I have been finding the whole clinic/procedure aspect of family very rewarding so far. I enjoy all the procedures I have been able to do here. One week all I did was assist with vasectomies. Another week I did colonoscopies, I got to suture some wounds and even do some skin biopsies. The variety at Eglin Air Force base has been pretty great. I've been really enjoying not doing inpatient work so it was pretty disappointing when I found out that all third year med students do a week of inpatient medicine in the hospital. One week of medicine isn’t soo bad, and I shouldn’t complain, but I did just get off that rotation and I feel that for the time being I had served my time. Needless to say I wasn’t too thrilled about the experience. Worse yet, they had a very light boring patient load. You would think that would be a good thing, get to go home early maybe? Not so much. Just more sitting around doing nothing until 6pm following the intern around and pretending to be excited about incredibly mundane things.
We did have a patient in the ICU that was kind of interesting, I got to see a bronchoscopy were they shoved a tube with a camera down her trachea and sucked out fluid from her lungs. If your wondering how that would prepare me for my family medicine exam that involves things like proper blood sugar and cholesterol screening guidelines. Anyway I tried to hide the fact that I was bitter and angry for being forced to do medicine again. One day the intern looked at me and said “you don’t look like you want to be here”. Guess I wasn’t doing that great of a job of hiding it.
So the cork almost blew off one day when a new patient came into the ER that was going to be admitted. At Tulane I would have typically gone and seen this patient at least initially by myself, and I got to like doing it that way. I could go at my own speed, ask the questions I wanted and make notes the way I wanted. Well that was far from the plan this time around. I was going to talk to this patient and ask questions, while the other med student wrote down the patients responses, write the note, and the intern would watch the whole thing. This really didn't fit with the way I was trained to take a history. You ask questions because you are thinking of a disease or something on your differential that it could possibly be. These questions may not come out in order, and only you can really know what you are thinking about. So it makes sense that the person doing the questioning also be the one to write the report. Unless of course the other student can read minds.
I played along with this, excited that I was going to finally get to do something useful. I started asking my questions and everything was going peachy. The intern was standing next to me and slowly she started inching her way in-between me and the patient. Then very subtly she asking her own questions, then she started taking over the conversation asking questions that I was about to ask. So I politely went to the other side of the bed and continued to tag team questions with her, although more annoyed at this point. Now let me pause for a second and explain something. This little dance may seem very tongue and cheek, and if your not a med student you probably think, so what, big deal! But, it is a big deal when you wait around for a week to do something like this as little and meaningless as it is, you have been trained in how to do this, and then the person who instructed you to do it started passively aggressively shoving you out of the way.
My blood was getting hot and then it happened, she put her hand up and said “I’ll just ask the questions from now on”. I felt like this was malignant gesture especially on a rotation as benign as Family Medicine. I stepped back from the bed, took a breath out and let the whole thing go. Not just the current situation, but my care for the rest of the week, if not the rest of the rotation, if not the rest of med school. In a split second I made a decision that it just wasn’t worth getting upset over. It wasn’t even worth caring about. For all of third year up to that point I would bust my ass whenever I could. I would take everything personal and micro focus on details of my performance, and where did it ever get me in my evaluations, or grade for a course? Nowhere! So what’s the point?
I decided I was done trying to impress this intern, or anyone and I faded into the background. Whatever happened it didn’t matter to me because I was a million miles away. And ya know something; it was a very liberating feeling. For the rest of the week I went through the motions, I wrote my notes, I saw some patients, but the entire time I didn’t let anything illicit a single emotion from me. No sympathy, no frustration, no cares what so ever.
Even though I am writing this post weeks later, I still sort of feel the same way. I'm very apathetic now and have more of an understanding why the rigors of medical education have a reputation for beating inspiration out of people. There are so many times in this process when we are chewed up and spit out, just to smile say yes sir, and do it again tomorrow. There is no room for emotion, this is a matter of survival, and those that choose to keep pushing on with a bleeding heart on their sleeves are the ones crying themselves to sleep every night, dosing on antidepressants, and trying to figure out how they are going to get through tomorrow.
The trick is to detach, but also to still care enough so that you don’t completely loose touch with your own humanity. Being a good doctor isn’t about being a nice caring doctor. Its about caring for your patient’s body, mind, and soul, but at the same time being able to separate completely. At least, that is the lesson I got out of this month.