Chronicles of M4 year: July recap
So I figured this being my final year of medical school, I would take the time to chronicle my exploits through the final stages of transitioning from Medical Student to Doctor of Medicine. Along the way I hope to give you a glimpse into what my life has been like, the challenges that I face, and the life changing decisions that must be made over the coming months. So without further ado, let's get started.
July 1st, 2013. 8 AM (I have to chronicle this particular day because a lot happened in a short amount of time and I just have to get it out in order for you to understand what I was thinking.)
The first day of a new year. Earlier in the year I decided to front load my schedule with the most time consuming of rotations so that the end of the year I would have all the time in the world to basically do whatever I wanted. So I have two inpatient Medicine months to start off my year, one with the UMC's Department of Family Medicine as an elective and the other with UMC's Department of Internal Medicine as a graduation requirement. My M4 journey starts off at "The Baptist", a hospital less than a mile from big daddy UMC that seems the majority of Family Medicine's inpatient service. With high aspirations of staying with UMC for residency I wanted the opportunity to experience their inpatient experience before making an informed decision.
On the first day I arrive to the resident's workroom on the 4th floor and see that the patient list is 20 patients long. Now for those of you that don't understand, a 20 patient list is a nightmare to round on. Each patient requires a daily note and it can be a difficult task to get every consult, lab test and procedure accomplished for each patient every. single. day. I came to work and this was definitely the place to be. I had the previous month off for USMLE Step 2 studying and I was tired of reading books and answering practice questions. I wanted to get back to the patients. So I hit the ground running with the residents and didn't look back.
This first day seemed like it went on forever. We would round with our attending, see a few patients, write some notes, order some tests, and take a break. Everyone has the assumption that rounds are like the rounds they see on Scrubs or on Grey's anatomy or anything else like that. While there is some truth to that, in a non teaching hospital you are a lone wolf. Not obligated to teaching students, or quizzing or "pimping" them on the latest guidelines of treatment. No. You get in, see the patients, make your recommendations and it is on to the next one. And that's what we did.
After a quick lunch we go see another patient. Obviously I can't give you any personifying information as that is against the law, I can tell you this patient was elderly, and very sick. Had a long history of heart failure, COPD, and lung cancer and was under our care for an exacerbation of his heart failure with fluid on the lungs. So we enter the room and see the patient sitting up in a chair hunched over a pillow, huffing and puffing as hard as possible. All I remember is the patient saying "I'm having trouble catching my breath. It's harder to breathe." To be fair, not an unusual complaint given the patient's history. We decide as a team to give the patient a little diuretic to hopefully get some fluid off and ease their breathing trouble. Problem solved.
We finish rounds with a quiet victory and proceed to the ER to see some patients of ours that came in. Now Emergency rooms are for lack of a better term, a glorified free clinic. People come to the ER because: 1. They don't want to go to clinic because they have to pay. 2. They can be seen in the ER without paying anything. possibly ever. 3. If you come to the ER you are required to be seen. There are some other reasons but I'd rather not discuss those with you right now. Bottom line is barring major trauma or true emergencies the majority of ER visits can be handled in a primary care clinic.
July 1st, 2013 3:30 p.m.
While we are wrapping up the discharge paperwork for a patient we hear the intercom "Code Blue, room such and such". UH OH. That's our patient. More specifically, that's our patient that couldn't breathe when we saw them 2 hours ago. So we're rush up to the floor. Now, on television codes are portrayed differently than real life. The chest compression/ bag mask ventilation is the same but with one difference. There is a literal TON of people in the room. The back ups for compressions, pharmacist preparing medicines, nurses documenting administration of meds, ER physician supervising the code, House physician whose patient this is. And a gaggle of sorts. So I watch from the hallway. 10 minutes. 15 minutes. 25 minutes. Nothing. They're gone.
Now I had seen people die in front of me before. As far back as my physician shadowing during my USM days. And a few times during my clerkship rotations the previous year. But this is the first time that I have seen someone pass away that I was able to conduct a conversation with only 2 short hours previously. This patient was really sick and nothing we were doing was helping. That is the dark side of medicine. That is one of the ways we as physicians could lose our compassion for our patients. We are fighting a losing battle from the beginning and that just hits closer to home. But I say this not to discourage anyone, but to reinforce my point. We must persevere and never lose sight of the things that make us who we are. Never forget the feelings and emotions that influence the decisions that we make. Always keep in mind the memorable moments. They define who you will become. This moment has shaped me for the better. Experience is life's best teacher. You always have the choice in the type of person you want to be, just like I refuse to lose my compassion for any of my patients, friends, loved ones, strangers and whoever else matters. Because if I do, I know I will not like the person I would have become.
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