post

Geriatrics and Palliative Care Medicine

That’s what this month has been all about.

Ok, so I did get a week of vacation at the beginning of the month, but after that I have been dealing with senior citizen patients, quite a few of whom are hospice care patients.

It has been strange — the palliative care side of things, that is. I feel like I have spent the last few years preparing for a career in which I do everything I can in order to help someone get better. And on occasion, we must get out of nature’s way and allow death to happen. However, this month I feel like that model of medicine has been flipped upside down — that my role has now shifted.

I feel like so many of the patients I see are desperate for help. They crave to die with dignity and with peace. And for that, they look to us.

It is different when the family members of patients come looking to you, not for hope in a recovery, but for hope in a peaceful passing.

I have a great deal of respect for physicians who choose to go into palliative medicine. I used to look at the specialty of Oncology/Hematology as the “saddest” of specialties. Yet it seems the field of Palliative Care is grimmer still.

Perhaps I am just not used to it.

But maybe I don’t want to get used to it.

Bookmark and Share
post

Month One

The first month of intern year is over. It was definitely a ride. For my first rotation I was assigned to the local county hosptial for a month of in-patient medicine. I have been told that the two hardest rotations of the intern year here are the months at county and the MICU month at the Universtiy Medical Center. Seeing as I’m still alive and breathing, and that I still have a job, I’d say that I survived my month.

The first challenge I encountered was just transitioning from a medical student to intern. I remember being asked things by nurses as a Sub-I (during my 4th year), or any other rotation. I could always fall back on the “I’m sorry, I’m just the student. I’ll let my team know” response. Even if I had an idea of what the answer would be, I couldn’t give any nursing orders.

And so the first challenge was transitioning from the one who could always defer (actually, I had to defer), to the one that now should be able make some calls regarding patient care without always running to the senior resident or attending with a “Can I do such-and-such for so-and-so” type of question.

Another part about transitioning from student to resident is that now I am a “doctor.” Now I have an M.D. after my name. Now my signature has the power to make things happen. Now I wear a long white coat (instead of the short one reserved for medical students). It was pretty trippy the first time I heard someone call me “Doctor.” Sure, I had had patients call me “doc,” or “doctor” as a student. But I always introduced myself as the student. Now, I introduce myself as Dr. W. and the nurses call me Dr. W.

They call me “doctor.” How weird is that? It was a weird thing for me when residency began. Heck, it’s still a weird thing for me if I pause and think about it. But I’m in this for the long haul. I’m not planning a career change anytime in the next decade. I’ll probably be called “doctor” for a long time — likely for the rest of my life. Might as well start getting used to it.

Bookmark and Share
post

Dr. W?

I was waiting in the lobby of the building. I had a 9:30 appointment with human resources. I knew they wanted to take a picture for my ID badge. I assumed I would be given some other info as well. I had already previously completed a bunch of new hire “paperwork” online.

As I sat and waited (im)patiently in the lobby I started playing with my phone. Then I heard a male voice call out, “Dr. W?” (And he did a decent job of pronouncing my last name, too!)

I almost laughed out loud. But I stood up and went to meet him, all the while trying so hard not to have a weird grin.

It’s still weird to hear someone seriously call me “doctor.” Better get used to it though. I start on service in about two weeks…

Bookmark and Share
post

It’s Over, But Not Really

It is now just over a week since I marched at my Commencement ceremony and received my diploma. Yes, the actual diploma was inside the folder — which is very exciting since all my previous diplomas (college and high school) had to be mailed to me once the financial office had decided that I no longer owed the school any money.

I suppose that this is officially my first post as an MD. I am now a graduate. I now can tack on the suffix M.D. to my name. I remember just one day after graduation I sat staring at my diploma. As I stared at it, I almost could not believe it was in front of me. I looked at the piece of paper — a sheet of paper that has been the most expensive (physically, mentally, spiritually, and emotionally) paper I have ever earned.
wpid-diploma-2012-06-4-02-18.jpg
During the days prior to graduation, I remember feeling excited. At the same time, I also felt nervous. Nervous about being done. Nervous about new responsibilities. Nervous about wearing the long white coat I have wanted ever since I looked into the mirror and saw how ridiculous my short white coat looked. I am now waiting for my long coat. Literally. I sent an email to the Graduate Medical Education (GME) office a few weeks ago with my size. I hope I sent in the right size. Again, I am excited. But again, I am nervous about the long white coat and all the responsibility it represents.

I have a few more weeks before residency starts and I step onto the wards as a new intern. During this time I will have to complete some online modules and get certified for Advanced Cardiac Life Support (ACLS). I will also complete my move into a new place. It is a few weeks that I know will go by very quickly. Actually, I feel like the next few years will go quickly, but I don’t really want to think about that at this point.

And so, my medical school career is over. One chapter is completed. But I know that I am far from the end. Medical training continues at the next stage — residency. I know, too, that it will continue long after I leave residency. Medicine, as they have taught me throughout medical school, is about lifelong learning. In the grand scheme of things, I am still at the beginning. I have “leveled up,” but I’m still at a very low level.

I have a long way to go. I know the road ahead will be hard. But it’ll be full of adventure, I’m sure.

I will continue to blog here. For those of you who have been following my journey thus far, I hope you stick around.

Bookmark and Share
post

Almost There

I am currently on the last rotation of my medical school career. It’s a 4-week elective called Whole Person Care. One week down. Three weeks to go.

A few weeks ago they began erecting the canopies for the graduation ceremonies. Throughout the month of May, the various schools on campus will be holding their own graduation celebrations. The School of Medicine will be having their commencement on the 27th of May.

wpid-PastedGraphic-2012-04-30-09-30.tiff

It’s pretty surreal to think the journey is coming to another milestone. I cannot say that the journey is coming to an end because I know I am nowhere near the end of it. Medicine is not a short journey that ends with a cap (or a tam) and gown. It continues for a lifetime.

As I finish this phase, though, I hope to continue writing and blogging here. I hope to share the ups and downs as they occur. Or maybe months later when I have had time to cool off or decompress. The fun, I’m sure, will continue and there will be plenty of stories to share.

Bookmark and Share
post

Film & Medicine

Aside from my pathophysiology paper that was due last Friday (which I need to start finish sometime today), I am done with that two week elective.

Tomorrow I start another two week elective. It’s called “Film & Medicine.”

I’ve gotten some wide eyes when I tell people that I’m going to be spending the next two weeks doing an elective called “Film & Medicine.”

From the course syllabus:

Because film encapsulates narrative efficiently, this seminar screens and discusses feature films which focus on stories about medical care. Films are chosen that explore the humanity of both physician and patient as prominent components of quality health care.

There looks to be quite a few interesting films scheduled to be viewed this year. In addition to the films, we have to write a 2-3 page paper and read the John Irving book The Cider House Rules.

Here are the list of movies:

I’m pretty excited about this class. It should be fun.

Oh, I am going to miss fourth year when it ends.

Bookmark and Share
post

Death Is Hard

In the past I have found it easy to say that it is harder to see a sick, hospitalized child than a sick, hosptitalized elderly patient. It is easy to reason that the senior citizen has lived a full life while the child has his future ahead of him. But I think this position ignores the viewpoint of the patient’s family. Sure, sometimes a family is prepared for the death of a dying grandfather who has lived a long life and is going out on good terms. But few are ever prepared for a tragic death that comes on suddenly — no matter what age it happens.

Recently I saw a patient who I shall refer to as Mrs. B. We were not the primary team. I saw her as a consult after she had been in the hospital for a rather extended period of time. At the time the consult came in the team was pressed for time so we split up the duties. I would go and talk to the patient while my colleague would put together a consul note summarizing the hospital course and patient’s past medical history using the patient record as a source.

Without reading anything about the patient I went off to find Mrs. B. All I knew about her was that she had been hospitalized for quite some time and that she was fighting an infection that had spread to the blood. As I walked up to her bed she lie silently with her eyes open. I asked her how she was doing but couldn’t make out what she was saying. I tried to ask her in Spanish but she only responded with a more excited mumbling sound.

I realized that I wouldn’t be able to take a history from her. That sort of thing is difficult in non-communcating patients. So I proceeded to perform a quick physical exam. I noticed scleral icterus (jaundiced, yellow eyes) and a few skin wounds. But nothing else really jumped out at me. I left, but not before looking over her chart and collecting her vital signs for the last 24 hours.

When we began rounding our attending began writing out Mrs. B’s information across the large white board that hung in the workroom. Everything we had been able to find from the review of the patient record went on the board. We dissected and discussed the details and the big picture. And, after almost two hours, our attending decided it was time to go and see the patient.

We paused at Mrs. B’s door to pull out some gowns. A nurse ran up to us and whispered, “She just died. The family is inside.” And, while looking at the nearest clock she added, “She died about an hour ago.”

I was shocked. I didn’t know what to think. I had just seen her and touched her just over two hours ago. And now she was gone. At the time I saw her, I had no idea how sick she was. And my physical exam didn’t tell me she was so close to death. During our discussion, though, our attending noted how bad her labs looked and that she would probably benefit from palliative care.

I don’t know how the family took her death. I didn’t go inside the room. I didn’t come back later. To me her death was sudden. I was not expected it so soon. But death, it seems, waits for no one. When it’s time, it’s time.

It is hard to care for sick children in the hospital. But I think it can also be hard to care for sick adults who face tragic endings as well.

Death is hard. Period.

Bookmark and Share