Friday, September 23, 2011

"this is an atypical day"

When the first year medical students took their first standardized patient assessment last week, one theme that emerged from the debrief was that their level of skill was not deserving of the white coat that we make them wear. We try to explain to them that by virtue of starting the training, they are already becoming acculturated to the identity of being a physician, and instead of feeling unworthy, they should instead work as hard as they can to become worthy to their patients.

I should have taken my own advice as I crept into the hospital today to shadow my first ward team.

There are lots of perks to my job. One is free, informal medical care. Another, however, is that I can contact almost any of the physicians I work with and say things like, "hey, would you mind if I shadowed you on rounds some morning?" and the answer is almost always yes. I have never taken advantage of this in the past, for a tangential reason that the students touch on: while I will never receive a white coat during my tenure, I feel unworthy to be another body taking up space in the business of saving lives. However, I apparently know enough to not to be annoying to either patients or the team, and so I sat still while the attending listened to presentations by the interns.

I've worked with Jackie for at least five years, and it's interesting to see how similar she is in "doctor" mode to her "teacher" mode. She still uses "fantastic" to describe information that she's happy about, and still asks a lot of related questions to check fund of knowledge of her team. However, instead of feeling extraneous, like it sometimes does in the classroom, it feels encouraging in the hospital setting. While the patient should be and is the most important thing in the presentations, I found myself heartened by the fact that she still tried to push the team's knowledge and give them something of value to take away from the session.

During the second patient round, I found myself looking around at a familiar setting. Same bed, same tray with toothpaste, same NG tube suction device on the wall. It was strange to think of myself on the other side of my dad's hospitalization. Now I was the one who knew what was being talked about right outside a patient's door, or that the seven minutes that was spent at the patient's bedside was easily tripled just in discussing the patient's current status, assessment, and plan behind the locked door of the ward room. Stanford is nice because they had set up an actual folding bed in the patient's room on which her husband could sleep, instead of tacitly allowing him to sleep on the floor by her bed, which is how my mom and I spent our nights after my dad's sugeries. I was touched by that foresight in resources.

I took pages of notes, mostly jargon and acronyms that I wanted to look up later. The medical student on the team, who I knew pretty well, spend some time explaining terms to me. I think he was grateful to flip the role to teacher for a little while. While we were visiting the third patient, we ran into another med student. One of this team's patients had been transferred to her team's care, so she gave an update on the fly. This was the second unexpected hand-off of information, the first being a quick conversation by the elevators with another attending about how to proceed with another patient's treatment plan. I was impressed with the sheer amount of information that gets transferred, in both formal and informal ways.

Of course, no walkarounds with strangers could be complete without a comment on my hair, which occurred in the final patient's room.

"I love your hair," the patient's roommate murmured. I usually give a part-humble, part-magnanimous response, but I knew that she didn't need another strange person in her room patronizing her when she just wanted to get home. I thanked her shyly, and tried to press my body into the wall to stay out of the way.

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