The first day of the third year of medical school was a very similar feeling to the first day of school when I was little, or what I would imagine going into war would feel like. This was a very special day because it marked the end of a 20 year epic of classroom learning. No longer would I be dragged through endless lectures for weeks and weeks on end. In a trade for baseball hats, and sandals I was now wearing shirts, ties, and a white coat loaded with so many medical manuals and examining tools it felt like a Kevlar vest, in fact if fate so happened to place a bullet in my path one day on the way to work, I would be willing to bet my PDA could stand up to at least a 9mm.
Entering the hospital was a step I had made many times before, from being a nursing assistant at the absolute bottom of the medical totem pole, to shadowing as a premed, to pretending to belong in the hospital as a second year med student. There is an up lifting feeling that comes with crossing the threshold of a hospitals doors knowing that I was going to actually be part of a team that will be seeing, and caring for patients, and that I will have a part in the decision making process. Not to mention it was really cool to wear the white coat with all kinds of stuff coming out of the pockets, which gave the illusion that my brain was so full that it was spilling out into my pockets, in my case this actually was quite the illusion.
Let me back up for a second, I am doing a month of Neuro with my roommate Kim at Oschner hospital. It was a freak chance of luck that Kim and I are on the same team, there are 14 or so other people doing Neuro, and 3 other hospitals I could have wound up at, but we work together well, and car pooling will be a plus. Oschner hospital is the current pride and joy of the New Orleans medical system. One of the only magnet hospitals in the area, when you step inside this mega-hospital, all the things that make New Orleans what it is from the potholes, to the quirky architecture are left behind, inside you will find a state of the art hospital, adorned with fountains, atriums, and every variety of marble Italy can produce. LCD TVs are in every patient room and there are robots, yes robots that roam the halls collecting lab samples from nursing stations and bring them to the lab.
The Neuro team Kim and I were assigned to was a consult service, meaning that when a patient gets admitted to the medicine team and suddenly they developed right arm numbness, or a suspected stroke they would get consulted by the neuro team, we will do our assessment, give a recommendation to the primary team (in this example, medicine), and they would be signed off from our service. This revolving door, really does move fast, and at Oschner it is not odd for us to consult on 8 new patients a day. There is a lengthy form that needs to be filled out called the consult form. This form is a three page document that is a highly structured account of a patients neurologic history and exam. We were shocked and scared to find out that as fresh green medical students we would be solely responsible for filling out the big bad neuro consult form our very first day on the job.
We would come to find out later that this great honor of a responsibility is really just glorified scut work (Scut work : Routine or tedious work often viewed as menial). The real reason for this form is mainly for insurance and billing. The important note that everyone cares about is what our attending scribbles on the very last page, or in some cases a whole separate note all together. Many times I think the fate of the consult form was that it was lost in the back of a patients chart never to be seen or read by anyone ever again.