Letter from a Medical Student

Sean’s little brother Brian is on a mission in Russia, he will be home next month-yay!! He asked Sean what it is that he actually does everyday and I thought it would be fun to share his response.

June 2, 2013

Sunday

Hey bro!

I will gladly tell you what third year is like! It is unlike anything I've ever done before, and it is both exhilarating and exhausting.

Let's walk through a day from this last week as a prime example. My attending physician (i.e. boss and the one assigning 50% of my grade for this rotation) Dr. Brodsky assigns me to see one of the four patients on my team in the Geriatric Ward of the Psychiatric Hospital. "You are in charge of this patient," he tells me. "You will be contacting the consults we need, seeing him every morning and evaluating his progress, and determining how we manage his care. I'll just make sure you don't kill the patient."

On each ward of the hospital (like Neurology Ward, Psychiatry Ward) there are always some number of patients. On the Geriatric Ward there are two teams, Turquoise and Gold, and I have the Turquoise team, which consists of around 4 patients. So far this week I have only directly taken charge of one patient, but by the end of the rotation I'll be taking care of four.

So what does it mean to take care of a patient? It means first thing in the morning (8AM for this rotation) we go first to the computer and read up on any notes written about our patient in the last day; there might be lab results, CT scans or other imaging studies conducted, or other events (like a patient falling) that are noted there. Once we gather those details then we go talk with the patient. And on the Psych Ward that's always something you have to be on your toes for. For instance, my classmate Jimmy went and saw his patient the other day - he first asked her how she was feeling. She just stared back at him for a few moments. Then she said with dead seriousness: "I flushed my children down the toilet." Not exactly the typical thing you want to hear from your patient first thing in the morning. And the fact was that she hadn't really done that, so the question is now why does she believe that? My patient has other troubles carrying on a conversation; specifically he stares off in the distance when you ask a question, and a full minute later he might answer with something rational. Most of the time, though, he just doesn't answer at all.

When we've finished our interview, then it's time for rounds. During most rotations that means taking a tour of the hospital to wherever the patients are that the team is taking care of, and each student or resident gets to present what they've found out about the patient between the chart and the interview, and the attending physician helps them make decisions about their care for the day. In Neurology that part was boring, because most patients had come in with a stroke (for instance), and there was nothing for us to do but wait and see if they got better. But in Psychiatry we're much more active. Dr. Brodsky is continually asking me: "So, will you change the patient's dosage of medication? Are these meds working? What else do we need to check on with him?" Very active care.

But taking charge of the patient means more than addressing just the Psychiatric issues. My patient was brought to the hospital because of a heart attack, and we are managing his appointments as he gets ready for a coronary bypass surgery. Except we're not sure he's actually in the right state of mind to even consent to such a drastic surgery, especially because he's so depressed that he doesn't really care if he wakes up from the surgery or not. That's not a good patient to put under the knife, so we are trying to figure out if we can get someone in his family to help make that decision for him. Meanwhile we have to contact the cardiothoracic surgeon to see what his opinion on all of this is. And by we I mean ME. Do you know how to contact a cardiothoracic surgeon, Brian? Me neither, but that's what I was expected to do. I got it figured out, gave that attending physician a call and explained the situation, and had a competent chat about how to move forward with his care. Crazy, huh? I hate making phone calls, and even more so to people that I don't know, and even more than that to people who have more power than I do and who may be responsible for grading my performance in the near future, and who might remember me if I bumbled a consult call to them. Yet I've found most doctors in the hospital will respect the medical student and give them a break.

Then when I've finished all those kinds of tasks, and in any other free time, I study. Because there are killer tests about the rotation that everyone has to learn, and there are only a couple of lectures per week that barely cover a fraction of the material. Where to look for the right material that will be tested on? That changes every rotation, too, and that is quite stressful to figure out, especially in a rotation that lasts a mere 4 weeks.

So that's what it means to be in third year. You're a little doctor. You are in charge of learning everything about the field of medicine you're in at the time, while taking care of patients and making real decisions about what medications to give, what lab tests to order, and how long they need to stay in the hospital. Sound like a daunting task? I think so too. We learned a lot about mechanisms of disease in the first couple of years, but we haven't had all that much training for this component of medical school. That's why I'm so grateful we had the continuity clinics and PIE experience working with patients, so that this wasn't our very first exposure to patient care.

Cool, huh?