Real Life: On the Wards

I have to apologize upfront for last week's bitter, angsty, and hurried blog post. I am indeed settling into this lifestyle, but I'm not going down without a fight. The material is coming very quickly, and the amount of information that has accumulated builds and builds. It will be a daunting task to master the amalgamation of these past two years of coursework for one big exam at the end of the year. Last week, after a solid 4-5 days of re-reviewing the slow and fast tissue action potential diagrams in the myocardium, Ronnie and I each savored a Budweiser in the Health Sciences Library 4th floor study room. Just a simple reminder to ourselves that there is indeed a light at the end of the tunnel. Nothing says "outward rectifying potassium channels" like the king of beers. Fortunately, I am not alone. Although contact with the mothership has become less frequent, my mother always seems to find another person (someone's brother's uncle's daughter who just finished med school) who shares the same disdain for the second year of med school. It is all well! Third year is a blast and almost upon you! It will be here before you know it.

My mother will be extremely pleased to know that I have found other means of release besides consuming America's greatest beverage whilst watching lecture capture. My "white cloud" status in the EMS world is slowly lifting. Last week we finally transported a patient on my shift (first time in many weeks), and a lovely middle-aged lady who was severely inebriated told me that I was the "most sweet and wonderful person she had ever met." After some friendly medical banter, she proceeded to put her hand on my knee and whisper her desire to have rampant intercourse with me if I were so inclined (no quotes allowed, since her exact words would preclude me from keeping this blog open to those under the age of 18). When I told the nice lady that I was not so inclined, she offered her daughters up instead. Luckily, by that time we had reached the hospital, and she could find another "handsome young man" to whom she could propose coitus. What can I say, at least they're getting younger. When I worked in Cary I was a hot commodity in the nursing homes, if I do say so myself. Could have gone on quite a few bingo dates.

Perhaps most rejuvenating was my brief trip to see an actual patient at UNC Hospitals. This year we take Introduction to Clinical Medicine II, and a few times a year we spend a couple hours "on the wards." This allows second year students to (for the first time!) venture into the hospital and interview/examine a REAL person. I emphasize the word "real" because until this day, we have mostly interviewed "standardized patients," SPs or actors that pretend to be sick. These characters evaluate our demeanor, personality, and professionalism, while a physician watches us through little cameras in the wall. Students are graded based on the thoroughness of their examination and overall personability. On community weeks we have the opportunity to see "real" patients, but there is something different about actually being in a hospital. The vast majority of children I see in western North Carolina really aren't that sick. They come for well-child checkups, or for a sore throat (pharyngitis) or ear ache. Once you've been admitted to the hospital, that's much more serious in my mind. In my case, I interviewed a patient who had been diagnosed with a terminal illness just days ago.

Our preceptor had scouted out a couple of the upper floors of the main hospital, looking for patients who would be willing to talk to second years (fresh meat, greenies, and wet behind the ears, you might say). Ms. Q volunteered to chat with us for a few minutes in the afternoon. We waited until her attending and residents finished explaining her diagnosis and treatment options before walking in wearing our freshly white coats. Ms. Q was in terrific spirits, and simply told us she would kick us out if she got too tired. Her family stayed in the room with us, so Matthew Wofford and I were able to hear her whole story from multiple sources. She was in her late eighties, and woke up a few nights ago unable to breath; she was at the Emergency Department hours later. A couple months ago, at her annual physical, she was given a clean bill of health. Now she's terminally ill; just like that. Her resilience was powerful; she chose to divulge her entire life story to us, solely for our benefit, not hers. We asked our questions, checked out her heart and lungs, and made small talk before it was clear Ms. Q was petering out.

I won't go as far as saying we made a connection, but as I took her pulse, I was reminded again of the human aspect of medicine. I get a very different feeling in the back of the ambulance, where I can work through algorithms and protocols before transporting patients to the hospital. I love it, but my basic skills and knowledge are so limited. I like the fact that there is so much more out there. In my white coat, with my stethoscope around my neck, the idea of becoming someone's last line of defense is tangible, and I realize how underprepared I am. Reading Lilly's Pathophysiology of Heart Disease or reviewing factoids in First Aid detaches me from the human aspect of medicine, but these encounters make its utility so much clearer.

Ms. Q remarked that for most of her life she has been mildly anemic. For the first time in my life I actually ran through a differential diagnosis in my head, reminding myself about the mechanism of anemia and what labs and tests I would need to run to determine its etiology. I think for me, every once in a while it's important to remember why all the hours of studying are so important. I just wish that the "every once in a while" came more often.


(Note: some details concerning "Ms. Q" were subtly changed for her privacy.)