Archive for the 'Medicine' Category
First Pediatrics Patient
July 10th, 2005Today marked the first time I was truly “saw” a patient. It was the second day of my peds clerkship, but my first day actually in the clinic. The six of us went to the well-baby clinic knowing we’d see patients, but we didn’t expect to see them so soon and without some sort of hand-holding or warm-up. The attending physician came in, told us to take a history and physical, and then said to go.
She walked out for a minute, and when no one said anything I thought everyone else was comfortable with what we were to do…but the moment someone said a word, everyone quickly admitted how unconfident and freaked out they felt.
Luckily we were paired up, which made me feel better initially, but that just meant there’d be two people in the room who had no idea what to do. We walked in, with a translator (since the patient only spoke Spanish), and went about interviewing the mother for half an hour about her 3-year-old’s simple little cough.
That wasn’t bad. Our physical exam, however, was pathetic.
We started by taking vital signs, which sounds easy, but trying to get the pulse of a squirmy kid is pretty hard. But not nearly as hard as trying to determine his breathing rate since his tiny chest didn’t move with each breath. Then, in my greatest show of clumsiness, I stumbled around trying to fit the huge adult BP cuff around his arm, when the translator started laughing. She finally admitted that all the vitals were already taken by the nurses.
Strumbling through several other parts of the physical, we reached the genital exam. We pulled down the kid’s diapers and then froze…we stood and looked each other in silence until we both said, aloud, “what do we do now?” Neither of us knew, so after some more uncomfortable silence we turned to the translator and asked her what to do! She then gave us some general suggestions on what to do. I don’t think we could have been more imcompetent…
Thankfully the mother didn’t speak english and couldn’t understand what we were saying to each other. In the end, when we went back in the room with our attending (who re-performed everything, but smoothly), we realized we didn’t miss all that much. But none of that erases this clumsy, uncomfortable, and memorable first experience of ours. I’d like to say that it can’t get any worse, but I’m sure it can.
Out With the Outpatient, In With the Inpatient
August 15th, 2005Life changed for good last Monday when we began our 3 inpatient weeks of pediatrics — the prior 3 weeks had been exclusively outpatient. Gone are the 9-to-5 days with no time pressure. Days now begin bright and early at 4:30am when I wake up in order to be at the hospital by 6am, only to start a packed schedule that involves rounds (walking as a team from patient to patient, in order to evaluate their progress), conferences, reading, and oh yeah, patient care.
Inpatient hospital life is the complete opposite of outpatient work. For example, if you show up 20 minutes late in the outpatient environment nobody cared or noticed, especially since the doctor would probably show up after you. Now, if rounds start at 7:15am and you’re not there, the entire team checks their watch every minute that you’re not there yet.
Despite the intensity of the new lifestyle, inpatient work is much more exciting and educational. Stay tuned for more posts…
Typical Day, part 1 of 2
August 17th, 2005Everyone always asks me what I do in the hospital. Here’s a description of my typical day, starting from when I get up in the morning.
The day technically does begin at 4:30 in the “morning”, even though the sky is even darker when I get up than when I went to bed. I then hang out in the shower for about 25 minutes; the first 20 minutes are spent standing still, trying to get the water to wake me up, even though the warmth of the water really just makes me sleepier; the last 5 minutes is when the actual cleaning business takes place. When I’m done with the shower and bathroom, I open the bathroom door to walk into the bedroom, only to be reverse-blinded. With my eyes used to the bright lights of the bathroom, and my room still dark because it’s essentially nighttime, I step out and see nothing but black. Just black. That sucks.
I then drive to the hospital, and it’s here where the only silver lining can be found. Even though I spend 90% of my time in this city stuck in parking lot-like traffic, 5:30am is a time that I can definitely expect no traffic on the freeway. None. Barely a car on the road. It’s so early that the metering lights are off…not just stuck on green, but off. Maybe I should rotate my schedule all year long to have such luck on the freeway.
I arrive at the hospital and start roaming the empty, cavernous hallways of the pediatrics floor…the only other people I see are some other med students and the few nurses that were stuck with the graveyard shift. Once I come to grips with how depressing the situation is, I start pre-rounding — checking up on my patients to see what happened since I left the previous day. And here comes the highlight of my day…because I go to each of my patients and wake them up from their sleep. These poor kids are waken up every 3 hours or so by the nurses to have vital signs checked, and I happen to pre-round on them right in between nurse visits. The moment they’ve managed to calm down after some stressful blood draws and to find a minute of silence in spite of the talking staff…I come along, shake them (and their parents) awake, and then proceed to annoy them by asking them, in broken Spanish, if they have diarrhea. I then poke them all around, asking “does this hurt” (still in Spanish) each time, and then finally leave them alone.
Don’t worry…we’ll see them again during rounds, which is where I’ll pick up next time.
Match Day Results
March 17th, 2007I’m off to UCSD for internal medicine residency.
UCSD has a strong medicine program and an excellent bioengineering department, where there are some faculty members with whom I want to do research. Plus, people say San Diego is a nice city.
Unfortunately, I will be moving further down south…but will return to the Bay Area eventually. I hope.
Internship Is Over
June 23rd, 2008My year of hell is finally over! No more notes, no more pre-rounding, and no more writing H&P’s. Now only two more years of general medicine before I begin training in what I’m truly interested in.