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[clustersoflife]

Perspective

https://www.nejm.org/doi/full/10.1056/NEJMp1806388

“I was stumped. Worse, I didn’t know why we needed to know. Nowhere in the books or the studies I’d read had a dog’s name contributed to the differential. But the attending took us back to the patient’s bedside and asked. “Rocky,” the patient said. And there followed a brief conversation that was more colorful than any other I’d had with a patient that day. It led to a transformation I did not fully appreciate at the time: there was an actual person behind that hospital-issued gown.Four years later, I’m not sure anything I’ve carried from residency has been more useful than that question.“

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Today I got yelled out and I threw that shit right back

A unit charge nurse yells at me claiming that somnolent, post-anesthesia patient is “pissed off” at me. I tell her “don’t put your problems with me on the patient, I’m right here, you can tell me yourself.” She starts giving me that fake ass “oh doctor I would never have a problem with you!” Like I don’t have eyes and ears. She yells at and bullies every nurse in her unit and harasses all the residents. I just stood there and kept repeating “use your own words and tell me what your problem is with me.” Until she snapped and said, “put your orders in faster!” To which I replied “that wasn’t so hard, right?”

The heme fellow yells at me because I’m being “insubordinate” for not doing his discharge for him (medicine was only consulted on this patient) I just hung up on him. He complains to my attending who tells him to do his own work and also hangs up on him.

ID fellow claims that I placed a consult on Sunday with him on a patient I don’t even know. He’s angry that I keep vehemently denying it and is in the corner with his attending. He keeps loudly whispering “she’s lying, I know it.” And I walk up to those two cowards and say “if you want to talk about me, have the decency to say it to my face.” They start stuttering and mumbling. Worthless. Turns out it was another female attending and the ID fellow messed up because he didn’t follow-up on the consult like he should have.

This rotation has made me so angry but I have to say that I’ve learned to fight for myself in the process. Because when no one will come to the rescue, sometimes we just rescue ourselves. I found a bravery in me that I didn’t know I had. I’m an angrier, more bitter, and exhausted person but I will never be pushed around again.

Moral of the story: Do no harm, but take no shit.

[clustersoflife]

classes on evolution used to talk about survival of the fittest-i imagined it abstract, but maybe we should've been studying 1984 instead

[clustersoflife]

Kobe Bryant once said in an interview that the peacefulness of an empty arena is beautiful, and I cannot help but agree to one of my all-time favorites. The energy you get from the serenity of an empty court, gym, or arena is more than enough inspiration to get yourself moving. I like working alone. I repetition. I believe people would get bored out of their wits if they see me practice because I simply do the same thing over and over and over and over and over again. I like repeating not because I like the rhythmic patterns of routines–although that’s part of it–but because it gives my body, my mind, and my heart the memory it needs to remind me what I need to do when it is needed to be done. I even apologize to my coaches for always asking them to elaborate everything to me, not because I don’t get it, but I would like to know how it’s done, why it’s done, and how it would look like once it’s done. And I would unceasingly apologize to them for being too keen with these details–I just want to know the reason behind every jab, every fake, every shot.

I have been playing for more than half of my life, and one thing remains the same, that basketball is a way of life; it’s either you live it or you leave it and that there should never be any excuses. It’s either you do it or you don’t, you find time or you make time, you simply just do it.

My parents have witnessed how basketball grew in me and I’m just thankful that even though sometimes they make me quit, they never stopped me from continuously letting basketball into my life. I overheard my mom talking to her friend the other day after seeing me fix my training bag for the next day, “she loves it too much, she once tried to quit but she hated herself for even thinking of that.”

Kobe wrote in his retirement poem, “you asked for my hustle, I gave you my heart”, but I think he forgot to put in, “and so much more”.

[clustersoflife]

Currently studying for my MCATS, I’ll be using mostly TPR review books, Kaplan Verbal, EC’s 101 series, and AAMC question pack as well as their tests. TPR and Kaplan both offer 3 full exams buy purchasing one book, and I’ll be purchasing the 10 full exams from NEXSTEP as well, along with the new full exam from AAMC. 

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I know my weaknesses, I know my strengths, and at times. I know I’ve done poorly in school in my first years, but I’ve been able to completely change that this year. I’ve worked really hard for my grades, but at the same time didn’t kill myself over them. Since other things are as important to me as ever, I believe that maintaining an average around 85% was better than an above 90% (I’m talking above GPA conversions, so anything between 85-89% is a 3.9 which is above cutoff for the school I’m looking at). 

I’m a person of faith, and with all sincerity I’m going to be putting the rest in Gods’ hands. I will push myself to do better and hope for the best. I am going to are about the little things, and I’m going to ensure that I get into med school.

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I am just a medical student.

She’s 58, but appears maybe three days older than 42. Her eyes are sunken, tearful, worried, anxious.  She tells me about her two grandchildren, and how she just visited them in Michigan.  She came to the hospital, straight from the airport.  She’s worried.  

She’s worried because her shortness of breath hasn’t gone away for over a month now.  She has had breast cancer, and opted for a more conservative approach - a lumpectomy with axillary node biopsy without radiation.  She’s admitted, and gets a chest x-ray and a CT scan, which show a pleural effusion with what looks like nodules in both lungs.  'Likely represents metastatic disease,’ reads the official radiology report. She knows, so I don’t bring it up again.

‘I am just a medical student,’ I think. 

On the second day, she undergoes surgery to evacuate the effusion, and her lung is biopsied.  Now, we wait for the pathology report.  I visit her everyday as we wait, sometimes two or three times. I’ve met her husband, and we know each other by first names.  Her daughter and son are also beautiful people, just like her.  They ask me questions, and I keep my answers limited to what I’ve read in the chart. They never ask me about the cancer. They know what the radiology report said, so I don’t bring it up again.

'I am just a medical student,’ I think.

She never complains. Not from post-operative pain, not from shortness of breath, not from coughing, not from anything.  I take my time with my physical exam, ensuring that I don’t miss any tenderness.  I don’t want her to suffer unnecessarily.  "Surgery is painful,“ I tell her, "make sure you let us know if you are in pain.”  She agrees, but never complains.  

The nurse corners me one afternoon, and asks me, “Is there any way to put in an order for morphine PRN for her?" 

'I am just a medical student,’ I think.

"Why?”, I ask.  

“Because when her family isn’t here, when she’s alone, she cries.  She’s in pain, she’s scared, but she’s a silent sufferer.”

Oh.

I am the first person she sees every morning, and I try to make sure she’s comfortable.  I offer extra blankets, water, anything I can do just to make sure she is as happy as she can be.  She appears more and more cheerful, and I spend what seems like hours holding her hand and chatting about life, the weather, her family, my family, my future goals, my girlfriend.  I show her pictures.  We laugh. We smile. But her eyes remain anxious and worried. 

She says she likes my bowties, so I make sure to wear one everyday for her.  And I tell her, “I thought of you when I put this one on this morning.”  She smiles through those tearful, anxious, worried eyes.  I smile back. And that is enough to make my day.

I walk in with my bowtie and smile around 6:30pm. She just got back from the CT scanner, and her family is around her bed, as per usual.  I visited, just to say good-bye for the day.  The sun dips a few degrees further West, just enough to peak through the curtains, and her husband turns to me and says, “Edwin, thanks for bringing the sunshine.”

I stand there, in a loss for words, armed with little more than a bowtie and a smile.

'I am just a medical student,’ I think.

“There’s something of yourself that you leave with every meeting with another person…” – Fred Rogers

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“That morning, I decided to write a letter to my future self. I planned to read it on the toughest of days, as a way to remember the anticipation I felt on Match Day.”

OB/GYN resident physician D. Kesley Robertson, MD at Emory University School of Medicine reflects on his first year of residency and advice for incoming interns, as part of the in-House “s/p The Match – One Year Later” theme issue dedicated to #Match2017.

http://in-housestaff.org/perfection-community-gratitude-623