Shadowing – ER edition

As I take a break from scratching my head over physiology, I thought I might recap what happened while shadowing in the ER this morning. For one, although it is only a Saturday morning in a quite, suburban town, I was surprised at the contrast of the ER-in-my-head with the ER-in-real-life. My vision of an ER is people running around and calling out vitals etc. to each other, papers being hastily shoved from one person to the next, and constant beeping with alarm noises going off every few minutes. Not so this morning. It was so calm! Nurses milled around (I even chatted with someone I knew from highschool!) and most of the rooms were empty.

When the doctor we shadowed (referred to as “Dr.” from now on) came in, we began right away. Dr. followed up on cases from the last shift and asked about a Jefferson fracture (which I had remembered studying, but couldn’t quite recall details…). Then Dr.  let us take a brief history for a patient, asked us to examine a patient with suspected bowel obstruction, and showed us 2 pelvic exams. We saw a severely malnourished patient at the end stages of COPD, listened to wheezes on another COPD/asthma patient and then witnessed someone rushed in with a subdural hematoma. For a “quiet” Saturday morning, I felt as if I saw a lot! I can’t imagine juggling even more patients on a busy night. Also, will this feeling of not knowing anything ever go away? I mistook a liver for a heart on a radiograph – surely this was the one question I should not have missed. Ah well, kick myself and don’t make that mistake again.

Just for fun, some new words: mirena, wells’ criteria, external os (of cervix), sinus tachycardia, afib

Emergency medicine seems almost like a game – you’re constantly juggling tests and patients and nurses and meds. How do ER docs keep all the patients straight?! It’s interesting in that you never know what you’re going to get, and so all of your training is used – radiographs, EKGs, physical exams (cardio, neuro, HEENT, etc), pharmacology, and on. One downside is that you never get to really know your patients. There’s too little time, and follow up will probably be done by primary care physicians. I guess the upside to this is that you never get attached to any of the patients – but I wonder if this affects your ability to see them as people rather than just as patients/diseases/cases.

Overall, this was an exciting morning, and I definitely hope to go back in and get used to a doctor quizzing me on things I should know.

A Brand New Module!

Starting each new module is always the hardest part, because I feel like I’m starting all over again – how should I study? what will questions look like? As I felt like I was settling into the musculoskeletal system module, it finished! Although I must say I am not too upset at that 😀 We’ve started our cardiopulmonary module, and it is a different beast. It is physiology heavy, and it is tinged with physics… and physics and I have a rough past 😛 I have been trying to self-study and use lectures as supplementary material. Since all of our lectures are recorded, I can speed up the videos, which gives me time to pause when I need to think about something or concentrate on writing notes (I can’t listen and write at the same time – not very well at least). This is really helpful since that means less of a lecture is lost on me.

As far as time management goes, I think I’m studying a little more efficiently by committing to staying on campus 8am-5pm M-F. Although this doesn’t always work out, it certainly helps! Because when I go home, it takes too much effort to pull out the books, and I only get about an hour of studying done. The biggest hurdle to overcome was a mental one: it’s okay to not know everything. This…this was especially tough because, well, what if someone dies because I didn’t study hard enough? If I had looked over that pathway or disease just once more… But this is a marathon. I want to remain mentally intact for the rest of my life, and I think I’ll do much more good by putting down the material sometimes (at least, I certainly hope so!). So I’ve had plenty of time to run, socialize with friends, read (currently on Barbara Kingsolver’s Flight Behavior), watch T.V., play the piano…

Thus far this school year, I have learned mountains of information about the body. I’ve learned about muscles, nerves, and arteries galore, diseases, the physical exam (we’ve had a few standardized patients now)…However, to my great dismay, I feel like I have also forgotten mountains of information. Sometimes it’s hard to focus or study because I’m so sure I’ll forget everything I’m learning right then. It’s very discouraging! And my to-review list is so long, I bet Santa’s list has nothing on me.

I’ve been seeing a few pieces of advice that I really hope are true:

1. The knowledge will come with repetition.
2. Just get through first year learning as much as you can, and not worrying about what you don’t remember. Everything will be repeated.

Hopefully I’ll know something one day. For now, I must go back to looking through a lecture and finding some practice problems!

 

Happy November!

How is it already November?? I have officially been in my program for 3 full months… It really feels like only yesterday when I was so excited and nervous for my first day of school, wondering what the next four years would bring.

I have been burying my head in the sand trying to study. We just finished our 8 weeks of the musculoskeletal system – whew! I finally started to feel like I was learning about the body. Anatomy has been one of my favorite parts. Dissection is fascinating because of course, the body looks nothing like a color-coded textbook diagram. All those structures really exist…!!

I am really thankful for studying so much biochem in undergrad, because it definitely lightened the load of studying. I am utterly astounded at the people who have, say, economics degrees or other humanities, and are learning all this material for the first time! It is a lot. Stacks of pancakes and drinking from a firehose and all that.

Overall, I have been enjoying this time though! I’m really trying to savor this year, because I’m listening to all the M2s beginning to stress about Step 1. I have been working on actively calming myself down, because I do get extremely anxious about my never-ending to-do list, and I am certain that self-calming skill will come in handy next year!

I still don’t know what I want to do “when I grow up.” So now that I have my white coat (our ceremony was in early October!), it’s time for a lot of shadowing! I have been playing with the idea of neurology or psychiatry, but I will definitely be doing some shadowing to see if that’s really right for me.

One striking difference I have noticed from undergrad to professional school is in the care of students. I feel so welcomed in med school, like I am a part of a big family. Faculty are constantly trying to help and encourage and provide. Doctors and upperclassmen want to mentor us. Everyone is always happily feeding us. And my classmates (mostly) are so much like me, yet so wildly unique…it’s such an interesting and fun atmosphere. Comparatively, undergrad…felt lonely. Everyone was competing against each other, and I often felt like a undefined blob in a sea of pre-meds.

I am finally coming to terms with the amount of studying time I need to put in. I have also come to terms with not knowing everything. I am still working on the guilt of not studying enough, don’t take a break because you don’t know everything, etc etc. Calming those voices are key to happiness I think. Then relaxation time can truly become relaxing, and which in turn allows me to recharge for another push through a set of notes, etc.

Hopefully the worst two modules are behind me, so I can keep up with blogging more! I was reading a forum where older students were lamenting their lost writing skills. I don’t have much to begin with, so I want to really make sure I keep working on it! Even in speech, I have a hard time being succinct. I just get so lost on tangents 😀 I also have a lot of resistance to blogging. I feel like I’m not “good” at it, or that my writing isn’t very useful to others or myself. But creating is hard, and I do want to challenge myself and grow.

Well I’m off to relax more! It’s intersession time!!

If anyone has great writing tips, I would love to hear about them!

Learning How to Introduce Yourself – It’s an art!

Today I went to school and played doctor. I am still giddy thinking about it!

My medical school teaches a year-long course (it will actually extend into second year) called Essentials of Clinical Medicine. A part of that is a class called “Physical Diagnosis,” where we learn how to take a patient’s history, do a basic physical exam, etc. Well we fledgling med students learned how to introduce ourselves today, and it was no walk in the park!

A big part of this is learning to see the doctor-patient interaction as a partnership, where the patient is the leader/president of him or herself, and we doctors (student-doctor in my case) are expert advice givers in our area. There’s a lot to learn about communicating well and learning to listen to other people, and extracting information from people who are in pain and/or uncomfortable. Some people won’t know how to describe pain, or will be in so much physical pain that they can’t. And others will have no idea about what symptoms are actually even symptoms. And it’s our job to find out everything pertinent in a professional and friendly manner.

So today was just a little practice!

I knocked on the door and introduced myself and my status as a first year medical student. Then I asked if the patient (our preceptor in disguise 😉 ) minded if I washed my hands. We struck up some casual small talk, and then shook hands. I asked to sit down – the asking is important! It all goes back to the partnership idea, and letting patients know that doctors are not their bosses who hold power over them. Then everything seemed to go well…but I was so nervous, I forgot what “OLDCARTS” stood for, and I kept forgetting the details the patient would say. This is something I must work on and fix! Either I will become more comfortable will my own flow of questions, or I will need to write as I interview. I cannot forget the words the patients use, because if I forget, am I really even listening? Moreover, will they feel like I don’t really care if I don’t try hard enough to remember? For instance, the patient said, “I have a chest pain that feels like a large pressure…an elephant on my chest.” And I later said, “A sharp pain…” which was not the way the pain was described.

My preceptor was just great. He was quick to point out mistakes in a way that showed just how important it is that we don’t make them (“Are you even listening to me?” *chuckle*), but he wasn’t mean or upset about it. I am excited to learn more from him, and his easygoing manner just makes time fly!

Overall, this was a great learning experience, and I am going to practice on all my friends. 😀 I am so excited to be practicing these parts of being a doctor, because I feel like it’s where I am severely lacking in experience. I know what school is and how to learn, and I know I have a LOT of medical science to learn…but the patient interaction in times of distress (for them, pain. for me, nerves) and then the differential diagnosis process…that’s what I am most excited to keep practicing.