ding!

I think my attending said it best to me at the hospital yesterday.

"We're not actually treating any of these patients. We're just trying to keep them from coming here."

And it hit me like a ton of bricks---there is so much in this life that I cannot "fix". It is something that I struggle with quite often. Therefore professionally, I want to fix.

Here I come--surgery, emergency or OB!!!

can you grab the knife in my back?

So I started this post back when I was on surgery and didn't want to finish it because I was worried about offending someone, or calling someone out, but after the last few weeks I've decided its important to say.

Med students do not always have the best intentions for other med students.

Take my dear friend, Joe, who was brutally f-ed over by a fellow med student, Kristi. She told him all he needed to do in the morning prior to rounding was to get vitals on every patient. So thats exactly what he did. Imagine his surprise when the attending lashed out on him when he didn't do a physical exam or find out why the patients needed surgery.

Or how about when my friend Alexis was working with John on medicine. They were on call together, and their team told them to go home for the night. John acted like he was going home in front of Alexis, but turned around (after she had left) and stayed the night, bonding with the residents to screw her over.

The worst is the med student who talks to residents about a fellow med student--in a not-so-positive-way.

And heres the other thing. As third years we are graded both subjectively and objectively--its to the benefit for some and to the detriment for others. As for my personal opinion---it can stink. You work your butt off to get a mediocre eval? Thats not good. But truthfully, I sometimes have a hard time with standardized tests, so to be praised for my hard work and have descent test scores is rewarding.

Plus! When did we stop being happy for one another? When did we stop saying "Congrats!" to a fellow med student when they found out they rocked a test? Or when did we stop saying good luck to other students prior to tests? My first year of med school I made over 400 good luck notes to each classmate---and I sincerely meant it. We're all a team here---we can do this by ourselves and be miserable, or we can work as one and succeed together ---even if it's just one of us succeeding at the moment. I miss that in my fellow students. Lets see more of that.

yeah, he's gonna die

So maybe I'm just a bit too sensitive lately. Or maybe I'm just too much of a novice, but lately the phrase "he's going to die" is really starting to tick me off. My next thought is "do something about it!!" Which is weird because when we're in the patient's room and they're on death's door, all I can think is man, I wish someone would help put them out of their misery.

So I guess I'm really conflicted with the whole death thing. On one hand I think we should do something when the patient is headed in that direction (that is definitely the surgeon mind in me). And on the other, if they are elderly and can't do anything for themselves, I think why is physician assisted death so bad?

I think the other thing my attendings have failed in mentioning, or perhaps even doing, is when a patient is on death's door and it seems like we're not doing anything to prevent it, its a really good time to talk to the family, make sure the patient is comfortable, if there is anything the patient would have wanted in those final days, and work on those kinds of things. Otherwise it seems like getting that final CT of their abdomen really isn't that important anymore.

frusteration builds.....

Recently we got a patient who is well known for leaving AMA (against medical advice). She continues to pop her hip out of place, get surgery, and then just when we're about to send her to an inpatient rehab, she leaves AMA. This has happened 4 times. None of the nurses like her; the case manager is ready to pull her hair out when we ask her to find placement; and now the surgeon refuses to fix her hip again.

Now I can understand the frusteration. I can't imagine doing this over and over and over and over. But guess what? Thats what we do anyway---its just on different patients. So part of me thinks, just suck it up and do your job. We're here to help people. That's what we signed up for. Residents, nurses, case managers get paid the same amount every year and it doesn't matter who we help, how many we help, etc. So you can understand why I got tiffed when the case manager said, "And just think-- Hillary Clinton is going to tell us we have to do this for everyone!!! Like hell I am! I am retiring if that happens."

I guess I just don't understand why it matters. People could care less if a medical student delivers their baby, and yet, the idea of everyone having an oppertunity to get well again by having health care available to all, absolutely freaks people out.

A person is a person is a person. Now make the f-ing phone call and get Ms AMA inpatient rehab.