Clerkship Diaries: Week 1 in Urgent Care

Week 1: PEDS110, Urgent Care Clinic at SFGH

*DISCLAIMER: there is no medical advice here, my primary role is a medical student who's learning and not a writer, patient details have been changed to respect privacy*

Monday 1/7:

Today was my first day of clerkships ever! I got lost driving to SFGH on the way there and back, I spent an hour on the phone with IT, and I forgot my stethoscope. But from the moment I stepped out of my car, lots of kind strangers welcomed me to the General. I’m so used to walking into SFGH for one half day a week but now I get to spend EVERY DAY here for a whole six months?? I just know that so much good is going to happen here.

At noon conference I learned that neonates can have strokes L. But I love that we get so many didactics sprinkled in our schedule every day! As soon as I returned to clinic in the afternoon, Dr. Marmor (a pediatrics queen) welcomed me by name and invited me to see a patient with an R2 named Jenny who was so warm and explained everything to me and our patient. Our baby had the cutest lil cheeks, and she had two older brothers who were so affectionate, constantly giving her kisses. Afterwards, Dr. Marmor also gave us the most concise and effective explanation of lung physical exam findings I’d ever heard. She showed us how to use an inhaler and a spacer, and then I got to explain all of that to our patient’s mom. My heart melted when I waved goodbye at the older brother and he was so excited to wave back. You know never know what moments are just gonna steal your heart!!

Lessons learned: Remember your stethoscope

Kudos to: Dr. Marmor for the warm welcome and excellent teaching

Tuesday 1/8:

I started off the day with some breakfast potatoes from the cafeteria – an obgyn resident named Artherine saw me behind her and TREATED me to my potatoes because she wanted to give me a warm welcome!! After morning conference, I met an intern named Yaya who was one of my MS4 small group leaders last year- and she remembered me!! We had so much fun hanging out in clinic together. I picked up a super sweet patient that morning in clinic who ended up loving on the senior resident more than me (it’s fine, I’m fine), and honestly it’s amazing how fast time flies in urgent care. I shadowed on a few more patients, slipped out to noon conference (which was about financial planning! I learned what a Roth was!), and then we had didactics at 1:15. I also bumped into my coach Toff when we were leaving didactics and it’s so fun to see familiar faces.

When I went back to clinic, I joined Yaya for a follow up visit on a baby that was only a few days old. The mom had some really complicated social circumstances, and I learned a lot from watching the team navigate their interaction with her to be as helpful as possible while also respecting her sense of agency and control. I also learned that newborns can have BRIGHT YELLOW poop and it’s completely normal. I’m still shook.

Towards the end of the day, I picked up one more patient – he had a pretty pathognomonic presentation of an uncommon condition. I felt a little self-conscious when I was presenting the patient because the whole room got quiet when I got to my A&P and the residents and attendings listened in and were like “mmm that’s not common in that age group”. I went back in with one of the chief residents Dannielle and turns out I was right – I didn’t feel particularly excited though because the condition sucks and his family has a ton of really tough social circumstances. We almost couldn’t get them their medications but then Dannielle made some calls and she got things to work out! It should have felt like a big win but I think I was little weighed down by their life challenges outside of the clinic that I didn’t quite feel it. I had this moment where I just let myself feel sad, which was helpful for me. I’m glad I got to close the loop at the end so I could sympathize with our patient because it SUCKS being a contagious and feeling treated like a pariah through no fault of your own. I hope they felt like we took care of them today. I hope they feel less hesitation coming back to the doctor. I ended up staying later than I needed to but it was okay. I’ve heard how tiring rotations get but no one told me how energizing it is to work on a meaningful case that’s intellectually stimulating and socially complex.

Lesson learned: Do the FULL physical exam, even if you’re feeling a little rushed in urgent care clinic and only think I need to examine one system. I need to practice my learning as a medical student, now is not the time to take shortcuts!

Kudos: Yaya who gave me high fives and took me along to see patients and cheered me on when I got that diagnosis right; Danielle who works really hard and is so GOOD at making stuff happen and so forgiving when I accidentally introduced her to our patients as Danielle instead of Dr. McBride; and Artherine for buying me potatoes!

 

Wednesday 1/9:

Today was an FS day so lots of didactics! No patients but 4 different sessions (2 lecture and 2 small groups). The highlight of the day was definitely seeing familiar faces I hadn’t seen in weeks! We were at the Mission Bay campus so we went to Spark Social for lunch which felt like a real treat (I got boba at the end too yay!). We were done a little after 3:30 which is definitely an earlier day than we get when we’re at the hospital. On the way back, I stopped by the Office of Admissions to catch up with my favorite UCSF queen Hallen Chung. I feel like I wasn’t stretched to grow today but the comfort of familiar faces filled my cup up.

Lessons learned: Dean Lucey told us that we’ll learn better if we try to compare and contrast as we study; if we read up on lupus one night, it’ll stick better if we can see how it’s similar and different to something else on the lupus differential like rheumatoid arthritis.

Kudos to: Hallen Chung for everything she does!!

Thursday 1/10:

I got to be helpful at morning conference when the attending couldn’t find a dongle for his laptop and I had the right one! It’s the little things. Clinic was chill, we worked on some cases and then I slipped out at 10:15 – had to RUN to catch the shuttle because those elevators take longer than I realized. I had so much fun presenting at Dr. Louise Aronson’s “Beyond Science” talk and hearing what the other presenters shared. I related to what Dereck Paul said about how hard it is to find your voice in the chaos of medical school. We’re hear so many messages from other people about what to do and how to be that it’s hard to hear our own. I want to be better at this, more in tune with myself. I don’t know how much I enjoy lecturing in front of big groups TBH but it’s pretty special that I got to share my dysmenorrhea work with so many people.

When I got back to SFGH, I caught the end of Schwartz rounds (and they gave me a tofu banh mi BLESS) – I was really moved at how many people feel so passionately about the culture and spirit of SFGH and how they take so much pride in working here. There were two women who were born at SFGH and always dreamed of working here when they were younger. It’s such a healthy reminder that we’re all connected through our love and pride for this hospital and is mission. In the afternoon, I was scheduled to shadow a pediatrician who focused on adolescent medicine and learned some stellar adolescent pearls. When I returned to urgent care, I picked up an infant with a fairly uncomplicated case; the parents were so lovely and we got him squared away. Jenny helped me with the physical exam and then my presentation so by the time I presented to the senior resident, I was so put together! Jenny and I then went in to see two sisters who were sick; the younger one was a huge fan of Doc McStuffins and so much had fun playing with my stethoscope, listening all over, and putting bandaid stickers on me. It was really precious but I wasn’t sure how contagious she was so I washed my hands and stethoscope multiple times with soap and water afterwards. Everyone says you get sick on your urgent care rotation but I’m trying my hardest not to!!

Lessons learned: The same diseases present SO DIFFERENTLY in different kids with varying severity and I need to get more comfortable with that instead of expecting everyone to present with my textbook idea!

Kudos: to Jenny for being there every step of the way for me today!

Friday January 1/10:

For my first patient this morning, the dad declined an interpretor and opted to translate for us; the mom was in the room and I wish I had brought her into the conversation more. I got some feedback from Dr Bardach when we debriefed the encounter. I feel a sense of ownership over this work now – I’m happy to close the loop and provide return precautions. I’m not sure how much space urgent care has for “healing relationships” – I’m hyperaware of how people want help and then they want to leave. I don’t think people come here looking for human connection. To serve these patients best, I feel like I just need to stick to the script. I’ve made barely any personal conversation with my patients and their families all week, and that feels okay.

My next patient was having a really rough time. I had to step away for noon conference, but when I returned in the afternoon, I went in with an attending who asked a lot of the same questions I had already (I guess I signed out to resident who signed out to Dr. Bardach who signed out to another attending and I never got to present the patient to her) but it makes me wonder what patients think when they have to answer the same question twice – does it feel like I didn’t listen to them? Do they feel like I didn’t do a good job or conveying their information to the attending? Or maybe they don’t really care and just want answers. The transformation in the patient though from when I first saw her to after she got some treatment was remarkable. I was pretty tired after that case but I picked up another precious little infant.

We took a break around 3 for ICE CREAM which is a weekly tradition for the pediatrics folks at SFGH. I had some gourmet grasshopper oo la la! I wrapped up around 5:30; I felt a little hesitant leaving. But I know I need to work on leaving feeling fulfilled and at peace, even if there are a ton of unsatisfying and incomplete things going on with my patients so I can be centered and intentional when I enter my personal time. I went to my favorite hiphop class, shopped at the Trader Joe’s next door, and picked up some Chipotle for dinner before having a quiet night in with some TV and reading (Kamala Harris’s memoir just came in the mail and I am obSESSED).

Lessons learned: I need to be more patient with myself.

Kudos to: Dr. Bardach for completing my BBOT <3