My first month consisted of mostly outpatient experiences, and the first week was spent in a Hematology-Oncology clinic. Though I didn't need the reminder, this week certainly solidified my conviction to never specialize in oncology. Not only is cancer a depressing disease (although exciting when cured), it is also incredibly complicated, even by medicine standards. The highlight of this week was getting to watch the doctors perform lumbar punctures and bone marrow aspirations - which, if you didn't know, involved taking a big bore bit and shoving it into a patient's pelvic bone and rocking it back and forth to get a sample of their marrow. Crazy, but effective! I almost got to do some of these procedures on Thursday, but the attending physicians fought over where I should go in the clinic and I wound up seeing patients instead of sticking people's backs. Oh well, maybe next time.
The next week I spent at the Newborn Nursery, and unfortunately I had to work on July 4th, because newborns don't stop coming just because it's a national holiday. Even though I love Independence Day, I was okay with working because it feels like I'm part of a team and everyone has to take the hit sometimes. I was fascinated to learn about the critical steps the doctors expect to see before a baby can go home, such as pooping. It was fun to get to do complete physical exams on little kiddos that are just pleased as punch to see you, to be the first physician ever to give them a check-up.
The next week I spent at the YCHC clinic, which I requested specifically because most of their patients speak Spanish. I haven't had an opportunity to speak so much Spanish since my mission, and it was relieving that I had remembered so much! Although it was fun also having the entire facility, including 5 attending physicians, to myself - none of the other medical students felt their Spanish was up to patient standards - I found out what a lull in work it is to be a pediatrician in midsummer. On one particular morning I saw nearly every patient myself, though three attending physicians were working there at the time. One of the doctors only had three patients scheduled for the entire day, and two were no-shows! They suggested I come back during the winter, when they would be flooded with patients.
From the lull of the clinic, I welcomed the 2 weeks I would spend in the pediatric wards. I didn't have to get up too early, and the new interns were more than willing to try to help us students shine with polished presentations. However, because they were new it seemed like no one had any time to review our patient notes, and during the afternoons we often sat waiting to be dismissed for the day. You see, as a student you don't do anything official like prescribing medications, so during the afternoons the residents will often send us away to go study or just go home. Most of us are perfectly happy helping out the team with whatever little chores need to get done, especially for the patients we are following, but if nothing is going on for us then we really really would like to just go. However, the new interns didn't know that they had such power over us, so we got stuck in a limbo where we couldn't really study effectively, or help out, or leave. All part of the learning experience! I was also pleased to work on the team with two other people who grew up not only in Los Alamos, but on the very street I grew up on! What a happy coincidence it was.
Speaking of expectations of a third year student, we have now entered the wonderful world of dual roles. This refers to the fact that we have multiple supervisors demanding differing and sometimes conflicting things of us. We are physicians, but also students. We care for patients, but we also go to lecture. What if a patient interaction is going long? Do I leave the attending to help the patient while I go to my lecture? On the one hand, I am committed to the patient and want to take responsibility for their care. On the other hand, when the attending physician is doing all of the prescribing and patient education, I am really just standing in a corner not doing too much, so I might as well leave. Unless that would make me look bad on an evaluation from the attending. Then again, maybe I'll get a poor evaluation for coming late to lecture. There's no way to win!
I also had my first experience with nighttime work in the hospital. For one week I had to show up at 5:30 and stay as late as midnight, but I was always dismissed to go home by 11:00pm. This week should have been a lot of fun, with relatively easy hours and not too much to do, but I had to catch up on my Continuity Clinic hours which took away from my sleep and free time. In addition, poor Brett was experiencing another developmental leap and a surge in his separation anxiety, so the sudden disappearance of Daddy during the evenings for an entire week made for some sad night-time wakenings the following week. Brett would wake screaming "Daddy!" needing to make sure I was there. The ever-changing weekly schedules of third year are hard on us all, but probably hit Brett worst of all, as it is so hard to explain to him why one week Daddy will be home early and the next he won't be home at all until after bedtime.
Only 8 more months of this (enjoyable) madness!
Interesting! I loved reading what is going on with everything. And that is a tricky situation, with balancing helping at the hospital and also being a student. I guess you just kind of hope for the best! I can't believe you are so close to being done!
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