A recent medical graduate who is required to work insane hours, never sleeps, and knows nothing about medicine, yet is expected to answer 1000 daily questions from nurses about how much lorazepam the crazy 82-year old woman in room 476 can have.
I walked into the hospital on my first day of being a doctor not really knowing what to expect. It was 6AM, and the senior residents walked in a few minutes later. The new second year residents looked the happiest to see us because THEY weren't the slaves anymore. It's like they were handing over the keys to the shittiest car to the people who didn't even know how to drive. But they didn't care, as long as they were out of the car.
The first day was hell - I had to make rounds on 25 patients I knew nothing about, and I was immediately bombarded with questions from the nurses, questions I couldn't possibly know the answer to.
"Can we take out 24's foley?"
"Can 15 have a clear liquid diet?"
"The guy is 20 has a fever. What should we do?"
"11 is confused again. Should we give Haldol or get a head CT?"
"Can I send 2 home today?"
Medical school doesn't prepare you for this stuff. AT ALL. If the nurses had asked me how morphine works or to draw a diagram of the coagulation cascade, that I could do. But the actually relevant clinical stuff? I was entirely unprepared.
I quickly figured out who the "good" nurses were. My standard answer was to ask them what they would usually do. If their answer was "What do YOU want to do?", I immediately labeled them "BAD". Fortunately it only took a few days to figure out most of this stuff. It's a sink-or-swim environment, and we all swam.
My first real test came the next day. My chief resident told me to assist Dr. F (not his real name) in the OR. My first operation!! I was absolutely ecstatic. No senior resident, no chief. Just me and the attending surgeon, a man I'd never met.
I walked into the OR to see Dr. F straining by himself at the case - a pancreatic debridement for necrotising pancreatitis. If it sounds awful, that's because it is. It's also a very difficult chief resident-level case.
"Who the hell are you?" he yelled.
I introduced myself.
"And why the hell are you here? Where's the chief?"
I told him the chief had asked me to help him.
"WHAT? Wait, so let me get this straight...two days ago you were a medical student, right?"
Yes, I said quietly.
"So the chief sent a MEDICAL STUDENT to help me debride a pancreas?!"
All I could do was stare at him and hope he didn't throw a scalpel at me.
"Oh for fuck's sake, come on. Scrub in, medical student."
I scrubbed my hands, put on my gown and gloves, and slowly took my place opposite him. He took a look directly in my eyes, paused for a second, and asked the tech to hand me an instrument, the same one he was holding.
Wait wait wait... hand ME an instrument?
"Yeah, but make it a plastic one like the medical students use."
He was kidding, of course. Over the next two hours he instructed me exactly what parts of the organ to remove (and what parts NOT to touch) and how. We worked together for those two hours cleaning the patient's organs. I was not a bystander or an observer - I was operating. I was a surgeon.
Dr. F turned out to be one of my biggest allies over the course of my training and one of my biggest influences. He taught me not only how to be a surgeon, but how to be a doctor.
Thanks, Dr. F. Thanks very much.
Wait, so this was your first year of residency? Can you explain how that works if one wants to become a surgeon like you? Like what would you do differently then If you wanted to be like a pediatrician? Sorry doc, I'm 14 and really want to become a surgeon.ReplyDelete
It depends where you live. If you send me an email with a bit more info (like where you live), I'll try to help.Delete
Now that's getting thrown in at the deep end!ReplyDelete
I take it this was before you had decided you wanted to specialise in surgery. I wonder what effect it would have had if that first encounter had been suddenly to deliver a baby, or make a critical diagnosis, or whatever.
I assume the chief took a royal bollocking later!
I don't know if you ever disclosed your country on previous blog entries, I just got here and I'm just binge reading your posts. Anyways, where you live the medical students have no contact with patients during graduation? Like no contact at all?ReplyDelete
We did, but we weren't responsible for their care. Nurses know not to ask medical students anything of any import, so "How much acetaminophen can I give" just never comes up.Delete