Starting off strong

One thing I’ve learned in the last year is the importance of starting out strong. So today, starting out my blog, I’d like to talk about starting in the hospital, consider this my prototypical “Behind the curtains of medical school” post.

I started my clinical rotations in July. Clinical rotations are basically where a third year med student, enters the real world of medicine: the hospital. I’d just spent the last six years of my life in a variety of classrooms. Initially it was four years of college, concealed from reality in the ivory towers of my engineering degree. After that, two years of med school learning basic science, blissfully unaware of real people. But in July I stepped into the hospital for the first time, with more than a little fear in my eyes.

We enter the scene on my first(ish) day of my first rotation – vascular surgery. It’s 4:30am, and I’m in the hospital, and groggy. Why am I groggy? I’m post-call¹, which a story for another day entirely, suffice to say that it’s my first day, but I’ve been awake and in the hospital all night, and I just got a page on my shiny new pager saying to go to a random floor in the hospital.

I wandered about aimlessly for a bit before a vaguely familiar face- another med student- flags me down and directs me to our lair. Once I stop looking like a stunned duck, one of the interns tells me all about this rotation, what to expect, and to this day, I have no memory of anything she said besides “now go pick up a patient and get ready to present – just ask the nurses what happened overnight if you don’t know what’s going on.”

The basic morning routine in the hospital goes something like this: Get to the hospital, check on your patients, and then, rounds. On rounds, the whole team (Attending doctors, residents, interns, med students, discharge planners, and other members of our medical entourage) goes room to room and discuss what happened to a patient overnight, how they’re doing/what is going on (your assessment), and what’s going to happen next (The Plan).

Early on as a med student, you’re first responsibility is to “present” them on rounds – give that brief summary, assessment and plan, along the way, residents or attending physicians will “pimp” you – ask you questions about what you’re presenting.

Unfortunately, on day one, I knew about as much real medicine as your average house plant, and while the fourth year student was trying to help me out, my first rounds was a disaster.

“What’s the method of action of heparin?” – “umm something to do with antithrombin?”

“Wrong “, (I later found out I was not wrong, as much as incomplete) “What is the most common cause of post operative fever on day 1” belted out another resident.

“Atelectasis” – This one I knew (later I found out that the evidence for this surgical truism is weak at best)

“Good at least you’re not completely incompetent”

Then, my resident asked me the one question no med student wants to hear on day one – “So what do you want to do with this guy?”

You have you understand, once you’re deep in third year, that’s your cue to unleash all your knowledge, impress the heck out of everyone, today, that question is where I earn my stripes… but that day, I had no clue. The very idea that someone would ask me this seemed preposterous.

“Physical therapy?” I tentatively replied, hoping that’s what the sympathetic fourth year student was trying to silently hint to me. “Good, maybe we’ll make a surgeon out of you after all.”

We moved on, I was off the hot seat, and afterwards my intern sent me home to sleep. To this day, I’ve never felt more off-balance than I did then. I’d like to think my trial by fire then, has made me prepare better, and hopefully will make me a better doctor.

So today, as I start this blog, and you wonderful readers start this journey with me, lets hope we’ve gotten off to a much stronger start.

That’s all for now folks. Feel free to post or email me comments, thoughts, anything else you think of.
Enjoy!
-Whitecoat Tales

¹In an amazing job of mismanagement, I received my call schedule at surgery orientation, and immediately I discovered I was on call DURING ORIENTATION. Trust me that this first night will be blogged about at length eventually. For now, all that is relevant is that on my first non-orientation day, I hadn’t slept all night, and hadn’t eaten in 16 hours.

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