Thursday, August 17, 2006

Learn from someone else's mistake #1: Humour and patients

It feels good to sit down after an 11-hour shift. And, I get to sleep in tomorrow (that's the good news; the bad news is it's because I'm doing a night shift tomorrow starting at 10:30 pm.)

Story time.

As we left the patient, the doctor pointed to a dressing cart and said, "How about you put some gauze and tape on her cut so her dad doesn't have to hold that tissue paper on it."

"Oooh," I thought, "I get to talk to a patient! No doctor in the room! Awesome!"

I collected myself and grabbed a roll of tape and some gauze, and carefully put it on the ninth-grader's wound in a very amateur and untrained fashion that is probably contraindicated in every way and will cause the nurses to shake their heads and mock me under their breath as soon as they seen it. But as I left, I said the fatal line:

"That should keep your dad from having to have his arm up for the next few hours!" Ha, ha, ha, I thought. A few hours. I'm so kind-hearted, cracking a witty joke and keeping these patients smiling.

The reaction was not what I expected.

The girl's eyes went big in horror and shock.

"A few hours?!"

They had been there for hours already and had seen us walk by their room several times to see other patients - likely including patients who arrived after they did. I quickly learned a lesson from the poor girl's reaction to my offhand comment: When it comes to joking around with ER patients, they don't find it funny if you make a joke along the lines that they have a long time left to wait. Most of them have been there long enough just to see a doctor. Unfortunately, they will likely be waiting there for a while longer as they wait for labs and xrays to come back. But don't remind them. Especially in joke form.

I figure that this could be the first of many mistakes that I post here, mine and others (med school classmates beware). Yes, I have come to terms with the fact that I may do two or three things wrong over the course of my medical education. So I'll try to immortalize them as they come along in what could be a great new VM miniseries. And hey, why not just talk about my mistakes? Here's another one. One that I didn't make.

This I learned from the doc I was following: Never give a patient any definite indication of how much longer they'll have to wait. Not that you should avoid the question or lie to them. It's just that things can get crazy. A patient we were seeing was getting antsy to go home, and he asked how long he'd be. The doc explained, "We're going to refer you to a specialist, Dr. Frist. We've paged Dr. Frist, and she always responds to her pages right away, so you shouldn't be here longer than ten or fifteen minutes." On top of all hell breaking loose in the ER, this also marked pretty much the first time that Dr. Frist didn't return a page. I felt really bad when I noticed him still in his bed an hour later and went over to explain what had happened.

Shadowing doctors is great now that I'm a medical student and not just a pre-med. Maybe it's just the docs I'm working with, but I've noticed a difference. Even though what I'm allowed to do is still very limited, the doctors have that much more respect for me. I've had deep conversations with six or eight doctors where they've gone into detail on questions I've asked about about their experiences in med school, lifestyles of various residencies, pros and cons of specialties. One gave me good advice about going the military route to pay for med school. And I've been so surprised by how much they care about my future.

All the stuff they're letting me do is part of that respect. Even though it's just been little stuff like going to a patient on my own and explaining that we'll need to run some more tests, or reducing a dislocated shoulder, or putting on a cast (the last two under close supervision), it's a good feeling when the patient asks why more tests are needed and I can explain, or feeling the shoulder pop back into place, or hearing the patient say "that cast makes my arm feel better already."

It's also a good feeling that I'm no longer just doing the pre-med thing - watching. Instead, I'm practicing. For when I get to do this for real. For a living. It feels good.
If I can choose to walk around an ER for "fun" for 11 hours, and still be willing to go back for another helping tomorrow (during a night shift, no less), I think this might be an indication that I've picked the right career.

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