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Why I Can’t Do Emergency Medicine

November 29, 2011 by 2 Comments

I can’t do Emergency Medicine. I do not like the environment of the ED. I don’t feel comfortable there. It has nothing to do with the people who work there. It has everything to do with the system. Allow me to explain.

There are many great things about Emergency Medicine. For one, I love the shift work. It must be awesome to leave the office and never have to carry a pager or be on call. When you’re on, you’re on. And when you’re off, you’re off. The salary is also an overall plus for those considering it. I mention just a few of the positives of EM to make the point that there are things I do like about it.

But the reason I can’t go into EM is the system and how it is (poorly) designed. I realize that my impression of the system is based on my experiences while rotating as a medical student through local hospitals that include a level 1 trauma center and a county medical center. So the picture I have is probably not representative of all hospital EDs. But I hope to stay in the area. I would like to stay in academic medicine. So I think my sample size fits.

While rotating through medicine and surgery I would often be sent to the ED to admit a patient. While going looking for my patient, I’d have to walk through hallways and aisles lined by chairs and gurneys filled with patients watching my every move. They watched because they hoped that my eyes would meet thesis and that I would stop. I hated that feeling. I wanted to stop an help them. But I couldn’t. I had no idea what they were there for. And they weren’t someone I was asked to see.

Perhaps this is just a small thing. But to me it was huge.

The second reason I can’t see myself going into EM is that there are just so many non-emergencies. The system of healthcare we have leads to so many people coming into the emergency departments due to complaints that should be dealt with in the primary care setting — or even the urgent care setting. I can only imagine that I’d be frustrated dealing with this on a daily basis.

It may not be much. Some may see this and minimize my reasons saying that they are silly. But in the end, they are the reasons that pushed me away from emergency medicine. And it’s a personal process everyone must go through for themselves.

Filed Under: Medical School, My Life Tagged With: , ,
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Breast Cancer Awareness Month

October 12, 2011 by Leave a Comment

It’s been a while since I have posted here. It’s been stressful lately with application going out, asking for letters of recommendation, waiting for word from programs.

I’ll be happy when it’s over.

In the meantime, here’s a video I found and am sharing in honor of breast cancer awareness month — because early detection saves lives.

Filed Under: Medical School, My Life, Other Tagged With: , , , ,
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That swell feeling…

September 27, 2011 by Leave a Comment

Today.. for the first time since I have been seeing patients… I felt like tears were possible; I felt that if I allowed it, MY tears would flow. Or at least trickle out. Not because I was being an idiot and getting berated by an attending. But because of the pain in the family members standing inside a dying patient’s room.

For a moment I felt the tears begin to swell. And I turned away, took a second, and kept my composure.

I have been in sad situations before. But this was the first time it (almost) got to me.

Filed Under: Medical School, My Life Tagged With: , ,
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My Weekend Rant

September 17, 2011 by 5 Comments

As I walked through the hallway of the Emergency Department, my eyes fell upon one particular gurney that was parked against a wall. It was a typical night in the ED. People were flowing through the doors and patients were being “roomed” in the hallways. As I looked at this gurney’s occupant, I cringed. The pale face with wrinkled skin and sunken eyes was all I could see. The body was covered up with a blanket. But that face was unmistakable. I knew the face — or at least I thought I did. I didn’t want to take the risk of being recognized so I quickly walked passed. I cringed, knowing that I’d have to walk back this way on the return trip.

When I passed the gurney for the second time I realized that the patient was asleep. This time I paused at the bedside. I noticed her wrist was exposed. And on that wrist was her identification badge. The name confirmed my fears. This was the very patient our team had discharged one week earlier and showed up in the ED the very next day with discharge papers still in hand. This was the patient whose medical record would reveal multiple visits to the ED for the purpose of obtaining meds.

If you’ve read this far and are wondering why I was so fearful, it’s because I feared that the patient would be a “bounce-back.” A patient becomes a bounce-back when they return to the hospital within the same calendar month after their discharge. When this happens, should the patient need an admission, they go back to the team that originally took care of them. The theory is that it provides continuity of care as the team is already familiar with the patient and his or her issues.

As I continued on with my work, I knew I didn’t want this bounce-back. I didn’t want the patient back on our team. She had been hard to work with in the first place. She had terrorized the nursing staff. She had frustrated her sitter. She had tried our patience. She had refused treatments. She was a difficult patient.

Like I wrote earlier, she was a frequent flier. I am not sure her repeated admissions helped her. Sure, she had physical ailments. And we could help the occasional exacerbation. But they were chronic conditions that we wouldn’t cure. To me, it seemed that the most pressing issue was her mental health. I suspect, and I’m no psychiatrist, that much of her behavior would improve with more attention to her mental health. But sadly, the system we are in affords little help to who need it, and even less to those who don’t think they have a problem.

As I begin to wrap up this post, I admit I am struggling. I don’t know where I am going. I suppose it is borne out of a frustration that is without an avenue of release. There’s nothing that I can do to help patients like the one above. And as I go into Internal Medicine, I am sure I will encounter many more people who, though suffering from significant medical and mental illnesses, will try the patience of those taking care of them.

Perhaps, this is just my weekend, off-day rant.

Filed Under: Medical School, My Life Tagged With: ,
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Call Day

August 13, 2011 by 2 Comments

Our team was on short call today. The intern and senior resident were raving about ZDoggMD and his videos. This is his parody of Rebecca Black’s song “Friday.”

We watched it during lunch in the cafeteria. I think this version is better.

Filed Under: Humor, Medical School, My Life Tagged With: ,
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Getting Along With Nurses

July 23, 2011 by 5 Comments

Update (7/28): A nurse read my post and sent me a comment. I have included it below. Also, as pointed out by Karen in the comments section, nurses can be “hims” as well. It wasn’t my intention to leave out all the wonderful male nurses. Initially I had written this post with “him/her” but it felt too awkward. And due to my grammatical issues, I couldn’t bring myself to use “they” when referring to single nurse.
*****

Last week, in my post titled Doctors & Nurses, K8 left this comment/question:

I’m about to start the journey of medical school. If you had to give advice to someone just starting, what would you say is the best way to appreciate and/or get along with the nursing staff?

 

I thought that was a great question. And if you glance back at that post, you’ll see that I said I’d answer her question in a separate post because I thought it was such a good question. Now, I still think it’s a good question, but I am struggling with coming up with a good answer — at least a good enough answer to justify writing a separate post for it.

As I look back on my 3rd year rotations, I’d say most (probably 98%+) of my interactions with nurses have ranged from neutral to very positive. I remember the first time I felt like I encountered a rather — gruff — nurse. She kind of just brushed me off. She was busy. It wasn’t like she was overtly mean to me. Another time I asked a nurse to do something and she mumbled about doing it later. I was like, ok… and my senior resident swooped in and let her know that we needed it done immediately. Needless to say she was not happy with him. But she did what he asked. In her defense, she was having a bad day before we talked to her. I had seen her on the verge of tears minutes earlier.

I guess I can only remember 2 sort-of-negative experiences. The rest of the time I have had nurses who at least answered me. Other– er, many times I have been roaming the halls of the hospital, completely lost, and a nurse is usually the one who asks me if I need help and points me in the right direction. Other times I have been staring at a stack of charts and a nurse chimes in asking which one I am looking for and she finds it for me.

On the other hand, I know that there are medical students who have had bad experiences with nurses. One classmate of mine recounted one instance that almost had her in tears. I’d like to think that this is more the exception, though.

But back to the question that I had intended to answer.

Do I have a secret to dealing or getting along with nurses? No. Everyone will do it differently based on their own personalities. And admittedly, there will be some personalities that may not mesh very well. Occasionally I watched as some of my classmates interacted with the nurses. Honestly, there were times I cringed. I felt like they were treating them like “the help.” Sure, it was a snapshot; maybe my classmate was having a bad day.

As for me, one thing I made a point of doing was to introduce myself by first name to a nurse during my first conversation with her. Usually this would be in the beginning of the conversation. The introduction usually got me their name too. And I tried to use her name each day when I saw her. Because when you follow an inpatient for even a few days, most likely you will have to talk to the patient’s nurse multiple times. I never cared if the nurse remembered my name or not. But I wanted her to know that I knew her name.

That’s pretty much it. That’s my answer. Because at the root of it, all they want is respect for the hard work they do.

*****
After posting this, I received a comment from @eyeseeyouarein, an ICU nurse:

Take good care of your patients, we’ll like you. Do that and treat us with respect, listen to us, and show common courtesy in your communications? We’ll love you. Get to know us, trust our judgement, and be our partner in care? We’ll cover your ass.

So there you have it… a perspective from the nursing side of things.

Filed Under: GUIDE, Medical School, My Life Tagged With: , , , ,
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Today’s Medical Lesson — Sausage Fingers

July 21, 2011 by 3 Comments

In my continuing quest to prepare for Step 2 CK in just over a week, I have been going over practice questions. Here’s something I reviewed today — a condition called Psoriatic Arthritis.

Here’s is a picture depicting classic symptoms of the disease:



Classic symptoms include:

  • morning stiffness
  • deformed joints
  • nail involvement
  • dactylitis
  • “pencil in cup” deformity on x-ray of hands

My favorite one is dactylitis — aka “sausage digit.” See the man’s left index finger? That’s the sausage digit — a diffusely swollen finger.

And that’s the lesson for today.

And I have really been wanting to share about what I learned last week (or was it the week before). It was about something called the “anal wink.” But I guess that will have to be for another day.

Hope ya’all are having a fantastic Thursday!

Update: And a thanks to Ryan who commented below to remind me to add the “pencil in cup” classical finding on x-ray!

Filed Under: Medical School, My Life Tagged With: , , , , ,