Posts tagged med school

That Horrible Feeling

When you see patients with scabies or pink eye and you feel the creepy crawlies just itching under your fingers and eyes for the rest of the day.

Jesus H. Cox, M.D.

Sadly, every one of my colleagues has met at least one person like this in their lifetime. I recently had to work with someone like this and it was not the most positive learning experience. As a learner, I do not have all of the answers, though I do my best to have one; then again, that is what this residency is all about: learning from my mistakes and learning to be better. Perhaps it was allowable in some bygone era to behave like this but not now.

Take a moment and reflect. Do you know someone like this?

Whoever thought of…

…Embedding a Starbucks store right inside of a hospital is a genius.

These stores are make a killing of my wallet.

Two Schedules on Shared Time

The challenge of my current schedule is that I must juggle my responsibilities between my core rotation and those of my clinic, to which I am obligated to spend time as well.

Sometimes it means missing out on some good learning opportunities due to conflicting schedules. Other times, the days off of one schedule coincide with the days on of another. I can be particularly hit hard if, like today, the day could have been spent sleeping post night shift.

Thankfully these scheduling anomalies are few and far between. However, when I think about how well established the challenges of balance are in residency, having an awareness of these issues can go a long way towards improving resident resilience.

The Paradox.

The Paradox.

How Do You Cope With Stress?

In my last community survey, I asked how you assess your stress level. The responses demonstrated just how diversely and how uniquely each person’s stress manifests.

This time, I would like to ask a follow up question and allow everyone to share how they deal with stress.

Beyond identifying and dealing with the source of the stress, I personally take more time to spend with my wife. I try to sleep earlier to catch up on rest. I take a step back from studying at home and instead take up sketching and drawing again while listening to music to help me relax. At work, I try to meditate during my breaks.

How do you cope with stress? Share your tips with everyone.

Hit him with everything!
When we get desperate with a patient - be it a cardiac arrest, a septic shock, or just outright aggressiveness - this is what the escalation of interventions feels like.

Hit him with everything!

When we get desperate with a patient - be it a cardiac arrest, a septic shock, or just outright aggressiveness - this is what the escalation of interventions feels like.

Our Deepest Condolences

One of the very first patients I had admitted was a 50-some year old father of three with a newly diagnosed colon cancer. His case read just like my father’s. Sudden changes in stool caliber. More bloating and fatigue. His wife started noticing that he looked thinner. 

By the time I had approached him in the hustle and bustle of the emergency department, the news had already been broken by the emergency physician. “You have colon cancer,” he remarked on the bluntness of that interaction. It had left him in such shock that he had little to say for most of the day. I took my time to be thorough, answering questions, gathering the history, doing the physical - his moderately ascitic belly and an enlarged liver already hinted at something more sinister. Having already been subjected to one rectal exam, he asked if I needed to double check again. I politely declined to which he breathed a great relief. 

I excused myself to review his CT scan, to get a better understanding of what was driving everything. There, on the black and white screen I saw a liver so large it seemed there would be no space for anything else in that belly. Pocked full of cysts and irregular tissue, it screamed only one conclusion: gross metastasis. 

"A few more tests," I reassured him and then he would go home, to follow up with the oncologist for further management options. I explained that the cancer had spread and that the options will be limited. He digested the news silently, his eyes flickered across the floor as he concentrated. When his wife arrived, I made sure to break the news gently. She wept regardless.

By the time I had sent him home, his belly was flatter once again, having been drained of all of the malignant fluid. The oncologist was to follow up with him within a week’s time. The prognosis was guarded but we agreed that he will be fine for at least the week.

Or so we thought.

It was a surprise to me then that not one week later, I saw him again on call in the emergency department, this time looking worse. He was confused, agitated, and grim - his skin had turned yellow. I quickly texted my attending: “Encephalopathy. Icterus.” The response was immediate: “Shit.”

Because most of the patient’s liver had been replaced by metastatic tissue, his body could no longer bear the burden. The liver had started to fail and with that, his kidneys were beginning to shut down. He was quickly transferred to the ward. 

We rediscussed code status with the family with the end drawing near and it was decided to change his care to palliative. We kept him comfortable until he died a few days later.  

Precipitous multi-organ failure is uncommon to see in someone who is still very high functioning. We never would have expected him to decline so rapidly. It was a surprise to everyone that he could be here one week and gone the next. Given his disease, there would not have been much more we could do medically.

But there are always things we could have improved on. From delivering the diagnosis with care, to advocating for a private room in his final days, to addressing the psychosocial needs of the family. These are areas that we can strive to do better. At the end of the day, this patient was not his colon cancer, he was a person. With a wife and three children. A friend to many. 

These were the pieces, in the torrent of changes that ensued on his second admission, that were lost.

"The patient died surrounded by his loved ones. We are grateful to have been involved in his care and offer our deepest condolences to his family and friends…End dictation."

A yawn is a silent scream for coffee.

A yawn is a silent scream for coffee.

Medical Education, Beware the Hidden Curriculum

The hidden curriculum is taught by the school, not by any teacher…something is coming across to the pupils which may never be spoken in the English lesson or prayed about in assembly. They are picking-up an approach to living and an attitude to learning.

-Dr. Roland Meighan