It's only been a little over a month since I started 3rd year, but it feels like years. The learning curve is STEEP, but I'm climbing slowly, and I'm enjoying third year. I especially appreciate the discussions about real patients whom I've met and touched.
Life is less black and white than the pedantic academic lecturers from the preclinical years would have you believe. There are so many situations where the "official guidelines" have to be thrown out the window and tailored to the patient that I wonder how the health care desk jockeys think we can possibly design a system of compensation based on a limited set of "standard quality measures" that doesn't somehow give physicians, patients, or both the short end of the stick. :tired: The first night I scrubbed in on a C-section at 2 AM(my first surgery where I wasn't just watching). I was so unused to having anything the surgeon said apply to me that she had said "cut" three or four times and the resident kicked me under the table before I realized that "cut" was ME. Well, it wasn't long before C-sections became routine, and I became queen of the bladder blade and suture scissors. Two weeks into the rotation and I'm already a little sick of the bladder blade and suture scissors.
This rotation, being the first one is a little crazy, because all of the interns are new too. This is good and bad. Good--I don't look too bad if they're screwing up too. Bad--they're not sick of procedures yet, so less comes the way of the medical students.
If nothing else, OB/GYN patients are interesting. They should run a "reality TV" show out of our floor. If it isn't the 16 year old girl who comes in with eclampsia at 36 weeks claiming she didn't know she was pregnant, then it's a post-hysterectomy patient throwing trash cans out of the room at the nurses and doctors and leaving AMA with an IV still in.
Proposal: Birth control should be added to the water like Fluorine. Some people should NOT be allowed to reproduce.
I am just amazed at the hours they expect us and the residents to work. Even if I was doing something that was my favorite thing in the world, I still would not want to do it for 12 hour days every day, some weekends, and 30 hours in a row about once a week. You just never catch up on your sleep. Get home at 6, make dinner, and then you feel like you have to go to bed by nine if you aren't going to turn into a banshee when you have to get up the next morning at 4:30. And let's not discuss how losing sleep one night a week screws with your sleep schedule.
Babies are cool, and catching them is such a privilege, but if I kept those hours for four years, I would hate myself and my life. Obstetrics is not for me. Upside? I'm finished. Took an oral, took a shelf board, and merrily walked out of that rotation. :wave:
Right now we're doing a clinical skills week, which is very cool. We're learning chest tubes, cricothyroidotomy, skin biopsies, various suturing techniques, etc. Today they actually took some cadavers and filled their various body cavities up with fluid so that we could practice paracentesis, thoracentesis, and pericardiocentesis. (Translation: removing fluid from the belly, the chest, and from around the heart). Our test at the end of this week is a mock accident scene put on by the fire department. Now this is fun. I do think I'm going to be an ER doc. :hyper:
Next on the list: Surgery. I have one month of Thoracic, and then a month of Trauma. I'm excited, although long hours are once again the norm, and long surgeries bore me. However, I did get two services that deal directly with emergency medicine, so I should count my blessings.
Now, I know that there are several MomMDers thinking about getting pregnant soon, so here's a lovely thought for you: A woman on our service this month had spontaneous quads. (No fertility drugs, no IVF, just good old-fashioned baby making). Spontaneous. Quads. EEEK! :yikes: Don't tell your husbands.
Done with surgery. DONE forever! Although some surgeries are very cool, I do not have the patience or dedication to be a surgeon.
Trauma service was lots of fun though. We got to see all kinds of accidents and a wide variety of injuries, which was great for me. We had patients in the ICU on the edge, and we had some that got away with minor fractures.I got to sew up a lot of lacerations. Train vs. car, people falling off ladders, lots of motorcycle accidents (Please wear a helmet!) and one instance of veterinarian versus bull.
Trauma service was also general surgery service for the prison. It's kinda scary, but they'll let the med students do a LOT on prisoners. When we were in prison clinic, the students pretty much were the doctors, and all we had to do was leave our notes in a pile for the doctor to look at later. If we needed him, we could call him in, but if we didn't think we did, we were allowed to do everything ourselves. In the surgery itself, especially minor procedures, I got to do a lot, and they let me intubate sometimes too.
So it was a good month for me for procedures, but I'm still not going to be a surgeon.
This month I'm on infectious disease, which is great because you've got textbook cases of stuff like endocarditis, and then also not great because you have HIV patients that don't want to take the HAART regimen and are paying for it with their lives. :goodvibes: Definitely NOT this month though. First trimester while on infectious disease service? :yikes: Can you say TORCH infection? Yikes. no thanks. It's kinda funny though, the other medical student in my class who also wants to TTC soon is on ID in december. we were both joking about that yesterday. I think I will also be avoiding that radiology elective.....
Doing cardiology this month, which is good and bad. I'm learning a lot, but I also have a lot more depressing cases. We had this poor woman who was clearly moribund, but her daughter just would not make her DNR. She had cardiogenic shock, ARDS, sepsis (WBC of 37), kidney failure and was 83 years old. She was full code. It was really sad, because I know the daughter was desperate, and would hang on to any small shred of hope ("But her oxygen saturation today was 2 points higher!") but three different attending physicians went in there and said that she was clearly going to die. She finally did, and it was horrible.
The other problem I'm having is that the other med student on my service is an appalling a$$-kisser. She's incredibly buddy-buddy with the residents and always has her lips on the attending's rear end, and it's really really really really irritating. Must. not. kill. classmate.
I am very ready for my (short) xmas break. I'm more than a little sick of being given adult responsibility on one end and then constantly being checked up on and patronized on the other end. I'm also sick of never having enough sleep, and of always having to show up to work in a good mood. Someone please tell me it gets better from here?
Someone walked himself out of the hospital today that came to us about a week ago in full V-tach arrest. It pretty much made my day.
I also talked to a man who just had a heart attack and was complaining about his hospital bill. He had been out smoking that morning. The conversation went like this:
Me: "How much do you smoke?"
Him: "About 1-1 1/2 packs/day. Sometimes more. My wife smokes about 2."
Me: "So, what $4 per pack?"
Him: "Yeah, okay."
Me: "So that's $15 per day x 30 days = $450 PER MONTH for cigarettes. And you're complaining about the preventable hospital bill?"
Him: "At least I'm not smoking dope"
Me: "I'd almost rather you did."
Sigh. This man said that "just for me" he wouldn't smoke until he got to his home an hour away. He was also reading a domino's pizza menu when I walked in his room this morning.