On day one of my vascular surgery rotation, I scrubbed in on a bilateral above-the-knee amputation. The patient had been transferred from an OSH (outside hospital) for stenting after 8 days of a massive aortic occlusion without any intervention and severe limb ischemia, and sadly our interventions ended up being too little, too late. On one of the last days of my rotation — November 5th to be exact, as votes were still being counted for PA, GA, NC, and NV — she was scheduled for hospice discharge…but not before my entire team attended her and her boyfriend’s wedding in the hospital. With still only one visitor allowed per patient due to COVID the rest of her family (including 7 kids between her and her boyfriend!) zoomed in. So we brought balloons, flowers, and cake to create a celebratory atmosphere, and it was a really lovely, bittersweet ceremony that briefly took everyone’s mind off of an otherwise highly stressful week. Definitely a clerkship moment I’ll never forget!
— Claudia Hentschel
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So it’s my first EM shift, and the overnight is pretty slow. Suddenly, at 2AM, the overhead speaker alerts us about a woman who coded in the field and is on the way. EMS was able to achieve ROSC [return of spontaneous circulation], but the patient coded again as she was being wheeled into the ED. As I proceed to jump into CPR, other team members draw up labs, pump a ton of Narcan, and establish an airway (the scope shows that she has aspirated vomit). After a few cycles of CPR, we get ROSC again without defibrillation. Unfortunately, her brain has more likely than not been fried from prolonged hypoxia secondary to coding not once, but twice. Twenty minutes later, the patient’s boyfriend of 3 months shows up, crossfaded. And he is carrying the 4 year old son of the patient (the kiddo’s biological father is incarcerated). As we discover, the patient is from Haiti and has very few family members in the States, so our only historian is the intoxicated boyfriend.
We ultimately admitted the boyfriend to the ED in order to administer Narcan to sober him up and obtain a more accurate and complete history. All the while, we spent the next 5 hours just hanging out with this kiddo, watching TV, eating ED snacks, and wandering around the halls. As the boyfriend sobers up, he shares that, earlier in the night, he and our patient had a lot to drink, then snorted what they believed to be cocaine (but was presumably laced). The boyfriend was coincidentally prescribed percocet for an MVC just a few weeks prior, and he had developed tolerance to any opioids in the cocaine.
— Anonymous
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In surgery, there are 2 rules for the med student: 1) Be ready with scissors, and 2) Don’t zone out. I followed these rules religiously until the last 2 weeks of clerkship year, when excitement for the upcoming holidays (and a particularly long case where I couldn’t see the field very well) made it too easy for the mind to wander to gingerbread and Christmas lights and being able to sleep in past 6am…
“Here are the scissors for you,” says the scrub nurse, as I feel the weighty metal of suture scissors placed into the palm of my hand. My mind jolts back from La la land. Shoot, what am I supposed to cut? I see a string held out with tension in front of me. My fingers move in an automatic reflex. *Snip!*
A few seconds later, my resident turns around and stares at the fresh suture she had been holding behind her, totally dumbfounded. “The suture just popped off by itself…in the strangest place possible.” She hands the suture back to the scrub nurse, who stares at the short tail coming off the needle head, remarking, “Well I’ve never seen that happen before.” A new suture is handed to the resident, all is well, and I religiously follow rule 3 for the surgery med student: Stay quiet and don’t interrupt.
— Anonymous
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“Sue” was the first patient I took care of while on medicine, and she ended up being the first patient that I felt was truly my own.
I was immediately struck by how optimistic, warm and humorous she was despite the circumstances in which we met: she, with a chronic autoimmune condition now with numerous resulting medical complications and on the waitlist for an organ transplant, and me, a clueless clerkship medical student who could offer nothing but an ear and an oddly similar sense of humor. Over the two weeks Sue was on my service, I could be found in her room chatting about her disease process, her mental health, her hopes and dreams, her family — everything. I would sneak her coffee from the “good” floors of the hospital and scavenge every nourishment room for Italian ice when she craved it. She was the highlight of my day, every day.
After I left the service she was on, I still visited her, albeit less frequently, and watched in dismay as she grew sicker and sicker. Weeks later, I saw on the track board that she had been taken to the OR – they had found a donor for her! I was elated.
When I went to visit her in the ICU afterwards, I was immediately taken aback by how different she looked. There were so many emotions I felt when I saw her, intubated and hooked up to dialysis catheters and more lines than I could count – happiness that she had received her transplant, distress at seeing her intubated and in such critical condition.
A visitor was in the room with her. “I’m Allison, the medical student who took care of Sue while she was on medicine,” I got out, before her eyes snapped open and she beckoned me over to her side. She grabbed my hand as we made eye contact and I just started bawling. Tears began streaming down her face too as I explained to her visitor that we had gotten to know each other extensively when she was under my care. Her visitor, who I would later learn was her daughter, said “wait, you’re Allison? You were all she could talk about before she went into surgery.”
That was the day I first understood how sacred the relationship between a patient and her provider can be. Sue ultimately left the hospital in good shape, and as we said goodbye that last time, in a moment that I will forever remember as the purest of clerkship year, she told me she loved me. The feeling was endlessly mutual.
— Allison Hare
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I hadn’t heard of acute post-anesthesia delirium until…On surgery we were all standing around waiting for a patient who was still non-responsive to wake up from MAC to be transported out of the OR. All of a sudden his eyes shot open and all 270lbs of him somehow flew OVER the secured safety rail on the bed – despite multiple people attempting to keep him in place. He hit his head on the wall (multiple feet away from the bed!) and landed on the floor, where he had no recollection of the event. Everyone was fine – patient included!! But he spent the next hour intermittently dozing off and apologizing for something he already didn’t remember as the team triaged his care. Moral of the story for med students on surgery: always stay alert with one eye on the patient–even if only to get out of the way!
— Anonymous
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One mother couldn’t stop vomiting mid c-section, but still the only thing she could focus on was how her new baby was doing. She kept asking if “her baby boy was okay.” (He was.)
On labor and delivery, one mother only spoke Mandarin and required an iPad interpreter for her entire 4 hour labor course. The team was screaming at her to push in Mandarin the whole time; after it was all over, I learned we had actually been using the word for “bread.” The mother didn’t seem to mind.
— Allison Hare
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My senior on OB/GYN: “C-sections are the best abdominal surgeries. They’re short, you don’t have to worry as much about blood loss, and you get a prize at the end.”
— Anonymous
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Went to place a foley catheter for a gyn onc case and placed it . . . in the vagina. Everyone was already scrubbed and there were no more kits in the room so we spent a veeeery long and uncomfortable 5 minutes waiting for the circulating nurse to find another one before the case could start.
[Of note: I still got clinical honors for the rotation! Moral of the story is that mistakes happen! And your team’s got your back. AND most importantly listen when they tell you good exposure is everything!!!]
— Anonymous
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My classmate and I spent the morning doing “social rounds” with our patients while on neuro consults. One patient was very sick and intubated but very much awake and oriented, and very much uncomfortable with that combination. We spent a good 20 minutes one day hanging out with her and cracking jokes to try cheering her up. As we got up to leave, she gestured that she wanted to tell us something; because she was intubated, we gave her a pad of paper and she wrote out two words in soft handwriting: “Come back.”
— Allison Hare
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It was the end of week 3 on medicine, and my scrappy team – short handed because we were down one intern – was prepping to cruise into sign-out at 6:00 on the dot. With fifteen minutes to go, the ED called out three admits. Resident got the patient nearly panting with COVID PNA, intern took the patient with cancer and new hematochezia with Hgb of 6.5, and I took on the healthy patient with 20 mins of chest pain. Straightforward rule-out MI, said the ED. The work is already teed up, just watch her overnight and don’t punt her to obs.
So I dutifully went to meet Ms. Q and learn her story. She was already on the floor, tucking in for the night, when I arrived. Her story was trivial – she was walking to the grocery store today from her car in the lot when she was gripped with dull retrosternal chest pain, maximally 4/10. She went back to her car to sit down – no shortness of breath, no palps, sweats, lightheadedness… I rattled on with my ROS. Just as suddenly as her pain had come on, it dissipated. Her kids had forced her to come to the ED, she said, and she was dismayed to have been admitted. She had never experienced this before, had no personal or family cardiac or clotting history, her only risk factor for a PE was a remote history of breast cancer 25 years ago. Her vitals had been rock solid (probably better than mine), and her exam and labs were unremarkable, CXR bland. I reviewed the attested ED note and started drafting my H&P and pending admission orders.
The rest of the team was still busy with their comparatively more complicated patients, and something wasn’t sitting right. I went back to the room and asked Ms. Q a few more questions. We got to chatting about family and recent happenings. I had already probed DVT risk, but this time, she said, “Come to think of it, Med Student, two weeks ago I was at home and my left leg swelled up to the knee for an hour. I elevated it and it went away, but that had never happened before.”
I left and found my resident who thought I was delinquent for taking so long. I proudly laid out my plan. “I know you MS3’s love d-dimers but we’re not barking up that tree. PE is specious at best. Dr. X hates dimers because they expose patients to unnecessary CT scans.” I made my case, and we haggled. I was dangerously close to entering hot water, but something truly didn’t sit right with me. “Look. Your H&P is solid, and I have to drive by her to sign off. I’ll think about it,” the resident said. I went home.
At 4 am, I woke up with a start after a bad dream involving Ms. Q. When I couldn’t drift off again, I rolled over and checked Haiku. There was the dimer, resulted at 11:05P in red bold font with (!!) appended, and a slew of other orders from 11:06P onwards. Her dimer was read back by the lab as 19.5, and a STAT CT PE by the poor night float led to the radiology resident waking up the radiology and ICU attendings at home. She had one of the largest submassive saddle PE’s anyone had ever seen, extending across the pulmonary trunk and deep into the segmental pulmonary arteries bilaterally. I texted my resident in a flash, “Did you see Ms. Q’s dimer and scan?!” Fuck. It’s 4:30. “Yes. I’m still here. Come.” he replied immediately. I bolted to the MICU from bed in record time.
The double doors of the MICU swung open with that familiar mechanical noise, and as I rounded the corner to Ms. Q’s new room, the MICU attending came over to me and shook my hand. “Well done, Med Student. The ED missed this, your haggard resident missed this, and she probably would be heading home this morning if not for you. Now take my Butterfly and show me the right heart.” I dialled up a shaky parasternal long (thanks Wilma!) and sure enough that RV was looking damn strained. Ms. Q was relaxed in bed with heparin gtt hanging beside her. “I feel completely fine but someone says I’ve got a clot,” she told me.
I share this story because it was the first time that I felt like many of the puzzle pieces we’ve unboxed over M1 and M2 finally clicked. This kooky curriculum is easy to fight and is flawed in many ways, but it does, mostly, work. As a clerkship student, I often felt like dead weight. Sure, we do some tasks that are helpful and save others some time, but ultimately most of our effort has to be recapitulated in some way by someone with an MD. However, more minds on a problem is always better for our patients. Even as a med student, a good H&P, judicious use of labs, and a little bit of advocacy for your wimpy plan might just save a life.
— Anonymous
