As pediatrics comes to a close...

I'm going to miss a lot of it, but I'm also going to not miss certain aspects of it.  As I typed that, I realized how this is going to be true for everything that I'm going to decide not to do.  For example, surgery didn't sit all too well with me, but the fact that I will never see the OR again after residency is somewhat disheartening.  The fact that I will never work up a patient all the way through the course of a stroke from a Neuro ICU standpoint is also not that great.  I wish I could do it all, but I can't.  I have to choose, and whatever I'll choose, I'll have a tiny bit of regret that I didn't choose everything else I didn't choose.  Med school is tough not because of the learning that we have to do.  The learning happens whether we like it or not, one way or another, through good and bad experiences.  The reason medical school is tough is because of the difficult choices that we have to make and the not-so-medical questions we have to answer.  Do I choose to follow through with this action?  How will this impact me? Others? My future patients?  Do I even want to stay in medical school?  Did I make the right decision in the first place to become a doctor?

EM, FM, Pediatrics

Haven't posted in a while, and to be honest, I don't know if I have too much to post.  The main thing is that this year is blowing past.  I went through a month of emergency medicine research in January, a month of Family medicine in february, and now I'm currently on 2 months of Pediatrics at the Children's Hospital of Michigan.  The experience and patient exposure that I'm getting is great.  I'm seeing a lot of classic pathologies like Diabetes, Down's syndrome, asthma, etc., and then I'm seeing a lot of rare things like spinal cord compression syndrome, Devic's disease (aka Neuromyelitis optica) and Pierre Robin Syndrome.  Honestly, I think I am getting the best medical education that I can get.  In terms of patient population and the clinical exposure, I'm not sure what can beat this.

I loved EM.  Hands down.  Nothing comes close to the experience I had on EM.

I loved FM as well.  But the thing that made me like it so much was my preceptor.  He was probably one of the coolest guys that I know, and one of the all-around best human beings probably alive today.

I am ambivalent about Pediatrics.  I am currently on the inpatient service and I am not so keen on the schedule.  My roommate is on the outpatient side of things and he seems to be sleeping very well at night (and into the morning).

Halfway through M3

I'm on break right now and can't stop thinking about whether I killed anyone or not.  It's not possible yet because I'm 'only' a medical student.  I think perhaps the thing that's gotten me thinking about this is me reading a book by the title of "House of God".  If I had to sum up the book in one phrase, it would be that it is the 'the cynical side of medicine we don't want to hear about, yet the cynical side of medicine that we need'.  Yes, the phrase is reminiscent of the ending of "The Dark Knight".

In any case, being half way though the third year of medical school, I'm beginning to panic.  Very very soon, I'm going to be very responsible for the lives and well-being of live human beings.  Thus far, it's been easy mode.  No matter what stupid mistake I made or tried to make, there were interns, residents, chiefs, fellows, and attendings to make sure that the level of my idiocy never shined through to the level of healthcare delivery.  Soon, that will change.  Gradually, I will be more and more responsible and liable for the patient.  What's worse is that the fear comes in two: A fear of hurting someone and the fear of personal failure.  But are those two the same things where my classmates and I are headed?  Yes, and no.  Depends on what matters more to each one of us.  I really hope I care more about the patient.

As I start to dig in again thinking about what is to come ahead in January, I'm excited and wary.

Done surgeRising at 4am everyday

Okay. Just finished my surgery rotation.  Man that sucked.  I'm sure it's much better as an attending than it is as a resident or a student.  Students have to get to the hospital to round on the patients before the senior, who has to get to the hospital before the attending to round on the patients to present to the attending.  Overall, the experience is one that I will never forget and one that I will never regret.  I saw some of the craziest things; liver transplants, for example.

About half-way into the rotation, I felt myself getting bitter about waking up at 4 or 5am in the morning even on the weekends and having to come into the hospital.  Then I remembered something again.  Something that I realized earlier this year.  I COULD complain about going into the hospital.  But...BUT...before I complain, I need to remember that there are other people who want to be in the hospital even less than me, earlier than me, and longer than me.  Sometimes, that's the resident.  Rarely, it's the attending.  Every single time, it's the patients.

No matter what field of medicine I go into, I need to remember something.  People come first.  Medicine is not a job.  It's a commitment.  Getting paid is not the number 1 goal.  Helping people get better is the primary goal.  Everything else is just frosting and sprinkles.

Still torn between surgery and emergency medicine.  Why can't I do both?

Capacity

So as part of being on the psychiatry team on the consult service, I get called a lot to go assess if a patient has the capacity to make a medical decision.  That decision can be anything, e.g. leaving the hospital, agreeing to the procedure, going to the bathroom instead of having to have a catheter, etc.  Sometimes, it's very clear that the patient doesn't have capacity.  For example, there was a patient with brain tumor who was being evaluated for decision to seek subacute rehabilitation following discharge from the hospital, and when I went to go see him with my senior resident, he looked at us and told us that he believed he had no brain tumor, and that we had promised him earlier in the day that he could go home when in fact we had never met him.  Other times however, it's not so clear.  Another patient today had gross hematuria (bleeding from the urethra) and needed a cystoscopy (tiny camera through the urethra to look at the bladder) to evaluate the bleeding.  Her bleeding was so bad that her hemoglobin level was dropping to dangerous levels and she needed to be transfused multiple units of blood during her hospital stay.  Despite this, she wanted to go home because she felt no pain.  After evaluating her with my attending physician, he came to the conclusion that she had the capacity to agree to having the cystoscopy, but didn't have capacity to refuse it.  She understood that having the procedure was beneficial to her, but didn't understand that not having the procedure and going home was detrimental.  In a way, it sounds like we're forcing her to have the procedure, but apparently, it's not, and many doctors operate on this paradigm.

Assessing whether someone has the decision-making capacity for choices that impact the quality of their lives is a huge responsibility, and one that is not always easy.

"We need to end black on black violence"

...is what one of the patients said today.  She was convinced that her ex-husband was the anti-Christ and that her cousin was shot, her husband is cute, she doesn't need anti-psychotic medications, her 401k wasn't being adequately maintained, there is going to be a war in California, etc.  She mentioned the above things in that order when most of those things were not associated with one another at all.  She at least stuck by her guns though.  When I spoke to her a few hours later, she was very sure and could not be convinced otherwise about her beliefs mentioned previously.

Psychosis isn't what media outlet has led people to believe.  It's not usually the desire to kill people and wear their skins or something gruesome like that, but it is simply being unable to function correctly due to the lack of control over our own minds.

With some of the patients being around my parents' age, I got to thinking, "this isn't just interesting, it's extremely sad, especially to the people who are in that person's life".  And so I was reminded yet again that patients are much like myself, human.  I wonder how many times I'll forget and remember again before I have the association down completely.

Study day

I've been studying for the past 2 days.  Actually, I went to the bar for a second last night with some people to talk logistics about school events that we have to plan.  Anyway, I'm studying at the moment, aside from writing this entry.  I have my neurology shelf tomorrow and I'm feeling okay about it.  I took a practice test that is sold and administered by the same company that makes the test that I'll be taking tomorrow and I did fairly well on it.  Well enough to pass anyway.

In any case, I feel like I've come some ways with dealing with exams.  During the first year of medical school, I freaked out whenever there was an exam.  In second year, I was just tired and feeling ragged inside from having exams every 2 weeks or sometimes weekly (because failure is not an option).  But this year, things are different.  I'm calm about my exam preparation.  I still cram, because I still believe it helps to a certain extent, but I'm better at preparing earlier on for the exam too now.  In fact, I kind of enjoy the day before the exam because it means that I have control of what I can do with my day.  Being at the hospital is different in that your time is not your own.  It's your resident's, it's your attendings, it's pretty much anyone's time except yours.

But I digress and complain.  In the 3rd and 4th year of medical school, students are expected to fulfill their duties at the hospital each day and go home and study more for the next day and also for upcoming exams.  And so we're somewhat forced to study every day.  Except that's a horrible way to think about it.  We shouldn't be forced to learn each day.  We should set out on our own to study and to become experts in what we've committed our lives to.  I think this applies to all people.  Even those that feel hopeless and directionless - to learn something new each day that interests us, or may be of use to us some day is a valuable and productive thing to do.  For our sanity's sake.  For our future generation's sake.  For yourself.