I officially completed a week of being on the wards, and I survived! I’m actually getting to the point where I can anticipate what’s going to happen with my patients, their care, and their operations. My attending consistently asks me what I want to do with each patient, and I now have a response that is better than “fix it” (which was my very first response when he asked me what I should do for the hernia patient in front of us).

I’m getting to the point where my resident can bypass the basic concepts with me, and we are moving on to more specifics (dosages, IV fluids, appropriate urine output, etc.) and nuances (for those of you interested, expected urine for a very obese person is calculated by using an average of their weight and their ideal weight!). Pretty exciting, I know. I’m also getting to do more in surgery. I successfully sutured some poor soul with little help from my resident and inserting catheters is now a no brainer.

My personal life is still suffering terribly. For one, we had the pork incident, just as Ryan described it. I am also aware that I was attempting to set up a sterile field in our bed last night at around 2am or so. Poor Ryan was very, very confused. Ryan is still a saint, and if you see him around, you should buy him a beer because he deserves it  

Just to keep the tally going…

Practice knots tied: 1246

Dreams about suturing/surgery: 2

Hernia repairs: more than I’d ever hoped to see

Call nights left: 2!

On Friday I had the unique experience of sitting down to a few beers with four M3’s, including my wife. When I joined them after work, the conversation started like this:

Cate: Hi! I missed you.

Ryan: Missed me? I saw you this morning.

Cate: No you didn’t.

Ryan: Oh, right…because you left at 4:50 AM.

Cate: right.

This coming from the same guy who woke up in the middle of the night last week while Cate was on call, looked at the empty bed and wondered why she was sleeping out on the couch. I’ll get used to this eventually…

Anyway, these medical folks don’t talk about sports when they get together, let me tell you. I pretty much sat there cringing and saying things like, “Oh, come ON!” in response to stories of practicing sutures on body parts that had been removed from their respective owners. Cate later explained that her suturing lab utilized a pig’s foot instead of a live person, and that this was the reason she could not look at my dinner on Friday evening…which was a huge pork chop.

Listening to their tales from the trenches of medicine, and how calmly they told them, I had to ask if there were any situations or sights that made their jaws just drop in disgust or amazement. Well, there were. And I will not write about them here.

In the end, though, I’m in awe of what Cate and her classmates see and experience in a day and how professionally they handle it. Cate is on call as I type this, and at last update, she had sutured a real person and was stepping up and answering questions about subjects she didn’t realize she knew.

More updates after dinner I’m sure. We won’t be having pork.

I officially finished my first week as a third year medical student, also known as a “clerk.” As luck would have it, I was the first person in my class to be “on call” meaning I came to work on Tuesday morning for my first shift and didn’t leave the hospital until 6pm on Wednesday evening.  Oy.

The terrible hours aside, I am actually pleasantly surprised by my experience thus far. My attending and resident are great teachers, and I feel more comfortable in the hospital than I ever did last year with my preceptor.  I have surprised myself by how comfortable I am walking into a patient’s room. I interview them, examine them, and they seem to think I know what I’m doing (I don’t).

Perhaps the most surprising thing about this week is how quickly my classmates and I have gotten the hang of things. I don’t have to ask what I should be doing or where I should be going. In my head, this week was going to be full of aimless wandering, boredom, and feeling awkward. Instead, I’ve missed many (too many) meals rushing from one O.R. to the next, seeing patient after patient in clinic, and then all of a sudden my shift is over and my belly is empty.

I don’t have time to relay every story about all the interesting patients I’ve seen, but I thought I’d share one patient who has particularly stuck out in my mind. We had a patient in the hospital with Broca’s aphasia due to stroke, meaning he could understand everything we were saying to him, but only has the capability to say one word back to us. He tries to talk in sentences using his one word (I can’t say the word because of HIPAA concerns). For example, though, if a person with Broca’s only said the word “dog,” he would try to say “dog dog dog dog dog dog dog” with different intonation, inflection, and pauses as he tried to convey his thoughts. It is incredibly frustrating for all parties involved, as you can imagine. For some students, I imagine they would feel very uncomfortable with him, but when I was rouding with my resident, I was able to decipher some of what he was saying when she was at a loss. It was unlocking my own ability to communicate with him that gave me the confidence to visit him on my own without fear. He looks at me when I enter the room, and he smiles.

My day off is quickly coming to an end. I’m on call tomorrow from 6am-6am and continue working through until Monday night. Ryan has been amazing through all of this, and we’re trying to maintain normalcy throughout these crazy couple of months. That’s all for now but  more stories to come…

Adding to the previous list:

Beating hearts felt with my hand: 1

Translators used to interview patients: 2

Catheters inserted by yours truly: 1

Pig’s foot used for suture practice: 1

photo courtesy of Patty B-e-a-r on Flickr

This email from Cate, sent at 12:16 A.M., sums things up nicely. Or not so nicely.

Update:
In the course of the last 18 hours, here’s my tally
gastric bypasses: 1
hernia repairs: 1
emergency appendectomy: 1
code blue: 1
failed attempt at a central line placement: 1
M&Ms (seriously, the candy): 27
Pages: 0
Minutes of sleep: 0
Homework assignments: 4
Anticipated minutes of sleep: 0

Off to get to work on those homework assignments!