The n00b Files - Week 6 of Pediatrics

I'm almost done with my pediatrics rotation, and I'm delighted to report that I continue to enjoy it. I'm on my second week of inpatient pediatrics, and so far, the experience has been good. More lessons learned:

1. My dad was right all those years ago. I should have learned Spanish. It would help so much with my patients. It's not so bad when you can get a live translator to stand in the room with you and help you communicate with the patient, but using one of those translators via phone almost completely eliminates important, human interactions like eye contact. It's not easy to show a mother that you're just as concerned about her child as she is, when you're both staring down at a speakerphone and speaking into it.
2. It's a good sign when your attending says that every day, rounds will begin with a cute photo of the day.
3. If you ever hear doctors talking about something that sounds like "go lightly," you can bet they're not discussing an Audrey Hepburn movie. 
4. I eat way fewer vegetables and fruits, on a daily basis, than I should. I mostly fill up my stomach and my day with carbohydrates, which are delicious, but empty, calories. This failing was brought into sharp relief for me recently, because I had been spending a lot of time during my community pediatrics rotation encouraging overweight children to have 5 servings of fruits and vegetables daily. It's nice that my "job" helps me reflect on my lifestyle and health.
5. I really, really like working in a community clinic.
6. Conversely, I'm really not that wild about the inpatient setting. 
7. Having an attending who empowers you, as the medical student, to call consults, assist in patient education prior to discharge, and generally do much of the work of residents, is a good thing, even if it means more work. As my new, awesome attending pointed out, if we spend all of medical school carrying no more than 2 patients at once, we'll be completely out of our element when, as interns, we'll be expected to carry close to 10 at any given time. Working hard in medical school kind of sucks, but it's good practice for when your decisions really mean something, after that arbitrary moment of graduation.
8. Life flies by. I just went to an information session about scheduling my last 18 months of medical school. It was both terrifying and incredibly exciting.
9. It's a wonderful thing when you're doing something that makes you happy, especially when you're going through a rough patch in life. I'm so grateful I'm on Pediatrics right now, and that I'm loving it.

Parents, Patients, and Attendings

On one of my last days of community pediatrics, I saw a 4-year-old Tamil girl who came in for a well-child check-up with her parents. I first encountered her in the hallway, where she was getting her vision screening. The entire thing was a tense affair, because she was having some trouble reading the chart, much to the chagrin of her parents. "Try the chart with the letters," they said, "She knows her letters." Dad was helping her cover up one of her eyes at a time because she kept peeking, the way children are wont to do. Mom came up to the chart and was pointing at letters along with the medical assistant, hoping that maybe the child was just confused by someone else's pointing. Yet the child's difficulty with vision persisted. Mom told Dad not to cover the child's eye for her, to let her do it herself. Dad kept saying, "but she's peeking!" Meanwhile, no one but me seems to notice that the little girl's eyes are welling up and she is becoming increasingly agitated by her parents' all-too-evident disappointment.
By the time my attending and I walked into the patient room after all her screening was completed, the little girl had been frankly crying and was wiping tears off her face. My attending asked why she was upset, and Mom admitted that she had been scolding her for her bad vision, that hadn't Mommy and Daddy told her not to sit so close to the television? But she had done it even when they told her not to, and now her vision was spoiled, and it was all her own doing.
I was so distressed by this whole thing. It reminded me forcibly of times I've gone through difficult situations and my parents, instead of comforting me when it was obvious I needed comforting, instead pointed out the mistakes I had made that had resulted in whatever pain I was feeling. (Case in point: when I accidentally backed into a parked car one night in my junior year of high school, setting off a cascade of events including police involvement, which was completely out of proportion to the tiny scratches my car had made on the victim's car, which was already heavily dented, I came home sobbing because I felt so terrified about having my first "accident." My mom's response? "I told you not to go out to that party tonight! Why did you drive home so late? Why were you on that street anyway? Who told you to give your friend a ride home? You shouldn't have done all those things," and, the implication was, your tears can only be blamed on yourself.)
This tendency to blame instead of comfort, to point out wrongs instead of pointing out solutions, is a terrible pattern my parents have demonstrated again and again. I suspect it's common to a lot of immigrant families, especially Asian ones. I wanted so badly to interject in the interview and ask the parents, couldn't they see how deeply their disappointment hurt their daughter? Wasn't it baldly apparent how very much this girl wanted nothing more than to make her parents proud? That it hurt her, probably more than anything else in her short life, to make her parents unhappy? And if they could see that--for who couldn't, who was observing that situation?--why on earth were they continuing to heap blame upon her? Even if some of her previous actions had indeed influenced her vision (which, they probably did not), what was done was done. No amount of scolding could make her vision 20/20 again. In short--what was the point of their displeasure with their daughter?
But even though I wanted to rip into the parents for their behavior, I knew it wasn't my place as the medical student (nor, might I add, would it have been my place as the attending...at least, not if I wanted to keep a good rapport with this family). So I'm standing there wondering how my attending would handle this somewhat awkward, and, to me, deeply painful, situation. Would she point out that the parents were being unkind? Would she be able to do so without offending them? And most important, would she be able to help them accept their daughter's vision and address it accordingly with a visit to an ophthalmologist?
In wonderful-role-model fashion, my excellent attending did all three, simply by suggesting that perhaps the girl had been sitting so close to the television precisely because she had difficulty seeing, and not the other way round. She also pointed out that the patient was upset because she was watching her Mom and Dad act visibly worked up. How could they expect her to even want to wear glasses, if she does indeed need them, if they exhibited such displeasure at the possibility? Both parents literally got looks of sudden realization on their faces, and at least to some small degree, their attitudes shifted and some of the tension in the room lifted. It was pretty masterful, I must say. I don't doubt that when that little girl has her first car accident, her parents will tell her what she did wrong before they say they're glad she's okay. But maybe my attending's small, insightful comment will do something to make those parents think, just a little bit, before blaming their child for all her failings.

The n00b Files - Week 3 of Pediatrics

I'm on my third week of Pediatrics, which means I've completed 2 weeks of Pediatric ER, and am on my first week of outpatient pediatrics. I've also fully completed 8 weeks of Psychiatry, during which time I neglected to write down any n00b lessons. But never fear! More lessons await, below:

1. Turns out it's not that hard to look into a lot of infants' and children's ears as I had previously feared. More kids than you'd expect are pretty calm about the whole thing, which makes life a lot easier.
2. On a related note, you know how you're taught to pull a patient's ear back and up in order to straighten out the canal and take a good look at the eardrum? Yeah, with infants and young children, it's a LOT easier to see the eardrum when you pull straight back. Now that was a revelation.
3. The great thing about psychiatry is that you get to spend a LOT of time with patients, just talking to them. I like talking to patients, so I liked that aspect of it. 
4. After seeing a patient who suffered from debilitating generalized anxiety disorder, I'm starting to believe that having severe anxiety may well be much, much worse than having severe depression. I actually felt like crying while talking to said patient, whereas I don't think I ever got emotional while talking to depressed patients.
5. Um, apparently you're not supposed to feed your baby any plain water until he or she is at least 6 months old. Babies are not good at regulating their water balance until then, so if you give babies water, their electrolytes can go all out of wack and then they can have seizures. So, don't feed your infant water!
6. ^Then again, very shortly after I wrote this, I heard my preceptor tell a mother of a 4-month-old that she can give her baby water if they're outside for a long time....so I guess the other lesson here is that the advice that doctors give can vary from doctor to doctor.
7. Subsequently, it's amazing/borderline scary to think how much of my behavior as a full-fledged physician will be directly influenced by the training I receive. For instance, I've learned at school that it's best to hold an otoscope with the handle down when examining ears. My preceptor last summer said that holding it upside down was the "weenie" way, and I had been taught well. Then last week, another pediatrician demonstrated a really adept way of examining an infant's ears...holding the otoscope upside-down. It was just crazy to realize that, more than likely, the way I ultimately do things (including the advice I give parents on some topics, the way I do physical exams, and probably more) may well be determined simply by the last way I was taught to do said things.
8. You can learn a LOT by watching the way your superiors interact with difficult patients and other medical teams. I was super impressed by the way one of my psychiatry attendings handled small and large annoyances. That dude had an amazingly cool head.
9. Psychiatry can really be a very amusing rotation. When I was on inpatient psychiatry, my team and I had many a laugh-filled morning of rounds while discussing some of the unusual things our patients said. For instance, this exchange:

                    Did you sleep well tonight?

                    I was 14 once.

          Or this one:

                    Can you tell me a little bit about your childhood?

                    Absolutely not. 

          ...Okay, so maybe you had to be there.

Ticking Time Bomb

In roughly the last week, I've lost my apartment, a great deal of my freedom, and my boyfriend. (To be perfectly honest, I "lost" all three of the above mainly of my own accord.) To say that it hasn't been an easy week would be a great understatement. Then yesterday, a male, Mormon, future OB/GYN classmate of mine and I were talking about childcare, and he asked me if I have a significant other. I said no, and he assured me that it was "okay" that I didn't have one at the moment, that I have "time" to find someone, but then again, my ovaries are "a ticking time bomb" because, hey, those things poop out eventually, and who knows if I'll still be fertile by the time I find someone with whom I want to procreate? (Again, to be perfectly honest, this is actually a really nice guy, and I don't think he meant any malice by what he said, none at all.)

The weirdest part of the whole exchange? His comment didn't even bother me. I don't know if that reaction was due to something awesome, like the idea that I'm well-adjusted and modern enough to know that even if I couldn't have biological children, I'd still be equally happy with adopted children; or something not-as-awesome, like I am just completely numb right now. Maybe it's just that I feel as if lots of people around me have been encouraging me to find a guy to marry/settle down with in the near future, for various reasons, and this is just another ludicrous one being presented to me. If I want to have biological babies, I better delve into the finding-a-life-partner thing with gusto!

I just feel like my life is changing rapidly, and the short-term future taking shape resembles a life I never thought I'd live, and that makes me deeply uneasy in ways I find difficult to explain. I'm glad I'm currently on a rotation that I really like, so that going to work can at least bring me some satisfaction instead of more frustration.

Spinning My Wheels

I went to my first spin class ever today (today being Wednesday July 18), and something about the class, and the music played in it, and the fact that I heard someone talking angrily about "spinning my wheels" at his current job on the lightrail last night, made me feel like the universe was telling me to blog about the experience. Or maybe I just feel like writing something.

It's a rather illustrative concept, isn't it, "spinning my wheels?" Generally, people resent finding themselves exactly where they started after expending a great deal of effort. That's why so many people I know say they hate running on treadmills; that's why "I'm just spinning my wheels at this job" was the Lightrail Guy's way of saying how frustrated he was about his work environment and lack of upward mobility. And yet.

During the second song in my spin class, the instructor was telling us to imagine ourselves coasting down a hill at full speed, 30 MPH, when we were spinning at low resistance, and I frankly was frightened at the thought. I was just fine with pumping my legs hard and fast but not changing my position at all. By which I'm trying to say--I don't mind moving fast, but staying in the same place. Is that bad?

I suppose it's a good quality for a person in medical school, which, if you enter it right after college, keeps you in a state of woman-childhood (or man-childhood, as the case may be) well into your late 20's. You learn how the human body works, how to fix it when it stops working, how to make people stop bleeding when they start and start breathing when they stop, and yet for years, you're always listening to what someone else tells you to do. You're not given true power until you're nearly 30, if not older. But I'm okay with that. I'm okay with treading water while I get my mental footing.

Last night, my second-grade teacher, who found me on Facebook about a year ago, sent me a message saying that her son possibly has a rare condition that she'd never heard about before. She asked me what I knew about it, and I was able to use my limited medical school knowledge (and the resources of the Internet) to give her some information. In a week that seems full of circles, it felt pretty great to have come full-circle enough to impart knowledge to a woman who once imparted knowledge to me. So do I mind spinning my wheels for a while? Not one bit.

I Win

Sometimes I hear about the problems my peers worry about and claim as their very worst experiences ever, and I feel so incredibly condescending. Few of my peers are experiencing the types of things I am. 

The n00b Files- Week 3 of Infectious Disease Consult/Week 11 of Internal Medicine

I'm now approximately one week away from finishing MS2 and becoming a wise 3rd year. In preparation for moving onto the second half of my medical school career, I am frantically gathering yet more knowledge as I wrap up my last month of the Internal Medicine rotation. Here's the low-down:

Lesson 1:
Being on a consult service is frustrating in that you make recommendations and write notes and put in orders, but ultimately the primary team makes all the decisions, and sometimes even decisions in your field of expertise. For instance, the primary team stopped an antibiotic on one of our patients without consulting our team first. They stopped it for a good reason, but stopping it without letting us know beforehand was kind of a crazy thing to me. But I get the feeling this sort of thing is not uncommon when you're consulting on a patient.

Lesson 2:
One thing that makes me really, really happy is talking to people in their 60s or so who've already made it through all the hurdles I face now as a 20-something. Most of them have found their life partners, borne and raised children, and had their careers. In a time when I feel like very few things about my future are certain, it gives me hope to look at others who have come before me and made it through and are still smiling. This is probably why I like working with the Alumni Association at my school so much.

Lesson 3:
This is not a lesson by any means, but I took a picture with one of my patients this week, by her request. It made me feel really happy (she was a sweet, short elderly lady who reminded me of all kinds of grandmas), and it also made me realize that doctors take pictures with their patients all the time--and this was hopefully the first in a long line of photographs to come.

Lesson 4:
I may never get over the mental/emotional trauma of seeing patients in the ICU. I know it's a bit rich to say that when I'm, oh, less than 6 months into many, many years of working in and around hospitals. But seriously, how does anyone look at a patient, legs sprawled about awkwardly, mouth open with an intubation tube and orogastric tube hanging out, and catheters and lines coming out of necks, arms, and you-know-wheres, and not shudder, even if for a millisecond?

Lesson 5:
One of the toughest things about being a student is having patients with complex medical problems, whose prognosis you can't predict. Heck, who even knows if the attendings can predict some patients' prognoses? But what I'm getting at is, it sucks to walk into a room in the morning and examine an unresponsive patient while said patient's spouse sits in the corner in expectant silence, hoping you'll tell them something about the patient's progress. Unfortunately, being as inexperienced as I am, I have no useful information for families in a situation like that. It's rough to walk out without exchanging a word with others in the room, but doing that is better than trying to exchange pleasantries, or worse, telling them things about their loved one's medical problems that simply are incorrect.

Lesson 6:
There are 14 specific "systems" that Medicare and Medicaid look for on a Review of Systems; you have to hit 10 to get full credit. They are: Constitutional, Eyes, ENT, Cardio, Respiratory, GI, GU, Musculoskeletal, Neurological, Derm, Endocrine, Allergy and Immunology, Heme/Onc, and Psych. Isn't that wild?

Lesson 7:
I'm really grateful that I don't have inflammatory bowel disease. That stuff sucks.

Lesson 8:
Learning where all the free food is in any given hospital is a worthwhile endeavor. It feels good to walk around with ice cream and smile mysteriously when others ask you where you got it.