I apologize for the lack of updates recently. I have been on call for the better part of the week and have not had a lot of time to myself for the last few days.
I hope that over the next little while, I can get back to a regular routine yet again.
Thank you all for your patience and understanding.
Tom of the Medical State of Mind
It is a peculiar thing to know what to expect on the way work.
You listen to the radio about a serious accident while driving.
You listen intently as the reporter notes the critical condition of the person currently being flown to the hospital, fed to them by some insider on site.
Faintly, you hear the whir of the helicopter above; the low rumble rattles through the glass.
You watch as the medivac makes its way overhead to the hospital helipad.
Your pager goes off.
You arrive live on the scene.
I recently had the opportunity to work with a medical student while on call. I had received notice of a ward issue to see that sounded appropriate for his level. I asked him to go first and that I would join him shortly thereafter.
When I arrived, he briefed me on the problem at hand. When I asked what his thoughts were and what he wanted to do, he supplied me with a full and extensive workup for a simple case of pain.
At one in the morning, I reminded him that our job was to make sure nothing life threatening was happening, that we have done enough investigations to aid us in that cause, and to keep patients alive until the morning.
Without the backup, manpower or support, we were not in the best position to start investigating and treating everything fully, unless something truly worrisome was suspected.
Put simply, our job boils down to a half measure.
When the emergency department is inundated with people, every service feels the pressure. Consults are requested, teams are pressured to admit or move patients. The night seems endless.
Last night, the emergency department was packed to the brim. I had never seen it so busy. There was no particular cause for this influx, no mass casualties or public event gone wrong; people just got sick at the same time for different reasons.
The night was steady until three in the morning. Many of my classmates on other services were present as well seeing patients. In those hasty moments between cases, we caught our breaths and checked on each other.
The key word to all of our conversations was “surviving.”
With great power comes great responsibility.
This quote comes to mind when I think about the new addition in my toolbox. I now have the authority to prescribe narcotics with my triplicate prescription pad. These are highly regulated substances for obvious reasons.
I must ensure that I dispense them appropriately. More crucially though, I must keep my prescription pad safe from theft.
In a previous post I highlighted some positive feedback I received about my history taking. I received a lot of comments about sharing what I was doing. I think that history taking is a very individualized process. In all honesty, there is no right or wrong way to take a history. Each person’s style is a reflection of their thinking process, their knowledge base, and their comfort level and that naturally evolves over time.
Having said that, this is what I generally do now.
I am very sorry to hear that you were dismissed from your school. While I know people who were unsuccessful in matching into residency, I do not know anyone who was dismissed before completion.
I think that your best course of action is to go to your school and ask for the reason and have a better understanding of what led to this decision. If any grievances they have with your training can be corrected, then you can appeal to return to class on the basis that those issues are addressed. However, if this is not the case, then I do not know how this may affect your prospects in other schools.
I think it is important to know what led to this dismissal before considering future plans towards medicine either at the same school or elsewhere.
Whatever comes from that discussion with your school, I wish you best of luck and hope everything turns out. Take care.
Tom of the Medical State of Mind