Internal Medicine – Day 1

1 hour of orientation. That’s it. 1 hour for possibly the most time intensive rotation of medical school. On paper it’s 12 hours a day, 6 days a week. Thankfully it’ll be a little less than that most days if the residents are nice (though I feel bad because they actually need to stay the whole time). At orientation we just went through kinda of basics of the rotation, assignments, etc. and afterwards we went straight to the wards. I was excited because the person who was listed as my senior resident was someone I had met before volunteering and had run into a few times during the outpatient portion of my peds rotation. Super chill guy and was looking forward to being able to work with him some more. The other 3rd year on the team with me and I got a little lost on our way to our team’s work room but we made it. We met the senior and the 1st year residents. They all were super friendly and welcoming. It was a really good day, rounding with them, getting to know them. And then I find out today was their last day on the team before they switch to their next service… sad 😥

Overall though, IM was more or less what I expected. Very similar to in-patient peds, just a bit… older. But we spend the day reading out patients, then running around to see those patients and talking about them, then coming back to the work room to write about those patients. Since it was our first day, we didn’t get to have our own patients yet, but it was a good glimpse into how the team operated. Because of that we didn’t have much to do and that made it a little slow after rounds since there also were no new admissions. Thankfully, they sent us home a little early after the cutoff for new patients. Tomorrow is when it really begins.

Inadvertently Omitted

Sometimes when (if) I proofread what I write I notice that I will have completely left out whole words from sentences, words without which the sentence doesn’t make a lot of, at least in the absence appropriate context. I find that it happens most often when I pause to think. As if that word is a cliffhanger that never made it on the page, except there’s less drama and more confusion.

Language is a crazy thing. I’ve always thought of as separate from the various things that separate humans from other animals, but the more I think about it the more I realize it really just falls in the category of abstract thinking; our ability to believe in/ assign value to things that don’t have “concrete” existence (at least that’s my understanding of the concept of abstract thinking, please correct me if that’s not quite accurate [though saying such a thing reinforces the point I’m about to try to make]). Among other things in that category are money, religion, and crypto (which is like abstract-ception). These things have value because we say they do. There’s function and purpose to it of course, that’s why from an evolutionary standpoint it stuck around and helped humans be so “successful” in such a meteoric fashion. We use made-up symbols and sounds to communicate ideas about made-up things that we associate with tangible things, but only with people who believe in the same made-up sounds, symbols and things.

But these beliefs run so deep that even if important made-up things are we can still often make sense the idea being communicated, even if we are talking to someone we’ve never met before who just happens to share our abstract beliefs. Or in some cases we can even use a key or a decoder to relate our made-up beliefs to the completely different made-up beliefs of another person.

Or sometimes those symbols and sounds can be used to talk about something completely meaningless and non-sensical that only makes sense in the mind of someone who likes to talk about things he doesn’t fully understand.

Family Medicine – Day 22

Another one down. These rotations have been going by so fast (at least it feels like that when they are over). As always, it was bittersweet having to say goodbye to this place that was my home for the past 22 days. The connections and relationships over these past few weeks were about to become a thing of the past. Was it a waste? I felt like I was emotionally invested here, but I really was just a blip in the day-to-day hustle-and-bustle of this clinic. Did I make an impact at all? Remember, if not it’s ok, you’re here to learn, not necessarily change lives or be remembered. Though I am sad I didn’t get to give a proper goodbye to all my attendings.

Overall thoughts on family medicine:

These rotations have kind of felt like a game show. We have all these doors in front of us, behind each is glimpse into in a life that we previously had little to no conception of. From what I saw of family medicine, this is definitely the work I envisioned myself doing when I decided I wanted to become a doctor. Sitting down with patients, listening to their stories, being invited to a have a peak into their lives, their worldview, their lived experiences, and leveraging that to provide the best, compassionate, patient-centered care that I can so they can go out and live their best lives, on their terms.

I saw a lot of that while I was here. But I also saw a lot of barriers to being able to do that properly or in the way I envisioned it. The paperwork. The bureaucracy. The scheduling. The missed communications (vs miscommunication). The redundancy. I can see how even with the best of intentions and the strongest of passions for this specialty (yes specialty, I will fight anyone who thinks otherwise), it can be easy to get lost and discouraged by all the red tape, but I also think thats where the art of medicine can really come in to play. We can’t necessarily change the circumstances in which we practice (at least usually not all at once), but we can change how we operate within those circumstances, just like in life. How we navigate our challenges and obstacles is what separates people for whom medicine is a profession vs an art. It’s a fine line I think, and easy to flip from one side to the other based on something as fickle as what side of the bed you woke up on that morning. We can’t expect to always have the good days. The days where we feel motivated. Where we feel the fire in our hearts. Where we feel our souls being fed. That’s just not the way life works. It may even be a bit much to expect more good than bad. 50/50 is acceptable (such is life in a world where rules are often made by people who are not personally invested in the communities they make the rules for), but every once in a while if you have those moments that remind what you’re here for; the stubborn old man who finally lets loose a hearty laugh. The little girl whose face lights up when you pull a dinosaur sticker out of her ear. The lady who came to you on the verge of losing everything, celebrating 2 years of sobriety. Those moments can make it all work it, and these are just some of the things I have seen in primary care and in having long-term relationship with patients and what draws me so strongly to this field.

That said, who’s to say I can’t have that if I choose to go down a different path. Maybe it will look a little different, but the feeling would be the same. Or maybe I can find a place where I can find work that sustains me, but also give me the financial stability and the time to do the work I think is important on my own terms. There’s still a lot to think about, and so much in medicine I still want/ need to see, but I’m thankful for this opportunity to experience life behind door number 1.

TTITF:
My gimpy, but resilient colocasia that I grew from a taro root from the grocery store instead of turning it into sinigang; unexpected moments of laughter; friends who are like family who still reach out even after long periods of not seeing or hearing from each other.

Family Medicine – Day 21

My last full day in Family Medicine (as a medical student). And I was with a new doc. From what she told me, sounds like she’s relatively new out of residency and still building her practice. Her schedule did have a lot of Ob, peds, and new patients. I really enjoyed her style though. She was very autonomy oriented, as I hope to be, always trying to get a sense of what the patient had in mind as far as plan/ treatment/ what they would be open to before making her own suggestions. It’s not that the other docs ignored patient autonomy, but some encounters did seem like they were very much centered around numbers and lab values vs centered around the patient (not to detract from any of the docs I worked with, they were all amazing and showed their compassion and demonstrated patient-centered care in other ways).

Now I’m not sure if that is a product of her maybe being a little younger than the other docs, have to do with the fact that she had a more contemporary medical education relative to the others, or due to the fact that she may not be quite as far along on the jaded/ burnt-out scale compared to the others. Definitely wish I could have worked with her more.

I saw 2 fresh patients who were establishing with her. I thought I had done a good job of eliciting their health goals with their new doctor without injecting my own agenda. They both had a primary goal of weight loss. And I went through kinda the different options and approaches and seeing which they would be interested in pursuing and patted myself on the back for being so patient centered. But then my attending basically wrecked me after I presented the first of those 2 patients and was like, well did you ask to see if she had already done her own research and have a specific plan in mind as far as her weight loss? How could I be so dumb? The patient didn’t have a specific plan in mind, but I thought it was a good things to ask, and so I did with the second patient. She also had no idea. BUT STILL I think it’s good to recognize patient’s ideas and expectations regarding their healthcare and be able to address it even if you think whatever it is they have in mind is no recommended and you have to tell them that, because at least they will know that you considered it and care about what they have to say.

TTITF:
Fast internet, old keyboards, sticky notes

Mad at the Drive-Thru

I had a craving for McDonald’s today. Apparently a lot of other people in Camarillo did too. The line was kinda long, but that’s how it be sometimes. I made my order; 2-for-3.99, a McDouble, a spicy McChicken, and a large fry (or large fries?). Looks like there was trouble up ahead and so took 5-10 mins for me to get up to the window, and when I did the cashier read back to me my order before charging my card. After I confirmed, he said, “Yea cause I don’t want to get it wrong because the last was really upset when I said the wrong order.” I expressed my sympathy to him and thanked him for his diligence.

Sometimes it blows my mind when people get upset at little things. Some guy was literally sitting is his car, gave orders out the window of said car, and just had to sit there until it was time to pay and get his food. But he decided to get worked up because the cashier made a mistake and maybe because the food was taking a little longer than usual. Sure maybe that customer was having a rough day, and I think it is reasonable to have a standards and expectation when being provided a service, but I my mind getting upset is never the productive option.

What does it accomplish? Ok maybe it made the cashier start to pay a bit more attention, but perhaps there is a way that the same thing could be accomplished without the same emotional toll on the cashier and on the customer.

In the earlier days of this blog I challenged myself to come up with three things I’m thankful for (3TITF [maybe I should just write it out]) with every post. It’s been a while, but I think I’ll try starting that up again:

Full, lush trees rustling in the wind, mangos, custom stickers

Sand Crabs

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.

Family Medicine – Day 20

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.

Family Medicine – Day 19

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.

Family Medicine – Day 18

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.