week 10: medicine part 2!
*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*
Week 10
Sunday 3/10
Daylight savings gave me a rough start to the morning. I still did my full work out and made my meals for the day, but I left later than I had planned which meant I didn’t have enough time to pre-round like I had hoped. I managed to squeeze in the key things and slip into our rounds at 8:03, our attending was also hit by daylight savings so she was running late and our senior had time to squeeze in some teaching! Today was short call so we got 4 new patients, all with super interesting cases. Rounds were really fun and we got to visit most everyone. Eric taught us a neat trick when we can’t see JVD because someone’s neck has maybe too much muscle or fat – we can look for a vein in the hand that pops out when our hand is down by our sides, we can slowly raise the hand and when the hand is at heart level, the vein should disappear because it’s draining downward because of gravity. If we can still see the vein, that means there’s volume overload. Like JVD! He cautioned us that it’s not a perfect measure, but I love learning lil tricks like that so much. Towards the end of rounds, we saw a patient who was a little mixed up on the date, but when we told her it was March, she immediately remembered what day it was and told us that it was a significant anniversary with her husband, who I don’t think is around anymore. It was a really tender, really sad moment. What more can you do than just sit with that, remind someone that at least right now, they’re not alone. This patient has felt really fragile, precarious since we admitted her. The team brought up the possibility of hospice earlier at rounds, and it just caught me off guard. She’s so young. I expected her to bounce back. But sometimes when someone is so sick, there’s not much to bounce back to.
Afterwards, my only real task was to write my progress note. It’s amazing to just step back after I write up these notes and read them – like what, *I* wrote that? Me?? I really push myself to show my clinical reasoning, to give good reasons why things are more likely or less the cause of the problem at hand. I kept asking the team for new tasks but everyone was so on top of it that there wasn’t much I could help with! Eric told me I could leave around 1:30, which yes is usually welcomed, but I felt like there was still learning to be had so I didn’t want to go quite yet. We were planning to do a paracentesis around 2 and then I wanted to touch base with our attending Anna because today’s her last day! The paracentesis didn’t end up happening, we looked for fluid in our patient’s belly and then couldn’t find a pocket that was big enough to tap! It’s great that diuretics are moving most of the excess water out of her body, and she seemed relieved by not getting stuck with our needle. Feedback with Anna was lovely, but I feel like I need to push more and have more specific questions ready for these conversations. I I wish we got more tips on navigating these kinds of conversations and making the most of them. It was sweet that she gave me a hug at the end of the conversation! I felt a little bad for leaving when she dismissed me because there was team dinner planned later that evening... but I wouldn’t have enjoyed sticking around the hospital for a few hours. It’s a six day week, only the start of week 2, and Libby was right when she said we’ll have a lot of years to “hang out with the team”.
Thinking today about the line between being helpful and being annoying. I asked a few times what tasks I could help with, there wasn’t really anything I could do. Asking again wasn’t going to help anyone. They really just want me to focus on my patient, on my note. During the thoracentesis, there were moments I wanted to talk to the patient but it was Jerry’s procedure and we were just watching. I didn’t want to interrupt his flow. It may have felt awkward to us, just standing around without saying anything during the prep, but he probably appreciated the peace and quiet and our patient might have too.
I’m glad I went home around 4, there wasn’t much more learning to be had at that point. I fell asleep not long after coming back and whew that nap felt amazing! I have some reading to do, some Uworld questions waiting for me, but hearing the rain against my windowpane and my background classical music is a nice vibe.
I’ve been thinking a lot more about chronic pain and how medicine is just so unequipped to treat it. We just give people pain medications or refer them out to physical therapy and seem to be okay with those limits. Chronic musculoskeletal pain is so common, it really limits people’s lives. The stretching class we went to yesterday was such an interesting perspective. It felt good to just focus on unwinding, to be open to finding knots and adhesions, to think about the kinds of tension we hold in our bodies. Healthcare professionals are on our feet a lot, there’s physical and cognitive stressors, and we are exposed to a lot of pain and suffering that I don’t always realize I’ve taken on. My FCM preceptor is very interested in these issues, she recommended I look over the trigger point therapy work book and I realized it has very similar principles to our stretching class! The lil mini balls we used to work out tension in different muscles have been ordered on amazon and I’m so excited to use them regularly. I hope this is knowledge that I can pass on to my patients with certain kinds of chronic pain.
I feel like I haven’t seen very many family members since starting medicine. I’m so used to it from peds, but a lot our patients don’t have a lot of people visiting them. Every time I visit someone or we round as a team, they’re alone.
Monday 3/11
I need to preround earlier, my patient had some unexpected hyperkalemia so I missed morning report! I did a lil teaching before we got started with rounds and then my presentation went well! Also our new attending is from South Carolina, small world!
One patient was swearing up a storm, he was in a lot of pain and didn’t have much patience but he kept apologizing to us. It was an interesting contrast. One patient was hilarious, he welcomed us in graciously, like we were stepping into his home, he joked about offering up cocktails. At one point, he called us the Beverly hills general hospital, when the nurse asked his size to get him some clothes to change out of his hospital gown, he called it designer clothing for the runway. He such a good sense of humor, and he was so generous with his gratitude for the team. A patient that I had been following was also in good spirits this morning. I didn’t know that rounds would be the last time I’d see him! Although, I was okay when I found out he’d been discharged during our didactics. It was time for him to go, and I’m glad that I got to see him get better.
Other fun highlights from the day include performing a moca which was fun, didactics was a case from our team and I love everything that Margaret Wheeler teaches us, Eric also made time for some teaching moments which were great.
Dr Thomas’s advice was to be specific about feedback, to really reflect on what to work on instead of broad categories; she’s right, goals don’t happen with the big vision, it needs specific, intentional planning of lil mini goals but where to START ugh
I almost teared up on the call with dad, I’ve been carrying around this sense of guilt and I feel like it’s just not right for me to shed it; it seems unfair that I walk to my car when the people we see take the bus etc etc, that I have warm jackets when there are people walking around the cold without pants. I’m usually good at sorting through these tensions and packing them up nicely but it just doesn’t feel right for me to not feel a little bit of this. But does it have to be guilt? How else can I carry forward reminders that the world is unequal (but that I didn’t make it this way), that I can see the humanity in others (without reducing them to their suffering)? Because everyone has joys and pride in this life. They’re different from mine. I need to start seeing people more through the lens of the goodness rather than trying to extrapolate to their pains. Maybe this is another place I can practice being present, just going off of what people tell me and bring to our encounters rather than trying to fill in all their blanks on my own, rather than painting so many people with broadstrokes of suffering. Dad helped put it in perspective; he said that all we can do is make the most of our opportunities and that we can value what we have. Reminded me that my life isn't perfect either. Our conversation made me remember that my parents didn’t work their tails off to provide for us and to raise us so intentionally for me to walk around feeling bad for what they’ve given me. It was a talk I really needed.
Tuesday 3/12 : FCM day!
I was running a little late today – I felt bad and I don’t like rushing when I drive! I should have gotten out of bed earlier and done my workout a little bit faster. Dallman didn’t seem to mind but still, it’s not the kind of student I want to be. I think it’s really sweet that you get greeted by so many “good mornings” when you work in a large office space like ours.
My first patient had a lot going on – she had alcohol, cigarette, and sugar use disorders. After our initial conversation, I left feeling kind of heavy, like she has so much going on and there’s too much to sort through, wondering how we’re supposed to help her ease her need for these substances when she’s relapsing and taking steps back or not even interested in changing. Dallman framed it so well; she said that our patient had a short alcohol relapse a few weeks ago and hasn’t used since. Relapse is part of breaking the cycle. Most people who get clean relapse, it’s the nature of addiction as a disease. Relapse isn’t a sign of weakness or not being committed, though we often shame people for it. The best situation is when relapse is short and our patients are honest with us – and this patient was both. I was so wrapped up in collecting the little details about all of these things going on with her that I didn’t zoom out to ask why she’s struggling with her addictions more than usual. Dallman asked her about new stressors, and of course there’s been a trigger that contributed to these steps back. Dallman reminded me that it’s REALLY HARD to make a big tough life change when you’re super stressed – she asked if MS3s tend to make big changes while on their clerkship year? No of course not (though you know a girl has been trying to get more fit, the building blocks for that have been laid down for a while). I returned to our patient with Dallman feeling much lighter and more hopeful. It’s powerful how my own ingrained biases around a linear course of addiction and cessation color my perspective. Dallman told me that med students often get too wrapped up in making changes *now* but that family medicine is about being in it for the long haul. As long as our patients are informed about the risks of their choices and feel supported in making changes and feel heard and cared for, then we’re doing the right thing even when our patients don’t act like we’d hope for them to. My other patients today also all had pretty serious smoking issues and none of them seemed all that receptive to quitting, but it’s such a big risk factor that we have to ask every patient every time.
One of our patients is opening a nightclub in an amazing location on the water – I can’t wait for it to open up because it sounds like such a neat spot! Another patient had an AKA (above the knee amputation) and he just wants to walk again but there’s a lot going against him; I felt a bit of blind optimism given his own hopes but Dallman had to be the realist in the room and say that it might not be possible. It’s important to adjust expectations and give our patients an idea of realistic prognoses. He said he’d been smoking for fifty years and wasn’t sure that quitting now would make a difference, I wish I had said that sure you might not be able to undo some of the damage, but it can make a difference for you going forward. Another patient we’d seen before, she’s a mom of two and today she was present and glowing which was such a change from the last time I saw her. One patient had some really poorly defined cognitive deficits and a complicated social situation we couldn’t really dive into. One patient I’ve seen a few times now, I wasn’t there for her appointment, but we chatted for a bit by the door about her mom’s birthday tonight and that was a sweet moment. Another patient carried a purse with everything inside of it and was grieving some losses. When Dallman was explaining her lung findings resulting from her smoking, she got a little sad, and Dallman immediately sensed it and reassured her. We listened to her heart which was completely normal and when I told her that her heart sounded great, she smiled a little bit and that was such a sweet moment. Her blood pressure was one of the BEST I’ve ever taken. I need to practice more but ugh it’s hard to practice on real people when I feel like I’m not perfect at these maneuvers.
At the end of the day, I stopped by the Walgreens on 24th and Potrero to pick up my special period NSAIDs that I’ll need to start taking prophylactically soon. Of course there’s a few colorful characters on the way in, but I was shocked to see how long the line was. But if our patients can do it then so can I. The man in front of me struck up a conversation; I was trying to work on my UWorld questions but he asked why I was in line if I worked here. I was like LOL well I’m actually a student at the hospital. The man in front of him struck up a conversation, I think he was a mechanic or something, and then afterwards he chuckled saying that he sees his clients all over the city, he was sure the same thing happened to me and then it was his turn to collect his prescription. I haven’t seen any of my patients out and about (not that I have that many) but it’s a sweet thought. I hope I do.
Wednesday 3/13
Morning rounds post-call is always and adventure. We had sweet Ms A who was gracious and kind, easily excitable and thorough delighted with our diverse team. She said we need more people of color and women to go into medicine. The next man was going through pretty intense alcohol withdrawal and was desperate to not end up on the streets again. Our next patient said she’d kill herself if she got discharged to the streets; psych confirmed that we should take her word seriously. She was very honest though because that’s who she was.
-Wound care teaching was SO fun! Who knew we use honey and silver and magical foams to dress our patients wound! It was an interactive hour of teaching with lots of hands on demonstrations
-Then I chatted with Larissa about feedback, even though we only had 4 days together! We talked about myers briggs for a while LOL and she was really into it which I appreciate
-Really focused on NOT HURRYING this afternoon and just taking my time with all the tasks (I had a long list and things kept emerging but it was good learning or I got to be helpful) and being patient with myself
-There was a moment at like 6:30 when I was pretty much all done, Eric was surprised to see me and joked that he couldn’t go home until I did; Jerry patted me on the back and told me to go home for like the third time that afternoon, we all chuckled for a bit and I just felt like I belonged. I’m going to miss that and miss this team and cherish these moments together. What an amazing team to start off the rotation with.
-Ending the day thinking about treasured and special it is to me to be in a field where we are given deeply intimate looks into our patients’ lives almost immediately upon meeting them. We learn so much about people and their stories if we get the time to listen (and as a med student all we have is time)
Saturday 3/16
Week 10
Sunday 3/10
Daylight savings gave me a rough start to the morning. I still did my full work out and made my meals for the day, but I left later than I had planned which meant I didn’t have enough time to pre-round like I had hoped. I managed to squeeze in the key things and slip into our rounds at 8:03, our attending was also hit by daylight savings so she was running late and our senior had time to squeeze in some teaching! Today was short call so we got 4 new patients, all with super interesting cases. Rounds were really fun and we got to visit most everyone. Eric taught us a neat trick when we can’t see JVD because someone’s neck has maybe too much muscle or fat – we can look for a vein in the hand that pops out when our hand is down by our sides, we can slowly raise the hand and when the hand is at heart level, the vein should disappear because it’s draining downward because of gravity. If we can still see the vein, that means there’s volume overload. Like JVD! He cautioned us that it’s not a perfect measure, but I love learning lil tricks like that so much. Towards the end of rounds, we saw a patient who was a little mixed up on the date, but when we told her it was March, she immediately remembered what day it was and told us that it was a significant anniversary with her husband, who I don’t think is around anymore. It was a really tender, really sad moment. What more can you do than just sit with that, remind someone that at least right now, they’re not alone. This patient has felt really fragile, precarious since we admitted her. The team brought up the possibility of hospice earlier at rounds, and it just caught me off guard. She’s so young. I expected her to bounce back. But sometimes when someone is so sick, there’s not much to bounce back to.
Afterwards, my only real task was to write my progress note. It’s amazing to just step back after I write up these notes and read them – like what, *I* wrote that? Me?? I really push myself to show my clinical reasoning, to give good reasons why things are more likely or less the cause of the problem at hand. I kept asking the team for new tasks but everyone was so on top of it that there wasn’t much I could help with! Eric told me I could leave around 1:30, which yes is usually welcomed, but I felt like there was still learning to be had so I didn’t want to go quite yet. We were planning to do a paracentesis around 2 and then I wanted to touch base with our attending Anna because today’s her last day! The paracentesis didn’t end up happening, we looked for fluid in our patient’s belly and then couldn’t find a pocket that was big enough to tap! It’s great that diuretics are moving most of the excess water out of her body, and she seemed relieved by not getting stuck with our needle. Feedback with Anna was lovely, but I feel like I need to push more and have more specific questions ready for these conversations. I I wish we got more tips on navigating these kinds of conversations and making the most of them. It was sweet that she gave me a hug at the end of the conversation! I felt a little bad for leaving when she dismissed me because there was team dinner planned later that evening... but I wouldn’t have enjoyed sticking around the hospital for a few hours. It’s a six day week, only the start of week 2, and Libby was right when she said we’ll have a lot of years to “hang out with the team”.
Thinking today about the line between being helpful and being annoying. I asked a few times what tasks I could help with, there wasn’t really anything I could do. Asking again wasn’t going to help anyone. They really just want me to focus on my patient, on my note. During the thoracentesis, there were moments I wanted to talk to the patient but it was Jerry’s procedure and we were just watching. I didn’t want to interrupt his flow. It may have felt awkward to us, just standing around without saying anything during the prep, but he probably appreciated the peace and quiet and our patient might have too.
I’m glad I went home around 4, there wasn’t much more learning to be had at that point. I fell asleep not long after coming back and whew that nap felt amazing! I have some reading to do, some Uworld questions waiting for me, but hearing the rain against my windowpane and my background classical music is a nice vibe.
I’ve been thinking a lot more about chronic pain and how medicine is just so unequipped to treat it. We just give people pain medications or refer them out to physical therapy and seem to be okay with those limits. Chronic musculoskeletal pain is so common, it really limits people’s lives. The stretching class we went to yesterday was such an interesting perspective. It felt good to just focus on unwinding, to be open to finding knots and adhesions, to think about the kinds of tension we hold in our bodies. Healthcare professionals are on our feet a lot, there’s physical and cognitive stressors, and we are exposed to a lot of pain and suffering that I don’t always realize I’ve taken on. My FCM preceptor is very interested in these issues, she recommended I look over the trigger point therapy work book and I realized it has very similar principles to our stretching class! The lil mini balls we used to work out tension in different muscles have been ordered on amazon and I’m so excited to use them regularly. I hope this is knowledge that I can pass on to my patients with certain kinds of chronic pain.
I feel like I haven’t seen very many family members since starting medicine. I’m so used to it from peds, but a lot our patients don’t have a lot of people visiting them. Every time I visit someone or we round as a team, they’re alone.
Monday 3/11
I need to preround earlier, my patient had some unexpected hyperkalemia so I missed morning report! I did a lil teaching before we got started with rounds and then my presentation went well! Also our new attending is from South Carolina, small world!
One patient was swearing up a storm, he was in a lot of pain and didn’t have much patience but he kept apologizing to us. It was an interesting contrast. One patient was hilarious, he welcomed us in graciously, like we were stepping into his home, he joked about offering up cocktails. At one point, he called us the Beverly hills general hospital, when the nurse asked his size to get him some clothes to change out of his hospital gown, he called it designer clothing for the runway. He such a good sense of humor, and he was so generous with his gratitude for the team. A patient that I had been following was also in good spirits this morning. I didn’t know that rounds would be the last time I’d see him! Although, I was okay when I found out he’d been discharged during our didactics. It was time for him to go, and I’m glad that I got to see him get better.
Other fun highlights from the day include performing a moca which was fun, didactics was a case from our team and I love everything that Margaret Wheeler teaches us, Eric also made time for some teaching moments which were great.
Dr Thomas’s advice was to be specific about feedback, to really reflect on what to work on instead of broad categories; she’s right, goals don’t happen with the big vision, it needs specific, intentional planning of lil mini goals but where to START ugh
I almost teared up on the call with dad, I’ve been carrying around this sense of guilt and I feel like it’s just not right for me to shed it; it seems unfair that I walk to my car when the people we see take the bus etc etc, that I have warm jackets when there are people walking around the cold without pants. I’m usually good at sorting through these tensions and packing them up nicely but it just doesn’t feel right for me to not feel a little bit of this. But does it have to be guilt? How else can I carry forward reminders that the world is unequal (but that I didn’t make it this way), that I can see the humanity in others (without reducing them to their suffering)? Because everyone has joys and pride in this life. They’re different from mine. I need to start seeing people more through the lens of the goodness rather than trying to extrapolate to their pains. Maybe this is another place I can practice being present, just going off of what people tell me and bring to our encounters rather than trying to fill in all their blanks on my own, rather than painting so many people with broadstrokes of suffering. Dad helped put it in perspective; he said that all we can do is make the most of our opportunities and that we can value what we have. Reminded me that my life isn't perfect either. Our conversation made me remember that my parents didn’t work their tails off to provide for us and to raise us so intentionally for me to walk around feeling bad for what they’ve given me. It was a talk I really needed.
Tuesday 3/12 : FCM day!
I was running a little late today – I felt bad and I don’t like rushing when I drive! I should have gotten out of bed earlier and done my workout a little bit faster. Dallman didn’t seem to mind but still, it’s not the kind of student I want to be. I think it’s really sweet that you get greeted by so many “good mornings” when you work in a large office space like ours.
My first patient had a lot going on – she had alcohol, cigarette, and sugar use disorders. After our initial conversation, I left feeling kind of heavy, like she has so much going on and there’s too much to sort through, wondering how we’re supposed to help her ease her need for these substances when she’s relapsing and taking steps back or not even interested in changing. Dallman framed it so well; she said that our patient had a short alcohol relapse a few weeks ago and hasn’t used since. Relapse is part of breaking the cycle. Most people who get clean relapse, it’s the nature of addiction as a disease. Relapse isn’t a sign of weakness or not being committed, though we often shame people for it. The best situation is when relapse is short and our patients are honest with us – and this patient was both. I was so wrapped up in collecting the little details about all of these things going on with her that I didn’t zoom out to ask why she’s struggling with her addictions more than usual. Dallman asked her about new stressors, and of course there’s been a trigger that contributed to these steps back. Dallman reminded me that it’s REALLY HARD to make a big tough life change when you’re super stressed – she asked if MS3s tend to make big changes while on their clerkship year? No of course not (though you know a girl has been trying to get more fit, the building blocks for that have been laid down for a while). I returned to our patient with Dallman feeling much lighter and more hopeful. It’s powerful how my own ingrained biases around a linear course of addiction and cessation color my perspective. Dallman told me that med students often get too wrapped up in making changes *now* but that family medicine is about being in it for the long haul. As long as our patients are informed about the risks of their choices and feel supported in making changes and feel heard and cared for, then we’re doing the right thing even when our patients don’t act like we’d hope for them to. My other patients today also all had pretty serious smoking issues and none of them seemed all that receptive to quitting, but it’s such a big risk factor that we have to ask every patient every time.
One of our patients is opening a nightclub in an amazing location on the water – I can’t wait for it to open up because it sounds like such a neat spot! Another patient had an AKA (above the knee amputation) and he just wants to walk again but there’s a lot going against him; I felt a bit of blind optimism given his own hopes but Dallman had to be the realist in the room and say that it might not be possible. It’s important to adjust expectations and give our patients an idea of realistic prognoses. He said he’d been smoking for fifty years and wasn’t sure that quitting now would make a difference, I wish I had said that sure you might not be able to undo some of the damage, but it can make a difference for you going forward. Another patient we’d seen before, she’s a mom of two and today she was present and glowing which was such a change from the last time I saw her. One patient had some really poorly defined cognitive deficits and a complicated social situation we couldn’t really dive into. One patient I’ve seen a few times now, I wasn’t there for her appointment, but we chatted for a bit by the door about her mom’s birthday tonight and that was a sweet moment. Another patient carried a purse with everything inside of it and was grieving some losses. When Dallman was explaining her lung findings resulting from her smoking, she got a little sad, and Dallman immediately sensed it and reassured her. We listened to her heart which was completely normal and when I told her that her heart sounded great, she smiled a little bit and that was such a sweet moment. Her blood pressure was one of the BEST I’ve ever taken. I need to practice more but ugh it’s hard to practice on real people when I feel like I’m not perfect at these maneuvers.
At the end of the day, I stopped by the Walgreens on 24th and Potrero to pick up my special period NSAIDs that I’ll need to start taking prophylactically soon. Of course there’s a few colorful characters on the way in, but I was shocked to see how long the line was. But if our patients can do it then so can I. The man in front of me struck up a conversation; I was trying to work on my UWorld questions but he asked why I was in line if I worked here. I was like LOL well I’m actually a student at the hospital. The man in front of him struck up a conversation, I think he was a mechanic or something, and then afterwards he chuckled saying that he sees his clients all over the city, he was sure the same thing happened to me and then it was his turn to collect his prescription. I haven’t seen any of my patients out and about (not that I have that many) but it’s a sweet thought. I hope I do.
Wednesday 3/13
Morning rounds post-call is always and adventure. We had sweet Ms A who was gracious and kind, easily excitable and thorough delighted with our diverse team. She said we need more people of color and women to go into medicine. The next man was going through pretty intense alcohol withdrawal and was desperate to not end up on the streets again. Our next patient said she’d kill herself if she got discharged to the streets; psych confirmed that we should take her word seriously. She was very honest though because that’s who she was.
With some of our patients, we talked about them being “poor historians” because what they were telling us didn’t line up with notes from the past – which is a challenging situation for sure for our team. But I wonder how much of being a “poor historian” results from being exposed to all kinds of traumas and developing (helpful or maladaptive) coping mechanisms to make it through. I was avidly following along with all the post-call presentations (though I definitely zone out every once in a while). It was validating when a question that I was bursting to ask – the attending asked before I could. TBH wish I could have shown my thought process but it felt good to know that I was thinking on the same lines as her. We also have some patients moving into hospice, which shouldn’t be jarring but I’m still surprised when it comes up. Hospitalization in older or sicker patients makes sense as a logical turning point – it’s miserable being hospitalized and the question now becomes how to avoid another hospitalization and maximize quality of life. Larissa reminded us that some patients are discharged from hospice doing better than when they came in. Our wound clinic at the general is called ISIS (this was named a while ago) so we kept saying “send Mr X to Isis” and yes it felt a little weird! There was a sweet continuity moment when I heard one of our patients last week has Dr Chodos as his PCP! One of our new patients was recently released from jail because of the reversal of the three strikes drug charges, he served FORTY years! Unreal and so unfair I can't even wrap my mind around it. After rounds, we visited a sweet patient and had some physical exam tips (parts of your hands are better at sensing temperature, others vibration!). Practiced our lung physical exam findings including tactile fremitus and percussion and found a bit of a pleural effusion : 0
Didactics was a narrative medicine talk. I liked getting to analyze art for sure. That was fun! I read up lots on my new patient, afternoon teaching with the attending about abx was a little over my head but I mostly followed it. Then my new patient was asleep and I saw Ms X for like thirty minutes and we had such a sweet conversation! I’m glad that I got to talk to her because I really wanted to. Was in a battle with UPS but finally got my package YAY!
Looking ahead to the weekend and watching a movie by myself sounds like a perfect afternoon, maybe pick up some ramen on the way out??
Thursday 3/14
Today was a wild ride. As soon as I walked into the elevator upon arrival, I saw a man in a wheelchair look like he wanted to get on but was having a bit of difficulty. I asked if he was going up, he said yes, so I held the elevator open for him. When he rolled in, I realized he was barely wearing anything, just had a white hospital sheet draped over him and some very infected leg wounds. I’ve learned not to bat an eye and make pleasant conversation, he was a sweet guy actually and I hope he was able to get his wound care. When I stepped out, I saw four police officers surrounding a man in handcuffs. It seemed excessive, but I didn’t know the circumstances around it so I continued on my way. Fifteen minutes into pre-rounding, I was feeling good, like today I’d be able to put together a solid presentation and show the team how I was sorting through a really complicated case. Instead, LCR crashed and I wasn’t able to pull my labs (which maybe I shouldn’t leave to the end of pre-rounding?). I didn’t even know where my patient was; I went to the ED to see if she was still there but she had been transferred upstairs. I texted Eric who knew where to find her but he said to call the lab to get her lab values because we needed them for rounds. I had blocked off thirty minutes to hang out with her but after all of this, I barely had ten. But I introduced myself and did a bit of an exam, got the interim history and managed to arrive to rounds two minutes early. Eric gave me an EKG to read which I was able to make some sense out of. We discussed patients and saw some folks.
Before rounds, I had a talk with myself. I had hoped today would be a day to show my clinical reasoning skills but maybe the real goal of today was to practice being flexible in inconvenient circumstances and making the best of not ideal situations. The team was so chill about our less than adequate pre-rounding but it bothered me that I couldn’t do my best. Anyways, I had kind of made up my mind to be grumpy about this morning. I didn’t want to be positive and reframe it. But I did reflect on what kind of team member and provider I want to be; even when I’m having these self-proclaimed “off days”, I still want to be gracious and supportive of my team and present for my patients. I don’t want anyone else to sense my mood or feel like I’m not treating them right.
Our sweet Ms Z was so tickled with her electronic cat (literally SO precious I love these things). Another patient that Anthony had been following was very unhappy with the limitations of our discharge. It was a hard moment, he said he’d do something drastic if he ended up on the street again but refused to elaborate on what that meant. I’m glad I checked in with Anthony and told him he was doing a good job; even though I was frazzled for my own reasons, that moment was about me being the kind of friend and teammate I hope to be. Another patient had a migraine which made me ask a migraine question and Dr Thomas said she was having a migraine right now and I was taken aback. Here I was feeling like the team had it all together and I didn't, and I forgot that they’re all people too, bad things might be happening to them, they might be sick or tired. They have more responsibility and stress than I do. It’s unfair to expect people to be operating at 100% all the time. No matter how smart or put together they are, they’re allowed to have bad days just like me!
We split off for intern report after a bit. I was also hungry sos I should have eaten breakfast before! I met the site director for the residency I think and asked if he was a resident or intern. LOL. The case was fun to go through, we had an hour after to work on things. I had literally one task, to make a phone call to get my patient’s methadone dosing, and it would not go through. Then my pen died and I was just bearing down on paper trying to inscribe notes on the paper without ink. It was an OFF day! But Libby was gracious and set aside like 45 min to teach us the ins and outs of reading EKGs. I went to Schwartz rounds and then Dereck said it was the same talk so I took them to Denise Davis’s microaggressions talk over sushi which was wonderful. I love that she had us talk about our names. I tried calling this methadone clinic again in the afternoon and started prepping my progress note, then went to didactics! I pretty much finished up my note and then Eric left but dismissed me but I wanted to see my patients. I chatted with one for a bit, she was really touched and thanked us for caring about her. I tried to be nonjudgemental with my questions. She said she was interested in HCV treatment and getting a PCP. I saw another patient for a bit too who seemed a little agitated, I felt bad for riling up but she said she was riled up before I got there LOL. Something clicked, maybe the fact that these women were having way worse days than I could even imagine, and my day didn’t feel so bad after all. I met up with Eric and asked my LONG list of questions, all of which he was eager and happy to answer. I finished up my note and then called it a day.
Talking to mom on the phone was super helpful today. She said she ALSO had a patient with opioid withdrawal and c diff and couldn’t tell what was causing the diarrhea today. She said that methadone clinics never answer the phone and that we should fax them LOL. As I walked through my day with her, I realized that it was a really solid day and that I did things well:
· Speaking up about racial inequity re college admissions/high school placements by neighborhood
· Not forgetting about calling this methadone clinic repeatedly
· Speaking up in didactics
· Keeping up with Libby’s EKG lesson
· Speaking up in the microaggression workshop
· Writing my note
· Visiting my patients and showing them that I care, seeing patients always seems to fill my cup up
· Asking Eric good questions about the case
· Finally kind of making sense of my case
· Not letting my bad day affect how I treat people and the energy I bring to the team
Off days are helpful too, today helped me realize what matters most to me. And being kind, warm, and present matter to me so much and I don’t ever want to be less than that for my team or patients, no matter how behind on work I feel or how unfair the situation is. I’m in it for the long haul but also to make all the little moments matter.
Friday 3/15
I worked my first real six day week and a girl is drained. Today was a really solid day, I wish I got home a little earlier but looking forward to some much needed sleep and rest tonight and tomorrow.
-We saw the prettiest angiogram at morning report today.
-We had a patient who I think was really frustrated with us but also kind of friendly, I wasn’t sure how to interpret his remarks but I always err on the side of positive intent. At the end of the visit, he called me sweetheart which I think means he likes me, I wish I could have hung out more because he seems like such an interesting man.
-At MDR, our social worker had to take a deep breath to brace himself for our requests (LOL)
-We had EKG and CXR reading practice towards the end of rounds - so much teaching!
-the energy of MATCH DAY was circulating around the room all morning! I feel like that energy makes me uncomfortable thinking about my own match day two years from now. It sucks to not have control and to play this interminable waiting game. It usually works out just fine, but how do you react when you didn’t get your first choice? How do you react when you are happy but the people around you might not be happy with theirs? Will I open my envelope around people or by myself? I hope I can go into the day at peace with whatever circumstances follow and that I feel proud for making the most of my medical training up until that point. I hope I’m less uneasy thinking about it as that day gets closer.
-Lunch was a beautiful feast with salads and fresh watermelon and TOFU sandwiches yum
-Moments with a patient today that stood out: she asked how old I was, if I liked my training; later I learned that she likes writing short stories and poetry and used to enjoy reading before her head injury. At one point she asked about what I was doing with my day off tomorrow and I told her I was gonna see the movie about kids with cystic fibrosis and she laughed, I know it’s ridiculous to spend my time out of the hospital thinking about being in the hospital but there’s something about learning about patient experiences that draws me in. She asked what c diff was and I explained why we were these yellow gowns, I also convinced her to give us blood for our labs, she told me about her anxiety and pain and started to open up about her history of trauma but I had to leave for didactics, I felt bad for leaving her more anxious than I found her :(! Later I went back, and I know she wanted more meds and I tried my best to explain our limitations but I’m not sure she was all that interested in hearing it. The toughest thing about today actually not being able to give her what she wants and feeling like she was frustrated with us. I’m glad we were able to give her some anxiety medications before the day was out.
Didactics was a narrative medicine talk. I liked getting to analyze art for sure. That was fun! I read up lots on my new patient, afternoon teaching with the attending about abx was a little over my head but I mostly followed it. Then my new patient was asleep and I saw Ms X for like thirty minutes and we had such a sweet conversation! I’m glad that I got to talk to her because I really wanted to. Was in a battle with UPS but finally got my package YAY!
Looking ahead to the weekend and watching a movie by myself sounds like a perfect afternoon, maybe pick up some ramen on the way out??
Thursday 3/14
Today was a wild ride. As soon as I walked into the elevator upon arrival, I saw a man in a wheelchair look like he wanted to get on but was having a bit of difficulty. I asked if he was going up, he said yes, so I held the elevator open for him. When he rolled in, I realized he was barely wearing anything, just had a white hospital sheet draped over him and some very infected leg wounds. I’ve learned not to bat an eye and make pleasant conversation, he was a sweet guy actually and I hope he was able to get his wound care. When I stepped out, I saw four police officers surrounding a man in handcuffs. It seemed excessive, but I didn’t know the circumstances around it so I continued on my way. Fifteen minutes into pre-rounding, I was feeling good, like today I’d be able to put together a solid presentation and show the team how I was sorting through a really complicated case. Instead, LCR crashed and I wasn’t able to pull my labs (which maybe I shouldn’t leave to the end of pre-rounding?). I didn’t even know where my patient was; I went to the ED to see if she was still there but she had been transferred upstairs. I texted Eric who knew where to find her but he said to call the lab to get her lab values because we needed them for rounds. I had blocked off thirty minutes to hang out with her but after all of this, I barely had ten. But I introduced myself and did a bit of an exam, got the interim history and managed to arrive to rounds two minutes early. Eric gave me an EKG to read which I was able to make some sense out of. We discussed patients and saw some folks.
Before rounds, I had a talk with myself. I had hoped today would be a day to show my clinical reasoning skills but maybe the real goal of today was to practice being flexible in inconvenient circumstances and making the best of not ideal situations. The team was so chill about our less than adequate pre-rounding but it bothered me that I couldn’t do my best. Anyways, I had kind of made up my mind to be grumpy about this morning. I didn’t want to be positive and reframe it. But I did reflect on what kind of team member and provider I want to be; even when I’m having these self-proclaimed “off days”, I still want to be gracious and supportive of my team and present for my patients. I don’t want anyone else to sense my mood or feel like I’m not treating them right.
Our sweet Ms Z was so tickled with her electronic cat (literally SO precious I love these things). Another patient that Anthony had been following was very unhappy with the limitations of our discharge. It was a hard moment, he said he’d do something drastic if he ended up on the street again but refused to elaborate on what that meant. I’m glad I checked in with Anthony and told him he was doing a good job; even though I was frazzled for my own reasons, that moment was about me being the kind of friend and teammate I hope to be. Another patient had a migraine which made me ask a migraine question and Dr Thomas said she was having a migraine right now and I was taken aback. Here I was feeling like the team had it all together and I didn't, and I forgot that they’re all people too, bad things might be happening to them, they might be sick or tired. They have more responsibility and stress than I do. It’s unfair to expect people to be operating at 100% all the time. No matter how smart or put together they are, they’re allowed to have bad days just like me!
We split off for intern report after a bit. I was also hungry sos I should have eaten breakfast before! I met the site director for the residency I think and asked if he was a resident or intern. LOL. The case was fun to go through, we had an hour after to work on things. I had literally one task, to make a phone call to get my patient’s methadone dosing, and it would not go through. Then my pen died and I was just bearing down on paper trying to inscribe notes on the paper without ink. It was an OFF day! But Libby was gracious and set aside like 45 min to teach us the ins and outs of reading EKGs. I went to Schwartz rounds and then Dereck said it was the same talk so I took them to Denise Davis’s microaggressions talk over sushi which was wonderful. I love that she had us talk about our names. I tried calling this methadone clinic again in the afternoon and started prepping my progress note, then went to didactics! I pretty much finished up my note and then Eric left but dismissed me but I wanted to see my patients. I chatted with one for a bit, she was really touched and thanked us for caring about her. I tried to be nonjudgemental with my questions. She said she was interested in HCV treatment and getting a PCP. I saw another patient for a bit too who seemed a little agitated, I felt bad for riling up but she said she was riled up before I got there LOL. Something clicked, maybe the fact that these women were having way worse days than I could even imagine, and my day didn’t feel so bad after all. I met up with Eric and asked my LONG list of questions, all of which he was eager and happy to answer. I finished up my note and then called it a day.
Talking to mom on the phone was super helpful today. She said she ALSO had a patient with opioid withdrawal and c diff and couldn’t tell what was causing the diarrhea today. She said that methadone clinics never answer the phone and that we should fax them LOL. As I walked through my day with her, I realized that it was a really solid day and that I did things well:
· Speaking up about racial inequity re college admissions/high school placements by neighborhood
· Not forgetting about calling this methadone clinic repeatedly
· Speaking up in didactics
· Keeping up with Libby’s EKG lesson
· Speaking up in the microaggression workshop
· Writing my note
· Visiting my patients and showing them that I care, seeing patients always seems to fill my cup up
· Asking Eric good questions about the case
· Finally kind of making sense of my case
· Not letting my bad day affect how I treat people and the energy I bring to the team
Off days are helpful too, today helped me realize what matters most to me. And being kind, warm, and present matter to me so much and I don’t ever want to be less than that for my team or patients, no matter how behind on work I feel or how unfair the situation is. I’m in it for the long haul but also to make all the little moments matter.
Friday 3/15
I worked my first real six day week and a girl is drained. Today was a really solid day, I wish I got home a little earlier but looking forward to some much needed sleep and rest tonight and tomorrow.
-We saw the prettiest angiogram at morning report today.
-We had a patient who I think was really frustrated with us but also kind of friendly, I wasn’t sure how to interpret his remarks but I always err on the side of positive intent. At the end of the visit, he called me sweetheart which I think means he likes me, I wish I could have hung out more because he seems like such an interesting man.
-At MDR, our social worker had to take a deep breath to brace himself for our requests (LOL)
-We had EKG and CXR reading practice towards the end of rounds - so much teaching!
-the energy of MATCH DAY was circulating around the room all morning! I feel like that energy makes me uncomfortable thinking about my own match day two years from now. It sucks to not have control and to play this interminable waiting game. It usually works out just fine, but how do you react when you didn’t get your first choice? How do you react when you are happy but the people around you might not be happy with theirs? Will I open my envelope around people or by myself? I hope I can go into the day at peace with whatever circumstances follow and that I feel proud for making the most of my medical training up until that point. I hope I’m less uneasy thinking about it as that day gets closer.
-Lunch was a beautiful feast with salads and fresh watermelon and TOFU sandwiches yum
-Moments with a patient today that stood out: she asked how old I was, if I liked my training; later I learned that she likes writing short stories and poetry and used to enjoy reading before her head injury. At one point she asked about what I was doing with my day off tomorrow and I told her I was gonna see the movie about kids with cystic fibrosis and she laughed, I know it’s ridiculous to spend my time out of the hospital thinking about being in the hospital but there’s something about learning about patient experiences that draws me in. She asked what c diff was and I explained why we were these yellow gowns, I also convinced her to give us blood for our labs, she told me about her anxiety and pain and started to open up about her history of trauma but I had to leave for didactics, I felt bad for leaving her more anxious than I found her :(! Later I went back, and I know she wanted more meds and I tried my best to explain our limitations but I’m not sure she was all that interested in hearing it. The toughest thing about today actually not being able to give her what she wants and feeling like she was frustrated with us. I’m glad we were able to give her some anxiety medications before the day was out.
-Wound care teaching was SO fun! Who knew we use honey and silver and magical foams to dress our patients wound! It was an interactive hour of teaching with lots of hands on demonstrations
-Then I chatted with Larissa about feedback, even though we only had 4 days together! We talked about myers briggs for a while LOL and she was really into it which I appreciate
-Really focused on NOT HURRYING this afternoon and just taking my time with all the tasks (I had a long list and things kept emerging but it was good learning or I got to be helpful) and being patient with myself
-There was a moment at like 6:30 when I was pretty much all done, Eric was surprised to see me and joked that he couldn’t go home until I did; Jerry patted me on the back and told me to go home for like the third time that afternoon, we all chuckled for a bit and I just felt like I belonged. I’m going to miss that and miss this team and cherish these moments together. What an amazing team to start off the rotation with.
-Ending the day thinking about treasured and special it is to me to be in a field where we are given deeply intimate looks into our patients’ lives almost immediately upon meeting them. We learn so much about people and their stories if we get the time to listen (and as a med student all we have is time)
Saturday 3/16
Spent this beautiful afternoon in Japantown, worked at a cute lil Japanese cafe, saw Five Feet Apart at AMC Kabuki, got mango mochi from the mall, and then carried out ramen from my fav place!
Sunday 3/17
When we went down to the ED to admit a patient, I thanked a nurse for holding things together because the ED was slammed and has been on divert for most of the day because they were full. She thought it was just flattery from the medicine team who had come down to examine our patient on the ED’s dime but I wanted her to know that it was was coming from a gal who identifies strongly with the ED!! Jerry made an interesting observation today- he said that he didn’t like EM because he said that every day was like a long call day for medicine, where he just had to triage people and give them the bare minimum of what they need without being able to get into the details of their care on the next day like the medicine team does. He also said the EM differential was SO broad and that it was too much for him; I wonder if as my clinical knowledge expands and I can tackle the nuance, will the magic of an undifferentiated EM patient still hold for me? Those points really stuck with me.
Another high point of today was going up to the roof twice today - once for lunch (I got a selfie with the team!!) and again with Eric for feedback. He said that I brought great energy to the team, and he really meant it, that the excitement and eagerness I have for learning makes it really rewarding for them to teach us. Eric made the point that I’ll never know medicine better than at the end of this rotation, same for OB/GYN etc etc and he’s right! That’s special and there are so many cases to soak in. Dr Berman joined us for lunch too, I feel like we were really hitting it off well today and I wish I got to work more with her!
My presentations on rounds went well – every presentation there’s something I can improve on which actually feels really good that I can hold onto a tangible piece of constructive feedback. After rounds, we hung out in the call room and Libby taught us more EKG stuff! After lunch, I got to bid farewell to one of my patients who was getting discharged this afternoon. Another moment that was fun was when Jerry was explaining a framework for neuro stuff and he was trying to think of the name for something but gave NO context and I was like “myasthenia gravis?” and he that's what he was actually thinking of LOL.
Our patient that we admitted from the ED had been in rough time. His stuff had been taken from him in a street sweep : ( I had been hearing about these in the news but it’s another thing to see that directly affect your patient. He was pretty sick and had to get admitted to the hospital – and he probably wouldn’t have even come into the ED if he had been able to take his meds! People want to erase homelessness from our streets but at the expense of real people in difficult, complicated circumstances.
As I was coming home today, I was thinking about how I hope that all my med school classmates are finding joy in the every day grind of clerkships. Whether it’s sorting through the nitty gritty of a clinical challenge or just soaking in time with patients or stopping to watch the sunrise while pre-rounding or kicking it with the team at ice cream dinners on call nights, I really hope that everyone is getting a little bit of time and space to enjoy what makes them happy in between the note writing and Uworld questions. It’s like my first instinct to just wanna power through and then enjoy things after my work is done but the work is NEVER OVER and I can’t put off being happy until it is! I’m in the midst of a unique and transformational year and I can’t put my life on hold or build up these binaries between WORK=hard and LIFE=fun, it’s just not true for me!
I was honestly worried going in today because I didn’t feel like I had enough energy to see myself through a six day week BUT I felt more energized as the day went. Time to start cardiology now!
Sunday 3/17
When we went down to the ED to admit a patient, I thanked a nurse for holding things together because the ED was slammed and has been on divert for most of the day because they were full. She thought it was just flattery from the medicine team who had come down to examine our patient on the ED’s dime but I wanted her to know that it was was coming from a gal who identifies strongly with the ED!! Jerry made an interesting observation today- he said that he didn’t like EM because he said that every day was like a long call day for medicine, where he just had to triage people and give them the bare minimum of what they need without being able to get into the details of their care on the next day like the medicine team does. He also said the EM differential was SO broad and that it was too much for him; I wonder if as my clinical knowledge expands and I can tackle the nuance, will the magic of an undifferentiated EM patient still hold for me? Those points really stuck with me.
Another high point of today was going up to the roof twice today - once for lunch (I got a selfie with the team!!) and again with Eric for feedback. He said that I brought great energy to the team, and he really meant it, that the excitement and eagerness I have for learning makes it really rewarding for them to teach us. Eric made the point that I’ll never know medicine better than at the end of this rotation, same for OB/GYN etc etc and he’s right! That’s special and there are so many cases to soak in. Dr Berman joined us for lunch too, I feel like we were really hitting it off well today and I wish I got to work more with her!
My presentations on rounds went well – every presentation there’s something I can improve on which actually feels really good that I can hold onto a tangible piece of constructive feedback. After rounds, we hung out in the call room and Libby taught us more EKG stuff! After lunch, I got to bid farewell to one of my patients who was getting discharged this afternoon. Another moment that was fun was when Jerry was explaining a framework for neuro stuff and he was trying to think of the name for something but gave NO context and I was like “myasthenia gravis?” and he that's what he was actually thinking of LOL.
Our patient that we admitted from the ED had been in rough time. His stuff had been taken from him in a street sweep : ( I had been hearing about these in the news but it’s another thing to see that directly affect your patient. He was pretty sick and had to get admitted to the hospital – and he probably wouldn’t have even come into the ED if he had been able to take his meds! People want to erase homelessness from our streets but at the expense of real people in difficult, complicated circumstances.
As I was coming home today, I was thinking about how I hope that all my med school classmates are finding joy in the every day grind of clerkships. Whether it’s sorting through the nitty gritty of a clinical challenge or just soaking in time with patients or stopping to watch the sunrise while pre-rounding or kicking it with the team at ice cream dinners on call nights, I really hope that everyone is getting a little bit of time and space to enjoy what makes them happy in between the note writing and Uworld questions. It’s like my first instinct to just wanna power through and then enjoy things after my work is done but the work is NEVER OVER and I can’t put off being happy until it is! I’m in the midst of a unique and transformational year and I can’t put my life on hold or build up these binaries between WORK=hard and LIFE=fun, it’s just not true for me!
I was honestly worried going in today because I didn’t feel like I had enough energy to see myself through a six day week BUT I felt more energized as the day went. Time to start cardiology now!
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