Island Med Student

Taken on my way to work.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I just finished my first week of my third-year surgery rotation. I have no better words to describe it other than pure hell. I was unfortunately assigned to night call for my first week. For four nights I endured 16 to 18 hour shifts with no sleep, no food, only small sips of water, and no time to sit down. In addition to the grueling hours, I was subjected to the fierceness of our residents.

On my very first night call, the residents began rounding on the patients at around 6:30 a.m. I hadn’t slept or eaten in almost 24 hours. I was empty in both body and spirit. When the resident asked me about the ins and outs of one of my patients, I had to admit that I simply didn’t know. Not only had I not realized that I was supposed to be monitoring them, but I couldn’t even figure out how to answer his questions because I didn’t know how to use the electronic medical records system (we had received no training). He knew it was my first night of surgery night call. I admitted to him that I had not been trained on using the system, and that I was completely new to the hospital. But it made no difference to him. He laid into me so hard, that I felt like I was being physically ripped apart. I held back my tears and quietly told him that it wouldn’t happen again.

I’ve only experienced one other clinical rotation before surgery, and it was entirely different. In my psych rotation, I knew what the expectations were, and I was able to surpass them all. The hours were reasonable, and the residents and attendings were kind and understandable.

My first week of surgery has been the polar opposite. I’m starting to understand what sleep deprivation can do to my body and mind. I’ve realized that I simply lose the ability to think without sleep, food, or water for 24 hours. Every part of me begins to break down, and my defenses are lost. Welcome to medicine?

From what I can ascertain from my first week, med school rotations (and especially surgery) are very much like boot camp. You’re expected to challenge yourself physically and mentally in every way. You’re looked down upon if you complain. Failure is not acceptable.

A year ago, our very own Medscape editor, Christine Wiebe wrote an article on med student hazing, and I was very much interested in reading it at the time. However, now that I have walked a mile in the shoes of a lowly med student being yelled at by a so-called “teacher,” I understand all too well the devastating consequences of med student abuse.

At the end of only my first week of surgery, I feel like a shell of a person. I don’t have the energy to give 100% to my patients. I’ve lost all hope, and the first night I seriously considered running out of the hospital. I felt all my compassion exiting my body like the sweat rolling down my temples. I simply didn’t care.

I understand that medicine is a challenging field. I realize that the “weaklings” might not succeed. I understand that doctors are responsible for making life and death decisions, and hence should be held to the highest standard. But I can’t say that I agree with torture as a means of “weeding out” the weak ones. And I now realize why I’ve met so many less than compassionate physicians. I guess I just want to believe that there’s a better way.

Click Here To View the Original Post on Medscape

I just responded to one of the billion emails in my inbox, and I thought I’d go ahead and post my response, as it might be helpful for all you first semester Rossies right now. I wrote another post about surviving your first semester at Ross, but here are some tips on staying positive. The writer specifically asked how to stay positive, and what to do about the scary upperclassmen who say that it’s impossible to make it.

Dear Writer,

Congrats on making it through your first day! Actually, looking back, I can say that the first few weeks were the toughest. There isn’t much you can do to avoid that. It’s just going to be hard, no matter what!

As for keeping positive, here are some tips:

1) Ignore EVERYONE who has bad things to say. Whether they are complaining about the study load, or Ross, or Dominicans, or the food. Just ignore them. Seriously, don’t listen to them!

2) Find some extracurricular activities. Whether it’s going for a walk, or run (my personal fave!), or picking avocados, or just having a beer at Tomato’s. Just find something. Don’t believe the people who say you have to study every second. You don’t. And you will explode if you try…not to mention the fact that you’ll probably do poorly on exams. Study your ass off, but take time off to have fun. It’s imperative!

3) Try writing down your thoughts (obviously, this worked well for me!) Sometimes, just putting all your stress into words can be incredibly cathartic.

4) Remember why you want to be a doctor. Figure out why you wanted to take this plunge. Write it down, if you have to, and post it over your study area. Whenever you feel like crap, think back to the reasons that made you come to Dominica.

5) Make friends. Try to find the cool folks. Like I said, ignore the complainers! Surround yourself with positive folks, and you’ll find that you end up being much more positive yourself!

Ignore those silly older semester students. They suck! Just worry about yourself, and try to make the best out of a very tough situation.

I wish you the very best! Try and keep a smile on your face, no matter what. A little smile can go a long way.

Cheers,
Kendra

Note: In true doctor form I am, of course, way better at dishing out advice than taking it.

First of all I just want to give a big “THANKS!” to all the readers of my blog. It’s amazing that so many people have any interest in reading my random musings. Secondly, I wanted to thank you all for the kind emails and comments that you’ve sent over the past two years. While it sometimes takes me a million years to respond, please know that I read them all and do my best to respond to every email. Speaking of, if you’ve sent me an email and are awaiting a response, please do wait patiently. I promise to respond to all of you in my “spare” time.

My last post was particularly weepy, and I really wanted to thank all you commenters. It seems like I get a comment just when I need it the most. And when I read your words, I am touched. It’s so damn kind of you to send good wishes to a total stranger (and some not strangers). Seriously, it means so much to me, you could never imagine!

Also, I wanted to give an update on my current situation. I have good news to share. Today’s work at the wound care clinic was SO MUCH better. The shift was only 11 hours long, and I had time to eat, pee, and even sit down. I also had some lectures and actually learned a few things. Looking back, I am realizing that night call is very taxing. Combine that with the fact that I had no idea what I was doing, or how to get around the hospital, and a heavy patient load, and you have my pity party story of a hard time.

While I’m still not 100% in love with this rotation, I at least think I can get by. I still don’t think surgery is for me, but I’m at least having a little more fun. Also, before I forget, I will list some of the things I learned today.

But again, thank you everyone! I hope to return the favor someday.

1) How to evaluate a wound (size, color, type, characteristics, etc.)

2) All about PSA, and how to evaluate a person with urinary complaints.

3) How to evaluate and manage a patient with an electrolyte or pH imbalance.

4) Stage 4 sacral decubitus ulcers are horrific and incredibly sad.

5) I am goddamn lucky to be in good health.

6) I am lucky that nurses exist and are willing to clean up a patient’s bowel movement so that I can clean their wounds.

7) How to use a vacuum to suck out all the pus and badness from an ulcer.

8 ) Wearing a plastic gown, face mask, and double gloves can make for one hot Kendra…especially when I am also lifting a very heavy patient at the same time!

9) I have a very strong stomach for grossness, and my extensive experience with poop is a blessing in med school!

I’m not feeling particularly happy at the moment. I finished my first week of surgery (all on-call nights), and I have to admit that it was particularly bad. I worked long hours, was swamped with work, did TONS of clerical work, got yelled at, and learned very little about medicine. This week I am assigned to the wound care clinic, so I’m anxious to see if it’s any better. I can’t imagine that it could be worse. All day I’ve been thinking about my decision to become a doctor. Right now, I don’t feel like I made the right decision. I just feel like it’s a horrible field, and there is very little that you actually do to help. Honestly, if I wasn’t 8 gazillion dollars in debt right now, I’d be quite seriously entertaining the thought of dropping out. There are so many other things that I could do, and they might be so much more enjoyable, rewarding, and allow me to have a life outside of work. Anyway, I guess I just really had a bad week. Hopefully, tomorrow will change my outlook on things…

Today’s pic was taken on a sidewalk a block away from the hospital. I almost stepped on the poor critter! Also, why do people always give me strange looks when I take pictures of trash and dead animals?

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Yes, every ounce of my brain, willpower, and now bubble bath has been drained from my life. I. am. so. tired.

Hmmm, stuff learned, this will be hard to do, but I promised myself I’d do it.

1) What a Jackson Pratt drain is, and how to use it.

2) How scary, shocking, and sad a three inch deep, 10 inch long, 4 inch across infected abdominal wound is. I can’t even imagine how it would feel to be able to look inside your own abdomen.

3) That I thought I couldn’t remember any Spanish until I had to ask a non-English-speaking woman if she’d had a bowel movement, and I suddenly remembered the word “kaka” and she understood enough to respond, “dos!”

4) It can be difficult to tell a drunken patient from one with brain trauma. At least it is for my untrained self. (It turns out he was both drunk and had neurological deficits due to the trauma.)

5) Residents can be evil, mean people and their meanness sometimes does more harm than good (more on this later).

6) The steps in pronouncing someone brain dead.

7) Before turning the hospital upside down looking for a patient, it’s a good idea to first check with the nurses to make sure they have not been discharged moments earlier.

8 ) Taking the time to help a bed ridden patient find her am/fm radio is a good way to break the ice.

9) If someone tells you that a patient has been discharged, but you insist that you just interviewed and examined them in bed, you should always stand your ground.

10) Paper work sucks. Again.

That’s all I can ‘member for now. Time to saw some logs…..

Last Sunday, my sister Bruce (her real name is Briana, but we call her Bruce…long story, and my nickname is Kev/Kevvy/Kevvy G) and her friend Rick came up to Brooklyn to visit Micah and me. It was her first time in NYC, so we decided to go to Manhattan for the day. We first went to Five Points in Greenwich Village for lunch. Then we went to Times Square, Central Park, and then to the Empire State Building. We ended up in the West Village for dinner, after stopping at a few other places in between. Everyone had an awesome time (except for the obscene line at the Empire State Building). Bruce, come back and visit me soon!

Thanks to Micah for taking all the pics, viewed here.

Yesterday was an uncharacteristically eventful morning. I awoke to the sounds of my doggies whining and I immediately knew that the only way to shut them up was to take them for a walk. I woke up my partner, Micah, and we hooked their leashes to their collars and headed down the stairwell of our apartment building. Halfway down, we saw a young man sitting beside a slumped over female on one of the stairs. While he looked distressed, it seemed like he had everything under control, so we just continued walking.

After taking the dogs to the park to do their business, we returned to our apartment building. Before we even got inside, the young man from the stairwell rushed out of the front door with a frantic look on his face. “Please, can you help me?!” he screamed anxiously. “Yes, what is it?” I replied. “My friend, I can’t get her up…please help!”

As soon as I heard those words, I spontaneously switched gears from doggy walking to emergency mode. When I opened the door to the apartment building and saw the young girl sprawled on the floor in front of the stairs, I immediately began creating a differential diagnosis. Could she have fallen and fractured her skull? What if she had become severely hypoglycemic and had a syncopal episode? Could she have just experienced a tonic clonic seizure? Perhaps she had a myocardial infarction secondary to a cocaine overdose? And of course, the most immediate possibility that came to my mind was that she was simply very drunk.

I was suddenly acutely aware of the details surrounding me. I noticed that the young man had a fairly heavy smell of alcohol on his breath and that his clothes were stained with paint and dirt. I surveyed the area and checked for any sharp or otherwise dangerous objects and saw none. I observed the position of her body and deduced that she most likely had not fallen down the stairs.

I leaned down to her and asked her loudly if she was okay. “No, he won’t leave me alone!” she replied. I asked her if she’d been drinking and/or done any other drugs and she admitted to drinking but denied using anything else. She was obviously agitated and as I leaned towards her I could detect alcohol on her breath. We went back and forth for a few minutes and she became increasingly belligerent and verbally abusive. She started screaming profanities at me and the young man, who I discovered was her boyfriend.

To make a long story short, I eventually realized that she was just very drunk and upset with her boyfriend. He was trying to get her to the car, and she kept physically attacking him and screaming. She made threats to attack me and called me some very unpleasant names. By this point, I had switched gears yet again into more of a psychiatric emergency mode. I tried using some techniques to calm her down and diffuse the situation. Luckily, having been called every name in the book already, her comments failed to offend or upset me.

After over an hour of failed attempts, I realized that I had no other choice but to call the police. So I dialed 911 and waited for the cops to arrive. They showed up just a few minutes later and I gave them a full report, including my information in case they needed to question me again. The police also failed to reason with the girl, so they eventually handcuffed her and hauled her off in a van to the police station for booking.

For the rest of the morning, I thought about the sequence of events surrounding the girl. I wondered if I would have responded to the situation the same way before going to med school. I guess most of it was really just common sense. But on the other hand, things could have turned out differently. She could have had no pulse, or been in the middle of having a seizure, and things would have been more serious. I don’t know if I would have responded as calmly or even remembered what to do. At the very least, I guess I gained some practice that I can use with actual patients in the future.

Click Here To View the Original Post on Medscape

I am tireder than tired right now. I just got home from my second night of surgery on call. That’s right, I just worked an 18 hour shift. It actually wouldn’t have been that bad, had I had time to eat, drink water, or pee. I didn’t have time for any of those things. I also never got to sit down. Anyway, I’ll stop bitching now and give you my list of “stuff learned.” Also, please enjoy my new before, during and after pics!

1) How to apply point pressure to an arterial bleed, and what it’s like to get squirted with blood when you don’t do a good job.

2) I thought I’d never have to make obscene numbers of photocopies ever again after quitting my job in an office. I was wrong.

3) What a pilonidal abscess looks (and smells!) like.

4) How important it is to do a full physical exam, no matter what the complaint. (I could have missed the very large inguinal hernia in a scrotum.)

5) Did I mention that photocopying sucks?!

6) How to perform a stool guaiac test.

Okay, I’m seriously falling asleep right now, and hence can’t recall the other stuff I learned, so I’ll save that for later. Can’t. Type. Anymore. Good night.