Jul 22, 2011

Medical Students

A loud voice jolts me out of my post-call, sleepwalking state.
(she peeks at my badge)
"DR KENNARD! IT'S NICE TO MEET YOU!" She reaches for a handshake.

I peer at her blearily, wondering why this woman is crushing my hand.

It wasn't that long ago that I was a medical student. I remember starting a rotation, wanting to make a great impression, and feeling like I needed to be super friendly and introduce myself to everyone. I was always a little hurt when a resident would blankly stare at me, looking like they wished I would just go away.

Now that I am a resident, I know why they looked like that. They were more tired than I ever knew was possible, and wished that I would just go away.

It's difficult to be a resident. It's hard to have a student breathing your same air, looking at you for scraps of knowledge and slivers of experience. You are jealous of them, because they have slept all night while you've been paged for insignificant notices (emergent Colace, anyone?) You are too tired to even reach for your coffee, never mind engaging in conversation with the bright-eyed, bushy-tailed mini doc sharing your space. Regarding teaching, the difficulty is twofold: I'm a first year resident, so I still feel like I know very little, and am unsure of teaching. My own learning curve is so steep, I don't have extra time or capacity to full engage someone else in learning. The other challenge is the kind of teaching that I do end up doing.

Student: "I went and saw the patient. She asked me if it was okay to play with her pet's poop. I wasn't sure, so I told her I would ask you."

Me: "I think what you're thinking of is the risk of toxoplasmosis to pregnant women, which can be transmitted through cat poop, so she shouldn't clean the litter box."

Student: "Oh okay. I thought that was it, but I wasn't sure what animal did that."

Me: "That being said, it is not okay with her to play with ANY kind of poop."

Student: "Well, I thought so, but I didn't want to say anything without talking to you first."

*Student leaves to readdress patient.*

Student comes back. Resumes earlier discussion.

Me (wondering): Are we still talking about this? Are you kidding me? It should go without saying that people should not PLAY with POO. You should know this, and you are fully authorized to give those instructions, without my explicit permission. We have now spent seven and a half minutes clarifying something that a three year-old knows.

At this point, the resident part of me is downing ibuprofen and reaching for a large, caffeinated beverage. However, the residual student in me sympathizes for this girl. Yes, it was a stupid question. But how much of others' time did I waste as a student? Granted, I'm sure my questions weren't as ridiculous/obvious as this, but I am certain that many good doctors spent a portion of their billable hours invested in my learning and being kind and patient with me.

It's hard to be a student. Even if you know an answer, you hesitate to say it to the patient, because what if your resident/doctor wants something else? Then you have to come back, and ask about the poop, and look absolutely worthless. You want to say, "No! I really did know the answer! I just can't do a normal patient visit because I don't want to step on your toes or screw anything up for you!" You look bad either way. You worry that silence makes you seem disinterested, so you ask questions to fill the dead space, which seems reasonable when you are just sitting there but distracts the doctor from their paperwork. Sometimes I would ask questions I already knew the answer to, just to seem smart and engaged. Looking back (see above reflections on being a resident), I'm sure this made me incredibly annoying.

So, it's hard to be a resident. It's hard to be a student. Each come with their own challenges. However, I think I prefer being the resident. Despite the less sleep and more responsibility, I belong somewhere. I have a job to do in which I am allowed to make decisions and exercise clinical judgement and practice good communication skills. I get to come to work at the same place every day and get better at what I do, and will graduate a competent doctor and masterful surgeon. I know the nurses. I know that I can always get a plain chicken breast at the cafeteria grill, and to stay away from the calzone. All of these small pearls add up to something that I craved as a medical student, and could never get, as I was essentially starting a new job every four weeks. Familiarity. Belonging. Security. Confidence.

Medical students, take heart. Know that your life will improve. And in the meantime, work on a firm, not enthusiastically crushing, handshake. And don't ask about poop.

Jul 2, 2011

The Top Ten Things I've Learned In my First Week as an Intern

A List of the Top Ten Things I've Learned In My First Week as an Intern

10. An entirely new vocabulary of words, acronyms, abbreviations for all things ob and gyn

9. I no longer need a gym membership. I walked eight miles yesterday around the hospital. On that thought, it would be genius for someone to invent a pager/pedometer. It would let doctors know how far they've walked AND save space around the waist.

8. In reference to #9, I never fully appreciated just how many things could be clipped to the waistband of your pants. Cell phone, multiple pagers, wallet, pencil holder, etc. Better tie the drawstring of those scrub pants nice and tight.

7. I can now think in military time.

6. Keep extra underwear and socks in the call room at all times. I'm sure all ob residents have learned this the hard way. That amniotic fluid can really spray.

5. 3:30 to 4:30 am is the "witching hour", as my upper level resident says. Not night, not morning yet, it is the hardest time to be awake. It is physically so difficult, bringing intense nausea, faintness if I stand too long in the OR or a delivery, and achy joints. The older residents tell me this is normal, and why working overnight is so hard. They say you never get used to it, but learn things that make it easier on you.

4. My name is now Kennard. Not Anne. Not Dr. Kennard. Just Kennard. The nurse will say, "Did you page Kennard?" I call back. "This is Kennard, I was paged." I'm glad I like my last name.

3. My life is now indoors and fully climate-controlled. The only way I know the weather outside is by touching the inside of the windows in the call room. It was 118 degrees yesterday. Who would know?

2. The sound of my pager induces an acute stress response. I can't sleep when I'm working overnight even if I have a little down time, because I am just waiting for that thing to go off. And for God's sake (or at least my husband's), leave it in the car when I get home. Otherwise it will beep all night.

1. How big ten centimeters is. I know it seems obvious...ten centimeters is ten centimeters! But I am learning how to do accurate exams to know when someone is ready to have a baby. To facilitate this, I've taped a 10 cm measuring tape onto my mealcard. The cafeteria workers think this is hilarious and now recognize me and laugh every time I come in.

More to come...