Sunday, June 20, 2010
Of Roads Less Traveled
So this last Friday we had to shadow the interns on the NICU (Neonatal Intensive Care Unit) to observe how they do their job...because come Wednesday it will be OUR job. Over all, the NICU, which I havn't worked on before, is pretty similar to the other rotations I've been on.
(I'll describe it because I don't think this is something the people understand very well, mostly because of it's poor portrayal in the media)
In the morning you gather facts (labs, overnight events, vitals, neonatal physical exam, ect.), you use those facts to uncover the patient patho-physiology (what's going on in their body), and if needed you apply your medical knowledge, as best you can, to intervene on the behalf of your patient...but being totally inexperienced, as I am, you aren't allowed to act until you run this whole discovery/thought process thing by your attending (ie. THE HEAD DOCTOR...capitalized for effect). That's where "Rounds" come in. Rounds is when every intern & resident gets together to run these things by the attending all at the same time. To compound things further, rounds is also the time when the attending gets to quiz (some would say torture) the group with medical questions in order to find gaps in knowledge and make them better doctors. For first/second year medical students, mentioning rounds will invoke a serious amount of fear and dread...if they say it doesn't scare them they are flat-out lying. But by the time you get to the intern level, most of the "sting" of constantly saying those hated words "I don't know" is taken out of you and you begin to view the process as a way to make yourself better rather than a way to make you look stupid. It took me along time to see rounds that way and my pride/ego still struggles with it often enough. However, rounding with this new doctor was a little different. He didn't question us incessantly, at least not today, but he did give a quick lecture which I was surprised by more and more as I thought on it.
During rounds we came to one of the neonates, around 36-37 weeks of age, that was in the NICU to get a little bigger and also to get off of the nice little drug dependency it had developed in it's momma's belly. We had it on several drugs to counter the withdrawal and it was doing nicely, however it would be in the hospital for several more weeks. As we were new to each baby the interns who were presenting (going through the process previously described) would say a quick blurb about the patient's history so us, the new interns, would understand what the babies were "in" for and what had been done to them thus far. When this poor neonate with the withdrawals was presented the attending stopped the intern mid-history to deliver this odd very elaborate story, which I will summarize as this blog is already very large. (NOTE: I don't think he was reprimanding the intern giving the history as the intern was being very professional about it)
Imagine there is a birthday party going on and you are all invited. There are pieces of cake on the plate and next to them small personal cartons of white milk to drink. However, the night before, you (he points to an intern) sneak in and with a syringe replace all the milk in each box with a different drink, apple juice, orange juice, coffee, strawberry milk, pop, ect. The day of the party the hospital gathers and as is normal for a celebration the crowd toasts with the milk. With the toast, one and all slurps simultaneously from their milk cartons without looking. Suddenly cries of surprise and disgust go out among the crowd as everyone discovers the contents of their cartons not to be white milk. "OH MY GOD!!!"; "DISGUSTING!!!"; "EWWW, IT'S BLACK!!!"
Where does this disgust and resentment come from? It's not because it is poisonous or that it tastes bad. It's because it isn't what you think it should be. A doctors job isn't to pass judgment, a doctors job is to pass on healing and compassion to his or her patients.
I thought this was a really fresh and positive outlook that he'd presented us with, compared to the often cynical views I'd seen and sometimes even expressed myself in my previous place of work. It's funny how you'd often hear people say "I won't say that." or "I probably shouldn't be saying this."...but then they'd say it anyway. It's odd how often the "non-judgmental" thing gets stressed in the academic part of medical school and yet I was 4 years through school and into my 1st year of work when I finally received my first lecture/lesson on the subject in the clinical setting. Like most things in life this idea of a non-judgmental doctor often falls far short of our imagined ideal.
As a beginner in medicine, I often find myself lacking in most things whether academia or practical skill, it's daunting to see how far you have to go to become the thing you wish. The only way I've found around freaking out about how far you have to go is to look at the ground and place one foot in front of the other towards your destination and tell yourself that you'll get there someday. I suppose this "non-judgmental doctor" is just one more freakishly far away place I have to go and as long as I'm moving one foot in front of the other toward it as a goal, someday even if I don't ever get there, I will be far closer to it than if I had never moved at all.
Newbie-Doc
(I'll describe it because I don't think this is something the people understand very well, mostly because of it's poor portrayal in the media)
In the morning you gather facts (labs, overnight events, vitals, neonatal physical exam, ect.), you use those facts to uncover the patient patho-physiology (what's going on in their body), and if needed you apply your medical knowledge, as best you can, to intervene on the behalf of your patient...but being totally inexperienced, as I am, you aren't allowed to act until you run this whole discovery/thought process thing by your attending (ie. THE HEAD DOCTOR...capitalized for effect). That's where "Rounds" come in. Rounds is when every intern & resident gets together to run these things by the attending all at the same time. To compound things further, rounds is also the time when the attending gets to quiz (some would say torture) the group with medical questions in order to find gaps in knowledge and make them better doctors. For first/second year medical students, mentioning rounds will invoke a serious amount of fear and dread...if they say it doesn't scare them they are flat-out lying. But by the time you get to the intern level, most of the "sting" of constantly saying those hated words "I don't know" is taken out of you and you begin to view the process as a way to make yourself better rather than a way to make you look stupid. It took me along time to see rounds that way and my pride/ego still struggles with it often enough. However, rounding with this new doctor was a little different. He didn't question us incessantly, at least not today, but he did give a quick lecture which I was surprised by more and more as I thought on it.
During rounds we came to one of the neonates, around 36-37 weeks of age, that was in the NICU to get a little bigger and also to get off of the nice little drug dependency it had developed in it's momma's belly. We had it on several drugs to counter the withdrawal and it was doing nicely, however it would be in the hospital for several more weeks. As we were new to each baby the interns who were presenting (going through the process previously described) would say a quick blurb about the patient's history so us, the new interns, would understand what the babies were "in" for and what had been done to them thus far. When this poor neonate with the withdrawals was presented the attending stopped the intern mid-history to deliver this odd very elaborate story, which I will summarize as this blog is already very large. (NOTE: I don't think he was reprimanding the intern giving the history as the intern was being very professional about it)
Imagine there is a birthday party going on and you are all invited. There are pieces of cake on the plate and next to them small personal cartons of white milk to drink. However, the night before, you (he points to an intern) sneak in and with a syringe replace all the milk in each box with a different drink, apple juice, orange juice, coffee, strawberry milk, pop, ect. The day of the party the hospital gathers and as is normal for a celebration the crowd toasts with the milk. With the toast, one and all slurps simultaneously from their milk cartons without looking. Suddenly cries of surprise and disgust go out among the crowd as everyone discovers the contents of their cartons not to be white milk. "OH MY GOD!!!"; "DISGUSTING!!!"; "EWWW, IT'S BLACK!!!"
Where does this disgust and resentment come from? It's not because it is poisonous or that it tastes bad. It's because it isn't what you think it should be. A doctors job isn't to pass judgment, a doctors job is to pass on healing and compassion to his or her patients.
I thought this was a really fresh and positive outlook that he'd presented us with, compared to the often cynical views I'd seen and sometimes even expressed myself in my previous place of work. It's funny how you'd often hear people say "I won't say that." or "I probably shouldn't be saying this."...but then they'd say it anyway. It's odd how often the "non-judgmental" thing gets stressed in the academic part of medical school and yet I was 4 years through school and into my 1st year of work when I finally received my first lecture/lesson on the subject in the clinical setting. Like most things in life this idea of a non-judgmental doctor often falls far short of our imagined ideal.
As a beginner in medicine, I often find myself lacking in most things whether academia or practical skill, it's daunting to see how far you have to go to become the thing you wish. The only way I've found around freaking out about how far you have to go is to look at the ground and place one foot in front of the other towards your destination and tell yourself that you'll get there someday. I suppose this "non-judgmental doctor" is just one more freakishly far away place I have to go and as long as I'm moving one foot in front of the other toward it as a goal, someday even if I don't ever get there, I will be far closer to it than if I had never moved at all.
Newbie-Doc
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