Untold Stories of the ER

As M2s, we get to apply for an elective for the next few months. I am in "Thrills and Spills" -- where you get exposure to the ER and learn new techniques such as intubation, IV placement, and suturing. Exciting!

I started shadowing this week -- first Grady (Blue zone) then Emory Midtown. Two very different experiences.

I LOVED my time at Grady. I was working with the residents, seeing patients, high energy (while simultaneously laid back?). It was great. At midtown, I was placed in the "red pod" which is assigned to the more intermediate cases -- abdominal pain, dizziness, etc... I was also working with an attending, which created a different environment.

Among all the craziness, the thing that struck me most was patient relationships. Both at Grady and Midtown, there were specific couples that just struck a cord within me.

At Grady, an 65yo woman was rolled into the ER because she was in pain and extremely hypotensive. IVs needed to be started on her immediately. Her husband was with her, and he was SO worried. As the ER attending was rapidly firing questions at him about his wife's medical history, he tried to answer the best as he could all the while shooting concerned glances over to his wife moaning in pain on the ER bed. As she screamed while the IVs were being placed, he had to leave the room-- I think it was too much for him. You could just see how much he loved her and how much he just wanted everything to be ok. His wife had a history of MS which even further showed his dedication and love to serve as a constant caregiver to a patient with a chronic condition.

At midtown, a 60yo woman came in for dizziness. Looking up her chart beforehand, I read her history -- "hepatitis C, liver cirrhosis, coagulopathies, double leg amputation after car accident in the 70s, severe dystonia." -- this lady again was a chronically ill patient. As I walked into the room to ask her about her dizziness, her husband was sitting there was well. He helped to answer questions that she couldn't -- filling in the details of her medical history. She was easily agitated and severely debilitated by her dystonia-- not an easy patient to care for, but again, you could tell how much her husband loved her, patiently staying by her side as her loyal caretaker.

Seeing these patients just reminded me of how much I love Ben and how it would break my heart to see him sick or in any kind of pain -- really giving insight into the patient's family perspective.

Passing the Torch

Tonight I met my "little sib." Emory assigns each of the incoming medical students a "big sib" to act as a guide/mentor/friend/whatever you need to the M1. It's a pretty nice to have someone to share their wisdom about medical school life because it's a pretty big adjustment, and you are freaking out about what you're doing for about the first 6 months.

I remember meeting my big sib last year and getting a follow-up email from her full of valuable advice -- overwhelming at the time -- but great to refer back to throughout the year. It's such a strange feeling to now be the "big sib"-- the wiser, older med student who has been through it all and is now giving advice to the "new generation."

I remember how advanced in their knowledge base and confident the M2s seemed last year. Am I really that M2 now? Looking back, I have learned an INCREDIBLE amount in this last year -- more than just facts and disease algorithms -- I have started to feel a little bit more comfortable in the doctor role, I have adjusted to the level of information we have to shove in our heads, I have learned to balance school with Ben, family, friends, and other interests.

Hard to believe a full year has passed and I am that much closer to becoming a doctor.

Walking a Mile in Someone Else's Shoes

Today we pricked our fingers to find out our blood glucose levels. Then, we gave ourselves subcutaneous shots of saline (instead of insulin) to mimic what diabetic patients have to go through every day...multiple times a day.

The worse part is definitely pricking your finger. I now understand why patients don't want to do it that often. I had to prick my finger twice because I pulled the lancet away too quickly (because it hurt!). I think the automatic lancets are worse than just having a needle you can poke yourself with -- there is definitely an increased level of anxiety as you push that button. There is also anxiety as you wait for your readout. Will you be in normal range? I felt anxious about it and I don't even have diabetes (my fasting glucose was 84, so need to start worrying quite yet). The needle for the insulin shot, however, is so tiny that I barely felt it when injecting myself -- definitely not as bad as I expected. The nurse told us that even some of the really young kids can inject themselves by the time they leave the hospital after their training.

Just a small slice of what life is like as a diabetic...

Highs and Lows

There are days where I feel so confident in my abilities and my future in medicine -- bring on the next patient, let me place an IV, let's do that pap smear-- and then there are days where I think "Oh, crap! I'm going to be doctor soon, what am I doing? A pap what?"

So here are few of my highs and lows over the last few weeks:

High: Taking a sexual history, doing a pelvic exam, pap smear, and STD test on a young female in the free women's clinic at Open Door.

High: Seeing a super friendly 50 year old male at OPEX and being able to provide health maintenance counseling. He had been diagnosed with melanoma and had focused on treatment for the past 5 years. Now that his melanoma was under control, he wanted to know what else he should be doing for his health. Being able to give advice re: immunizations, colonoscopies, EKGs, physical exams, and prostate exams = totally within the realm of things I can do.

Low: Learning how to do pelvic exams with standardized patients. Awkward contrived setting. Unsure of role (am I doctor or student? Is this women patient or teacher?). Conflicting advice from teaching doctor and standardized patient. Being corrected before having the chance to correct myself. Just...overall yucky feeling of incompetence.

Low: First physical exam under supervision of OPEX preceptor. Patient -- 26yo male coming in for yearly physical. Here is the thing...whenever I see patients close to my age, my confidence skips town. I feel like 7 year old playing doctor . The ease of taking a history slips away, the physical exam becomes a series of steps you have to memorize instead of a natural compliment to the history. Now, I didn't do terrible. I asked the right questions, I heard the regular rate and rhythm of his heart, I saw the clear tympanic membranes. BUT, it was uncomfortable. I know it, he knew it, and my preceptor knew it.

High: Knowing my crap about diabetic patient management and diabetic ketoacidosis in small groups this week. Maybe I do actually know something...

From the First Cut to the Final Goodbye

A few weeks ago, the anatomy faculty hosted a memorial service to commemorate those who had donated their bodies to further our medical knowledge.

The ceremony opened with "Amazing Grace" being played on the bagpipes by one of the students (none other than my anatomy partner). As the notes bellowed through the chapel, we all sat reflecting on the time spent with these cadavers in the anatomy lab. I remembered how I felt sad and strange after the professor made the "first cut" into our cadaver, the first time turning our cadaver over and seeing his face, holding his hand for hours on end as I worked to find those small muscles, arteries, and nerves of the hand. I remembered how grateful and, strangely, proud I felt that our cadaver had such large, well-preserved muscles and (relatively) little fat. I remembered how somehow our cadaver had escaped being shaved before donation, and little hairs would end up all throughout our dissection. I remembered the awe of holding his heart in my hand, the fear of puncturing his intestines, and the satisfaction of finding that nerve/artery/vein/lymphatic vessel after hours of searching and meticulous dissection. I reflected on all the time I had spend with our cadaver and how much I had truly learned.

Other students read poetry, sang songs, gave spiritual reflections, and told stories. We lit a candle and laid down a flower for each cadaver, silently thanking them for providing us with such an enormous gift, their own bodies, so that we could learn from them and use that knowledge to become the best doctors we can be.