Newbie Dad
Tuesday, August 31, 2010
Newbie Dad
Just a really quick update on the baby (My wife won't let me tell people his name...I really like the name :S). It's crazy how attached we are getting to this little guy, he really kicks my wife a lot now, mostly at night. I get right up to her belly and talk to him...sometimes it seems to calm him down almost. Last night though, I told him I was going to wrestle him when he got out of his momma's belly if he didn't leave her alone...suddenly he paused in his "thumping" on her (as if he was contemplating the consequences)...and then he kicked her abdominal wall so hard you could almost see the foot imprint pressing out on my wife's belly...what a little rascal...I wonder often what he's going to be like when he grows up. My wife and I are already so attached to him and we haven't even really seen him yet...this whole thing is giving me a whole new perspective on my parents, my patients, and life in general.
Newbie Dad
Newbie Dad
Scrambled Insides = Scrambled Intern
2nd day on the job and already much easier...there could be a lot of different factors at play causing this, I think the biggest one is that I discharged 2 of my patients and so now I am only carrying 2 total...I'm told this isn't a good thing. Each intern has a personal cap of 9 patients (the biggest I've ever had)...so while I'm on easy street it's really similar to a red neck who just one the lotto...easy come, easy go...I'm open for 7 admits, which if I get all at once will be hell on earth...and it's happened before, so I've been told by my wise seniors. I'm crossing my fingers I will build up my list slow though..it's all I really can do.
One thing that never gets easier on the blog or in medicine is making and admitting to mistakes. This one wasn't a mistake in my medical judgment though...really what it was is that I was rushed and I was cutting corners, which is ridiculously immature. My complex patient (who I'm calling Jamie) has a lot of problems and a really deep history (by deep I mean her daily progress notes make a small novel). I was rushed yesterday while learning all the new things you have to learn on your first day and so I did a down and dirty run through of "who she was" and made myself well acquainted with her "acute" history, but only very lightly skimmed her back story. Yesterday, I'd made a note to know her in and out before rounds today, but as we were yet again pressed for time today I again managed her acute issues and brushed through her history very, very briefly...passing by a word called in her history "Heterotaxy"...I was skimming. I thought about it and I had never heard of it before. "Must be some neurological finding.", I thought to myself. I kept on skimming and never thought to look it up...that was my mistake. Well I can tell you exactly what the word "Heterotaxy" means now. That one word is the explanation for all of her complex pathophysiology, directly or indirectly, from her heart malformation to her kidney insufficiency. If they had said "Situs Ambiguus" it might have caught my eye more, because I know of a similar condition, "Situs Inversus".
Most people, unless you are extremely unlucky, are born with their organs in particular positions. For instance, the heart faces ventricles left in most, the spleen is on the left of the abdomen, and the liver on the right. What if you took that image and "inverted" it (like a mirror)...that is "Situs Inversus". Having your organs in "mirror" position can cause problems (arteries can get "kinked", surgeons can operate on the left when they need to be on the right, etc.). "Situs Ambiguus" is somewhere in between, it covers a lot of different defects in the organs, as well as, a lot of different organ orientations. This seemingly simple word, "Heterotaxy" defines my patients clinical picture...and in a effort to be efficient I glazed right over it...so you can see how much of an ass that made me while presenting in front of my group. I start presenting and the attending had to break in and correct the history, because I didn't know the patient well enough...pathetic, considering I only have two patients. Luckily, I redeemed myself because I was managing her health care very well (in the acute setting)...still a major stigma not knowing her full history like that. I can learn two things from this, if you see a word you don't know...LOOK IT UP!!!!!!! and secondly, know WHY you are treating your patient, don't get so lost in the minutia that you can't or won't see the big picture. As for my student...
I don't know much about teaching and I'm not really sure if I should be teaching a medical student when I myself am still learning, but I sat her down after rounds and talked to her about my presentation. I carefully pointed out each of my mistakes and how I could have corrected them...I also pointed out the very obvious lapse in clinical thoroughness, why I made that mistake...I thought the "why she shouldn't do what I did" was pretty obvious ;P (seriously though it sucked). I then talked about her patient and her presentation, I tried to be much less critical of her than I was of me and instead highlighted the things she did good (I've heard that it's a better way to teach than to point out all of the students mistakes...I'm trying to figure this teaching thing out as I go). I did point out one mistake of her's though, but instead of telling her specifically what she did wrong and how she could correct it, I instead compared it to a mistake I made on a patient not too long ago...showing why it was a mistake and why it needed to be done differently, by my story and not by hers. I don't know if this was the right way to "teach" it, but I really hated it when residents taught me by just pointing out mistakes and then would say "fix this" when I was a medical school student...I don't know I'm honestly really at a loss for all this...it's hard feeling a responsibility and obligation to do something for someone and simultaneously know that you are the one of the least qualified people to be filling those shoes (but you have to anyway).
Ha, I think that last statement actually sums up residency quite nicely, because I often feel the exact same way towards my patients. In that respect, maybe my goal for my student should be the same as the one I hold for my patients I care for...to do the best I can possibly do and leave them both, at least, a little better off than when I found them.
Newbie Doc
One thing that never gets easier on the blog or in medicine is making and admitting to mistakes. This one wasn't a mistake in my medical judgment though...really what it was is that I was rushed and I was cutting corners, which is ridiculously immature. My complex patient (who I'm calling Jamie) has a lot of problems and a really deep history (by deep I mean her daily progress notes make a small novel). I was rushed yesterday while learning all the new things you have to learn on your first day and so I did a down and dirty run through of "who she was" and made myself well acquainted with her "acute" history, but only very lightly skimmed her back story. Yesterday, I'd made a note to know her in and out before rounds today, but as we were yet again pressed for time today I again managed her acute issues and brushed through her history very, very briefly...passing by a word called in her history "Heterotaxy"...I was skimming. I thought about it and I had never heard of it before. "Must be some neurological finding.", I thought to myself. I kept on skimming and never thought to look it up...that was my mistake. Well I can tell you exactly what the word "Heterotaxy" means now. That one word is the explanation for all of her complex pathophysiology, directly or indirectly, from her heart malformation to her kidney insufficiency. If they had said "Situs Ambiguus" it might have caught my eye more, because I know of a similar condition, "Situs Inversus".
Most people, unless you are extremely unlucky, are born with their organs in particular positions. For instance, the heart faces ventricles left in most, the spleen is on the left of the abdomen, and the liver on the right. What if you took that image and "inverted" it (like a mirror)...that is "Situs Inversus". Having your organs in "mirror" position can cause problems (arteries can get "kinked", surgeons can operate on the left when they need to be on the right, etc.). "Situs Ambiguus" is somewhere in between, it covers a lot of different defects in the organs, as well as, a lot of different organ orientations. This seemingly simple word, "Heterotaxy" defines my patients clinical picture...and in a effort to be efficient I glazed right over it...so you can see how much of an ass that made me while presenting in front of my group. I start presenting and the attending had to break in and correct the history, because I didn't know the patient well enough...pathetic, considering I only have two patients. Luckily, I redeemed myself because I was managing her health care very well (in the acute setting)...still a major stigma not knowing her full history like that. I can learn two things from this, if you see a word you don't know...LOOK IT UP!!!!!!! and secondly, know WHY you are treating your patient, don't get so lost in the minutia that you can't or won't see the big picture. As for my student...
I don't know much about teaching and I'm not really sure if I should be teaching a medical student when I myself am still learning, but I sat her down after rounds and talked to her about my presentation. I carefully pointed out each of my mistakes and how I could have corrected them...I also pointed out the very obvious lapse in clinical thoroughness, why I made that mistake...I thought the "why she shouldn't do what I did" was pretty obvious ;P (seriously though it sucked). I then talked about her patient and her presentation, I tried to be much less critical of her than I was of me and instead highlighted the things she did good (I've heard that it's a better way to teach than to point out all of the students mistakes...I'm trying to figure this teaching thing out as I go). I did point out one mistake of her's though, but instead of telling her specifically what she did wrong and how she could correct it, I instead compared it to a mistake I made on a patient not too long ago...showing why it was a mistake and why it needed to be done differently, by my story and not by hers. I don't know if this was the right way to "teach" it, but I really hated it when residents taught me by just pointing out mistakes and then would say "fix this" when I was a medical school student...I don't know I'm honestly really at a loss for all this...it's hard feeling a responsibility and obligation to do something for someone and simultaneously know that you are the one of the least qualified people to be filling those shoes (but you have to anyway).
Ha, I think that last statement actually sums up residency quite nicely, because I often feel the exact same way towards my patients. In that respect, maybe my goal for my student should be the same as the one I hold for my patients I care for...to do the best I can possibly do and leave them both, at least, a little better off than when I found them.
Newbie Doc
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