nANIMOv

I always wondered why they were there. Why do they roll in with the waves just to burrow back down into the sand? Why don’t they just stay underground? Do they have to come up to eat? We used to catch them and feel them scamper around in our hands. I used to be afraid they would burrow through my skin. We would collect them in our 10 gallon plastic bucket and try to observe them undisturbed by the tumult of the tide, though perhaps more for sport than any investigative endeavors.

Interestingly at night, they don’t seem as eager to make their subterranean retreat. Maybe it makes sense because their predators may be asleep, but why even hang out? Is there more food? Is it cozy up on the surface? What is it is about nighttime that makes them so much more bold.

It’s really interesting seeing all the different personalities and practice styles of all the different physicians. It makes me wonder how I’ll be once (if) I get my shit together. Will I be the type to bring my computer/ device in with me? Or will I take notes on a paper towel? Or will I try to keep the story straight mentally in my head? Or maybe there will be a new cool standard of technology (Google Glass-esque?).

Will I try to address all of my patients issues in our “15” minute visit and give them a hard cutoff in order to get to the next patient? Or will I take as much time as I need with each, even if that means making other patients wait a long time and me having to work through lunch?

Will I be the doc that MA’s complain about at lunch?

Will I be the one patients switch to? Or the one they try to switch from?

Will I work to live or live to work? I’m not sure yet which one is better. I feel like neither one is ideal.

I’m afraid of indifference.

It was a day of affirmations. I got a lot of comments from patients today that I was doing a good job. It felt good to be affirmed that at least from patient perspective I was doing ok. Not that this was the first time, but the ratio was just higher today. Part of it may have been that I didn’t feel as pressured today to get on to the text patient. Part of it may have been the fact that most of my patients were English speaking. It just so much easier to make a personal connection with someone who speaks the same language, despite my best efforts to be very personable through a translator with the Spanish-speaking patients. That’s why I need to really become better at my Spanish, thought today I also had a primarily Tagalog-speaking patient. There was a patient today who wanted to practice her English which was a good opportunity for me to practice my Spanish. We still had a translator to mediate some of the harder medical terms and longer sentences, but it was a good experience. I NEED MORE PRACTICE.

Today is what I imagine a day in primary care to be like. Running from patient to patient, barely having time (if any) to catch your breath before the next one is ready to be seen. Not feeling like you have enough time with them, but also hoping that they don’t have more issues to talk about because you have to run to the next exam room. And I only was seeing 4 of the 11 patients this morning. Charting through lunch while I take bites of the adobo I packed as I tab and scroll through the patients chart, typing intermittently. Lunchtime isn’t even over and the first patient of the afternoon is already roomed, vitaled, and ready to me seen. The afternoon was slightly more chill. Patient were less complex and their conditions were all pretty well controlled. Also I heard a lot of murmurs today. Last patient was a joint injection in the thumb which was pretty cool, and I actually ended up getting out a bit early.

Days with this attending are always kinda chill. He picks out patients for me to see beforehand so I know what’s coming up, there’s space between patients, and I don’t have to frantically look at 4 different charts not knowing which one I’m going to end up seeing. That said, I did have to a rectal exam for a patient with some abdominal pain and rectal fullness. Not sure if my attending had planned for that. Then I did kinda your standard diabetes/ hypertension/ high cholesterol patient. And then a 9-day-old newborn weight and color check. Some good variety.

Slowwww day today. This morning I only saw 2 patients, plus a couple prenatal visits, a well-woman exam, and a cryotherapy visit. In the start of the afternoon I was was getting pinballed back-and-forth between clinic stations because nobody knew where I was supposed to be:

The doc I worked with that morning thought I was supposed to be with him in the afternoon (doc #1). The doc that I had on my schedule wasn’t expecting me (doc #2) and said I was with another doc (doc #3). I waited for doc #3 outside his office, but then one of the MAs came by and said he wouldn’t be there until the evening. So I went across the building to go talk to the office administrator and on the way ran into doc #1 and gave him a quick update. The admin said that based on the schedule I was with doc #2 as I thought, but she shot her a message just to verify it was ok. Once I got the ok, I headed back across the building and doc #1 reminded me that I should check with the admin about tomorrow because I was schedule with doc #4, but she was supposed to be on vacation, so I went back and then was told I would be reassigned to doc #3.

Anyways I finally had it all straightened out and when I got back to the side of the building I would be working that afternoon got sent straight to a patient’s room. An interesting case of refractory abdominal pain and chronic illness. Then after that silence. A whole slew of no shows (some of them shared a common factor which I thought was interesting and we could have a discussion about social determinants of health). Then a couple more folk at the end of the day. Such is the nature of primary care.

“That’s really a funny way to laugh.”

“Funny or not, ya know, when ya laugh you can be happy.”

“Why is that?”

“Why? When you’re happy, you laugh!
Which also means that if ya laugh you’ll be happy!
Even though you’re so small, you look like you’re suffering a lot.
Ya just need to laugh! When you’re sad, just laugh!”

“If I laugh when I’m in pain, I’ll look like an idiot!”

“That’s not true! See you can test it for yourself!”