doc w/ pen

a journalist becomes a doctor before your eyes

Month: January, 2018

Friendly inspiration

When I was in Chicago over winter break, I spent most of my time with my family. But I also caught up with my old “crafternoon” buddy. We talked shop, discussing the best paper collage glue and the sharpest scissors for maximum cutting precision. We also wandered the aisles of Hobby Lobby, picking up random treasures to use in our respective craft projects. Going to Hobby Lobby with a fellow craft addict is both marvelous and dangerous. Marvelous, in that you inspire each other with ideas on how to use this or that trinket; dangerous, in that you rationalize each other’s ever-expanding pile of purchases. But it’s mostly marvelous. My friend also graciously gifted me some vintage children’s book and magazine images, as well as other colorful paper.

Below are some of my recent origami crane cards, made with these new acquisitions. Click on any photo to open up a slideshow with larger images.

 

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Only in medical school … (#2)

The other morning, I was standing in front of my bathroom mirror, getting ready to head to the hospital. I had planned to leave at 6:50 a.m. It was already 6:45.  I felt rushed, running late. I still needed to put my make-up on. But in this moment, I was struggling with my hair. My springy red curls just weren’t sitting quite right around my face. So I grabbed a comb out of a bin on my bathroom’s narrow windowsill and with it parted my hair just left of center. I examined the new distribution of my curly locks.

“There,” I thought. “That looks better.”

But as I stared at myself in the mirror, I noticed that the hair on either side of the part wasn’t laying down flat. It bowed upward, each side threatening to defect to the other. I reached into that same bin and pulled out a bottle of hairspray. I spritzed the part and gently smoothed down both sides to prevent mutiny.

“That will keep my part patent,” I said aloud, to no one but myself.

I laughed. “Patent”? Who uses that word to describe hair? That’s a word we use in medicine to describe tubular structures in the body that are open and unobstructed, like healthy veins and arteries, or a stent that has been placed to keep a diseased artery open. Only someone in medicine would describe a part in their hair as “patent.”

Later in the day, I thought again about what I’d said, and how I should write this blog post. Again, I laughed, but for a different reason. I’d inadvertently applied one of my favorite literary elements, alliteration, to my inadvertent use of medical terminology in a nonmedical context. Alliteration is repetition of the same consonant letter (or sound) in adjacent or nearby words. In my statement: “patent part.” Only a writer would be likely to notice that.

In the busyness of clerkships, I find humor where I can. Sometimes, that means laughing at myself, and the funny fusion of my many facets.

Understanding the umbrella

I quickly snapped this picture while walking to the hospital this morning.

In Chicago, where I spent most of my life, “winter” means having to dig your car out from a mountain of snow and bundling up against sub-zero windchills. In New York, I’ve seen people wearing down jackets and gloves when the temperature plummets to *gasp* 50 degrees. When I see these people, I chuckle to myself.

“Wimps,” I whisper under my breath. “They think this is cold?”

But finally, today, we got a real winter day in New York City. It’s been snowing for hours now, with several inches predicted. And it’s coming down pretty hard, even by this Chicagoan’s lofty standards.

For perhaps the third time this winter (not counting the days I spent with my family in Chicago over Christmas), I donned my long, down coat. For the first time this year, I tugged on my heavy snow boots. (And was reminded just how heavy they are.)

As I trudged down the slick sidewalk toward the hospital, I wondered how those people who wore parkas in 50-degree weather were doing. I hoped they were surviving. I thought about how ridiculous all this thick, winter garb looks on everyone, but how no one cares (or laughs) because we’re all just trying to stay warm.

In New York, some people attempt to fight the snow with an umbrella. I took this picture to prove it.

And then I saw the umbrella.

Yes, the umbrella. I’d forgotten about the umbrella.

Different cultures handle adversity in different ways. New York City definitely qualifies as a separate culture. It’s practically a foreign country. And as I was reminded today, some New Yorkers handle the adversity of blowing snow by shielding themselves with umbrellas.

When confronted with this fact, I did exactly what I’d told myself we don’t do in winter: laugh at how people were coping with the weather. It just looks so ridiculous. This is not rain, people! It’s not falling straight down. It’s not even falling sideways. In this wicked wind, it’s swirling and blowing in every possible direction. The only way to truly protect yourself from being pelted is to hail a taxi. And lord knows how rush hour traffic in Manhattan is when it snows.

This is the thing about New York, though. Walking these streets, you see a little bit of everything. Everything from a woman wearing a turkey stuffed animal on her head to a guy strolling down the sidewalk in shiny-cotton-candy-pink spandex to commuters hiding under umbrellas in the falling snow. Sometimes you’ll stare, laugh, or shake your head. Sometimes another person stares, laughs, or shakes their head at you, because they think you’re the weird one. Somehow the city survives on this invisible undercurrent of understanding that we’re all a little weird, all a little different, and that’s ok. It’s actually pretty cool. Even if you carry an umbrella in the snow.

Be my doctor

Like it or not, medical school is full of tests. Some are useful. Others seem pointless. In a recent clinical assessment, I received important feedback that let me know that when it comes to patient care, I’m on the right track. I tell the story in this essay, which was originally published in the online magazine The American. You can see the original version here.

Be my doctor

On every medical school rotation, we have at least one OSCE, the clunky acronym for Objective Structured Clinical Examination. If I had my way, “structured” would be replaced by “stressful,” because that’s what it really is.

You’re asked to interview and examine a standardized patient (aka actor) while being both videotaped and watched live by real doctors, usually the people in charge of your clerkship, and your final grade. The observers work from a checklist (that’s where the “objective” comes from, I think) to measure your performance. Your “patient” has a different checklist.

I confess that being watched, videotaped, and assessed against a detailed to-do list makes me nervous, which makes me more likely to forget things that I otherwise wouldn’t.

Two weeks into my eight-week internal medicine rotation, I endured a particularly stressful OSCE. You had 20 minutes to conduct a focused history and a physical exam. (In an encounter with a patient, “focused” means tailoring your questions and physical exam to respond to the person’s “chief complaint.”) You’re given five minutes to discuss your diagnostic impression and develop a plan. On the spot, you needed to figure out what was wrong and what to do about it. After which you left the exam room, had five more minutes to organize your thoughts, before explaining your findings, assessment, and plan to the observing “attending” in a three-minute presentation, morning rounds-style.

Unlike most OSCEs, you didn’t know what was on the checklist ahead of time. As with most OSCEs, you had to make good on a certain number of items to pass. If you didn’t pass, you had to repeat the exercise.

Anxiety is built into this territory. But once I get going, I’m fine. Early nerves give way to clinical instincts.

This OSCE was no different. About 10 minutes before we each met our patient, we received a clinical scenario along with some lab values and vital signs. After reading up and thinking through what I’d ask and do, I met with and assessed the patient to synthesize her signs, symptoms, and story with what I’d read. I asked my questions, examined her, and quickly thought through my differential diagnosis. I then presented her with the most likely diagnosis, along with my proposed treatment. As a medical student, I informed her I would discuss everything with my team before proceeding.

I asked if she had any questions. Though she’d been hospitalized with pneumonia, she was most anxious about her breast cancer, which had been diagnosed earlier. She told me she wanted her family involved in understanding what was happening. I was impressed with her acting skills – tears seemed to well up in her eyes as she lay supine on the examining table. I put my hand on her shoulder and reassured her we would bring her family in, and together discuss everyone’s questions.

I was about to continue comforting her when a loudspeaker announcement abruptly informed me the encounter was over. I should leave the room immediately. I felt myself flush with frustration. My patient was in distress, on the verge of tears, and I had to abandon her — something I’d never do to a real patient.

I followed protocol: I left, thought through my findings, and returned to present them before my attending and the patient. Then came the feedback. The physician asked how I thought I’d done. I said I thought my physical exam skills were rusty since I hadn’t been practicing them much since an earlier rotation several months before. The “patient,” who apparently has been performing this same OSCE for years, emphatically disagreed. She said I’d just performed one of the most thorough physical exams she’d experienced in this OSCE go-round. More significantly, at least to me, the patient told me she wanted me as her doctor. “What kind of medicine are you going into?” she asked me. “Are you going to be practicing in New York?”

Yes, the patient was an actor, but I got the feeling she was only half joking. She said she felt genuine empathy and compassion from me, things she doesn’t sense from everyone. When she was distressed, I stood closer to her (but not too close) and actually touched her. I offered to bring in her family to answer their questions. She described me as confident but not arrogant. For example, while I was sure of myself in explaining my diagnostic impression and treatment plan, I also emphasized my role as a medical student, and how I’d first confirm everything with my team. She said I had a sense of humor – I’d made an impromptu joke about hospitals based on something she said, and I’d gotten her to laugh. She told me I was a good listener, explained things well, and made her feel comfortable.

Her compliments disarmed me. All I could say was “thank you.” Both patient and preceptor also offered constructive criticism, which is essential so I can improve.

But when it comes to improvement, compliments can be just as important as criticism. My patient’s invigorating observations reminded me that I was on the right track and needed to stay on it.

The experience was a boost on a number of levels. Maybe it’ll help calm my nerves before the next OSCE. Maybe it’ll help bolster my confidence when I finally treat real-life patients on my own. Though I haven’t even graduated from medical school yet, I now know there’s at least one person who wants me as her doctor.