My first week of inpatient medicine was exciting and amazing. Patients came in very sick and one to two days later they were able to come home again. From my eyes, it looked as though patients were on the verge of death and were given another chance at life everyday in inpatient medicine. I found it so exciting that we were able to diagnosis a problem and fix it- what could be more gratifying than that?!
Unfortunately, at a metropolitan hospital, not every patient wants to get helped. In fact, we had several patients who left "AMA" against medical advice for one reason or another. One patient in particular really disturbed me when he left AMA. A patient came in for a life-threatening condition where his airways were closing up and he was unable to breath. Since he was so sick, he had to get a tube placed into his throat to breath for him. For several days, he was kept alive through the help of machines. On the 4th day, he woke up and extubated himself (a crazy painful ridiculous thing to do) and demanded to be discharged. He was brought to our floor to stabilize his other medical problems, try and figure out what caused his airways to close up in the first place, and to make sure that he was stable enough to go home. Within 5 minutes of arriving, he demanded to leave. I spoke with him to try and find out why he wanted to leave. I thought that if I tried hard enough, I could convince him to stay, I could be his advocate. Instead, after everyone on our team tried to reason with him he walked out. I felt really uncomfortable watching a man who I knew would not live much longer without medical help walk out, convinced he was doing the right thing for himself. He was so proud that he showed the doctors who was "boss." He loved making a scene. It was really painful for me to see that his need for another drink was leading him to a very soon early grave. He could not be reasoned with and everyone on the team shrugged him off. In the end, we cannot make a patient do anything. A patient has the right to make their own decisions, even if they are the wrong decision. Even so, it was really discomforting to know that the next time I saw this patient medicine would not be able to do much to help him. To me, it was my first experience watching a patient die.
Saturday, September 13, 2008
Sunday, September 07, 2008
Outpatient --> Inpatient
I completed my 2 month rotation in family medicine and outpatient clinics (TB, urology, cardiology, ENT, ID, ortho peds, rheumatology). Although my first week was overwhelming (wait I have to remember all the right questions to ask the patient, do the right physical exam techniques, remember my findings, write a note, present my findings to my attending, and carry a conversation with a patient I just met?!), I used the low-pressure outpatient clinics to stay positive and focus on doing better with each clinic. Each day I feel like I was able to improve on something or learn something new or really reach out to one patient... but each day I did that I was confronted with 1000s of things I still hadn't learned, the reality of how much better I could have done something, or thing I shouldn't have said. With each day I felt like it was one step forward and a 28479 steps backwards.
I met so many amazing patients in such a short time- one afternoon I had a patient who was an inmate, a middle-aged woman who never learned how to read, and a male to female transgendered patient. I felt privileged and even excited to be able to work with so many interesting patients, even though it was through considerable hardship in their life that they became "interesting patients." My outpatient experience was exciting everyday because everything was so new- I'm sure that migraines aren't thrilling for most practicing physicians but for me, it was such a thrill to have a patient who I wanted to help, read about how to help her, and recommend the appropriate treatment for her.
Although most days were exciting for me, I had a few days when I felt a tug of the negativity of medicine that so many of my classmates have warned me about. I worked with a patient who had many serious health problems and yet was always ready to blame someone else or something else for the poor care she took of herself. I was really discouraged to meet someone who didn't seem to be invested or even interested in their health. This woman's health problems were a reason for her to be concerned and to make life changes; instead, she did nothing and came to see a physician sparsely. As I talked to her about ways that she could improve her health I started feeling resentful for talking to this woman who clearly didn't seem to care about her health. I disliked this woman for her excuses, for her poor health habits, for her disdain of her own body. This woman was going to die very soon as a young woman with poor habits, and she totally did not seem to care when she was told this. I left clinic that day feeling deflated. I was disappointed in myself. I felt guilty for having a visceral emotional response to this woman. I felt guilty that I found being negative about patient interactions. After speaking with other students and physicians I learned that everyone gets a patient like this. The trait that I realized would be helpful in my future would be to learn that coping with situations and being able to move on from them. In my last week of clinic, I was able to see this patient again. She had started to make some positive changes that I was very eager to hear about but I still had a negative thought in the back of my mind questioning whether she would be able to maintain these positive changes.
I hope to keep all the valuable lessons I learned in my first 2 months in mind with my next rotations. Tomorrow is my first day of inpatient medicine- my first taste of the grueling hospital hours of medicine, my first experience with overnight calls, my first opportunity to work with very sick patients. I'm not sure what to expect with this new rotation. One thing that I know will be true throughout the next two months- I will always have much more learning to do.
I met so many amazing patients in such a short time- one afternoon I had a patient who was an inmate, a middle-aged woman who never learned how to read, and a male to female transgendered patient. I felt privileged and even excited to be able to work with so many interesting patients, even though it was through considerable hardship in their life that they became "interesting patients." My outpatient experience was exciting everyday because everything was so new- I'm sure that migraines aren't thrilling for most practicing physicians but for me, it was such a thrill to have a patient who I wanted to help, read about how to help her, and recommend the appropriate treatment for her.
Although most days were exciting for me, I had a few days when I felt a tug of the negativity of medicine that so many of my classmates have warned me about. I worked with a patient who had many serious health problems and yet was always ready to blame someone else or something else for the poor care she took of herself. I was really discouraged to meet someone who didn't seem to be invested or even interested in their health. This woman's health problems were a reason for her to be concerned and to make life changes; instead, she did nothing and came to see a physician sparsely. As I talked to her about ways that she could improve her health I started feeling resentful for talking to this woman who clearly didn't seem to care about her health. I disliked this woman for her excuses, for her poor health habits, for her disdain of her own body. This woman was going to die very soon as a young woman with poor habits, and she totally did not seem to care when she was told this. I left clinic that day feeling deflated. I was disappointed in myself. I felt guilty for having a visceral emotional response to this woman. I felt guilty that I found being negative about patient interactions. After speaking with other students and physicians I learned that everyone gets a patient like this. The trait that I realized would be helpful in my future would be to learn that coping with situations and being able to move on from them. In my last week of clinic, I was able to see this patient again. She had started to make some positive changes that I was very eager to hear about but I still had a negative thought in the back of my mind questioning whether she would be able to maintain these positive changes.
I hope to keep all the valuable lessons I learned in my first 2 months in mind with my next rotations. Tomorrow is my first day of inpatient medicine- my first taste of the grueling hospital hours of medicine, my first experience with overnight calls, my first opportunity to work with very sick patients. I'm not sure what to expect with this new rotation. One thing that I know will be true throughout the next two months- I will always have much more learning to do.
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