Day 1 of Clerkships:
Surgeon: “What nerves innervate the groin?”
Me: “Uh I’m not sure specifically.”
Surgeon: “Oh they don’t teach that to you anymore? What anatomy textbook do you use?”
Me: “Netter I think.”
Surgeon: “And it wasn’t in there? Hmm…”
Me: …
* * *
A haiku:
I thought I’d try out
Orthopedic surgery
such misogyny
* * *
Very first day, very first patient goes, “you look nervous.”
* * *
My chief to me on my last day: “You did a really great job… for this being your first rotation.”
UGH.
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Clerkship year is really hard. We’re constantly put on display with embarrassment, adapting to new hospitals and teams who make it clear that our presence is a burden, then we go home at night to get 20-40% on UWorld and just always feel like a failure. But don’t complain about it!! Med students are “too entitled these days”—and hearing that from attendings just makes me feel even more inadequate and like I can’t keep up.
* * *
Tried to take a staircase down to the CHOP lobby and ended up locked out in a courtyard under construction 3 blocks away from the CHOP main entrance. The construction workers suggested I go to the ED entrance (maybe for more than 1 reason).
— Sabrina Bulas
* * *
I made my 15-year-old patient laugh for the first time in her lengthy hospital stay by remarking on how terrible my nails looked compared to hers.
* * *
Got lost in the bowels of Pennsy carrying a suspected tumor sample from an ongoing surgery while trying to locate the pathology lab.
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I held a kidney in my hands today as part of a living donation. It was incredibly humbling. It was also so squishy. Humans are such fragile beings.
* * *
Early during my IM rotation, I took on a patient who was going through withdrawals. It was my first day prerounding on her, and I wanted to examine her pupils but had forgotten my penlight. So I took out my phone and turned on the flashlight. She recoiled, and I immediately realized that I’d made a mistake. “Why are you taking your phone out?” she asked, clearly alarmed. I began to explain that I had just wanted to examine her eyes, but she cut me off: “I’m sorry, but can you just go? I just can’t handle this right now.” Not knowing what else to do, I did just that: I left.
Later that day, my attending took me aside and told me not to preround on that patient anymore. I still remember what she told me: “This lady’s been going through a lot. She’s distressed. She’s tired of so many people coming into her room and asking her questions, and now she thinks that we’re taking pictures of her. I think you prerounding on her would make things worse right now.”
I’ve never gone to the wards without a penlight since then.
But this story isn’t about penlights’ superiority to phones. It’s about communication, and how what seems innocent and well-intentioned to you can feel disrespectful, invasive, or even frightening to someone else.
That’s true in all aspects of life. But it has extra salience in medicine, because being hospitalized is scary, uncertain, and alienating. A hospital itself is an unsettling and strange setting: patients are surrounded by beeping machines, lines are protruding from their veins, and electrodes are on their chests. A procession of total strangers inspects their body every day, and they can’t sleep well because every night, their blood gets drawn. And, of course, being hospitalized is a reminder of one’s own mortality. This is why the therapeutic alliance is so important: by building it, you can help to make the experience of illness less distressing.
One of the most important things that you, as a student, can do is help to ease some of your patients’ uncertainty. Be it by explaining why you just performed a particular maneuver on your exam, why you delved into a topic when taking their history, or why an upcoming test was ordered–really, doing anything that removes some of hospitalization’s mysteriousness–you can make a patient’s anxiety a bit more bearable.
But the converse of that is true, too: if you don’t explain what you’re doing and why, you risk giving your patient yet another stressor. The last thing you want to do is to add to your patient’s uncertainty or anxiety, but if you aren’t careful, you can easily do just that.
The moral of this story? Always consider how your actions might make your patient feel. I’d rather make this point by writing about a time when I did this *right*, but the truth is, I learned this lesson by screwing up.
— Jonathan Walsh
* * *
My 60-year-old patient, feet in stirrups as I prepare to perform a pelvic exam, takes one look at me before carefully tucking a strand of her pink wig behind an ear. She pulls down her Nicki Minaj face mask and says, “Now [me]—don’t you go falling in love with me now!”
Dr. Betancourt behind me, unprepared for this comment, desperately wondering what visit type this now constitutes: “Hehe, he’ll try!”
* * *
EM was a cool experience towards the end of the year. To walk into a completely undifferentiated patient’s room and actually having confidence and skills that I’ve gained over the year to try to piece together the patient’s clinical picture. So cool to see how far I’ve come (while also knowing there’s so much left to learn)!
* * *
My 78-year-old OB/GYN attending, speculum seconds from entering the patient’s vagina: “You know, these were all my dad’s instruments!! They just don’t make tools like they used to.”
* * *
When I was on my IM subspecialty rotation, I had the honor of taking care of a patient, M, with a rare and rapidly progressive illness. She was a former English professor, an absolutely brilliant conversationalist and an extraordinarily kind soul. When asked about her mood during her intake, she answered “loving life.” And getting to speak with her every morning and afternoon was the highlight of my day for two consecutive weeks. Her face would light up when I walked in, and we’d talk about anything and everything (as time permitted, of course). She’d ask about my life, about my friends and my family, and I got to know so much about hers. On the last day I was on the rotation, she told me, with tears in her eyes, “Though I’ve only known you for two weeks, it feels like you’re a member of my family, and I want you to stay in my life. If I somehow make it to my 75th birthday next year, I’d love you to join.” Holding back tears, I told her it would be my pleasure. About three weeks later, I received a text from my intern, informing me that she had passed away on home hospice. Once again, I held back tears in the moment, but I went home and cried for hours. Not because M had passed, but because I was so incredibly grateful and humbled to have made a real human connection during an otherwise very dehumanizing year. And every time I felt demotivated, crushed by the performative charade of clerkships, I’d ask M for a sign (as silly as that may sound), and I would always receive it, be it a wonderful patient interaction or a beautiful sunset. And while some part of me hopes it is because her energy is still out there, taking care of me, I ultimately accept that it is because beauty and goodness are everywhere, hidden in plain sight. Sometimes you just need a special patient, a special person, to help you see them.
* * *
There’s nothing like running into classmates during clerkship year. The instant understanding is so refreshing, and even though I don’t see our class a ton since we’re all on different schedules, I feel like we’ve gotten closer through shared trauma.
* * *
Neurologist to patient: “You had a stroke, sir. We’re going to look at your heart but it was probably from the diabetes and the cocaine.”
* * *
Psych patient at the VA: “Is this a complex web of narcissistic paranoid delusions, or am I simply the target of a big joke on somebody?”
* * *
I walk into my delirious patient’s room at 7 am, and he is laying in bed, legs spread wide, gown up above his navel, penis fully out. He starts trying to get out of bed and is threatening to walk out (he is hospitalized for weakness and seizures so he is incapable of walking). I try to gently tell him he should stay in bed when all of a sudden he yells: “I NEED TO TAKE A SHIT.” I try to call for his nurse, but the call button on his bed is not working. “RIGHT NOW,” he insistently yells at me. I am almost done with my Clerkship year but 0% equipped to handle this situation.
* * *
One morning on ESS we walked into the room of a little old lady with a bowel obstruction. She had just had a laminectomy and was now going to be taken back into the OR that morning. The team swoops in, tells her she’s going to surgery imminently, and swoops out. I stayed behind because she looked a little scared. I asked her what was wrong. She told me that her husband was currently hospitalized at another hospital and was very ill. Her son was with him, so she was all alone. She told me she was scared and lonely; she had no one with her. I had nothing to do that day, my co-med student was going to scrub into our cases. I asked my intern if, once I was done with my tasks that morning, I could go sit with our patient before she went back to the OR. He was confused as to why on earth I would want to do that but said, “Why not?”
I went back after rounds and sat with her in her room. I went with her to the pre-op area. I sat with her there. She told me about her family, her community, and her life. The nurses assumed I was her granddaughter; I didn’t correct them. For that day, in a tiny way, I was her granddaughter. I would never want my grandmother to be alone and scared going into surgery. I walked her back to the OR and held her hand as they put her to sleep. I stayed with her throughout the operation and took her back to the PACU and then back to her room.
She did not remember me the next day, delirious on her pain medications. But I know that I did the right thing by her. I was there for her when no one else was. I gave her what I could as a medical student on surgery, my time and my heart.
* * *
When I was on inpatient psychiatry at the VA, they gave the patients these awful monochromatic pajamas to wear around the floor. Coincidentally, the set of colors that these pajamas came in was the same set of colors of the small selection of scrubs that I owned. One week, it just so happened that the color of the patients’ pajamas exactly matched the colors of scrubs that I had chosen that morning for literally every single day that week. The patients got a huge hoot out of this, of course, and kept telling me, “You’re one of us now, doc!”
* * *
Things I will never forget:
Getting cheered on by everyone to “PUSH HARDER” while driving the uterus
Sawing through the femur. My hands were numb.
First time doing CPR. How the world around me became just sweat, breathes, bodies, as I hear a voice say “you’re at 100, faster, deeper, recoil, good”
Watching a father inches away from his wife’s vagina, hands tightly holding on to her, hollering “YES I CAN SEE HER, GO PUSH” <3
Delivery board: A column among many columns of scheduled deliveries written in blue marker just like the others: 34 wks. Stillborn.
Failing a shelf.
Honoring.
3 weeks after following a patient in the 30s with untreated end-stage rheumatoid arthritis, my heart ached the first time meeting her twin sister and seeing what could’ve been with access and treatment
— Girl
On my first L&D shift, like 15 minutes in, there was a delivery, which went successfully. As a clerkship student, I knew I was up to deliver the placenta, which of course I hadn’t done before. I started applying traction and pulling to follow the bony structures of the pelvis. It wasn’t really budging, and the resident I was with encouraged me with “pull harder… harder… OK MORE.” I ended up ripping the cord. It felt embarrassing. But I also felt weird that at that moment I was more concerned about my poor performance than the patient. (the patient was fine, placenta delivered successfully by the resident, with no complications). But I keep reflecting on how medical school, clerkships, and this career path enable us to be so self-centered and care about our skills, how we’re perceived by higher-ups, over patient care. This isn’t always the case, but I really felt it at that moment.
* * *
It feels so cool how much we learn in a single year. To be fair, the year felt really long and was quite a struggle. But I actually feel like I understand some medical lingo and how the hospital operates *some* of the times
* * *
>>>>> calling consults
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I wish someone had told me to actually be open-minded going into clerkship year. It’s so funny how my assumptions about different fields and their work-life balance and culture were completely wrong. I can’t tell you how many classmates changed their minds about what they want to go into because of getting into clerkships and being surprised.
