As I travel through third year, rotating from service to service, hospital to hospital, my life is filled with a barrage of unfamiliar faces, strange new computer systems, new keypad codes for new supply rooms... and I search for the slightest bit of comfort, something that I already know, something that I don't have to figure out... and that thing is usually candy.
Wherever I am, whatever I'm doing, I always make sure I know where the nearest candy machines are, which ones charge only 75 cents for the candies, which ones try to get away with charging a dollar fifty. I know which soda machines sell diet coke in a can (Pepsi isn't the same thing, and diet coke in a plastic bottle isn't the same thing...) and I know which ones are generally well stocked, which ones take the crumpled dollar bills...
So, as my life spins out of control, I can sip Diet Coke and nibble on Starbursts as I jot down new supply room door codes, try to memorize the new names and faces that will be evaluating me, and try to figure out the new computer system.
Monday, February 9, 2009
Sunday, January 18, 2009
The Descent Continues
My medication change, my talk with the Site Director, my realization that if I just kept getting up in the morning, going to the hospital, coming home, taking Ambien, going to sleep, and getting up again, I could go on indefinitely. And that's what I did- I slogged back and forth between the student housing and the hospital. I ate, I slept, I did all the things and ordinary human being is supposed to do during his or her time on earth. And I fell into an equilibrium.
Realizing that things were better, but not great, I again called Dean Stewart to ask about taking time off. “Now that you’re psychiatrically stabilized, I don’t see that there’s any benefit to you taking time off…” I wanted her to understand that while I felt my feet were becoming more firmly planted beneath me, that things weren’t right. I was functioning in the hospital, puttering about, writing notes, presenting on topics; and while I wasn’t excelling, I was now certainly up to standards. She advocated self care, telling me that perhaps I should take a day off on the weekends as opposed to voluntarily going in to the hospital to see my patients.
I eventually finished my 5 weeks of internal medicine at Glendale and returned to my home hospital at [] medical school for the final five weeks of the rotation. When I arrived I’d been branded as a “student in trouble,” a distinction which awarded me “extra help” in the form of constant suggestions during my presentations. Were I not to have been branded, I believe, a lot of those little mistakes would have gone unnoticed, or would have appeared in my evaluation as qualifications to my otherwise stellar performance. But instead, my preceptor, desiring to “help” me decided to do so by bringing our preceptor sessions to a screeching halt when he sensed that I did not understand something. The other 3 people in the sessions politely waited as my presentations were drawn out and picked apart. Did I understand the difference between infection, and vasculitis? Yes, I stammered, turning red; the preceptor was doubtful that my response reflected true understanding and launched into a long explanation.
Realizing that things were better, but not great, I again called Dean Stewart to ask about taking time off. “Now that you’re psychiatrically stabilized, I don’t see that there’s any benefit to you taking time off…” I wanted her to understand that while I felt my feet were becoming more firmly planted beneath me, that things weren’t right. I was functioning in the hospital, puttering about, writing notes, presenting on topics; and while I wasn’t excelling, I was now certainly up to standards. She advocated self care, telling me that perhaps I should take a day off on the weekends as opposed to voluntarily going in to the hospital to see my patients.
I eventually finished my 5 weeks of internal medicine at Glendale and returned to my home hospital at [] medical school for the final five weeks of the rotation. When I arrived I’d been branded as a “student in trouble,” a distinction which awarded me “extra help” in the form of constant suggestions during my presentations. Were I not to have been branded, I believe, a lot of those little mistakes would have gone unnoticed, or would have appeared in my evaluation as qualifications to my otherwise stellar performance. But instead, my preceptor, desiring to “help” me decided to do so by bringing our preceptor sessions to a screeching halt when he sensed that I did not understand something. The other 3 people in the sessions politely waited as my presentations were drawn out and picked apart. Did I understand the difference between infection, and vasculitis? Yes, I stammered, turning red; the preceptor was doubtful that my response reflected true understanding and launched into a long explanation.
Friday, December 26, 2008
My descent into hell
Glendale had a community hospital where the nearby wealthy landed should they not have a medical problem urgent or obscure enough to land them in one of the “fancier” university hospitals in the area. It was a small hospital, contained in one building, and having only four floors. While [my med school's hospital] has a MICU, a PICU, a NICU and a SICU, the last three letters standing for intensive care unit, the first letter standing for medicine, prenatal, neonatal, and surgical, the Glendale hospital had only an ICU which occupied only one part of one floor. The other specialties, medicine, neurology, surgery, pediatrics, and obstetrics and gynecology were distributed throughout the four stories.
After arriving in Glendale, myself and the other two students from [] medical school met briefly with the Course Coordinator, a smiling woman named Joanne, who gave us the keys to our student housing, and ushered us into a conference room to meet the course director, a kindly gray haired internist named Dr. Foulton. Dr. Foulton had a halting way of speaking and often, while trying to recall a specific point, or think through a particular problem would close his eyes and hold his hand up as though shielding himself from sunlight. He had a gentle manner, and a gruff, albeit soft, voice. Dr. Foulton, unlike some attending physicians didn’t STRIDE through the hospital, he walked. He led with a quiet confidence that required no outward reminders of his rank or position. He did have the curious habit of introducing students as doctors and this was the first time I was to hear myself introduced as Dr. Forest. It was unnerving, and had a classmate or nurse introduced me as such, I would have qualified with “STUDENT doctor.”
The student housing at Glendale consisted of three houses- two of which were filled with [my med school] students, and one of which was for med students from [a nearby med school]. That house had only one resident, a medical student doing her family practice rotation. In my house, some students were lucky enough to have single rooms. I shared my room with another [my med school] student named Allisa Carter. Allisa was doing her Ob Gyn rotation and spent more time out of the room than in- an arrangement which suited me well. In fact, when I first moved into the room I didn’t see her for the first couple days and knew only that I was co-habiting with someone who had small feet, expensive shoes, and a penchant for tidiness.
I slowly slipped into a routine- I’d get up at 6 to be at the hospital at half past for pre-rounds where I’d stop by my patients for a brief assessment. Rounds were at 7 sharp, a relatively informal affair lead by Dr. Foulton. We generally stood in the hallway- anyone who had a new patient to present would give Dr. Foulton the run down, and then we, as a group, would visit certain patients. Usually we’d visit new patients, or those with interesting physical findings. One of my patients had aortic stenosis, for instance, and we went to her room where we lined up, one by one, to listen to a heart murmur that radiated from the right side of her upper chest to both sides of her neck. The aortic valve separates the heart from the rest of the circulation, and when the valve is stenotic, meaning it doesn’t open quite enough, the blood flow makes a distinctive noise as it tries to force itself past the too-small orifice. Instead of lub dub lub dub, I recall hearing Bwoosh, Bwoosh, Bwoosh. At the end, Dr. Foulton took the woman’s hand in one of his larger ones, and gently thanked her. When I returned later that day, the woman didn’t wish to see any more medical students.
It was at Glendale that I first noticed things were really wrong. Normally chipper and awake in the mornings, I found myself with eyes closing during rounds. Coffee did little to lift my early morning spirits and I found that this tiredness followed me through the day. While I normally have an excess of energy requiring me to volunteer for duties on other floors, merely for the opportunity to gallop up or down the stairs, at Glendale my feet simply didn’t want to walk, just as my face simply didn’t want to smile. A friendly greeting was as difficult as trying to mold frozen butter. I could muster a smile, but it was more of a grimace. My eyes did not squinch shut and the rest of my face remained frozen. Every morning, I awoke and went to the hospital, but with each step I could barely muster the energy to continue with another. And another. And another. I wanted to melt into the floor and disappear.
My roommate from school called me, but I didn’t return her call. It didn’t seem worth it. Picking up the phone. Talking. Dr. Foulton asked me questions on rounds and I was unable to respond, unable to think. Thoughts slipped from my grasp like melting ice cubes. My psychiatrist quizzed me about my medications. Did any of the medications look different? Had I switched from genetic to brand name or vice versa? Was I taking the medications? She increased my Wellbutrin and Ritalin doses and I emerged from underwater, if only enough to look around and reaffirm what I knew was true. I needed to die. My doctor had prescribed me Ambien, and each night I took enough pills to render me unconscious- I didn’t want to worry about getting to sleep, I didn’t want to remember getting to sleep. Sleep waited for me at the end of each day like the period at the end of a sentence. With 40 mg ambient, sleep was sure. It would happen. And I awaited the end of each day so that I could resume my unconscious state.
I had a favorite computer in a corner where I would sit with my head down, long hair loose around my face, crying as I pretended I was mesmerized wit the computer screen, the keyboard. “You’re the most devoted medical student I’ve ever seen,” said a resident, noting I was always in the hospital. “What else is there?" I wanted to ask. The evenings found me released from the hospital but I was unable to fill my time. I studied, nothing stuck. I watched television, still not comprehending. The medication change helped a little bit, but it was powerless against the immense tide of my depression.
I asked the dean if I could have some time off. That way, I figured, I’d be able to address whatever it was that was dragging me to the bottom of the ocean. And I’d be able to study for my ob-gyn shelf. I just needed a little time and then everything would be OK. I also needed a haircut, but it cost money, and more than that, it cost energy. Because getting to the hair dresser or first finding a hair dresser, then getting to one, would take energy. And for what? My hair hung like a dress that’d been in the back of the closet for 3 years too long.
“Are you safe?” asked Dean Stewart during one conversation. I’d sneaked to one of the hospital bathrooms for this conversation, and told her that yes; I was safe, explaining that there were a number of other students in my house. I wanted to tell her that I wasn’t safe, that even as I spoke to her I was thinking that the bathroom, on the second floor, wasn’t nearly high enough. Were I to jump, I would likely survive. Each day I imagined slicing into my skin with a scalpel, watching a thin line of blood appear as the upper epidermal layer separated, and then seeing the yellow, lumpy fascia as the knife cut deeper. At this point, the edges of the cut would pull apart. My cuts often assumed the shape of a fish- narrow at each end with a wider belly at the center. They never healed as they should have. Instead of sewing the opposite sides together, I let them stay to heal as they would. The scar tissue would fill in and I’d be left with a dark rose reminder. My upper left thigh was filled with such reminders. A doctor once asked what the significance of this part of my body was- and there was none. I’m right handed and when I sit, my right hand is next to my right thigh. I cut on my left thigh once when I ran out of room. I cut on my stomach a few times for the satisfaction of slicing skin that had never been sliced, and I cut on my wrist on three angry occasions.
I wanted to cut but I had no privacy- I shared a bedroom with Allisa, an arrangement that left me unable to cut, unable to dose myself into a 24 our sleep, and unable to binge, hiding the contents in our shared closet. So, every day, I went to work imagining that a car would hit me as I crossed the road. I imagined slipping on the hospital floor and disappearing into a puddle that would evaporate.
One day, Dr. Foulton asked me to speak with him after rounds. I followed him into the conference room and he asked me how I was. I told him I’d had a rough time during Ob-Gyn, but that I’d be fine. “We do not rule through fear and intimidation here,” he said gently. I couldn’t answer; if I opened my mouth I’d start crying. I sat silently, finger in my emotional dyke. He told me that he did have his doubts, that I seemed like a bright young lady. He suggested I seek counseling. He said there was a minimum standard, and that I was not meeting it. I finally offered that I have a mood disorder and said that I was trying to get time off.
“This is the real world,” he said, explaining that if I was having difficulties coping, that taking time off would solve nothing- I would have a brief reprieve and return to the same problems. I wanted him to understand that I wasn’t normally like this, that taking time off would enable me to solve what was wrong so that I could return as an improved individual. He seemed to believe that I needed to handle things and not run away from whatever problems I was experiencing. “I’m not running away! I’m sick! I have an illness! I’ll take time off, recover, and then return,” I wanted to say. But I was silent, finger back in the dyke.
After arriving in Glendale, myself and the other two students from [] medical school met briefly with the Course Coordinator, a smiling woman named Joanne, who gave us the keys to our student housing, and ushered us into a conference room to meet the course director, a kindly gray haired internist named Dr. Foulton. Dr. Foulton had a halting way of speaking and often, while trying to recall a specific point, or think through a particular problem would close his eyes and hold his hand up as though shielding himself from sunlight. He had a gentle manner, and a gruff, albeit soft, voice. Dr. Foulton, unlike some attending physicians didn’t STRIDE through the hospital, he walked. He led with a quiet confidence that required no outward reminders of his rank or position. He did have the curious habit of introducing students as doctors and this was the first time I was to hear myself introduced as Dr. Forest. It was unnerving, and had a classmate or nurse introduced me as such, I would have qualified with “STUDENT doctor.”
The student housing at Glendale consisted of three houses- two of which were filled with [my med school] students, and one of which was for med students from [a nearby med school]. That house had only one resident, a medical student doing her family practice rotation. In my house, some students were lucky enough to have single rooms. I shared my room with another [my med school] student named Allisa Carter. Allisa was doing her Ob Gyn rotation and spent more time out of the room than in- an arrangement which suited me well. In fact, when I first moved into the room I didn’t see her for the first couple days and knew only that I was co-habiting with someone who had small feet, expensive shoes, and a penchant for tidiness.
I slowly slipped into a routine- I’d get up at 6 to be at the hospital at half past for pre-rounds where I’d stop by my patients for a brief assessment. Rounds were at 7 sharp, a relatively informal affair lead by Dr. Foulton. We generally stood in the hallway- anyone who had a new patient to present would give Dr. Foulton the run down, and then we, as a group, would visit certain patients. Usually we’d visit new patients, or those with interesting physical findings. One of my patients had aortic stenosis, for instance, and we went to her room where we lined up, one by one, to listen to a heart murmur that radiated from the right side of her upper chest to both sides of her neck. The aortic valve separates the heart from the rest of the circulation, and when the valve is stenotic, meaning it doesn’t open quite enough, the blood flow makes a distinctive noise as it tries to force itself past the too-small orifice. Instead of lub dub lub dub, I recall hearing Bwoosh, Bwoosh, Bwoosh. At the end, Dr. Foulton took the woman’s hand in one of his larger ones, and gently thanked her. When I returned later that day, the woman didn’t wish to see any more medical students.
It was at Glendale that I first noticed things were really wrong. Normally chipper and awake in the mornings, I found myself with eyes closing during rounds. Coffee did little to lift my early morning spirits and I found that this tiredness followed me through the day. While I normally have an excess of energy requiring me to volunteer for duties on other floors, merely for the opportunity to gallop up or down the stairs, at Glendale my feet simply didn’t want to walk, just as my face simply didn’t want to smile. A friendly greeting was as difficult as trying to mold frozen butter. I could muster a smile, but it was more of a grimace. My eyes did not squinch shut and the rest of my face remained frozen. Every morning, I awoke and went to the hospital, but with each step I could barely muster the energy to continue with another. And another. And another. I wanted to melt into the floor and disappear.
My roommate from school called me, but I didn’t return her call. It didn’t seem worth it. Picking up the phone. Talking. Dr. Foulton asked me questions on rounds and I was unable to respond, unable to think. Thoughts slipped from my grasp like melting ice cubes. My psychiatrist quizzed me about my medications. Did any of the medications look different? Had I switched from genetic to brand name or vice versa? Was I taking the medications? She increased my Wellbutrin and Ritalin doses and I emerged from underwater, if only enough to look around and reaffirm what I knew was true. I needed to die. My doctor had prescribed me Ambien, and each night I took enough pills to render me unconscious- I didn’t want to worry about getting to sleep, I didn’t want to remember getting to sleep. Sleep waited for me at the end of each day like the period at the end of a sentence. With 40 mg ambient, sleep was sure. It would happen. And I awaited the end of each day so that I could resume my unconscious state.
I had a favorite computer in a corner where I would sit with my head down, long hair loose around my face, crying as I pretended I was mesmerized wit the computer screen, the keyboard. “You’re the most devoted medical student I’ve ever seen,” said a resident, noting I was always in the hospital. “What else is there?" I wanted to ask. The evenings found me released from the hospital but I was unable to fill my time. I studied, nothing stuck. I watched television, still not comprehending. The medication change helped a little bit, but it was powerless against the immense tide of my depression.
I asked the dean if I could have some time off. That way, I figured, I’d be able to address whatever it was that was dragging me to the bottom of the ocean. And I’d be able to study for my ob-gyn shelf. I just needed a little time and then everything would be OK. I also needed a haircut, but it cost money, and more than that, it cost energy. Because getting to the hair dresser or first finding a hair dresser, then getting to one, would take energy. And for what? My hair hung like a dress that’d been in the back of the closet for 3 years too long.
“Are you safe?” asked Dean Stewart during one conversation. I’d sneaked to one of the hospital bathrooms for this conversation, and told her that yes; I was safe, explaining that there were a number of other students in my house. I wanted to tell her that I wasn’t safe, that even as I spoke to her I was thinking that the bathroom, on the second floor, wasn’t nearly high enough. Were I to jump, I would likely survive. Each day I imagined slicing into my skin with a scalpel, watching a thin line of blood appear as the upper epidermal layer separated, and then seeing the yellow, lumpy fascia as the knife cut deeper. At this point, the edges of the cut would pull apart. My cuts often assumed the shape of a fish- narrow at each end with a wider belly at the center. They never healed as they should have. Instead of sewing the opposite sides together, I let them stay to heal as they would. The scar tissue would fill in and I’d be left with a dark rose reminder. My upper left thigh was filled with such reminders. A doctor once asked what the significance of this part of my body was- and there was none. I’m right handed and when I sit, my right hand is next to my right thigh. I cut on my left thigh once when I ran out of room. I cut on my stomach a few times for the satisfaction of slicing skin that had never been sliced, and I cut on my wrist on three angry occasions.
I wanted to cut but I had no privacy- I shared a bedroom with Allisa, an arrangement that left me unable to cut, unable to dose myself into a 24 our sleep, and unable to binge, hiding the contents in our shared closet. So, every day, I went to work imagining that a car would hit me as I crossed the road. I imagined slipping on the hospital floor and disappearing into a puddle that would evaporate.
One day, Dr. Foulton asked me to speak with him after rounds. I followed him into the conference room and he asked me how I was. I told him I’d had a rough time during Ob-Gyn, but that I’d be fine. “We do not rule through fear and intimidation here,” he said gently. I couldn’t answer; if I opened my mouth I’d start crying. I sat silently, finger in my emotional dyke. He told me that he did have his doubts, that I seemed like a bright young lady. He suggested I seek counseling. He said there was a minimum standard, and that I was not meeting it. I finally offered that I have a mood disorder and said that I was trying to get time off.
“This is the real world,” he said, explaining that if I was having difficulties coping, that taking time off would solve nothing- I would have a brief reprieve and return to the same problems. I wanted him to understand that I wasn’t normally like this, that taking time off would enable me to solve what was wrong so that I could return as an improved individual. He seemed to believe that I needed to handle things and not run away from whatever problems I was experiencing. “I’m not running away! I’m sick! I have an illness! I’ll take time off, recover, and then return,” I wanted to say. But I was silent, finger back in the dyke.
Saturday, November 22, 2008
80 Hour Workweeks
"Well, I start work at 6 am so I get tired early," I said to the grocery store clerk, who had just commented on my yawning.
"So, what, you get out at 2?"
"No..."
An 8 hour, or even a 10 hour day has become a luxury. I forget how it is outside of medicine sometimes. There are reminders, though. When I exclaimed that medical students can now get to the hospital later, now at 6 am, my parents, unfamiliar with the world of medicine, didn't really understand how that could be "late" to start work. They also don't understand that a shift may last 24 hours. That people who shouldn't be on the road driving a car, are in the hospital working with desperately ill patients. And they don't understand that this is an improvement.
Resident physicians in hospitals are now legally limited to 80 hours per week of work. There are other stipulations, making 36 hour shifts illegal, and ensuring that there is a reasonable amount of time between shifts so doctors don't have two hours to come home, shower and change scrubs, and return to the hospital.
Many attribute the changes to the Libby Zion case. I don't know many of the specifics of the case- but the gyst is that a young woman named Libby Zion went to the emergency room at a New York hospital and was given medication which interacted with a medication she was on, or an illegal drug she'd been taking- I'm actually not even sure why she went to the ED in the first place, actually. But, anyway, she went to the ED, there were some over-sights, and she ultimately passed away. It turns out that her father's a journalist, so the case gained wide recognition. The mistakes and oversights that were made in the ED were eventually blamed on sleep deprivation and long work hours for residents.
Some seasoned Attending physicians look at that case and dismiss Libby Zion as a cocaine addict who has somehow lead to the ruin of modern medicine, but I think, all things considered, that the diminished work week has been a good thing.
There are arguments against it- some argue that by decreasing hours from 120 to 80, interns have now been cheated out of 40 hours per week of learning and others argue that increased patient pass-offs between residents increase mistakes. Those who protest hours regulations don't like to mention the effects of sleep deprivation upon the doctors, patients, or upon those unfortunate enough to be on the roads while fatigued residents are driving home.
But, whatever the root cause, or whatever the arguments are against hours regulations, I am reaping the benefit and am lucky enough to be entering medicine at a time where there is at least an acknowledgement that long hours are bad.
"So, what, you get out at 2?"
"No..."
An 8 hour, or even a 10 hour day has become a luxury. I forget how it is outside of medicine sometimes. There are reminders, though. When I exclaimed that medical students can now get to the hospital later, now at 6 am, my parents, unfamiliar with the world of medicine, didn't really understand how that could be "late" to start work. They also don't understand that a shift may last 24 hours. That people who shouldn't be on the road driving a car, are in the hospital working with desperately ill patients. And they don't understand that this is an improvement.
Resident physicians in hospitals are now legally limited to 80 hours per week of work. There are other stipulations, making 36 hour shifts illegal, and ensuring that there is a reasonable amount of time between shifts so doctors don't have two hours to come home, shower and change scrubs, and return to the hospital.
Many attribute the changes to the Libby Zion case. I don't know many of the specifics of the case- but the gyst is that a young woman named Libby Zion went to the emergency room at a New York hospital and was given medication which interacted with a medication she was on, or an illegal drug she'd been taking- I'm actually not even sure why she went to the ED in the first place, actually. But, anyway, she went to the ED, there were some over-sights, and she ultimately passed away. It turns out that her father's a journalist, so the case gained wide recognition. The mistakes and oversights that were made in the ED were eventually blamed on sleep deprivation and long work hours for residents.
Some seasoned Attending physicians look at that case and dismiss Libby Zion as a cocaine addict who has somehow lead to the ruin of modern medicine, but I think, all things considered, that the diminished work week has been a good thing.
There are arguments against it- some argue that by decreasing hours from 120 to 80, interns have now been cheated out of 40 hours per week of learning and others argue that increased patient pass-offs between residents increase mistakes. Those who protest hours regulations don't like to mention the effects of sleep deprivation upon the doctors, patients, or upon those unfortunate enough to be on the roads while fatigued residents are driving home.
But, whatever the root cause, or whatever the arguments are against hours regulations, I am reaping the benefit and am lucky enough to be entering medicine at a time where there is at least an acknowledgement that long hours are bad.
Saturday, November 1, 2008
Civility?
Sometimes I wonder who's actually crazy- me or everyone else. And sometimes it's a hard call.
My school promotes "civility in the learning environment" which basically means that the dean's office works to ensure that medical students are not hit by flying surgical instruments, launched in an operating room temper tantrum, and that we are not routinely humiliated, belittled, or otherwise abused. The dean's office also works to limit student work hours. Working 100 hours a week, coming to the hospital at 4 am, and working for 36 hours in a row, for instance, is no longer tolerated. We're also supposed to average one day off a week.
The dean's office is going to great lengths to ensure what any other reasonable institution outside of medicine would offer automatically.
Now, there are things in the medical school environment that are difficult but that work. Pimping, for instance, is a term used to describe the Socratic Teaching Method. This is where an attending physician asks medical students questions that they may or may not know the answer to. So, why do we use warfarin instead of heparin in this case? What is this (pointing to part of an x ray)? Is this drug metabolized by the kidneys? Yes? What percent of the drug is metabolized by the kidneys? The questions may go on and on. But when done in a benign manner, a student might feel embarassed about the sudden attention to his or her lack of knowledge on the subject of indirect hernias, in rabbits, but the student leaves with a lasting memory of the significance of rabbit hernias.
Incivility is being purposely humiliated in the absence of any detectable learning or teaching. At worst, it may involve physical harm, although I've never had the pleasure of witnessing this. One incident that has forever embedded itself in my mind involves an attending physician I had the pleasure of meeting during a particularly difficult rotation.
For background, this particular medical specialty rotation took place at Madison Hospital (not the real name). Other students having done this rotation at Madison described it as "the worse experience of my adult life," "miserable," "depressing," and any other number of adjectives commonly used to describe a horrific experience.
Every day I travelled 45 minutes to arrive at the hospital at 5 am to round on my patients and I'd generally get out at around 7 pm, unless it was a "short call" day in which case I'd "officially" be done at 10 pm, although this was often subject to interpretation.
Anyway, one particular attending was about to start a didactic session for the medical students, a bunch of the interns, and a bunch of the residents. There were about 20 of us in all. I made a flip comment to someone about how women's lib and chivalry couldn't co-exist.
Attending: Chivalry and womens lib had nothing to do with one another
Me: (thinking- whoops, maybe that was a dumb thing to say; turning bright red) Um
Attending: But, I'm interested, Emily, what are your thoughts on chivalry?
Me: Uh, sorry! (bright red)
Attending: I think Emily has something to say to all of us about chivalry. Go ahead Emily, you have the floor..
Me: (wondering if my comment was inappropriate, still bright red) uh
Attending: We all want to hear what you have to say about Chivalry. Emily is a big expert on chivalry (gesturing)
Meanwhile I had about 20 sets of eyes staring at me. Someone else tried to say something
Attending: No, I think we should all see what EMILY has to say.
Me: (not sure where to look, everyone's staring; I had NO IDEA what to say so I decided to talk about some things I'd read pertaining to the attending's area of expertise) Well, I was reading some papers about gastric cancer and uh
Attending: No, we're all interested in your thoughts on women's lib and CHIVALRY. Please tell us all how the two are related...
After what seemed like forever, it ended. I'm still not sure whether my comment was inappropriate and I certainly never meant to annoy the attending.
I'm not sure if that counts as incivility in the learning environment, but it was embarrasing, unpleasant, and I afterwards regarded this particular attending physician with some amount of fear.
What are your thoughts? Take the poll shown on the right side of the screen!
My school promotes "civility in the learning environment" which basically means that the dean's office works to ensure that medical students are not hit by flying surgical instruments, launched in an operating room temper tantrum, and that we are not routinely humiliated, belittled, or otherwise abused. The dean's office also works to limit student work hours. Working 100 hours a week, coming to the hospital at 4 am, and working for 36 hours in a row, for instance, is no longer tolerated. We're also supposed to average one day off a week.
The dean's office is going to great lengths to ensure what any other reasonable institution outside of medicine would offer automatically.
Now, there are things in the medical school environment that are difficult but that work. Pimping, for instance, is a term used to describe the Socratic Teaching Method. This is where an attending physician asks medical students questions that they may or may not know the answer to. So, why do we use warfarin instead of heparin in this case? What is this (pointing to part of an x ray)? Is this drug metabolized by the kidneys? Yes? What percent of the drug is metabolized by the kidneys? The questions may go on and on. But when done in a benign manner, a student might feel embarassed about the sudden attention to his or her lack of knowledge on the subject of indirect hernias, in rabbits, but the student leaves with a lasting memory of the significance of rabbit hernias.
Incivility is being purposely humiliated in the absence of any detectable learning or teaching. At worst, it may involve physical harm, although I've never had the pleasure of witnessing this. One incident that has forever embedded itself in my mind involves an attending physician I had the pleasure of meeting during a particularly difficult rotation.
For background, this particular medical specialty rotation took place at Madison Hospital (not the real name). Other students having done this rotation at Madison described it as "the worse experience of my adult life," "miserable," "depressing," and any other number of adjectives commonly used to describe a horrific experience.
Every day I travelled 45 minutes to arrive at the hospital at 5 am to round on my patients and I'd generally get out at around 7 pm, unless it was a "short call" day in which case I'd "officially" be done at 10 pm, although this was often subject to interpretation.
Anyway, one particular attending was about to start a didactic session for the medical students, a bunch of the interns, and a bunch of the residents. There were about 20 of us in all. I made a flip comment to someone about how women's lib and chivalry couldn't co-exist.
Attending: Chivalry and womens lib had nothing to do with one another
Me: (thinking- whoops, maybe that was a dumb thing to say; turning bright red) Um
Attending: But, I'm interested, Emily, what are your thoughts on chivalry?
Me: Uh, sorry! (bright red)
Attending: I think Emily has something to say to all of us about chivalry. Go ahead Emily, you have the floor..
Me: (wondering if my comment was inappropriate, still bright red) uh
Attending: We all want to hear what you have to say about Chivalry. Emily is a big expert on chivalry (gesturing)
Meanwhile I had about 20 sets of eyes staring at me. Someone else tried to say something
Attending: No, I think we should all see what EMILY has to say.
Me: (not sure where to look, everyone's staring; I had NO IDEA what to say so I decided to talk about some things I'd read pertaining to the attending's area of expertise) Well, I was reading some papers about gastric cancer and uh
Attending: No, we're all interested in your thoughts on women's lib and CHIVALRY. Please tell us all how the two are related...
After what seemed like forever, it ended. I'm still not sure whether my comment was inappropriate and I certainly never meant to annoy the attending.
I'm not sure if that counts as incivility in the learning environment, but it was embarrasing, unpleasant, and I afterwards regarded this particular attending physician with some amount of fear.
What are your thoughts? Take the poll shown on the right side of the screen!
Monday, October 20, 2008
Surgery
In medical school, we “rotate" through all different specialties so we can pick the one we like the best. Right now I'm "rotating" through surgery.
I actually like surgery. It's the first time this year I've gotten to "scrub in." That’s the hospital term for scrubbing-your-hands-and-forearms-with-brown-colored-sopey-stuff-that-leaves-you-skin-with-a-brownish-hue. The point of scrubbing is to prevent the spread of infection; very important in surgery, as I'm sure you can imagine.
Basically, the operating room is divided into Sterile Areas and everything else. The Sterile areas are noted by their blue color and consist of tables, draped in blue cloth upon which surgical tools sit, the scrub nurse, clad head to foot in a blue surgical hat and robe, and the patient, who once prepped and draped, becomes an honorary member of the sterile field.
Before you scrub in, you can't touch anything that's sterile. That means stay far away from anything and everything that's blue. I still cringe before placing my hands on anything blue outside of the OR. That includes furniture, clothing... I've been trained well.
Once you’re scrubbed, you can’t touch anything that ISN'T sterile, or blue. So after "scrubbing" you walk into the OR, butting the door with your hip, with your hands held up, not too low, because then their not sterile, and not too high, because then their not sterile. Generally, the scrub nurse is an expert in all things sterile, so when entering the OR, I generally look to him/her for instructions which usually consist of- don't put your hands there, your hands are too high, your hands are too low, watch the table... Basically the scrub nurse protects the OR from the medical student.
Anyway, once you're scrubbed and in the OR, the scrub nurse holds up your sterile gown, letting you put your hands in the sleeves. You also do a "twirl" maneuver to tie the sash of the gown, where another person holds part of the sash, and you literally spin around. I felt really uncomfortable with the gowning part of the set up because I felt like having nurses essentially "dress" me was demeaning to them- tantamount to having them fan me and feed me grapes.
But, it's not demeaning, and it's all in the name of sterility. And, once you've been gowned and put on two sets of gloves, you can help out with the actual surgery. Today this involved holding retractors. In the same position. For a long long time.
I actually like surgery. It's the first time this year I've gotten to "scrub in." That’s the hospital term for scrubbing-your-hands-and-forearms-with-brown-colored-sopey-stuff-that-leaves-you-skin-with-a-brownish-hue. The point of scrubbing is to prevent the spread of infection; very important in surgery, as I'm sure you can imagine.
Basically, the operating room is divided into Sterile Areas and everything else. The Sterile areas are noted by their blue color and consist of tables, draped in blue cloth upon which surgical tools sit, the scrub nurse, clad head to foot in a blue surgical hat and robe, and the patient, who once prepped and draped, becomes an honorary member of the sterile field.
Before you scrub in, you can't touch anything that's sterile. That means stay far away from anything and everything that's blue. I still cringe before placing my hands on anything blue outside of the OR. That includes furniture, clothing... I've been trained well.
Once you’re scrubbed, you can’t touch anything that ISN'T sterile, or blue. So after "scrubbing" you walk into the OR, butting the door with your hip, with your hands held up, not too low, because then their not sterile, and not too high, because then their not sterile. Generally, the scrub nurse is an expert in all things sterile, so when entering the OR, I generally look to him/her for instructions which usually consist of- don't put your hands there, your hands are too high, your hands are too low, watch the table... Basically the scrub nurse protects the OR from the medical student.
Anyway, once you're scrubbed and in the OR, the scrub nurse holds up your sterile gown, letting you put your hands in the sleeves. You also do a "twirl" maneuver to tie the sash of the gown, where another person holds part of the sash, and you literally spin around. I felt really uncomfortable with the gowning part of the set up because I felt like having nurses essentially "dress" me was demeaning to them- tantamount to having them fan me and feed me grapes.
But, it's not demeaning, and it's all in the name of sterility. And, once you've been gowned and put on two sets of gloves, you can help out with the actual surgery. Today this involved holding retractors. In the same position. For a long long time.
Sunday, October 12, 2008
Plant Dignity
So I was reading the Wall Street Journal yesterday. And in amongst the articles bewailing our economy, there was an article on the subject of plant dignity laws in Switzerland.
These plant dignity laws have made genetic engineering experiments quite difficult, as scientists try to breed pest resistant crops and other such things. Now, ethics committees have to get involved to determine whether or not these experiments compromise the dignity of the plants.
My peas just met a very undignified end. I can only hope that they didn't suffer too much.
These plant dignity laws have made genetic engineering experiments quite difficult, as scientists try to breed pest resistant crops and other such things. Now, ethics committees have to get involved to determine whether or not these experiments compromise the dignity of the plants.
My peas just met a very undignified end. I can only hope that they didn't suffer too much.
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