Medicine From The Trenches

Experiences from medical school, residency and beyond.

Hospital Haiku

“hospital moonlight

cacophony of machines

teardrops cascading”

As we come to the end of National Physician’s Week and today, National Physician’s Day, I related this haiku from one of my most gifted and amazing friends. Some years back, he suffered a  critical and life-threatening illness that resulted in profound changes in his life with some time in the intensive care unit. This illness changed a man who is talented beyond belief, a brilliant creative genius and professor in ways that few of us can relate or even imagine. Still today, he’s affected by his illness and the events that surrounded it.

I share this haiku because it brings to mind, something that we as physicians must always remember about our patients. They place their health, their trust and many of the most intimate aspects of their lives in our hands. With our hands, we have to care for them; relate to them, in many ways hold them, and be mindful of the honor and privilege of having them place their lives in our care.

As such, we also have to be mindful that illness changes their reality and in many cases their lives profoundly especially when they are critically ill. We have to reach out and extend more comfort over the “cacophony of machines” that becomes the background of their intensive care and sometimes hospital care experience. We have to block that “cacophony” whenever and wherever we can.

I remember watching a tear roll down the side of the face of one of my ICU patients who appeared comatose. The nurses were bathing him and chatting with each other as they turned him. I saw the tear; asked them to speak with him over the ICU noise background. I asked them to play music in his room and I always held his hand when I entered the room to examine him. I am sure that my soul could feel his soul even though he didn’t ever speak to me. I never saw that tear again, after we began speaking and focusing on him, holding his hand, touching his face, and playing his favorite music even though he did not recover from his illness.

I seek to connect with my patients without exception as that is my honor as a physician/surgeon. I spent years learning the science and techniques of medicine and surgery but in these, the later years of my clinical practice, my focus is on the art of medical practice. Within that art is my chance to give some of my heart to those who have placed their trust in me (and my training). I strive to be more human and more comforting. To do less of the science and more of the art is great joy for me. My joy is in the connections; kind of strange for a surgeon.

On this National Doctor’s Day, I am honored to be a physician and grateful for all that this profession has given me. This profession has given me far more than I can give back but I will spend as much time as possible giving as much as I can to those who are in my care.

30 March, 2017 Posted by | medical school, medicine, practice of medicine | , , | 2 Comments

A touch of tenderness (Reblog)

Here’s is a great post to remind us that touch may be the best medicine out there for our patients. Don’t be afraid to touch your patients and connect with them. This is the true “magic” of medicine. Touch is needed more today than ever.

Sue Vincent's Daily Echo

The Cathedral by Rodin.

My son gleefully squeezed harder at the knotted muscle in my shoulder, with a ‘Now I’ve got you’ as I groaned in agony. We have established and agreed that he has a slightly sadistic tendency where I am concerned. It may have something to do with my knack of getting just the right spot on the painful muscles as we got his body working again. Day after painful day, for months on end. So now it is payback… and he appears to enjoy it. He still manages to lay the blame squarely on my aching shoulders, muttering something that sounds vaguely like ‘hereditary’.

He is a little more squeamish than I. His face screws up in horror as my wrist bones crunch back into place when he applies traction. It is, however, nice to regain freedom of movement occasionally. So I make him do it…

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25 March, 2017 Posted by | medical school | 3 Comments

Great Post from “Life of a Med Student”

“Beyond the H&P” A Guest post by Jessica Morgan It’s 4:00 pm on a Thursday: time to present at teaching attending rounds. I have prepared my presentation and know about the patient’s pathology, but I can never help myself from being incredibly anxious for these moments. I gather my papers and begin…

via Beyond the H&P — #Lifeofamedstudent

24 March, 2017 Posted by | medical school, residency | | Leave a comment

You Have Matched!

A hearty “Congratulations” to all who matched! This is the next step in your medical career no matter where you matched. On Friday, you will find out where you matched; some taking the news with tears and fears. Make no mistake, if you didn’t match, the future becomes more uncertain but certainly not bleak. As I have stated in other posts, those who didn’t match should be aware of the current S.O.A.P process and should be working on getting a training position for next year.

If you have matched, some things to work on as soon as you can:

  • As soon as you know where you will be training, get in contact with one or two of the senior residents to find out which textbook(s) is (are) the major reading material for your program. Purchase the book(s)(electronic or paper) and start reading.
  • Make a list of the sentinel journals for your specialty and start reviewing articles. You need to practice evidence-based medicine. Getting a head start on your journal reading helps to make journal reading a habit.
  • Start a physical conditioning program if you have been relatively sedentary during medical school. Aerobic exercise (30 minutes per day) can help reduce stress, help with stress and keep you healthy. Make physical exercise a habit along with journal reading. Even on your on-call days, you can walk/run the steps for a quick work out which will keep you more efficient in the long run. You will also sleep better if you are in good condition. Add some strength training too.
  • Find a place to live if you are moving. Don’t put this off because you need to be comfortably in your residence before orientation week in your new hospital. Your home should be simple, convenient for commuting to the hospital, restful and useful for your lifestyle. Though you won’t be spending tons of time at home, you need for your home to be your haven in your off hours. Make sure you have a washer and drying in your residence. You don’t want to be heading to a laundry room when you need to be sleeping.
  • Get your paperwork done for your training license as soon as you get information from your program. Some states have many tasks for you to complete before you can be licensed for training purposes. The sooner you get this done, the better.
  • Take a week or so off but do this long before you start your program. You need to have a bit of fun but using too much time in vacation before you start your PGY-1 year can be a problem too. Complete off time is great but not an escape.
  • When you get your residence, scout out several routes to the hospital so that you know how to get in even if there is a problem with weather, roads and other mishaps. Make sure your car or bicycle is in good repair with a good back-up plan.
  • Learn how to cook and take your meals into the hospital. Trust me, hospital food in most cases, is not great for keeping you healthy. I cooked on my days off, put a week’s worth of meals in the freezer and carried them in for my call days and nights. Good nutrition is key to good learning and training.
  • Learn a good organizational system for your ward work. I used an Excel program complete with dropdown menus for my sign-outs; still use this system. Learn to make check-off sheets to stay on top of your patients and their needs (lab tests, radiographic studies).
  • If you can, arrive a couple of days early to get familiar with your hospital’s physical layout, systems for dictation and record-keeping. Do a recon mission that will save you time in the long run.

Finally, this is a great time of learning and professional development. Having some organization is key to keeping your head in the right place. Enjoy the experience so that you can take advantage of every minute of residency with a positive attitude. Don’t underestimate the value of a smile on your face because you are learning the tools that will make you a good physician.

14 March, 2017 Posted by | medical school, organization, residency | | 5 Comments

If I could change one thing in the lives of those around me…

I would ask them to stop comparing themselves to others. Don’t compare your grades, your scores, your running times or anything else to anyone except you. Strive to be the best you that you can be looking at the past for experience and to the future for achieving goals. In these days of social media, when everyone is busy scanning what others are doing on sites such as Instagram, Snapchat and Facebook, look only into the mirror and be content with the miraculous person that you see staring back at you.

Your wiles and abilities have enabled you to navigate your life so far. Your experiences can allow you to toss what doesn’t work and hold onto what does work. Your goals can give you a reason not to hit the “Snooze” button in the morning but they also give you a heading for progress. If you express gratitude for what you have learned/mastered and keep you eyes on your goals, there is little time for envy, jealousy and other negatives that can hinder your progress.

I always know that there will be others who are faster, richer, thinner, smarter and more beautiful that me. I applaud them, celebrate them but I am so grateful for being able to breathe air, run my race and figure out my “stuff” these days. I am healthy, happy and blissfully loving life as I touch my students and patients lives. In short, I connect with humanity and love every second of those connections as they come.

A great and free gift to all of us is the ability to look around and lend a helping hand to anyone in need. The greatest joys come from helping others without the expectation of receiving something in return. On any day and at any time, one can choose to change one’s thinking about any situation; reach out and just connect with those in need. In today’s world, the needs are great and dire.

So in the early days of this new year, look at yourself and be thankful/grateful while looking around to see who you might help at any moment. Wear a smile (cheap accessory) and savor every moment of life as they move by. These are free gifts!

3 January, 2017 Posted by | medical school, medicine | | 1 Comment

Time keeps moving and it’s is a blessing that it does keep moving.

In most places, we await the end of 2016 and the beginning of 2017. The passing of one year and the advent of another full of hope and promise for most of us. Still, nothing is new because time always keeps moving and everything changes often from one instant to the next. I have allowed this movement, this continuum to spur me to renew and reinvent myself without question.

This past year to my surprise, I embraced long distance running. My stress level dropped to nothing; my self-empowerment went to high levels. As I race along streets at 3AM, the only time I can get 1.5 hours of pure running into my crammed schedule, I do this movement for me and my sanity. I work on problems, I accept my world with joy and gratitude. This turns out to be a great way to get every day started and every challenge faced head on.

I will often mull some paper or new information as I tread along my winding path in my neighborhood near one the the Great Lakes in midwest United States. I can always hear the ebb and flow of the waves of the lake as I run along the beach; even if it’s too dark for me to see them. On a bright moonlit early morning, now long before sunrise on these shorter winter days, I love seeing my breath just in front of me.

Since I live in a suburban area, I seldom meet any automobiles in the early morning. If I meet anything, it’s a heard of deer grazing or a racoon crossing the empty street heading for the deep woods next to the lake. The deer ignore me but after spotting a coyote or two, I run with mace but still I run with emphasis and determination.

The thing about running, or even a brisk walk to begin your day, is that you can’t do these tasks for others. As a physician, my life and my practice has centered around being present to help my patients and students with solving their problems even if I ignore my concerns. With running, I do this for me and me alone; heady for non-self sacrifice. I think about me and how my middle-aged body runs faster and faster in the cold early morning darkness.

Daily running has a way of adding discipline into every aspect of one’s life. I eat healthy and clean because I know that high fat, high simple sugar foods will zap this burst of energy that running gives. I also forgive my occasional indulgence of beer on a non-practice evening because I have already run and exercised for the day. I also know that I am at my thinnest and lightest weight in my adult life; enjoying how well my clothes fit and how comfortable I am parking far from my destinations and hiking the extra distance.

The discipline that I have achieved with running, eating healthy and lifting a few weights has allowed me to keep a ready smile on my face and a song in my heart. I find that I simply enjoy interacting with my patients; joyful that I can help them feel better and meet the challenges of their worlds. This is some of the true magic of medicine that we keep learning, practicing and enjoying our art no matter where one is in the process. For many, just navigating the health care process is a source of added frustration and fear. Let your patients know that you are always the final common path for them as they place their health and trust in you; have their best interests in mind always.

As this year draws to a close, remind yourself of why you entered this profession and how fortunate you are to be able to help your fellow humans in any way small or large. Remind yourself that while this is a job for you, it’s often a change of life for your patients. Remind yourself that there is magic in empowering your patients; appreciating their fellowship and challenging yourself to be the best that you can be especially being authentic.

31 December, 2016 Posted by | life in medicine, medical school | | 1 Comment

We Do This

Last evening I was visiting with my classmates in one of the ministry classes that I am taking. As we moved through our discussion of our readings, my classmates nibbled on German Chocolate brownies that I had baked the morning before. I love to bake, therapy for this surgeon, as it is very nice to create something and watch other enjoy it. One of my mates produced a bottle of Benedictine with a supply of glassware; brownies and Benedictine!

One of our discussions in class centered around meeting Jesus. Quite an interesting discussion for a couple of physicians; two of us in the class. I related a story about one of my first patients that I treated as a medical student. This wonderful little patient was affectionately named “Ratso” by my supervising resident at the time. He was a patient in our Veterans Hospital coming in when his lung disease would get out of control.

“Doc, I was holding hands with Jesus”, he exclaimed to me as he began to respond to our treatments. He had been quite disoriented when his blood carbon dioxide level had achieved values that would be incompatible with life for most people. This patient not only had high levels, he turned the corner pretty quickly. “Yes, I will believe you saw Jesus”, I said to him as he clearly recognized me at last. I was seeing Jesus too.

So this is why I do this. For Ratso and the hundreds of others that I treat with care and love. Remember that what we do is like no other profession out there.

9 December, 2016 Posted by | medical school | , | Leave a comment

Some Thoughts for Those Starting Medical School this Month

As you get settled into your first-year coursework, I want to share some thoughts that come to mind:

  • Remember that you are fortunate to be on the doorstep of pursuing a magical profession. For everyone who achieves a seat in medical school, there are many who wish to be in your place. Honor them and remember them as you gather the knowledge that will make you a good physician.
  • Medicine is not easy, especially the study of the art of practice. There are many “all-or-none” tests along the way. There is a large volume of material to learn, master and apply to the practice of medicine and as such, you must make peace with that volume of material.
  • There are no “short-cuts”. This means that you have to make a concerted effort to be willing to take the long road. If you are looking for a short way around your work, medicine likely isn’t the profession for you. Get out early rather than later because medical school is expensive and quite unforgiving.
  • You are going to be working on people and not pathology. While pathology is interesting, always remember that the person with that pathology is loved by someone. Be willing to put yourself in the place of the patient or their loved one and treat them as you would wish to be treated.
  • Don’t believe what you hear but trust what you experience. Don’t go into any class or any rotation with preconceived notions of how it will be. Medicine is interesting and absorbing. Allow yourself to learn with a fresh approach and with fresh energy. While people who go before you will tell you horror stories about certain professors and certain subjects, it’s up to you to figure out and navigate them. You may be pleasantly surprised at how much you will enjoy this process.
  • Take some time to do something outside medicine at least once per week. Go to a movie, visit a museum or attend worship services. These outside activities keep your studies in perspective and keep your brain alive.
  • Keep yourself physically fit. Walk the stairs, take a 30-minute run daily and eat/sleep well. These physical activities will decrease stress and keep you healthy in the long run. Junk food, while quick, can make you overweight, sluggish and prone to picking up infections. Take time on weekends to prepare healthy (minimally processed) food and freeze it for ease during the week. You will save money, something that is always good.

Don’t forget to enjoy the process. Remember that you WANT to be here. Before you complain/gripe about something, try to figure out a couple of solutions or if the complaint/gripe is worth your time. If not, then focus on your studies and keep moving forward.

15 August, 2016 Posted by | first-year, medical school | , , | 1 Comment

Getting Closer to the Start of Medical School!

This is a great post by a medical student. So much wisdom here.

Potential Doctor

As the start of medical school approaches, I can feel the excitement continuing to rise! This is going to be such an amazing journey! I know it will be very challenging and will stretch me in many ways. I am going to give it my very best effort, knowing that my family, friends and God’s strength will help to sustain me through the upcoming long journey!

Since my last medical school update, we have managed to get a lot done:

  • Take Basic Life Support class (CPR and AED): Done! Very useful course that I think everyone should learn!
  • Update immunizations: mostly completed. Pending 2 reports following a chicken-pox titre test and chest X-Ray. Two more tetanus shots will be done in August and February.
  • Financing my medical education: meet with the bank (done, credit-line approved!), apply for government financial aid (done, waiting for my application to be processed) and scholarships (done…

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29 July, 2016 Posted by | medical school | Leave a comment

In Today’s Climate…

Over the past couple of weeks, I have listened to the speeches at both political conventions along with the news reports of law enforcement officer killings/GSW injuries and civilian killings/injuries. Watching and reading new media reports have to be taken within the context of one’s experiences. My experiences have been as the daughter of immigrants, a biracial woman, a physician and a theological student. My heart breaks for those who are suffering and those who suffer. My oath, the Hippocratic Oath, that I swore many times as a medical student and now physician compels me to alleviate suffering wherever I find it.

The suffering may be physical or mental as many seek out our help in getting and keep them healthy. We, by our training, have to find, by any means necessary, a method of navigating the health care systems under which we practice as well as the political/social climate that we encounter. Sometimes that navigation can be as simple as a touch, a connection and sometimes that navigation involves working with every resource at our disposal to give the best care that we can achieve. My hope, my prayers, my experiences and my training have giving me insight.

I want to recount an experience that happened to me as a fourth-year medical student. I was returning home, driving a small red Mazda hatchback automobile, from a shift at one of the large city hospitals of my medical school affiliations. It was late at night, I was exhausted, ran out to my car in scrubs throwing my short white consultation jacket with hospital identification card and my stethoscope on the front seat along with my purse and overnight bag. As I drove through the rain-soaked city streets of this depressed neighborhood, I saw the reflection of police lights in my rearview mirror. I immediately pulled over to the side (I wasn’t speeding because of the weather) and stopped as required by law.

The police car pulled in behind me with two young officers getting out of the car quickly with their weapons drawn. For a split second, it took me in my exhaustion fog, I couldn’t believe that the weapons were aimed at me. I sat very still, keeping both of my hands on the steering wheel as one of the officers shined a flashlight on me; the other pointing his gun through the open window on the passenger side. “Get out of the car and put your hands on the roof.” one of them shouted.

I slowly opened the door, tears beginning to form in my eyes and shaking quickly overtaking me. I complied with his request stating the my identification and automobile registration were in my purse on the passenger side. I said that I was a medical student on my way home but the officer kept yelling at me to spread my legs and “shut up”. I couldn’t stop shaking (I even shake now as I remember how frightened I was). “This car is reported stolen,” he kept shouting in my ear. He began to pat me down. “This is a huge mistake,” I said in a shaky voice. “Please check my identification and look at my hospital cards,”I said.

It seemed like hours but in a few minutes, another police car pulled up with another older officer getting out. “What are you doing?” he asked. “We have the car and suspect in custody”. I was crying from fear and exhaustion. The officers immediately put their weapons back into their holsters as the other policeman said that I was free to go. I was so petrified that I couldn’t put the car in gear for a couple of seconds. I finally drove off slowly weeping uncontrollably.

What would have happened if one of those guns had discharged by accident? I would be dead by mistake. What would have happened if the other police car had not arrived? I would have been arrested most likely. It was a mistake but the first two policemen didn’t show any indication that they would check my identification. It was my first experience of being stopped by the police and not given the benefit of just being treated as a fellow human being.

As I read and hear of stories of any persons being stopped by the police, I still feel that fear from so long ago. I haven’t been stopped since then and I interact with police on a daily basis as I perform my job in surgery. Those interactions are always professional and quite polite but when I see their service weapons, I always remember that stop. I react to police officers through the lens of my experiences as I suspect all people do.

I have infinite respect for police officers as they have very difficult jobs under very dangerous circumstances. I have spent many hours with two detectives in the gang-violence division of my local police precinct learning about gang symbols and gang culture, rampant in the city that I practice in. I want to understand and stem this violence, treat its victims as they frequently end up in the trauma bay. Largely the street gangs in my city are involved in turf wars and drugs. The motorcycle gangs run in the suburbs dealing in drugs and human trafficking, another scourge of city and suburban living.

So today, I end up on the roof of my hospital, being thankful for my life and all I encounter in my practice of medicine/surgery. I always pray for insight, guidance and the ability to give the best to every patient/family member/loved one that I can give. I meditate during my distance runs, post-call in the bright sunshine of the early afternoons, as we are living in a climate of increased polarization by community leaders and populations today. I pray that I continue to live in the “gray areas” and not become jaded or polarized to the violence. I pray to continue to seek insight and solutions to the troubles of those I serve and treat; always remembering that the practice of medicine is my greatest privilege.

Yes, I swore that Hippocratic Oath as a medical student, as a graduate physician and I keep remembering it. I didn’t know back as a medical student, what I was swearing to but I know now, how difficult this profession can be. There are times of despair, depression for me as the hours tick past 30 and hope in humanity as I move thorough my theological studies. As the years have gone by, I am more of a “believer” and more spiritual than when I began this journey. I learn each day and I am grateful for the learning. When I look back, I would not change a single experience, even those that have frightened me.

 

29 July, 2016 Posted by | medical school, medicine, practice of medicine | | 2 Comments