Do What You Love.

This year of rotations has taught me to be more flexible, be more willing to try new things, and forcing me to move out of my comfort zone. Every four weeks brings a new adventure, a new set of doctors, nurses, office staff, patients. I feel like I just become slightly competent, then I’m whisked away to the next place. I finally don’t get lost in the hospital and the next thing I know I’m uprooted again. 

Everywhere I go, I’ve got my backpack. Always prepared for anything. This is what I’ve learned to stash away since I’ve started. 

1. Small padfolio with my CPR/ACLS cards, immunizations, and a resume

2. Spiral notebook 

3. The Merck Manual of Patient Symptoms, perfect for general practice, ER, internal medicine, urgent care, pediatrics 

4. Mosby Diagnostic and Laboratory Test Reference

5. Surgical Recall Book for my surgery rotations 

6. Stethoscope, penlight, reflex hammer

7. Makeup, deodorant, gum, tide pen, small comb because you just never know if you’ll be spending the night in the hospital 

8. Combination lock just in case there are lockers to put my things in

9. Granola bars, fruit snacks, peanut butter sandwich

10.  Nalgene water bottle

{Original idea for this post from here.}

I hate not knowing what happens to these people. We had a code on the floor this afternoon and flat out sprinted from the ER to the floor to help. Turns out it was a patient I had helped to admit last week. He had been doing fine, needed a relatively simple operation, but for some reason went into arrest. No pulse, no rhythm, nothing. And we actually managed to get him back. Tubed him and off he went in the helicopter never to be seen again. 

I like the ER because it is simple {sometimes} to rule out the things that will kill someone and then send them back to their primary care to figure out the rest. But I feel like this is why primary care providers are so bogged down. Having to wade through referrals and patient after patient that needs a full workup for something so complicatedly endless like “weakness,” fatigue,” or “I just don’t feel right.” There really does need to be some sort of bridge program between the ERs and the primary care docs to keep these people from just bouncing back and forth with no answers. It’s stressful to the patient, and just a drain on the whole system. 

It’s official. I bucked up and signed up for the boards. 90 days and counting until I take the most important test of my life. All the marbles and a whole lot of loan money are riding on this one. 

Being stuck in the middle of nowhere is terrible and a blessing all rolled into one. Plenty of time to go stir crazy, and plenty of time to study. I’ve made a pretty detailed study plan and I’m proud to say that the last four weeks I’ve been sticking to it. 

I’ve been using the USMLE Step 2 book to study from because I really feel like the PA resources lack detail. The medical school books may be a little more in depth than we need, but I’m finding that it helps me so much more to learn the concept, vs trying to memorize random facts. I’ve got that and a couple of question banks that hopefully will do the trick. 

The variety of patients that I see in the ER are also helping. I’m able to go home and review things that I saw, not having to waste my time prepping for the next day because hey, anything can happen. 

Back in action. I’ve migrated from the Nation’s Capital to small town USA. I’m working in the ER for the next two months learning new things at every turn. 

This is my second to last rotation. And I feel like there is still so much I don’t know. Not just, yeah I’ve heard of that, but don’t remember, but literally like yup, never seen that before. People never cease to be amazing. 

The people I’m working with are great. Willing to teach and challenge me. I don’t love the ER though, but I think it’s my personality. I don’t like the fact that I have no idea what could be walking in the doors or come flying in through the ambulance bay. The not being prepared part I guess. Working in this type of setting you have to be innovative and quick. Skilled in so many different areas, expected to “cure” everyone instantly. People come in with these chronic problems and decide that tonight is the night the ER docs will fix them. 

I also have been seeing how this system fails so many people. People with limited access to follow up, with no primary care doctors, that just continue to bounce in and out with no long term fix. It’s hard to watch. On days that we have a lot of psych patients, or drug seekers, or the alcoholics, I leave the ER feeling like I did nothing for anyone. All we did was temporize the problem. 

It’s good for me to do something like this though. Everyday I’m a little less scared then the day before. All of my other rotations I have been able to more or less look ahead, read up on the things that I could be seeing the next day. Not here. And that last little bit of nerves and discomfort is what I need to shake before graduation in August. 

I’m posted up in a hotel about 20 minutes north of the city. Not too walkable to anything major, but the hotel provides a free shuttle to the metro and a smaller downtown area.

What I’m glad I’m learning:

Public transportation is not always the most reliable. I constantly feel like I am chasing down a shuttle or metro. Things are late, traffic is terrible, and the inconvenience of not being able to get in my own car and drive is definitely challenging. I had this romantic notion of not having to drive, but the truth is, is that unless I would be fortunate enough to live right in the city, public transportation is a rough alternative to what I’m used to.

The other predicament is traveling alone. I would love to wander and go out at night, but being on the metro alone past 9 or 10 is just stupid. The logistics of relying on someone else really complicate things.

That being said, I love the city. I enjoy walking and do believe that it is a healthier lifestyle. There is so much to do here, I just think it would be difficult to uproot my life and come here alone.

It’s just as important to figure out what you don’t like about a place as it is to determine what you do like.

“To my mind, the greatest reward and luxury of travel is to be able to experience everyday things as if for the first time, to be in a position in which almost nothing is so familiar it is taken for granted.”

-Bill Bryson

This is also how I feel about this year of clinical rotations. Everything is new and even though I’ve been at this for almost 9 month now I’ve still got the freshman goggles on. Big time.

I am currently working with oncology patients in Bethesda, MD, just about twenty minutes outside of Washington, D.C. Getting a small taste of the city life and checking “see the cherry blossoms” off my bucket list.

There is just something about these people. The perspective I get on a daily basis constantly forces me to remember to be grateful. Helps me to appreciate the simplicity of a normal day. I am not questioning if they are drug seeking, their pain is real. I am not wondering why they are complaining, their worries are justified. This patient population has been the most kind, respectful, wonderful group of people to treat. They are in horrible situations, but the insight they have on life is absolutely mind blowing. They have rough days, days when they are cranky and tired, but I’m not having to question their intent.