With a growing …

With a growing avalanche of new knowledge and skills bearing down on them, they feel increasingly overwhelmed by what they do not know. They soon discover that, instead of expanding their capacity to make a difference in the lives of others, the rigors of medical school have constricted their field of view to their own survival.

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose.

Quote from The Atlantic article by Richard Gunderman, “For the Young Doctor About to Burn Out.”

Home again

I’m back at my alma mater for a rotation.

It’s been really interesting to see how it’s done in Canada. I’m at a new hospital, at an academic center, with slightly less sick patients, so it is a biased look, but hearing the great talks and hallway lectures from the attendings about research and studies, and questions still unanswered, has reminded me of how fun and exciting it is to do research, and to have a project that you really own and shape.

I was pretty sad this week, as I thought seriously about whether to go back to Canada or the US for residency. Even though I’m back “home” where I lived for 6 years, being away from NYC, which has been home for the last year and a half, has me feeling a bit lonely as I get used to my new placement. I felt sad thinking I might feel lonely the next years, through residency and potential fellowship, as I keep moving place to place, and still don’t know where I want to and where I can or where I will settle and make my home.

But I just got to keep reminding myself that things change, and to enjoy this moment.

It’s snowy outside, and pretty cold, but life is good.

Halfway through sub-i

Well I’m halfway. Last week I worked every day of the week. A patient coded while myself and my co subi were alone on the floor. Backup came, of course, but it was terrifying nonetheless. Next time we’ll know what we can do, instead of just auscultating while the patient is struggling to breathe.

I’m getting into the flow of things. Said bye to some patients I’ve grown fond of. One patient has her adult daughter by her side almost every moment day and night. Her daughter feeds her, changes her diaper, and keeps her company all through the night. I felt happy and sad to see them go. Will I get to ever know what happens to them? That’s goodbye for real?

I feel like a job is done when patients leave, but really its just that my part is done. They are rarely completely healed, just stable and safe to go home.
It feels good to feel myself becoming more efficient, less afraid, growing. But I also feel myself hardening a bit. Like things don’t affect me as much. It partly comes with experience I guess but mostly just helps to work faster. There are limitations to hospital care and as much as I love the pace and intense patient care, and I love the interdisciplinary work, but I also feel sometimes like just a pit stop or a bandaid. Are the changes I make going to impact their health down the road? Will their primary care doctor make any changes? Will they follow up? Are they any more healthy?

Two Mondays to go.

First day of sub I

Disagreements between when a patient was ready to go led to the patient being discharged late in the day, at the family’s insistence. Pts family is frustrated that discharge took so long. I overhear the son say “you’d think its the first time they’d ever done a discharge!” And it was! Haha!

I got scolded today by a private attending for stuff done by someone else, and had lots of frustration taken out at me but really it was such an awesome day! It feels so good to take care of people.

Family medicine

Family docs are the nicest! Specializing is overrated.

Bout dem kids

When the kids are good its the best feeling! When they’re misbehaving I can’t stand them and want them out. Some people don’t like treating adults because they often are contributing to their illnesses. But I have more empathy for a smoker with lung cancer than a child throwing a tantrum.

Psych tidbit

Interesting thing I learned from my psych rotation: both when people sink into depression, and when people come out of depression, the person is the last person to feel the change in their mood.

I have a patient who is a 100% example of this. I really like working with him. He has gone from total catatonic to talking and expressing his feelings, his worries and even sometimes thinking he might be getting better. Today we did a crossword puzzle about fruits together. He laughed for the first time in months ( not while doing the crossword, but later when I was testing his memory and asked him to repeat something I had told him a while earlier. Because he knew he wouldn’t be able to do it) I feel really fondly toward this patient, really rooting for him. I feel sad that I will be finishing my rotation soon and won’t see him again most likely. I hope the next med student treats him well.

New new

When I was in Surgery I would see the kids in internal medicine rotation and think “Weenies.”

They were laughing, happy, so young and free. At least, that’s how it seemed through my eyes, burning from weeks of waking up at 4:30am to stay at the hospital until 6pm.

Now I’m in medicine myself and I don’t feel bad at all. I like IM.

Interdisciplinary: Who dat?

I met up with a couple friends from undergrad two nights ago.  One of them, BM, is in Physio school.  It was pretty cool to compare how our respective programs have been similar or different.  Mostly different so far.

She said that she was surprised how much writing is involved in PT school.  She had to write 3 papers so far.  I forget what the first paper was on, the second was on an experience with someone with a disability (this paper was done in partnership with a student from Osteopathic school), and a third paper on a topic of her choosing, which she wrote on Physio clinics under the public payment system.

It was really cool, how right off the bat her training is integrated into the training of other health professionals.  She recently finished a rotation in the neuro oncology ward, where she sat in on case reviews with med students.  She also completed some assignments where cases were reviewed by a team of students: a nursing student, a physiotherapy student, a medical student, and so on.  Each student reviewed the case and discussed their treatment plans from their discipline’s perspectives.  It must have been so interesting to see how each member approaches a patient, and to see how the treatment plans can compliment (or maybe even contradict) each other.

I told her how my mom recently hurt her shoulder when she fell on her elbow, and has a partial tear of rotator cuff muscles.  The orthopedic surgeon can’t do anything for her, so she was told to just let it heal on it’s own.  She had lost quite a bit of her arm’s range of motion (i.e. couldn’t put on her seat belt without help or a lot of pain) so she booked an appointment with a physiotherapist and has been really happy with the help she has had from there.  My friend BM was happy to hear this.  She said, “See?  We aren’t just support staff!” — I got the feeling this was more so directed at the world (Them!) than me.

One of the assignments BM had was for a group of the physiotherapy students to find out the different roles of various members of the health care team.  Her group did pretty well but in the end couldn’t figure out the difference in role between a licensed nurse practitioner and a registered nurse.  Her tutor asked them, “If you don’t know the difference between a licensed nurse practitioner and a registered nurse, how do you expect them to know the difference between a physiotherapist and an occupational therapist?”.   More than support staff for sure, but still trained to be a part of a team.  Definitely more than my training has been so far.  For sure these discussions haven’t come up in medical school, and yet I’m sure doctors will always be a part of the health professional team.  From my perspective, it’s too bad.

I thought back to when I learned about some kind of wrist-related pathology in first year Anatomy.  Was it carpal tunnel?  I don’t remember.  But I remember being told that the treatment for it was surgery.  Perhaps to cut open the flexor retinaculum, if it was carpal tunnel.  Frond was sitting beside me, and during break after lecture he told me he was so surprised that we were being told the treatment was surgery, rather than the much less invasive manual therapies he had learned and treated clients with in his previous life as a body worker.

Maybe it’s just my med school.  After all BM goes to a university that has made it’s name on “innovative” (unconventional) teaching styles.  It seems to work.  But regardless, more interdisciplinary training from the start of med school is something every med student (and patient!) will benefit from.