Back at the Ranch

Nobody seems to believe me, but I am really really happy to be back at my home base hospital.  After 6 weeks away at two different hospitals, it is thrilling and relieving to be back where everybody knows your name, and people say how they missed you and how nice it is to see you again.  It seems shocking to the other interns, but the nurses really are nicer at our hospital, and you miss that when you go to other hospitals where you have to go into a 20 minute explanation as to why you don't know where the 4x4 gauze is kept in the stockroom before anyone will lift a finger to help you.

It's also really great to be back with all of the other interns in my year.  It's odd to me that I missed them, but it was so nice to be among other people my age who knew me and liked me and joked with me, instead of competing with me for cases or hanging out amongst themselves.  I'm back on the surgery rotation, and this time it's with another surgical intern as well, so I'm enjoying the chance to actually work with my co-interns now that we're all coasting towards an all-surgical 2nd year.  We're all getting our contract renewals for the coming year, and it's so shocking to think how my internship is already more than half over, and I am actually surviving and smiling at the same time.  I'm excited to see who will join us for the next year, and a little nervous at the prospect of actually being in charge of people under me.  I've struggled a little with productively instructing and directing the students that rotate with us, and I've decided to make a better effort to observe the various methods my seniors use to motivate and teach them, so that I can help foster smoother teamwork, and not just scare them into hating surgery.

I only have 2 weeks on this surgical rotation, and all I can think about is how overwhelmed and busy I felt when I was doing surgery in August.  At times, I was in tears from the exhaustion and disappointment in myself.  And now, I keep finding myself with nothing to do, and wondering how I ever thought this same surgical rotation was insane.  I've had a few nights where things got a bit busy, like big cases going into the OR and the senior pager I held exploding with consults, but we managed it.  It might be that I found ways to cope, or that I simply was so busy at the other hospitals that this now seems a snooze in comparison.  Or maybe it's that it's easier to remember that, whatever happens, the call will always end at some point, and I can get things done in time.  In other words, there's less reason to panic than there was before.

This surgery thing, I think it's actually doable.  Hmm.  =)

To Sir, With Love

One aspect of medicine which is so pervasive, yet infrequently discussed, is the role of teaching. By this, I mean the day to day, person to person teaching that happens on every rotation that one goes through as a student or resident. I've always enjoyed this part, because it makes me feel like learning is a tangible discussion, rather than a formal and stiff lesson. There's something thrilling about walking away from a lively spontaneous discussion on sickle cell anemia or primary amenorrhea, that makes you feel like you gained so much just by staying tuned in for an extra five minutes.

What's not so easy, I'm discovering, is leading that teaching process. I've always loved sharing information with others, and reinforcing what I think I know with a group of people who inevitably remember better than I do. As medical students, we are continuously expected to teach and help each other, as well as to give more formal talks on disease processes and case presentation. But I'm realizing now that this type of teaching, which is simply informational, is the easy part. What's not so easy is to teach someone how to be a medical student, how to get through doing physical exams and admissions and learning to formally present a patient at rounds. I remember helping third year students with this last year, and I never found it as difficult, perhaps because the responsibility ultimately didn't fall with me.

But perhaps I was also lucky, and didn't have too many encounters with that Thorn In Your Side, the lazy medical student. Most medical students I knew, often my friends, were incredibly smart but also terribly hard working. They didn't mind coming a little earlier or staying a little late to get things done, especially if it meant learning how to do something new that would later be an expected responsibility, like drawing blood or placing IV lines. I myself enjoyed staying late to learn how to do central lines or surgery consults, because I wanted to be sure that I at least had an idea of how they were done before I was expected to do them regularly. This is, of course, most likely a ridiculously rosy picture of myself, and I know that on many occasions I have been an inadequate or incompetent student. But I can say with 100% certainty that I always tried hard.

Somehow, it never occurred to me that there are some people who make it past the first two years of school and are still trying to make it through with as little work as humanly possible. These are the people who don't want to see the complicated cases, even if they are classically tested on the board exams. These are the people who don't want to learn how to properly present a case, and refuse to recognize the value in an efficient exchange of patient information between colleagues. These are the people who consistently disappear to the cafeteria or library if you don't keep your eyes on them, and always have a complaint about something or another. Every conversation is about which specialty gets you the most money for the least work, and every assignment is met with a complaint (and even talking-back). And, of course, these are the people who are most persistent in asking about how to game the system and get the best recommendation letters.

A lot of residents I know are of the mentality that if a person wants to screw him or herself over, let it happen. We are all adults, this isn't daycare, if someone doesn't want to learn how to work hard, that's their problem. I wish I had more of a hands-off attitude like that sometimes, because I feel like I am letting myself get more stressed about this type of situation than I need to be. But I feel that if all doctors are also teachers, we have a responsibility to help our students find the motivation to work hard, and form good habits. I also feel that I have a responsibility to all the students who do work very hard on rotations, even if it isn't a specialty they want, and it isn't fair that other students slack off and there are no consequences. I know that I had a lot of bad habits as a student, many of which I still struggle with, and it's only with the consistent help of people who cared that I've been able to make any improvement at all in my SOAP note writing or patient presentation. So, I don't want to give up.

I wonder how my parents did it.