Since I had been given my charge through a game of Telephone, I was left to figure out whether I needed to go balls-to-the-wall, or whether Julia Brant was playing tricks on me. Since it was for the kids, and I'll do anything for the kids, I tried to find a middle ground. Rebekah Macfie and I went to a costume store on our way back from Chapel Hill, and we decided that I should probably work within the confines of my green scrubs. As much as I would have liked to purchase an adult-sized Superman outfit, or perhaps "Sexy Nurse," I didn't want to be the only member of the team garbed in "French Maid" (and, what would the parents think!). So, what goes with green scrubs? First thought was Gumby; we have a similar physique. But, as we perused the store, it appeared that Gumby masks were completely sold out. Go figure. Ninja turtle was option number two, but we settled on something we found in the Christmas section. There before me were elf boots, an elf hat (complete with ringing bells), and a finely crafted elven belt. After a quick stop at the dollar store to find my elf tools (which ended up being a giant pair of plastic elf scissors and some snowflakes to pin on my scrub pants), I was ready.
Turns out not showing up in a mask from Scream VI was probably a good idea. My residents went the classy route: a cow and a lady bug, tail and wings included, both working well with their medicine-business attire. Our attending rounded as a witch, and we all were big hits with the chillens. The last patient we rounded on was a kid about 6 years old who was as adorable as can be. We all lined up in the room and watched patiently as our attending examined him and set forth the plan. Meanwhile, our little one decided to play the "Guess What I Am!" game with our costumes:
What do you think I am?
A cow!
What do you think she is?
A ladybug!
And what do you think he is?!
Ummmm... a dragon?
My heart sank. I was being discriminated against because of my height! No elf can be 6 foot 5. Clearly my proportions are closer in approximation to a dragon than a tiny elf. Henceforth, I was no longer "Robby the Elf." I was a Dragon-Elf. The "Drelf."
Later that day I had the opportunity to "admit" my first patient (still wearing my elf gear, obvi). "Admitting" means that a patient comes to the hospital, usually from the Emergency Department or a private practice, and needs to be in the hospital for an extended period of time. There is an entire History and Physical (H&P) form to fill out in order to get the patient into the system. This entails taking the history (chief complaint, history of present illness, family history, social history, etc.), doing a physical exam, and writing an assessment and plan. I presented to my attending, and then did my first "dictation," which was a complete and utter disaster.
If you listen to an experienced physician dictate, it is a blur of words. ThisisDr.TomArnold-A-R-N-O-L-DdictatinganH&Ponpatientnumber34243243285dateofbirth5/2/2000for... They have the entire format memorized, and they can bang out the whole plan in two minutes or less. It is a skill. A couple hours later, a typed up report pops up in the electronic medical record (EMR), fully visible for all to see. Like most things a medical student does for the first time, my first dictation was a train wreck. If I hadn't known how to "press 2 to pause," I would be still attempting to dictate that first H&P today. The whole thing is supposed to flow like a story; a beautiful soliloquy that anyone can read and follow. It should be chronological and orderly. Instead, my first history went something like this:
Um, yeah. So this patient, um, is being admitted for abdominal pain? So 6 months ago he sneezed, um, and then again a couple weeks later. He sneezed that is. But yesterday he started cramping up. In his abdominals, that is. But I'm not sure if that was a new finding because he gets that all the time, like once the week before. And oh yeah, he's lactose intolerant and he ate a lot of cheese. But not yesterday. Shoot! Did I mention the sneezing? Um.
This accident-in-slow-motion went on for about 45 minutes. When it finally popped up on the computer, I decided to rewrite the entire thing before my attending discovered my total incompetence (thank God for the ability to revise history). It would have been much quicker for me to write it all out in the first place, but time and practice are key to acquiring a new skill. By the end of the week, my dictations were a million times better. The biggest question is always whether the dictation will be transcribed correctly. This is an exact copy of the last line of one of my dictations:
"Dr. T and rhythm position him Mary it would go to feel with the transcriptionist the name of the game to straight Liza Young tube Mary Elizabeth Young. Thank you very much for this transcription in this wound."
Fortunately, this was the only word vomit of the week, but I now try to enunciate my words more clearly. I guess that particular transcriptionist didn't speak Elvish...
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