I wanted to write down some thoughts on clerkship at the end of my first week of Pediatrics, but, well I was on call 3 nights in 7 days and had a busy social schedule thereafter (that’s right! I have a social life! Probably more so than I had before clerkship to be honest, because I’m a lot more aggressively prioritizing it. I have plans almost every evening that I’m not on call.) I mostly wanted to write down what surprised me, and now I’m worried that I’ve already started to take things for granted that were totally new just a few weeks ago…
They say learning in medicine is like drinking from a fire hose. I say clerkship is like chugging Gatorade on a hot summer’s day when you’re thirsty during a strenuous bike ride. It’s kinda overwhelming because your heart’s pumping and some degree of spillage is inevitable, but you also kinda want to look like you can handle it in front of the people (or person) you’re with even though you can’t really. But most of all, the sugar and electrolytes and water replace what you don’t even realize you’ve been missing, and they produce pleasing sensations in your mouth and tummy and provide positive reinforcement for what you’ve been doing and help propel you forward. Anyway, I love it (clerkship), so far, almost as much as I love bike trips and mixing metaphors.
On my first day I felt like a deer in the headlights, like I literally didn’t know anything. What is a patient chart? What does it mean to be admitted to hospital? What’s rounding (is that how your body changes in response to sleep deprivation and consequent calorie overload?) What does it mean to be on call? And when should I wear scrubs and why do doctors wear them outside the hospitals–do they just really love spreading germs around? So I’m going to try to explain some of these concepts, because we’re not really taught them in the pre-clerkship years (because we’re too busy learning e.g. that the dentatorubrothalamic tract travels in the superior cerebellar peduncle; oh B&B, I’m still bitter!)
Patient chart – OK, this one’s pretty simple; at the hospital I’m at, it’s a binder containing all the information pertaining to the patient’s current hospital admission. Including a detailed history (what brought them to hospital), progress notes (have their vital signs been stable? have they had any difficulty breathing/eating/pooping/urinating etc? do they have any other complaints?), lab results etc. The tricky part sometimes is figuring out what information to file under what tab, and this can vary depending on what the patient was admitted for. For example, someone with an eating disorder has slightly different charts that are filled out compared to someone with kidney disease, and the infants in the neonatal intensive care unit have different charts compared to those same infants when they move to the pediatrics ward. At LGH, there are different tabs for physician’s notes and progress notes; progress notes are written by nurses, who generally check on their patients every few hours, whereas physician’s notes are written by doctors and medical students after morning rounds and if there are significant changes to the patient’s condition.
Rounding – This one I still don’t quite get, to be honest. So far my understanding is that after coming to the hospital in the morning (8am start where I’m at), we look at the charts for the patients admitted by pediatricians on our ward to see what happened overnight… was the patient stable, do they have any new symptoms etc. After reviewing the chart, we’ll go talk to the patient, ask some targeted questions and perform a focused physical exam to get an idea of how they’re doing today. Then we’ll go write up a note about what we did, signing with our name and MSI3 (stands for medical student intern, year 3). I think the idea also is to come up with a plan for the patient with our attending doctor – investigations, medications, consultations, plans for discharge, and include that in the progress note, but I haven’t done much of that yet.
Now for the softer stuff… for inpatient Peds I’ve been at Lions Gate Hospital on the beautiful North Shore and it’s been swell. I’m here on Peds with one other medical student, and he’s a fantastic colleague. The call rooms are plush but have no windows; I find them too dark at night and have an incredibly difficult time waking up in the morning, to the point where I’ve considered sleeping in the resident lounge instead – yay natural light! I’m still trying to figure out the food thing… Week 1 was amazing, I brought all my food from home, but was also carrying around like 7 Tupperwares… not exactly the pinnacle of elegance (not that that’s ever been my strong suit). Week 2, things started to slightly fall off the rails… and now it’s Week 3 and I’ve only been eating cafeteria food – which is actually great but expensive – and takeout. Lots of plastic waste, more animal products than I would consider ideal… I need to get back on track with preparing food, but it’s hard and I’ve been prioritizing spending time with friends, sleep and getting exercise over eating healthy. Can’t win ’em all, at least not at the same time.
I have this new policy where I don’t check Facebook (not Facebook Messenger, just Facebook the app where I get to fuel my narcissism and feel inadequate relative to other people simultaneously) at all while on hospital grounds. I was surprised by how much that’s helped me be less anxious and more productive, and some days I even feel like I can handle adulting (that doesn’t last very long). I still check Twitter on my breaks, but I find the ratio of news to humblebragging to overly flattering selfies much more favourable.
So to sum up, so far inpatient Peds has treated me fantastic, and I’m sad it’s going to be over so soon. As a hopeful family doctor to be, I can count on two hands the number of weeks of training I have left in any one discipline, such as Peds, so I’m trying to make the most of this very limited and special time. As Annie Dillard writes… “We have less time than we knew and that time buoyant, and cloven, lucent, and missile, and wild.”
In future posts, I’ll also explain being on call, hospital admissions, the scrub thing, what a consult is, who an “attending” is and why we’re using an adjective that sounds like a verb as a noun, inpatient vs. outpatient rotations… and probably more. I’d love to hear if anyone finds any of this remotely interesting or useful (or not!), so leave a comment below…
Riding the train through northern Puget Sound, likely not far from where Annie Dillard wrote Holy the Firm. “We have less time than we knew and that time buoyant, and cloven, lucent, and missile, and wild.”