A third year told me, “you do a whole lot of sitting around and waiting during third year.”

That pretty much describes my last day on the General Surgery service. Well maybe not completely. A fellow first-year and I chased around senior residents and attendings trying to find someone to fill out our evaluation from.

I asked an attending in the morning at around 9 (right after she finished lecturing on the large intestine to a group of 10 of us). She looked at me, smiled, and said, “How do I know you?”

That’s the problem when you are a first year and only spending a week and a half (7 clinic days) on a “rotation.” Each day I saw a different attending. And she suggested that I speak up more so that she could get to know me.

I have no idea what to speak up about, though. When I round with the team, I’m the bottom of the totem pole! After only one year of medical school, I still have no idea what they are talking about. There’s no way I can put together a sensible question that would do anything more than waste time and slow them down.

Well the attending then looked to a third year and said something to the effect of: “I don’t know why we have to fill out an evaluation on for the first years. They’re here for a week. What are we supposed to evaluate them on?”

And she’s right! How are they supposed to get to know us when we hardly see them? And what exactly are we there to do? Watch and observe. So why can’t we just sign an attendance sheet or something like that? We need a full page, triplicate sheet to be evaluated on our performance (that consists of showing up to clinic and watching attentively)?!?

Well the attending asked if I’d be around later in the day and I said I would. So she said she would do it later.

Well my classmate and I finally found a senior resident who agreed to sign it off for us. But he wanted to sit down and talk to us. But before he actually signed it, he was paged to go round with the attending (the same one I talked to earlier). So we followed like little puppy dogs waiting for a treat — in this case the signature.

Well after rounding ended, the chief resident walked off without a word. We thought he was coming back since the attending was still around. But then she walked off in another direction. Unsure about what was going on, we hung out with some of the interns since they were still with the patients. Then, deciding to go look for the chief resident, we went to the OR and found him and the attending scrubbed in and ready to begin a new operation.

So then we sit in the call room for two hours just talking to the interns about life and medicine before we decide to go back to the OR and see if the case is done. It is, but we have to wait till the patient is taken to the recovery room. Finally the chief resident takes us back to the conference room. He talks to us for about 40 minutes about medicine, surgery, and life. The conversation was great, though. I learned quite a bit from him and really appreciate the fact that he took time to be so candid and share with us. For that I am very grateful!

My frustration stems from these evaluation forms we have to fill out. I could’ve scrubbed in on another case today. But instead, I’m sitting around trying to wait for a signature. Now that’s a really useful and educational use of a day! Well, if I am to stay positive, then at least I got in some very interesting and enlightening conversation.

Well I finally was able to Scrub in on a surgery case. This is one week after my time on the General Surgery service was supposed to start. The case was a morning case with a scheduled start time of 8:45. But we ended up late.

It was an abdominal surgery case so I was excited about what I might get to see. (I am purposely being vague about the details of the case to protect the identity of the patient. I have no idea how many operations were done this morning.) However when I got to the OR, I realized that the surgery would be laparoscopic. So instead of standing over a human body with a large incision, I stood staring at LCD monitors for over two hours.

I counted at least six holes through which either a laparoscopic instrument or camera was inserted. There was only one camera. The third year I’m following got to hold the camera for the last part of the surgery.

I stood quietly trying to stay out of the way. So it was a long morning for me. When the operation was finally over, the surgeon looked at me and told me to stick my finger in one of the holes. Air had been pumped into the abdominal cavity during the surgery. (This provides space for the surgeon to work.) I was then instructed to stick another finger in a second hole. The residents proceeded to suture the other holes while I waited for them to get to mine.

My first time in the OR was definitely not exciting, nor was it something to write home about. But for completeness, I’m blogging about it. And I’m sure I’ve written about more boring things before.

In the afternoon I spent an hour and a half in clinic, but there was nothing outstanding about that.

Since I’m writing a little bit each day during my time on General Surgery, I decided to split the post up. Here’s day 4. You can find days one through 3 by scrolling down or clicking here.

Day 4: I think I have a little better idea of what it means to get “pimped.” I thought I had a taste a couple days ago when an attending quizzed me about a CT scan displayed on the computer. It was basic anatomy. Identify the indicated organ (pancreas) and vessel (splenic artery) on the image. Well today, it was a whole other level.

I attended a lecture with other medical students and residents in the surgical conference room. There were a total of 3 first year medical students at the beginning. The attending asked who the first years were and we sheepishly raised our hands. Then, looking to one of my classmates, he asked what is the blood supply to the stomach. My classmate replied that it was the gastric arteries coming off the celiac trunk.

That answer is true, but the attending wanted more. Not getting any more answers he asked, “Did you make it to second year?”

Honestly, at this point, I was telling myself not to laugh. Not because I could’ve done any better. I just think its funny when people have power trips and think they’re so much better than other people. I’m glad I didn’t, though.

He then looked to another first year and I. I said “gastroepiploic,” while the classmate next to me answered “right and left gastrics.” Well we both were right (since there are five vessels), but then we got lectured for answering a question with the wrong intonation. He told us we need to be confident. No questions. And then the follow-up, “You want to be doctors, right?” (For those of you wondering, a third year finally correctly answered, “left and right gastrics, left and right gastroepiploics, and short gastric.”)

The rest of the hour he spent pestering the residents, particularly one female resident who had the nerve to say “I don’t know” to one of his questions. He retorted that her response was unacceptable as a second year resident. And proceeded to call on her to answer a question at least once every ten minutes.

Oh well. I’ve always heard attendings could be rough on us learners. I just have to use this as motivation to learn my “stuff.”

I switched to General Surgery after a week and a half at Child Psychiatry. For this rotation, I’ll try to give a day-by-day account of how it went down. And I guess I should write that I was assigned to one third year for the whole time. In a sense, I’m discovering what the life of a third-year is like.

Day 1: Didn’t do much today. The third year I was following was assigned to Minor Surgery. So watched as two patients had sebaceous cysts removed from their backs. The cuts were about an inch deep (if I remember correctly). Not much blood and since this was a minor procedure, the patient had only local anesthesia and was awake the entire time.

The attending asked the 3rd year to suture one patient using a particular method. He replied that he had never done that before. But that didn’t stop him because the attending explained it and had the student do it anyway. I wondered what the patient was thinking as he heard this conversation.

Makes me wonder if, should I ever need a major hospital stay, I want to be admitted into a teaching hospital.

Day 2: All the third years had lectures this morning. In the afternoon there was clinic. Apparently it was a very busy day with a lot of patients. Before I left, I got to see two patients with either an attending or the 3rd year I am following.

There was one attending with whom I was absolutely impressed with. She is a surgical oncologist and invited me to come see a patient with her because I didn’t seem to have anything to do at the time. The patient was an elderly gentleman who had colon cancer. She had resected the cancerous part and was now suggesting that he undergo chemotherapy. Chemotherapy was suggested to reduce the risk of the cancer recurring.

The man told us that he had fought in three wars, but this situation scared him. I was so impressed with the “bedside manner” of this attending. She took his hand, explained to him the pros and cons, reassured him, answered all his questions, and then told him that the choice was his to make but that she would not care or love him any less whatever he decided. He remarked that he was glad she was his doctor. He kissed her hand. She hugged the patient’s wife. It was clear that she had cultivated an excellent doctor-patient relationship in which the patient and his wife truly trusted and liked their doctor. I even heard the patient say that he and his wife would adopt the attending.

I can only hope that one day I can have that sort of relationship with the people I treat.

Day 3: My third year was post-call today. I came in for pre-rounds at around 6 AM. We went around with the senior resident and everyone presented to her. An hour later we joined 2 attending surgeons and rounded with them. Apparently everyone was a bit high-strung because the attendings were present. I learned that the attendings normally only round on certain days and the rest of the week the residents and medical students present their patients to the senior resident. So there was a little more stress since no one wanted to mess up or not have an answer for either of the attendings.

Still wondering if I will get in the OR before my time here is up. But then again, I wouldn’t be able to do much…

I stood at the end of the hallway looking out through the large windows. Outside the sky was gray, the blacktop was damp, and the trees were dripping. It was a stark contrast to the interior. Here, where I stood, the walls were brightly colored, cartoonish faces squinted, frowned, and smiled, and random quotes encouraged readers to share and play nice.

Less than ten feet away from me a doctor was interviewing a patient. I’m not sure how the interview went. I wasn’t paying too much attention. I knew of this patient, though. The young pre-teen had been admitted because she had reported thoughts of killing herself. One might think that this bit of information might be betraying the patient’s identity. But sadly, many of the patients I have been seeing in the child psychiatry unit have/had suicidal ideations.

In a place like this, the patient population seems to have more in common with the dreary weather outside than the bright, cheerful surroundings inside. I’ve spent three days on the unit, and it has been — well, shocking. I have found it all quite interesting. I will definitely not cross Psychiatry off my “list.” But if I had to describe what I’ve seen in one word, that word would be “sad.”

When people hear that I am spending time in the Child Psychiatry unit, I often get asked if they patients look different. Maybe they think these patients have “crazy eyes” or some other telltale sign of craziness. If there are, then I certainly don’t know what the signs are. But to me, these patients look like any other child you might find playing in a schoolyard playground. Except that a number of them are very depressed. And they look sad. But if they were happy, I could picture them laughing and hanging from a jungle gym set or fast and high on a swing set. My point is that visually, these kids wouldn’t stand out if you put them in a lineup with other children.

Abuse is common, though. So are hallucinations — if I can call them that. I’m not sure what the doctors are calling them, but a number of the kids report seeing or hearing things others don’t see or hear. I guess the staff will need to determine if they are truly hallucinations. One patient sees demons at night. Another sees ghosts without any limbs. Others hear voices that tell them to hurt themselves or other people.

When I found out I had been assigned to psychiatry, I thought it would be really fun. I imagined having adult patients telling me outlandish stories that would make me laugh. Then I found out I was assigned to Child Psych. Most of the patients I’ve seen here have made me cringe. Their stories are heart wrenching. It was shocking for me to see some of the things I saw. And as far as the cases of abuse, I wondered, what kind of society do we live in that produces children so mentally damaged by physical, sexual, and emotional abuse?

I have about a week and a half left in Child Psych. I’m sure it’ll be memorable.

At Orientation I learned that I had been assigned to Pediatrics for my first two weeks before classes begin. Not quite sure what to expect, I followed the directions and found myself sitting in a conference room Monday morning with the rest of the Freshman who had been assigned to Pediatrics.

The group in the conference room also included third and fourth years who were on their Pediatrics rotations. After an orientation to how things were done in the Children’s Hospital, the Attending Physician took sent us off to find the teams we were assigned to. Some first years went to the cardiology consult team, others to the GI team, some to the NICU and others to the PICU.

I, along with one other first year, headed to the Pediatric Teaching Office (PTO). The PTO is located across the street from the Children’s Hospital.

I quickly found out that the PTO is a very relaxing place to rotate through. Over my one week there, most of my time was spent sitting in the office along with the residents.

When the residents did go in to visit patients I was able to go in with them and watch, hand out lolipops, smile, and ask the parents some questions regarding the development of their child. The residents/attendings were really nice about letting me listen to some sounds with my stethoscope. One of the interesting things I had a chance to listen to was a heart murmur that indicated that the patient had a ventricular septal defect.

In between patients, there was not much to do. I did not bring a textbook to study. I would have found it interesting to talk to the 3rd year medical students or even the residents and attendings. But I didn’t want to get in their way. Those not seeing patients were busy looking up things on the internet, reading an article, telling jokes, discussing wedding plans, and describing the latest exciting cases going on across the street in the main hospital.

As a first year it was at times very overwhelming because I had no idea what the acronyms and jargon meant. I couldn’t chime in on the discussions of exotic childhood diseases or advise on the appropriate vaccination for a 6 month old coming in for a “well child check-up.” I did, however, appreciate being able to watch a number of different doctor interacting with their patients. It is interesting to note the different styles — some bad, but mostly good. Those little things will definitely be something to pay attention to as I cultivate my own style in dealing and interacting with patients.

Part of me feels like I just want to get through these first two weeks of “Clinical Experience” and start lectures. At least I will have something to do. And I will know what to do — study. But I realize that once lectures start I will miss the PTO.