’t even bother naming your character for the credits. You feel that dumb.
Tenth, the assistant will now help you into a second pair of gloves; these are thin, white, latex, and no, you can’t get your fingers into these the right way either. Eleventh, another assistant will hand you one of the ties to your surgical gown that contains a little card at the end. This part is tricky. I’m still not exactly sure how this works but somehow you wind up spinning around in a circle with one tie in your hand while the assistant directs you and holds onto the other tie with the card and then hands it back to you when you’ve spun around and then removes the card so you can tie a bow. It’s like trying to do some kind of ballet maneuver after coming off the Tilt O’ Whirl and being completely wasted. Confusing.
Somehow, I don’t know how, but somehow it all gets done. Then you are magically allowed to touch anything blue (the surgical dressings and drapings) and even the patient but you still can’t put your hands down by your side. They must always stay up in the area below your face and above your waist.
The operating room is an unnatural place for this reason: microbes. All of the awkwardness stems from the fact that tiny, microscopic organisms are everywhere just chomping at the bit to jump into any human orifice and cause havoc and although we can’t see them, we have to somehow find a way to make sure none of them jump into the holes we’re about to put in the patient.
After scrubbing in for the first time, I walked over to the patient and began observing the surgeon performing a hernia repair. I started talking to the scrub nurse in front of me and on the other side of the patient, then looked back down at the patient, then back to the scrub nurse and instinctively used the back of my right hand to push my glasses back up my nose. BIG MISTAKE. Immediately the scrub nurses flipped out and the surgeon, somewhat sternly, ordered me to get out of the OR. Then, having mercy on my poor traumatized soul, the nurses said it was okay and that I just needed to take off my outer gloves. I did and cautiously returned to the patient’s side as the staff explained to me that touching my glasses was off limits because of the microbes on them (which makes me wonder why glasses are even allowed in the OR in the first place). So I watched the rest of the surgery, very interested in what was my first hernia repair, and more aware of every tiny movement my hands made than ever before in my life. At the time, it was serious and startling but thinking back on it, the whole environment seems comical to me. You know that game you play as a kid where you pretend part of the floor is lava and so you make completely unnecessary leaps from one piece of furniture or designated safe spot to the next until you get from one side of the room to the other? In the OR it feels like you’re playing a game like that but with your hands. And the things that aren’t lava aren’t as obvious as a couch or a floor rug. They’re things like glasses and pencils and charts and doors. Things that you’re not used to avoiding like they’re going to burn you but you suddenly have to begin thinking as if they were. Nowhere else on earth is this kind of environment to be found. Of course, the surgeons and scrub nurses have been playing this game for years so they navigate this very unnatural setting with the ease of a stock car driver in a go cart race. They know all the little tricks and maneuvers, what to touch, how to touch it, and when. I, on the other hand, have entered this brave new world with the motor skills and dexterity of a fetus.
After the surgery, I had more awkward moments trying to successfully rip off my surgical gown in a clean fashion and open a weird trash can with my foot to throw away my mask. I ended up just stuffing it in my white coat later because I couldn’t figure it out. I scrubbed in for three surgeries and every one of them was just as awkward. Maybe one day I’ll get the hang of it but today definitely isn’t that day.
Now, a bit about the surgeon I have been assigned to. He is both the nicest and the most intense person you will ever meet, a very interesting combination. Before meeting him, the other surgeons told me that he works so much, if he ever left, it would take two surgeons to replace him. He walks fast; he cuts faster. The surgeon performed four surgeries before lunch: a small bowel resection on a patient with crohn’s disease, a hernia repair, and two cholecystectomys (gall bladder removals). You want to know what the craziest part is? He’s about 65 years old. No joke.
The first time I saw the surgeon, I walked into his OR to observe him performing the small bowel resection. Almost immediately he began “pimping” me. Pimping, while carrying a much different denotation in an alternative line of business, in medicine means to ask someone pointed, fact based questions in rapid succession. It’s like the Socratic method on steroids. I’m not used to it because my previous two LCE doctors have been super nice and considered LCE a great add on to the 1st and 2nd year experience but not essential and so they took it easy on me. Apparently this surgeon, like many in his field, considers the OR a proving ground for the young physician and plans to batter my poor inadequate brain into shape over the next four months. I was sort of warned about this from another medical student who was on his service but not to the extent that I felt I needed to study. I definitely need to study. The words “I don’t know” came off my tongue literally about two dozen times this morning, two dozen too many to gain the respect of a surgeon like this.
Despite this change of pace, I really admire him already. For one, he calls taking a break for breakfast or lunch “metabolic rounds” which I think is hilarious and awesome. But more importantly, he has an extremely hands on approach with all the patients. He even goes into the waiting room to bring them back himself and then again to talk with the families in person as soon as the surgery is over. When asked about the relationship he has with his patients, the surgeon answers that he sees them once a few weeks before the operation to explain it to them, during the surgery, and then once after for a post-op check up and that’s it. And he says he likes it that way. He tells me he doesn’t want to be married to some patient and their chronic illness like the internal med docs. He says he wants to see them, get them well, and then move on. And almost instantly I realize I don’t want to be a general surgeon. You see, I believe I need the patients. I need to talk with them. I need a relationship with them, not just a transient exchange. I don’t need to be “married” to them like the internal med docs but seeing them over a period of a couple months or even just consistently for a few weeks would keep me sane. I can’t be in the OR doing eight surgeries a day, on call every third night and weekend and still care about the patients. I need to see them conscious more than just two out of three times. I need to connect with them. At the same time, I need the practicality of surgery. I need a well defined job, an organized path to healing someone. The answer? Sub-specialize. A surgeon who likes relationships is an oddball but in fields like transplant surgery where the patient needs to be monitored extensively before and after the operation, a feeling of fulfillment can perhaps be found. And that just may be the exact thing I end up doing.
Something cool that I wanted to mention happened was that I got to go back in the pathology lab and see what happens when tissue is sent for biopsy. It was interesting to see how the pathologists clean out the organ, slice a piece off, quickly freeze it on a metal disk, make a thin slice of it (very similar to how a person uses a machine in a deli to slice off bits of turkey and cheese for a customer, a little too similar…), load it onto a glass plate, stain it, and then look at it under a microscope to determine if it’s cancerous or not.
At the end of the morning I was exhausted. Not a good type of exhausted or a bad type of exhausted. Just exhausted. I didn’t really feel like I was falling back in love with medicine today like I thought I might but I have some hope that this LCE will turn out well. At least it will inspire me to work harder.
The following is essentially and exert from a conversation I had with my friend Rosie online tonight.
“Lately I’ve been feeling that I simply do not want to be spending so many long hours of my life surrounded by death. I mean, I much rather be at the movies or making them or just eating at a cafe somewhere or playing guitar, anything lighter than being around death. Which is pretty much everything. But its not even simply death. It’s being the one who makes decisions that could either change people’s fates or give them a one way ticket to the grave that freaks me out. I don’t know anything and I don’t see how I will ever get from where I’m at now to being able to confidently and quickly make those decisions on a regular basis.”
Tomorrow is the first day of my surgical LCE rotation. I am scared and excited and hoping that it will reignite my passion for medicine, something I badly need to happen.
Distracted. So distracted. Four days of studying in the same place is not good for one’s mental health. I broke down completely tonight and spent (I won’t say wasted) 88 minutes watching the Woody Allen movie “The Purple Rose of Cairo”. I thought it was good. Not his best. But the ending really saved it. Also, pretty decent acting.
It’s 3am and I’m freaking out because I don’t know much of anything about mitral valve prolapse. Part of the reason I’m so anxious is because I’ve been reading House of God and all the close calls with death I read about Roy going through, I feel like I will end up going through in a few years except, unlike Roy, I wont have the knowledge to handle them and the patient’s really will die on me. It’s been a struggle for me to not get distracted but reading House of God reminds me that however boring these printed powerpoint slides may seem, they contain information that I will need to save the lives of my patient’s soon. I need to be in love with this material so I don’t forget it in a pressured moment. And what’s more, the Harvard medical students in Shem’s novel are given responsibilities like they’re doctors already. One of them, Towel, even tells an intern to go home and he takes care of some of the patients, writing orders but not signing them. Crazy. I can’t imagine 6 months from now when I’m in the clinics all the time actually having the confidence to write orders. I definitely feel like I’m gonna be the useless med student who doesn’t know anything.
Study, Study, Study
Today is Veterans Day but there is no such thing as a real day off for med school students. Consequently I have spent the day inside studying as I will for the majority of this four day weekend. Did I mention that weekends basically don’t exist in med school either?
Path lab was pretty cool today. For two hours we rotated between eight different stations, each containing a few different human hearts (from cadavers) and a pathologist to explain the abnormalities and diseases each one had. I found it to be very interesting and a great learning experience plus the chance to hold real human hearts in my hands again was awesome.
We are so privileged.
I cannot be more frustrated.
Once again Kevin and I attempted to record electric guitar and once again it sounded like crap. We were using my church’s mac, interface, and mic this time but we still had the same problem we’ve been having which is that it sounds like it’s being recorded on a tape deck. So we stopped. If we couldn’t get it to have decent quality we weren’t going to waste our time recording. I don’t know where to turn anymore when it comes to this problem. It’s so ridiculous. Meanwhile, I can’t record again till around thanksgiving because of school so we’re losing another two weeks.
Med school is not conducive to doing pretty much anything that is not med school.
Also today, we had another Arts and Humanities scholarly concentration meeting. Our faculty leader said she might be able to get us invited to the opening of the brand new Dali museum in St. Pete which would be incredible. She also mentioned that we should essentially be editors for a new book on a variety of drawings med school students have given her over the years as parts of assignments she’s given them. It seems pretty interesting and I’ve never been an “editor” before so why not.
We finished our second CPS small case today with a correct treatment plan. CPS is cool if only for the fact that when you finish a case you feel like you really know a disease well, from the way it presents in a patient to it’s complications and treatment.
It seems we’re all a little down nowadays. Whether it’s the science or the social isolation, I think there is a steady feeling of drowning that can be found in the hearts of our class. Lately, I’ve been listening to the new November EP from Sleeping At Last’s Yearbook project. I’ve grown fond of it more for theraputic than artistic reasons, although I do find the music quite pleasing.
is that I don’t have to have the answers,
just a little light to call my own.”
- Ryan O’Neal
I’m not always sure that I’m going to make it through this year but I’m sure that I can make it through this day and sometimes, that’s enough.
Tonight, Polley and I attended the annual Halloween party that’s thrown by and for the first and second year students. This year it was in the histo labs and I have to say it was a lot of fun. A ton of people came dressed up. It’s always interesting to see the future of America’s healthcare in the form of crayons, witches, angles, video game characters, gumby, a sheep, Audry Hepburn, superheroes, vampires, and whatever else you can possibly think of. Polley and I were a sheriff and an outlaw respectively with real cap guns and everything! I think the insane amount of drugs and heart conditions I have to memorize is causing me to regress into my childhood again. I am probably embracing it a little too much.
Kevin and I were supposed to finish recording the electric guitar at my church this week but that didn’t happen because they were using the computer we need. Hopefully we can get to it next week. I’m so ready for this album to be finished.
Study, Study, Study
We had a good PD lecture today in which our instructors brought out Harvey, a patient simulator dummy, to help us understand what different heart murmurs sound like in different parts of the chest. Harvey is cool. While he doesn’t have any legs, he was featured on an episode of Grey’s Anatomy and that’s enough to make anyone okay in my book. Afterward, I had a skills session with my friend Amber, a standardized patient and a 4th year student who was showing us the ropes. It’s hard as heck to hear some of these heart features. Our standardized patient also had slight edema in her legs which was pretty cool for me because I was able to touch it and learn how to properly identify it. At this point in my career, I feel like I’ve listened to several hundred hearts but still only have a vague idea of what specific abnormalities actually sound like. Hopefully that changes soon.
My last day of my Pediatric LCE rotation was a very good one. I saw a baby with impetigo and then interviewed a freshman in college about a bad skateboarding accident he had a few weeks ago in which he suffered a concussion and skull fracture. The college kid and his mother were super nice and told me all about how the accident and meds he’s on affect his taste, give him headaches and vertigo and keep him awake at night. It was an interesting pediatric case that made me asses the mental and emotional well being of a patient as opposed to the purely physical which I had seen in every other case this rotation. My last patient was a small boy with a red and speckled white soar throat and swollen lymph nodes. My LCE doctor took a swab of his throat and the nurse started a strep test. Before it finished, I told her that I believed the child had strep throat and what do you know? The strep test came back positive! I can’t think of any better way to have ended this LCE than with properly diagnosing strep throat. So exciting. It made me believe I actually know a thing or two.
As I was getting ready to leave, my LCE doctor told me that the whole staff loved me and were sad to see me go. I told him and them that I would come visit again sometime.
The staff that I’ve met there truly are wonderful. They work as a family to bring thousands of children back to health every year. They taught me what the ideal pediatric clinic should be like: a caring, fun, and friendly environment where children find relief and parents find peace of mind. It sincerely warmed my heart to know that this great group of people is so fond of me.
We had another Clinical Problem Solving session today. It went well. My group was super thorough as always which was fine; I just get frustrated that when we all agree to order a certain, very obvious, set of labs or tests, and instead of actually ordering them and seeing the results we sit around and talk about them for half an hour and then order them. Also, I feel like a lot of people have a hard time seeing the perspective of the patient. While we sit back and debate over whether it’s one diagnosis or another and order procedures and tests that take several days to come back to us, the patient is having diarrhea 11 times a day! And yes, “technically”, it’s not an emergency, the patient probably wont die, but it’s diarrhea 11 times a day! That’s more than a little disruptive to her life. She wont be able to go to school or work with that. Not to mention the pain and discomfort. I don’t know, I guess I just feel like we’re a bunch of mad scientists with god complexes when we’re in a room talking about all the disease processes and debating whether the patient has one specific type of a disease or another specific type of the same disease that both have essentially the same treatment. It feels like we care more about having our opinion proved right than relieving the pain of the patient. The focus seems off to me.
But I digress, the truth is I’m prone to shoot from the hip, shoot first and ask questions later, something that could get me in big trouble in medicine. The difference in that specific diagnosis may have made some difference in how we treated the patient. The right thing to do in most cases is to never treat until you have a completely confident diagnosis. I learned that a little more today from my peers and the preceptor. I think I’ve just been disillusioned by the stark contrast I’ve seen between what we’re taught in class and what’s being done in the clinic. Ninety-percent of the time, you don’t know the exact cause of the illness and yet you still prescribe some kind of antibiotic or pain reliever and ninety-nine-percent of the time the patient gets better in a few days. It’s this kind of empirical medicine, guess work that I’ve been getting accustomed to where the goal is purely to relieve the suffering of the patient. Whether that’s good or bad, I don’t know but I guess maybe, at least for now, I should try to steer myself closer to my colleagues state of mind, that is be extremely thorough and assume that every symptom has a specific and logical cause and that we can always figure out what that cause is. I know that’s not always how it works in the real world but we’re not in the real world yet, we’re in medical school.
Study, Study, Study
