And so our fateful hero returns (that’s me, if you were unaware), after an exhaustion-induced hiatus, secondary to starting clerkships. Specifically, the surgical clerkship. I’ll start with my thoughts about clerkships in general, and then maybe dive into the life of a surgeon (or surgical clinical student).
Quick background: medical students do two years of classroom work (known as pre-clinical), then take a really freaking hard 8-hour test (known as “The Boards” or “Step One”). Then we spend our next two years working in the hospital in different specialties, seeing which ones we like, which we don’t, and trying to get exposure to that which is actually medicine.
So it’s the Sunday night before I’m about to begin, and I’m just nervous as hell. I know that the next day is going to be only orientation, with no actual patient interaction or anything, but my eager/anxious pit in my stomach has been swelling all night. Monday is very orientation-ish, with nothing too boring, and nothing too exciting. We talk about expectations, learn how to scrub into surgery, how to get into sterile gowns, get a basic idea of how clerkships and clinics work, have a couple lectures on surgery, and a workshop on suturing and tying knots. More on that whole business later. I iron all my shirts, have the better half show me which ties go with which shirts, and try to go to bed early.
Tuesday is the first official day. I’ve reviewed how to talk to a patient (called “taking a history”) and examining a patient (called “examining a patient”). I’ve read suggestions from classmates and previous students, and I’ve excitedly received my first page to learn what time to report to my team. Tuesday arrives, I wake up early (“early” still means about 6am, ha!), shower, get dressed, and drive over to my hospital where I’ll spend the next month.
I meet my team, which consists of a chief resident, two interns, and myself. Lots of personal attention, but lots of responsibility. I’m starting to already realize everything in medicine (and life?) is a trade-off. More attention, more responsibility. Give a drug for this problem, it causes that one. Perform this procedure for a disease with risk amount X, and hope that it’s less than the new risks you’ve made from the surgery.
You’re really, I mean really, just thrown in there. You finish second year taking your boards, and you think you’ve got medicine down pat. You know what every drug does and what it treats, you know how every disease process works. And then you get into clinics, and you’re immediately humbled. You know nothing. There are new acronyms, strange new drug names, new locations, new computer systems, and new people. But to everyone else, it’s totally normal. You’re already playing catch-up.
You don’t want to seem like an idiot, but you’re also excited and inquizative. But you don’t want to be annoying, either. Your team isn’t just your team, it’s also people that are evaluating you, and trying to feel you out to see what kind of a team member you’re going to be. So you ask questions about things you’ve never ever heard of, and take notes to try to look up the rest later. You learn to mutter questions quietly and secretly to nurses and your interns, who will probably help you out (and aren’t really evaluating you as critically): they just finished medical school 3 weeks ago, so it’s easiest for them to remember where you’re at.
I quickly realized that real medicine is very different from ideal medicine. You’re supposed to give everyone a full check-up, look in their eyes, ears, and nose, and feel for their thyroid, but who has time for that? And different specialties want different things. Surgeons are obsessed with infections, fluids, nutrition, pooping, and farting. The obsession with the latter two is still novel to me. A patient told me he had a “tremendous fart,” and I was disappointed when no one else on my team even smirked at the description.
Feeling stupid makes you learn quickly, which is one reason I’m usually not too distraught when I get an answer wrong: I know it’ll be locked into my head from that point on. At the same time, “don’t get sick in July” is just way too true. Your doctors won’t be as quick to get a diagnosis, and your sutures won’t be as straight. Everyone’s supervised by multiple people, but July is usually especially hectic. You get a flood of new medical students, newly-graduated doctors, new residents, and new official attendings. Everyone’s trying to figure everything out, and it can be difficult.
The feeling has faded now, but I was so surprised at how very entitled I felt after my first week in the hospital. I was working 12-14 hour days, 80-90% on my feet, and I really felt like I should be getting some sort of special treatment because of it. That I should be rewarded or recognized for it. I wanted to go to the mall in my scrubs with my operating room hat hair so everyone would see that I’m a hard-working medical student. It was cognitivie dissonance at its finest: I’m paying $50k a year to work my ass off, so I figure there must be something I’m getting out of it right now. It was such a strong feeling that it really took some conscious effort to remind myself that I chose this path (and thank you, blog, for reminding me).
I’m incredibly exhausted, but incredibly happy. I’ve really started to get the hang of this whole clerkships thing (so far, at least), and it’s been a really amazing experience to see many of our patients go from the ICU to the wards to being discharged. I’m going to miss seeing them so frequently. And to you, the patient that we lost two weeks ago, and to your family, who allowed me to be part of the discussion about you: you’re one I will never forget. Thank you for your friendly smiles and waves each morning, and for trusting me into a most private part of your life. That physicians have the privelege and honor to be part of patients’ lives is a most amazing and sacred part of the practice.