Wow, has it really been a month since I've posted? Apologies, my loyal reader(s) (hi mom!). I successfully survived my family medicine clerkship and sat through long hours of lecture during our "continuity curriculum" week (sidenote: how in the hell did I ever survive the first two years of medical school? I can barely sit and listen to a presentation for an hour now; I can't believe I used to do it for 4-8 hours straight every day).
Which brings me to my current location within the lands of an "Elective Block". Unlike some of my classmates who decided to do something clinical with that time, I decided to pursue a research elective, which I have concluded (as I sit in Starbucks and sip on my delicious holiday drink) was quite possibly the most awesome decision I've made this year.
The original plan was to have one study I was going to pound out in this 4-6 week period. Well, that 1 study turned into 2, and the 2 turned into 3 (well, more 2 1/2) and suddenly I am growing research protocols out of my ears and dreaming of HIPAA waivers of authorization. Yet despite all the madness, the simple fact that I get to set my own schedule has been incredibly refreshing. No sitting around in the afternoons on the wards bored out of my mind, no scut work, no asking permission to leave, no early mornings unless I am feeling particularly motivated. Ahhhhhh.
There is one thing that has been particularly maddening though; it's $%#@$%ing impossible to get anyone to do something for you if you're "only" a "medical student." It's the sad reality of the authority purgatory we reside in. On the wards, we can make treatment recommendations but can't prescribe medications. We can place orders but they have to be co-signed. Our notes are part of the medical record but residents must write separate notes for billing purposes. Because there is so little we can actually accomplish independently, we exist in this strange limbo where we can do a lot but there's very little we can actually "do." So it's understandable that there tends to be this dismissive attitude towards med students in the hospital, and I'm cool with that. But the reverse is also true - it often seems impossible to get anyone to do anything for you as a med student. On the wards, I've learned to stop signing my pages with "MS3" because if I do it'll be over an hour until I get a call back. I always go back to a moment on my psych rotation when one of my fellow students on the team slammed down the phone and yelled "Do they REALLY think its only the med student who wants this CT? Just for sh*ts and giggles?!? I'm CALLING because my ATTENDING wants the damn CT scan! RESPECT MAH AUTHORITAH!"
Yup, been there before.Well, I've found that the research realm is not exempt from this phenomenon. Every email I send needs at least one follow-up before I get an answer. Every voicemail I leave requires at least one call-back before I get a reply. Being that I have precious few weeks where I can devote all my focus and time to this, I'm trying to get things done in an expedient manner, but too often it's like trying to work in quicksand where every action requires twice the normal effort. It's almost a daily occurrence where I want to have a cow and just yell "I'm CALLING because my
PI wants the damn form signed!"
So, if there is anyone from the IRB reading this: Please. If a medical student is asking for help in getting something done, try to help the first time. We are not rogue anarchists set loose in the hospital to do what we want all willy nilly. If we're trying to get something done, there's typically a damn good reason why we are.
Now, back to my delicious holiday drink.
Was riding up the hospital elevator up from the Starbucks in the lobby this morning with a classmate of mine. We were both clutching venti size coffees, and I turn to him and go:
instruments to surgeon during procedure, and help perform counts of surgical instruments throughout the procedure. To the upper left of the patient resides the individual providing first assist to the operation - who, among other things, uses the bovie to cut vessels and tissues at the lead surgeon's discretion, helps provide traction to tissue planes to aid in dissection, etc. And to the right of the first assist lies the domain of the medical student: the position of second assist. Here one typically aids in the operation by holding retractors to open the operative view, use suction to remove smoke, fluid, and blood from the operative plane, and tightly covet the Mayo scissors that one uses to cut suture ties. But with the myriad of surgeries and surgical approaches out there, there's also a wide variety of places where the surgeon and assistants stand to get the best exposure into the surgical field. And just likes plays on a football field, its up to the medical student to learn where to proverbially 'line up' for the snap. In an academic institution like my own base of operations, typically a resident provides first assist during the operation and the medical student stands beside as second assist for the operation. But during chance opportunities, such as when the resident is taking the lead on a case, med students are given the opportunity to run first assist, which is infinitely more fun for obvious reasons - namely, being able to more actively participate in the case. Rarely, a med student is offered to take the lead on simple cases (appendectomies, cholecystectomies, etc), which is always something worthy of writing home about, no matter how mundane the case may be for everyone else in the OR.
the game of golf. All too often, you find yourself feeling incompetent, frustrated, disheartened, or some combination of the three. As your shot out of the shrub grass careens off the tree and lands in the water hazard you didn't take into account, you begin to ask yourself why you even play this stupid game to begin with. But a handful of times during a round, the balls rises gracefully into the air and plops, like it should, down onto the green within spitting distance of that birdie. And before you know it, you're paying another set of green fees and are back for more. Likewise, third year is full of foibles and f*ckups, sometimes asking yourself why you're doing this for the rest of your life. But every once and a while, you get to see or do something incredibly cool that reminds you why you're in it in the first place. And you come back for more.
first patient I've seen with 3+ pitting edema, I damn near lost the entirety of my index finger into his left shin. But this story is about crackles, and I noticed a certain quality to his voice as I was talking to him in the exam room. No hoarseness or changes in phonation. But it sounded like someone had just poured themselves a bowl of rice krispies and set it in the corner. The snap, crackle, pop became more audible with each labored breath he took. For some reason, the moment brought me back to my early days of listening to the lungs, waiting for total silence and listening intently, hoping to catch a crackle or two in passing. And here I had a patient sitting in front of me with so much fluid brimming out of his lungs that I didn't even have to place a stethoscope on him to hear the crackles.
