Learning How to Bite My Tongue

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A 3 year old heard the surgeons say that when he started eating again he would be able to leave the hospital and go home.  His recorded intake improved immediately.  Several meals later, the nursing staff discovered that he still wasn't eating, but was merely stashing the food under his pillow.

I was quite impressed by his problem solving as a 3 year old and the fact that it took the adults around him several meals to figure it out.

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Typically, patients' issues are summed up in a quick phrase on their chart that gives the physicians a quick idea of what's going on.  "MVA" for motor vehicle accident or "intestinal dysmotility" for example.  I couldn't help but laugh when I looked at a patient's file and saw, "ran over by an Amish buggy."  You don't see that everyday - though it was not the only buggy accident I saw in my few week rotation there.

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I try to not endorse stereotypes, but one surgeon recently reinforced the negative views on surgeons when she showed up to a meeting with the team an hour late and promptly yelled at the rest of the team for not accomplishing things on time.

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To capture some of the ridiculousness I have encountered as a medical student:
Surgeon: Med student, where's the tape? (Once again, we don't get names)
Me: I'd be happy to go find you some.
Surgeon: You don't have some with you?
Me: No, I'm sorry, I don't.
Surgeon: You should have some in your pocket in case I need it.
Me: I'm sorry.  I'll go get some.

Apparently, I should have multiple supplies in my pockets just in case someone asks for them.  If nothing else, surgery is teaching me how to bite my tongue.

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And lastly, a quote from a TV show I was watching recently that sums up how this year has been:
"Treat me like an idiot...like I'm a medical student!"

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Growing up?

You probably shouldn't be at a children's hospital if...

...you're 17 and telling us about your tattoos of your "baby momma" and your 3 year old son.

...you're 20 and we unintentionally walk in on you laying on top of your lesbian lover.

...you're 21 and came here because you have a baby, even though she didn't need treated.

...you're 19 and married...even if you do still live with mom.

...you're 21 and your tox screen comes back positive for opiates, marijuana and amphetamines.

(All true stories of recent encounters I've had)

This is a children's hospital...made for kids and childhood conditions. Never growing up doesn't qualify you as a childhood condition.

Things I've Learned & What I Want to Do:

Throughout my first rotation in internal medicine (and my first week of my surgery rotation), I learned a bit more about what I like and what I don't and how that affects what I'm interested in choosing for my future career.

1. I like teaching patients.  One of my favorite parts of working with patients is being able to answer their questions and teach them about aspects of their condition they don't understand.  I loved being the one patients could talk to about anything they wanted to know. One of the highlights of my rotation was sitting talking with a patient and his wife for an hour about a whole list of questions they had that no one had taken the time to answer.  I think teaching patients is something that can be part of any medical practice but can be incorporated even more in primary care because there is more time to talk about preventative medicine.
2. I don't like adults. I've mentioned it before, but the more experience I have, the more it confirms that caring for adults is not something I can see myself doing every day.  Many of their conditions are a a result of their own poor life decisions and non-compliance is the norm.  I also don't have any desire to manage diabetes and hypertension, which is a huge part of adult medicine.  Obviously, this is pushing me even more strongly into pediatrics.
3. I like caring for the whole patient.  I really enjoyed being able to look at all aspects of care for my patients when I was on a general medicine service.  It was frustrating for me when I was on heart failure because our team was only concerned with things relevant to cardiac issues.  That was amplified even more when I was on the infectious disease consult service and my team was mostly in charge of tweaking antibiotics.  I didn't like seeing aspects of care that should be addressed, but not having the ability to do so.  Wanting to care for patients as a whole makes primary care seem like a much better fit that being a specialist.
4. I need variety. I also don't like that as a specialist, you deal with that one aspect of care all day every day.  It took me about two days to be tired of heart failure management.  Infectious disease was a little more interesting to me, but I still wouldn't want to do only that.  This is yet another reason why I'm leaning towards primary care.
5. I want to be the patient's advocate.  When I was on the general medicine service, I enjoyed being the one who coordinated care between the different specialist teams and the one who was in charge of making sure everything that needed to be addressed was being managed.  As a primary care physician, this would be a big part of what I would be doing.
6. I can't do emergency medicine. During my first week in surgery, I responded to two traumas with the trauma surgery team and both of them broke my heart.  The first one was an eight week old baby who had multiple skull fractures from being abused by his parents.  Twenty minutes later, a fifteen year old boy was brought in who had tried to hang himself and if he survives will be brain dead.  Those two traumas showed me that there is no way I could do emergency medicine every day.  I couldn't deal with seeing that daily nor would I want to be desensitized to those kinds of tragedies.  Before this realization, emergency medicine was fairly high on my list of possibilities.
7. I'm not interested in surgery.  I already knew this, but even just a week in surgery has confirmed my suspicions.  I don't enjoy the hours, the type of work or the reduced interaction with patients.  Surgery was never really on my list of possibilities, but now I can officially mark it off.

With all that said, my old list has been updated to:

1. Peds
2. Genetics
3. Peds Heme/Onc
4. Family Medicine
5. Med/Peds