The Differential: Medscape Med Students Blogs

Another Memorable First

Ben Bryner -- Hi everyone, my name's Ben Bryner and I'm very excited to be part of The Differential. I'm a student at the University of Michigan in my fourth year of medical school. About a month ago, after getting partway through my fourth year, I joined a year-long master's degree program in clinical research. (I'll go back to finish the last several months of med school and match into a residency with the class just after mine.) I'm researching in the pediatric surgery department, which is very rewarding.

I grew up in Utah and went to college there. I really love it here at Michigan. The skiing may not compare to what I was used to, but I like being in a friendly college town, the attendings and residents are out of this world, and the first three years really flew by.

I was reminded of just how fast the time has gone when I recently attended the annual memorial service for the families of those who donated their bodies to our medical school's anatomy department. My fellow students (as always) did a very nice job with their musical performances and remarks. It took me back to my own trips to the anatomy lab as a first-year student. That first lab session really felt like my initiation into the field of medicine. Lots of the first year classes felt like college, but this was a real transition; that was when I first really felt like part of the vast but distinct profession of medicine.

Some people like saying your anatomy donor is your "first patient." This makes some sense, because they're the first human you learn from directly, instead of hearing about things in the abstract from a professor. But the patients I've seen in the third and fourth years are different from donors; while they teach you how to interact, discuss, examine, and diagnose, they are primarily there to receive care and go on with their lives. But the anatomical donors have taken things one step further; their bodies are there solely for our education. It's an amazing gift, and many physicians really feel a bond with their anatomical donor throughout their career.

I really appreciate that gift, especially considering that my first real patient during third year was an elderly woman missing nearly all her teeth who called me "the thtupideth perthon I ever met" on rounds for no apparent reason. And still, I kind of liked her, probably because there's a similar bond with your first patient in the hospital, too.

The Art of Doctor-Patient Communication

Kendra Campbell -- I was listening to a fellow student take a history from a local (Dominican) patient a few weeks ago. The student (who was American) was trying to ascertain how long ago the patient’s last menstrual cycle occurred. The patient thought that the student was asking her how long her menstruation lasts, so she responded “3 to 5 days.” Without verifying what the patient actually said, the student wrote down that the patient’s last menstrual cycle was 3 to 5 days ago. It turned out that the patient actually had not menstruated for over 3 months, which was an extremely important detail that the student missed.

Incidents like this happen all the time. Unfortunately, when it happens in medicine it can make the difference between life and death. It’s easy to assume that just because you are speaking the same language, that there is comprehension on both sides. In Dominica, where I live, the national language is English. Most of the students come here from the United States and Canada, where the national languages are also English (and French in Canada). However, the English that is spoken by Dominicans can be very different than what is spoken elsewhere. For example, in Dominica, alcohol is frequently considered synonymous with rum. So, if you ask a patient if they drink alcohol, they may honestly tell you “no.” However, they could be drinking 30 beers a day. Another example is that when they use the word “foot,” they frequently mean their entire leg. So, if you don’t ask them to specifically point to the pain, you might end up with an entirely different diagnosis.

These types of errors in communication aren’t restricted to differences in culture. There can be vastly different ways of communicating within the same culture but between different age groups. A teenager will likely describe their symptoms with different words than an elderly person. And the list goes on and on. There are so many subtleties involved in accurate communication and history taking that it’s no surprise that many patients end up not being treated properly due to poor doctor-patient communication.

I think that physicians should be particularly sensitive to the subtleties involved in talking to their patients. Just as a surgeon’s delicate use of a scalpel is an art, so is proper history taking and communication with patients. As with many forms of art, there is always an element of natural ability combined with practice and dedication. Even if you do have a natural ability to communicate well with patients, you should never forget that it is still an art, and as such should be continually practiced and adapted.

An Informal Meet and Greet

Ben Ferguson -- Greetings from unseasonably hot and sunny Chicago! I'm Ben, a student and researcher at the University of Chicago.

After some pondering, I've determined that there's no good way to be self-referentially thorough yet concise, and still avoid sounding vain, so I'm going to do what med students often do best: make a list. There are lists for everything in medicine and medical school: patients' medications, contents of the ischiorectal fossa, bugs and drugs left to study in the 2 hours remaining before an exam, to-do items to accomplish when you return to your "real life" if ever so briefly, and so on. (Most lists' contents will soon be forgotten, yet another skill for many medical students, and the aforementioned items are certainly no exception, especially those that are purposely forgotten as a matter of removing them from one's mental imagery. I think you can probably figure out which one I'm referring to here.)

So without further ado, behold my list of things:

1. I went a little crazy once and decided to put off med school for a while to do a PhD. That's where I stand now. The formidable Step 1 is fortunately behind me, and I'm working in a lab full time studying receptor tyrosine kinases in lung cancer. You may have to take my word for it when I say it is AWESOME. Sometimes.

2. I attended the University of Illinois and studied physiology and chemistry there. I also was a singer in a jazz a cappella group for a while, a time about which I fondly reminisce, not for the singing itself, but for the wondrous free time I had back then! I don't currently sing, but I'm considering it. Stay tuned.

3. I recently got engaged to my high-school sweetheart, Abbie.

4. Starbucks, and the speed with which it empties my wallet, will be the end of me. But, it keeps me awake and provides me with much people-watching fodder, something without which I really can't study. I'm weird like that.

5. There are a few things that I'm really passionate about: the intersection of medicine and technology, smoking cessation and prevention (I'm a lung cancer researcher -- what do you expect?), Macs, and making people laugh as much as possible.

I think that's enough for now. For more about me and my past, visit my personal blog, where I write about anything that comes to mind.

Finding the Cervix

Pin-Chieh Chiang -- A month ago I was on an internet forum and found an interesting discussion where a medical student was asking for advice on how to find the cervix. It appears that this person had had some bad luck and had never been able to locate the cervix without help. Fellow readers shared some good tips, so I bookmarked this forum as a reference I could use when I’m on my OB rotation later this year.

Little did I know, on my very first day of my Family Medicine rotation, I found myself wishing I had read through that forum more carefully. I just started a week ago and it already seems like it’s guaranteed I will do at least one pap smear every day. It shows how little I know about medicine when I didn’t expect to have to do pap smears in family practice.

Before this, I’d done only one pap while in medical school. When it came time to teach us how to do female and male exams, my school turned to an agency called Project Prepare. It’s a great program where the instructors are the patients themselves. My instructor walked me through how to do a breast and pap and then I performed it on her. This way she was able to give me exact feedback.

When I faced my first real patient, my mind wandered back to Project Prepare and thought how wonderful it would be if this patient also told me exactly where her cervix was. Needless to say, I had some missteps in the beginning. There were several times where I had to excuse myself, leave, and ask my preceptor to come in and help me.

The worst pap was the time when, due to a language barrier, I didn’t catch on that the patient had a previous total hysterectomy. So there I am wondering why the vaginal canal was so short and why in the heck could I not find her cervix. I had to ask my preceptor for help only to feel like an idiot that I didn’t put all the clues together. By far the most exciting pap was when I had a patient with uterus didelphys. My preceptor gave me a heads up on that patient and also some tips on how to approach the exam. I definitely hadn’t expected to see that during this rotation.

Early on, I expressed frustration over my inadequacy. All my preceptors kept telling me that practice was going to make the difference, just as a lot of the comments stated on that forum. I believe they were right, and during the past few pelvic exams, I’ve been able to find the cervix every time.

When Doctors Do Harm

Ali Tabatabaey -- I had never been so ashamed of my profession. I was listening to the complaints of a dear friend, and I had nothing to say.

The humble complaints of a man approaching his death are not something you can ignore easily. He is a hemophiliac infected with the HCV through contaminated blood products. Due to the neglect of a few doctors at the ministry of health over 10 years ago, there are many people suffering like him today. He has been fighting cirrhosis the last few years of his life and he just found out that the disease is not backing down.

The atmosphere in my country's health system, promoting fear of all blood-borne viruses, doesn’t make life easier for people like him. Being infected with HCV has denied this friend of mine the ability to undergo any elective surgery or to have any dental work done, and it has caused him great social suffering.

He told me about how he booked an appointment for an upper GI endoscopy. He prepared himself for the procedure by self-injecting the needed factor concentrates. Then he showed up at the internist’s office with all the required papers, only to wait a couple of hours before being told that the doctor would not show up that day. He went through all the same trouble the next day before finally having the procedure done. Afterwards, he listened anxiously as the doctor talked about his grade III esophageal varices. On top of that, his ultrasound the week before showed “portal pressure estimated at 20mmHg, with splenomegaly and severe ascites.”

Yet worst of all, just as he was getting ready to go home, the nurse who had failed to read his file before the endoscopy began to protest frantically, “Why did you not mention that you are HCV positive?!” Without hesitation, the internist joined in the badgering of the already devastated patient, adding insult to the injury.

“I don’t know what they sought to achieve by making me feel guilty," my friend said, "while all the other patients stood outside wondering what all the fuss and screaming was about.” I had no answer.

My friend was obviously crushed and wanted to make his voice heard, and I was the closest target belonging to the group that has hurt him most: doctors. So he talked and talked, and I just listened. I don’t know what had hurt him more, the fact that he was going through all this pain because of the neglect of a few doctors a decade ago, or because he was treated like a jerk by a doctor who was too busy to read his file, or maybe because he had to lie to the patients standing outside to escape more harassment? Perhaps it was simply that the endoscopy report made it clear that no doctor could do much to help him, and no one even took the time to talk to him about his fears and anxieties.

“First do no harm” -- you can’t put it any better than that. I remember someone saying that most of the diseases we encounter will either improve or degrade by themselves, whether we help out or not. We are just there to accompany the patient and maybe make a few adjustments. But we have indulged so deeply in such trivial adjustments that we often forget our true role in the healing process.

I have spent the last seven years trying to learn about medicine. And if there is one thing I learned, it’s that although becoming a doctor might be insanely difficult, being a healer can be a piece of cake -- all you have to do is put yourself in the patient’s shoes to realize what not to do.

It Takes the Bad to Appreciate the Good

Kendra Campbell -- My first cardiac patient had a double above-the-knee amputation. He wore a brown toupee and he didn’t say a word to me during the entire exam. But I guess I can’t blame him for being so untalkative as his skin was made of rubber, and he didn’t have an ounce of blood pumping through his body. His name is Harvey, and he is a cardiac patient simulator. He has real life feeling pulses, blood pressure, respirations, and heart sounds. And the best part is that you can program him to have all kinds of cardiac problems.

Up until this point, I have been doing most of my cardio and respiratory exams on people who are perfectly healthy. I would say the words “patient does not have any murmurs, ejection clicks, snaps or extra heart sounds,” but I really didn’t know what any of those things even sounded like. Now, thanks to Harvey, I’m really starting to get it!

At first, I couldn’t tell the difference between a diastolic and a systolic murmur, but now I can. I can tell the difference between aortic regurgitation and aortic stenosis. I know what crackles and wheezes sound like in the lung fields. And I’m really glad that they have us learn all of this on Harvey first. I know that it will sound a little different in real life, but it’s nice to be able to switch back and forth between various diseases, and to compare the different sounds. It’s really helping me to understand how the sound matches up with the pathophysiology. Before, when I had only heard the normal, healthy sounds, I really didn’t appreciate the pathologies.

I guess it’s kind of similar to things in life. You don’t fully appreciate your health until you’re battling a disease. You can easily take a friend or relative for granted until they’re not in your life anymore. If you move to a third world country after living your whole life in the States (like I did), you don’t realize how much you loved Taco Bell (and other incredible restaurants) until you are forced to eat hundreds of boxes of mac-n-cheese.

For some reason, it seems like humans need a dose of the “bad” or “pathological” to really understand and appreciate the “good.” Harvey still has a lot left to teach me. I guess it’s good that my first patient doesn’t have to actually suffer to teach me about the bad.

Getting Drilled

Anna Burkhead -- ”Pimping” … ’tis the season for it! For those who are unfamiliar with the use of this term in a way other than the derogatory street name, walk in a student’s shoes for a day and you will learn its meaning.

In a medical student’s world, “pimping” is an art perfected by many attendings. It is the art of asking questions, sometimes at warp-speed, sometimes on completely irrelevant non-medical material, all to test your knowledge and poise. As in the Getting Caught Unprepared entry below, I recently had a bad experience being pimped.

This week I was working on the Gynecology Oncology service. I scrubbed in for many a surgery, where I soon realized that I was basically a sitting duck for 5 hours straight, or however long it took. I was asked questions ranging from “What are the anatomic borders of the perirectal space?” to “What are the seven ancient wonders of the world?” and trivia ranging from “In which portion of the fallopian tube does fertilization occur?” to “What is the Greek origin of the word ‘trivia’?”

Some questions I answered correctly, others incorrectly. After morning rounds on Thursday, I was satisfied with my overall performance in the pimping sessions. Thursday night I was on call, and after a busy night including stat C-sections and babies born so quickly the doctors didn’t even have time to run down the hall into the room, I was exhausted by Friday morning. It was almost time to go home, and only one thing was standing in my way … morning rounds with my attending.

Of course he had to pick Friday morning for the day we have “late rounds”. So, after arriving at the hospital at 4:30am on Thursday, pre-rounding on my Gyn-Onc patients at 4:30am Friday, and finishing my duties in Labor & Delivery at 7:00am, I waited around until 8:30am for rounds. I dared not find a place to catch an hour’s worth of sleep, because I knew I would wake up and be in a daze during rounds.

Rounds started off quietly, and as we had a lot of patients to see, the attending kept the questions to a minimum. Then, outside the room of a patient with ovarian cancer, he suddenly went into full pimp mode: “Ovarian cancer is usually diagnosed at what stage?” I know this. Next, “What percentage of ovarian cancer is diagnosed at that stage?” I think I know this. “What is the 5-year survival rate for ovarian cancer diagnosed at that stage?” I don’t know the exact answer, I’m going to estimate. “What is the first-line chemotherapy for ovarian cancer?” Don’t know that, would have known that if I studied more. “What is the response rate for the first-line drug for stage IV cancer?” Don’t know that either. From that point on, the questions were outside of my knowledge base.

I was feeling dumb, and my 28-hour sleep-deprived brain was not allowing me to take it gracefully. After grinding my self-esteem into the sanitized hospital floor, the attending closed up the patient’s chart and went to replace it on the cart. In the process, the chart dropped to the ground, the binder came apart, and three weeks worth of progress notes, labs, and orders scattered all over the hall. As the rest of the team invaded the patient’s room in a swarm of white coats, clipboards, and the quiet nods that are customary in a cancer patient’s room, I stayed behind to pick up the papers and reassemble the chart. As I was on my knees in the hall cleaning up the mess, I looked at my amniotic fluid-stained shoes (by the way, OB/GYN requires shoe covers, I learned the hard way) and realized I was at a low point.

I felt like I would burst into tears if the attending asked me one more question I couldn't answer. But, I tried to keep my “I’m interested in the things you’re saying” expression plastered on my face for the last 20 minutes of rounds. The attending asked me a few more questions, and thankfully I was able to answer them correctly. At one point, he actually said I “nailed” one of the answers! That made me feel better.

At the end of rounds, I was excused, drove home, and slept for five hours. When I woke up, it was a new day. Actually, it was early afternoon on the same day, and I was still in my scrubs on the couch (gross, I know). But it felt like a new day, if you know what I mean. I felt happy with the work I did while on call, and satisfied with my pimping performance during rounds. It’s funny how the wrong answers, near-tears, and low points are brought into perspective by a few hours of sleep.

(PS – the string of questions on ovarian cancer was asked specifically to teach me the “Rule of 70”, which my tired brain was not picking up on. So, in retrospect, the questions were not that hard, but going on no sleep, you could have asked me my birthdate and I would have had a hard time coming up with the answer!)

The Lure of Surgery Can Be Fleeting

Ali Tabatabaey -- Wow! What an experience. If you feel that you’re unwillingly being seduced into mastering the art of “the Blade” instead of the science of medicine, there is nothing like a back breaking seven-hour session at the operating room to change your mind back!

During this surgical marathon an extern fainted and the other intern preferred to take a seat, while the aid nurse handed her responsibility over to me during the second part of the operation. It was supposed to be a simple tumor resection but after taking a look at what was inside, it ultimately turned out to be a single-team APR.

The patient was an Iraqi resident who had undergone total colectomy a few years ago, but the rectum had undergone malignant changes and he now had a huge abdominal mass. This father of four was in his early forties and had been diagnosed with ulcerative colitis 20 years ago. Since all the worthwhile doctors have left Iraq due to the security situation, he chose to come all the way here to undergo the resection.

The mass had invaded much of the adjacent tissue and there were a lot of adhesions left over from the first operation. So the first few hours were spent trying to reveal the original anatomy of the abdomen and then getting rid of the invasive mass.

Just before the operation there was a ruthless race between the interns to determine who, if anyone, could scrub in. I never knew I could stand for this long. In the last hour I thought I was about to join the casualties too, but I managed to fallow through. It was a great experience, yet not one I would fight for the next time around. As the wise surgeon reminded me during the operation:

“People fall in love with surgery all the time, but turning it into a lasting relationship is not something all can do!”

Getting Caught Unprepared

Pin-Chieh Chiang -- It was the last week of my first General Surgery rotation, and in fact the last day of surgeries that I would be scrubbing into for a while. There’s never a good excuse for showing up unprepared, so I won’t give one, but the bottom line is I didn’t read up on the surgeries for the day. Somewhere in the back of my mind I was hopeful that my preceptor wouldn’t notice. I only thought this because he never really asked many questions before. In retrospect, my preceptor would always ask one or two questions and when he realized that I had done my homework, he would leave me alone.

This time, it was pretty obvious that I had not done my reading and he smelled my uncertainty. With both my hands holding onto retractors and my legs getting numb from fear and standing all day, I had to make a quick decision. Do I lie and try to swim my way out of this one or just tell the truth and sink? To be honest, I just can’t lie. Plus at that moment, I didn’t feel very confident in myself that I could be saved either way. So I told the truth once again hopeful that he would let me go for being truthful.

I had no such luck. My preceptor was not going to left me off the hook. He drilled me into the ground. I literally felt like I was buried. He even made a point to say, “Because you’re not prepared today, I’m going to make you sweat.” Let’s just say at the end of the surgery I felt too beaten to follow him out like I usually did before. While I stayed by the patient, the anesthesiologist, the anesthesiologist’s student, and the scrub tech all took turns consoling me.

There were many things about the experience that made me want to hang my head in shame; realizing I had not read and was caught by my preceptor, not being able to answer his questions intelligently, and knowing that three people had witnessed this event. However, I think the worst part about the whole experience was in the end when my preceptor was closing. He said, “I was going to let you close, but because you didn’t come prepared, you just lost the privilege.”

To end on a positive note, this was just one of the many valuable lessons that I learned on this surgical rotation, which I thoroughly enjoyed. Like how Ali put it – “Surgery is addictive!”

The Daytime Drama Award Goes to … Me!

Kendra Campbell -- Excuse me for a moment everyone while I take a few seconds to freak out. The last semester of basic science instruction is HARD! It seems like there is almost double the material from last semester. We have a million clinical procedures to learn. The questions are all clinical vignettes (no easy primary questions). Our professors expect us to actually remember stuff from our previous classes (gasp -- the nerve of them!). And we’re expected to take an exam at the end of this semester, which will allow us to sit for the USMLE Step 1. If we don’t pass it, we can’t sit for the exam.

In addition to this overwhelming amount of academic stuff, I am the president of an organization, I’m volunteering at a local school, I write for this blog (as well as my personal blog), I’m in a Scholars program (which requires MORE work, and a much larger time commitment than the standard program), and I have approximately a million other things to do.

I’m seriously freaking out right now. I haven’t freaked out like this since the first week of med school! I’m going to die! AHHHHH!

Okay, now back to your regularly scheduled program. I feel much better now.

I’m realizing that I might have piled my plate a little too high for this semester. My time has become quite a precious commodity -- even more so than before. I like to consider myself to be very good at time management. It’s a skill that has served me well in med school. Many people have asked me how I manage to accomplish all the things I do in a day, and I’ve always chalked it up to good planning, and the ability to manage my time. However, right now I’m wondering if my abilities are starting to fail me.

Has Kendra bit off more than she can masticate this time? Will she find out that in her pursuit of achievement, she’s pushed herself too far? Will she even be able to make it to her first examination without losing her mind? You’ll have to stay tuned to find out. To be continued…

Learning Pager Etiquette

Pin-Chieh Chiang -- This might sound silly, but I really did not know what was involved in using a pager, let alone actually paging someone. I remember a time when pagers were the hottest gadgets, but that was literally a decade ago. Since then cell phones have taken over and pagers have became a thing of the past.

This is of course not the case in the hospital. As far as I can tell, almost every doctor I’ve encountered carries their own pager. I frequently notice the pager when my preceptors get paged and they take a break from what they were doing to go return the call. Other than that, I never really gave pagers much more thought, until I had to page a preceptor myself.

There have been plenty of times when I couldn’t seem to locate my preceptor. I knew we were supposed to meet at a certain time but don’t know where. Or we were supposed to meet at a specific place, but he hadn’t shown up and 30 minutes had passed. Early on, I wasn't sure if I should page my preceptors or not. Somewhere in the back of my mind I had reserved paging a doctor for only life-or-death situations, and I didn’t believe I qualified. I was also worried that I would be annoying them or interrupting something extremely important. So in the beginning I would always first try to hunt down my preceptor and stake out what I thought would be the most likely locations to find him. When I worked in a team, we usually split up going to different areas of the hospital. It seemed to work well at first and then I found myself in situations where I was touring the whole hospital without any signs of my preceptor. I started to worry that I was wasting time and my preceptor would think badly of me because they did not know where I was.

So finally I got the courage to start paging my preceptors, and now I have learned the amazing truth that it’s really not a big deal. Remember to press the pound sign at the end of your page – I had to figure that out the hard way. If you leave the extension of the phone you paged from, don’t walk away from that phone – thankfully it was a colleague of mine that made this mistake and not me.

The bottom line is to learn to deal with pagers; they’ll probably always be in your life whether you’re paging someone or the one getting paged.

Moving Up the Med School Food Chain

Kendra Campbell -- It’s back to school time again. I just purchased all my new binders and notebooks, and refreshed my store of colored highlighters. Monday was the first day of classes at my school. Since I don’t actually have to attend the classes, I was planning on just staying home and watching them. But something told me that it might be fun to take a trip around campus. So, I walked down and checked out all the new faces.

Ahh, the innocence of all the first semesters! They walk around campus in complete oblivion, confusion, and excitation. For they are about to embark on one of the most challenging, grueling, and rewarding adventures of their lives: med school on an island in the middle of nowhere. Many of them are well prepared for the journey they are about to begin. Some of them have absolutely no clue what’s about to happen to them. But either way, they will all face new challenges, which they’ll have to overcome to survive.

I am both elated and worried for them -- because I know that some of them will pass with flying colors, while others will find out that they just don’t have what it takes. Sometimes I just want to grab them and shake them up a bit. I wish that I could lend them the wisdom that I’ve accrued in the year that I’ve been here. However I know that most of them will have to learn to survive by making their own mistakes.

The strange thing is that I am at the end of my basic science tour of duty. After this semester, I will have everything it takes to sit for the USMLE Step 1. I will then be moving on to the clinical years. So right now, I’m the “old school.” I am the highest up on the med school food chain of students. But in just four short months, I will become the “new school.” I will once again be the lowest on the food chain. I will be the one walking around with a dazed look on my face, while all the higher up students will be smiling as they watch me mutate into something new.

And so goes the progression through medical school. One day you’re at the top of your league, and the next day you’re right back down at the bottom. I think it’s a very good lesson in humility. No matter how high up you think you are, there is always someone who is higher. But that doesn’t make me the least bit sad. Actually, it gives me the motivation to keep going and to do the very best job that I can.

10 Ways to Assure that Your Pager Will Go Off

1. Unintentionally notice that it hasn’t gone off in “a while.”

2. Be in the middle of talking to a patient and/or patient’s family about important questions they have regarding their illness and/or prognosis and/or treatment and/or unsatisfaction about one thing or another.

3. Get onto the elevator.

4. Remember that your distended bladder had tried to get your attention about 2 hours ago and finally decide that you can take a moment to acknowledge its needs.

5. After having been essentially NPO all day, finally make it down to the adjunct part of the cafeteria that’s still open, grab something to eat, and take a couple of bites.

6. Sit down to

6 ½. write this.

7. Be on the phone with pharmacy who just paged you because the orders you just tried to put in for your patient’s TPN turned out rather jumbled and didn’t quite make logical sense.

8. Attempt to lie down and get some sleep.

9. Be on the third try (you’ve already been interrupted) at presenting your most complicated (by 2 pages) patient on rounds (make that 3 pages) and deciding how to manage him (pending the 4th page).

10. Spend one minute on the floor your cross-covering (before you know anything about the patients).

Surgery is Addictive!

Ali Tabatabaey -- I thought it might be a good idea to do some dirty work just before fading into the sunset, so I’ll be finishing off my internship with a couple of months of surgery. I’ve said this before and I’m pretty sure about it, that my true passion is internal medicine, but boy I have to admit “the scalpel is addictive”!

Things did not seem this interesting when we saw it from a distance as an extern. Yet at close range with the scalpel in your hand it’s a whole new world. No wonder so many of my friends name surgical residencies as their top choices. I don’t know what it is. Some say surgery is so appealing because you literally see everything that you are working with and in most instances you don’t have to assume something indirectly. And whenever you’re not sure, you just cut the patient open and take a closer look!

But I say it’s more than that. Maybe it’s the sense of power in being able to explore the body of a living human being. Or maybe it’s the on-spot sense of accomplishment with every operation. Or just maybe it’s the carnivore inside us crying out after years of civilized suppression! Whatever it is, it feels great. Holding the scalpel in your hand gives you the permission to cut open someone else’s body, take a look around, cut out anything you think doesn’t belong there and sew it up when your done.

Once you’ve tasted it you just want more. You crave bigger cuts and more complex operations. The simple appendectomy won’t be enough anymore; Deeper cuts, more blood, bigger sutures … ha ha ha (evil laugh)! Wow! I guess it’s got all the characteristics of a true addiction. Hey, but who am I to talk? I’ve only aided a couple of operations. We’ll see what happens as things unfold through the rest of the course.

Temptation to Slack Off

Pin-Chieh Chiang -- Before 3rd year began, my class had an orientation to clinical rotations with the Dean of Clinical Education. Among the many things she talked about, one particular item stood out for me. It was the topic of performance and how every little negative detail will find its way to her office. This includes things like being late, clashing with the nurses, and anything that made you a burden to the team. What struck me as strange was the idea of performing below par. How bad do you have to be for the Dean of Clinical Education to become aware of the situation?

Now that I am on rotations, I can see why creating negative vibes can be an easily made error. Take the concept of being on time. Last block my preceptor told my colleagues and me to arrive at the hospital at 7:30 am to read an EKG book for 1 hour. With nobody to keep tabs on us, pretty soon some of my colleagues were arriving later. It was tempting to consider taking the book home to read so that we could sleep in. However, I knew I would never be able to read with a baby at home so I stuck to the 7:30 time until I finished the book.

Then there’s the possibility of not getting along with staff. I’m sure we’ve all heard stories about nurses being mean to medical students just because they can. I’ve definitely met a few of those, but honestly for the most part I haven’t had much trouble. Almost every nurse I’ve interacted with so far has been extremely helpful. A couple times I made some simple mistakes of forgetting to wear my badge or not closing the curtain when examining a patient and I would get chewed out by the nurses. Still, a good apology and a promise to never fault again always seemed to ease their minds.

There have also been a couple of times where I had ambiguous instructions from my preceptor. I would be told to go ahead and take the day off or go round on this list of patients “if” I wanted to. When I first heard this, I thought, “Maybe, just maybe, my preceptor doesn’t want me to round on his patients.” Then I came back to reality and decided I really wasn’t going to be let off that easy.

I can see why it would be easy to slack off on rotations. It’s tempting to think that once you leave the hospital or clinic, you are done for the day. I love the idea of ending early to go home and catch up with my daughter. However, the truth is the work never ends even when you leave the hospital. My preceptors aren’t done, they still carry their pagers. For me, there’s always more reading that can be done. The key is to not fall for the temptation to slack off, because rotations are really what you make out of them.

OB Oh My

Anna Burkhead -- I just finished my first week on OB/GYN. I started with a week of Low-Risk OB, then I have a week of High-Risk OB, and then two weeks of GYN oncology. At the end of the rotation there are oral exams and, of course, the shelf exam. I’m glad to do the OB weeks first, because from what I hear, they’re more time-consuming than the GYN weeks, so I will have more time to study for the shelf in the last two weeks. I sure do hope that’s true, because despite the fact that I am off this weekend for the Labor Day holiday, OB = craziness, and I love it!

When you're “on call” in OB, you really need to be on your toes. In other rotations, getting a page means taking a long, leisurely 10-20 seconds to find a phone and return the page. In OB, when my intern gets paged, she glances at the beeper, practically topples her stool, and sprints off towards Labor & Delivery, yelling for me to finish or put on hold what she was in the middle of, and “come to Room 7 for the delivery!” My first night on call in OB, I did not sleep for 32 hours. And apparently it was a slow night!

Labor and Delivery is also a place to come to grips with some pretty sobering life events. In the past five days, I got to deliver a baby for the first time, and I have also witnessed a delivery induced out of necessity at 23 weeks, which, as we all anticipated, would not have a good outcome. Being a quite sensitive person, these types of events can be overwhelming for me. I have definitely gotten teary a few times, more out of happiness than anything. But I can’t let the waterworks flow too much, or else I won’t be able to see to catch the slippery baby!

I’m afraid that I might encounter the dilemma of loving all of my rotations and not being able to choose a specialty. Just two weeks ago I was baby-crazy, loving the newborn nursery and seeing pediatric milestones reached. This week, I’m still baby-crazy, but all I can think about is delivering them! What’s a young medical student to do??