Clerkship 6: Operational Family Medicine/Shipboard Medicine
I spent my elective rotation this year working in a medical department that few physicians will ever get the opportunity or privilege to work in. I was assigned to an amphibious assault ship in the Navy and spent 4 weeks embedded in her medical department. During this time, the ship made a port call where I joined the crew, underwent an 8 day transit across the ocean to get back to home port, and then spent 2 weeks in her home port. We had a fleet surgical team embarked with us for about half the time I was on board, until we got to home port, and that added to the opportunities that I had on board. On the ship of this size, there's 2 docs: one FM physician (the SMO) and a GMO, a physician who's only finished their intern year before being sent out to the fleet to serve for a few years before finishing residency. We also have an IDC, essentially a PA/NP who can see patients on his own and is a senior enlisted member--a chief petty officer. With the FST, we also had a surgeon, another family doc, a CRNA, a critical care nurse, and an OR nurse. And there are lots of corpsmen. I learned that our corpsmen are way more qualified that they're given credit for in the hospital environment and can basically run sick call by themselves most days. I got referred to as Doc most of the time, saw patients on my own, and then ran them by the IDC or GMO, depending on the day. A typical day in medical starts with the khakis meeting to talk about the plan of the day, then quarters where the plan is passed to the corpsmen. There's a little time for cleaning before sick call starts, when anyone who's ill or injured presents to medical. Its kind of like urgent care clinic. When you're underway, its also the equivalent of going to the drug store for an OTC. After that, the providers have a few appointments each. Medical might run physicals, or screenings, depending on the day of the week. The afternoon is mostly admin time, cleaning stations, and maybe training. A lot of the patient presentations were very routine. Shipwork is hard on bodies, so there were lots of MSK complaints. URIs run rampant when you have close to two thousand people living together in a tin can for weeks on end. But on the more interesting end of things, I also saw surgery being performed on a ship in the middle of the ocean, some really nasty infected liberty tattoos, and a bartholin gland cyst. I got to do an I&D with only a corpsman “supervising”. I sutured a hand lac closed entirely on my own. In terms of ship life and the big navy, I saw a burial at sea, spent time in the combat information center, was up on the bridge during night watch and during a gun test during the day, spent time in Pri Fly during flight operations, and went down into the main spaces on the ship to see what exactly makes us move. I participated in a gun shoot while we were underway and knocked out both of my weapons quals once we got into port (hello sharpshooter!). I helped serve lunch during a "picnic" in the hanger bay. I did yoga on the flight deck when we were only surrounded by water for as far as the eye could see. I learned so much more about ranks and customs and courtesies. We had rough seas more than once and I never got seasick. My biggest complaint? The ship was COLD! My stateroom was COLD! Also, it was over two miles from the ship to get off base and even further to get to the commissary. Integrating into medical here was a lot harder than in the clinics or hospitals. They're not used to students always rotating through. No one was really sure where to stick me or what I could do. It took awhile to get me up to speed, and that annoyed the SMO. The corpsmen were really amazing about helping me learn the ropes though.
I don’t know if my operational career is destined for the surface fleet or somewhere else in the Navy or Marine Corps. I do know that I want to spend more time in the operational community. Time to try to fit more operational experiences into my MS4 schedule, as if scheduling wasn’t hard enough to begin with! It was a breath of fresh air being out of a hospital and really more of the type of medicine that I think I want to practice!