Beginning A New Lifestyle

I’m a week deep into my Internal Medicine clerkship and I’m happy to report that I’m loving it so far! Sure the days have been long, but there has been virtually ZERO instances of boredom within these past few days. Plus, the interns and residents I worked with this past week have been gracious enough to let my classmate and I out at least a couple hours early each day. (I’m supposed to be at the hospital from 6AM-7PM. Lol, yeah.) I’ve been learning so much new & pertinent information so far and have been able to watch that information be applied on real patients. I was in the CCU (Cardiac Care Unit) this past week, so the patients that I saw were those who had critical heart issues and who needed to be monitored on a constant basis. It was an intense environment full of healthcare workers who had to be attentive at all times to all the patients there. There was also a death on my first day there and a couple of other patients who were transferred to hospice care to prepare for their own passings. A pretty sad way to start off my third-year…but on the other hand, there was a good number of patients who were adequately treated and discharged from the unit! Also, the team that I worked with all week was full of pretty awesome people!

But before I get too deep into my experience at the CCU, let me step back real quick and touch on what I did on the day before I started working in the CCU. On Monday of last week, we (we as in the 30-or-so of us in the IM clerkship) had an orientation session specific to the Internal Medicine clerkship. Because I had flown in late the previous night from Miami and had gone to sleep around 2 AM, I was TIIYYAAD all day on Monday. But I was able to stay awake long enough to glean the important information given to us that day. We finally began to understand the sub-rotations that we were assigned to within the overall IM clerkship and we made our call schedules for specific sub-rotations that necessitated them. (I’ll be working four weekend days and a week of nights during this clerkship. Say it ain’t so! 😅) My IM schedule consists of:

  • 1 week of Cardiac Care Unit
  • 1 week of General Cardiology
  • 2 weeks of Renal
  • 1 month of Transitional Care
  • 1 month of General Medicine

So as you can see, third-year is quite complicated to understand. I’m here still trying to figure out how all of this works, and I’m the one living through it! However, we got a better understanding of what to expect during this clerkship and we were handed a bunch of papers to better supplement our knowledge. We then attended a few sessions, which included a Geriatric interactive presentation where we talked about different ways to properly care for the elderly, an ultrasound activity where we practiced how to perform a transthoracic echocardiogram, and a trip to the Crisis Control center where we participated in a simulation that enabled us to consider what living in relative poverty felt like and how powerful the concept of “generational poverty” can be on underserved populations. ‘Twas an interesting & busy day but by the time the last session (Ultrasound) rolled around, all I could think about was how nice it would be to collapse on my bed. I ended up crashing around 9 PM…only to wake up at 4:30 AM to start my first day on the CCU.

My first day up there was not really what I expected it to be. Then again, I had absolutely no idea what to expect in the first place. I walked up to the unit dressed up in a shirt and bowtie, only to be notified that I was supposed to be wearing scrubs. Go figure. After changing into scrubs, my classmate and I got assigned patients, which surprised us because we were previously told that we were going to be merely observing today. So we researched our patients and went to meet them. My patient had suffered a heart attack and was scheduled to have stents placed in his heart to open his occluded coronary arteries. He was a pleasant man to take care of, and I was actually able to watch the procedure he needed (Percutaneous Coronary Intervention) the next day! After getting the information I needed for my patient, the team and I all began our morning rounds, where we presented our patients to the attending (head doctor in charge) and visited our respective patients as a group. This took almost FOUR hours. FOUR. HOURS. It turned out that this was a particularly busy morning and that rounding this long was unusual, which relieved me. The experience was really cool though and having to present to the attending on my first day was quite challenging, to say the least. Especially since I wasn’t aware that we would have to do so. But she was understanding and gave both me and my classmate some useful advice for presenting patients, something that she continued to do throughout the week. After that marathon morning of rounding, we were notified about a patient who was not recovering from his acute condition and who would end up passing away that day since there was nothing that the team could do for him anymore. My classmate and I joined the Cardiology fellow on our team as he sat with the patient’s family to discuss the unfortunate circumstances that he was in. The conversation was a heavy and sad one where the whole family was in tears, but they were also understanding of the situation. The fellow handled the conversation very well and I’m grateful to have been able to witness that conversation, because I’ll definitely have to have those conversations with the families of patients that I will be helping to treat in the future.

The afternoon consisted of a third-year med student conference that we were required to attend (we have these conferences almost every day), following up on our respective patients, writing notes on them, sitting in on an impromptu lesson from the fellow, and talking with the team about a variety of things. I was actually surprised as to how flexible our time in the afternoon was. I found that I could actually get quite a lot of stuff done in that time, which is very good to know moving forward. We were free to leave around 5 PM and I immediately felt the fatigue hit me once I got back home. Crazy thing is, I needed to study and review material that I had forgotten during my post-Step vacation. I also realized that my mind was still in vacation mode, so I had to force myself to snap out of that mentality. I got a little studying in, but ended up crashing again around 9 PM, only to do it all over again the next day.

I won’t go into length on what I did each day because then I’ll be sitting here typing this forever. But it’s worth noting that each day had a similar schedule and although it has been a busy week, it certainly beats having to watch a lecture in the classroom. Even the whole “having way less free time” thing hasn’t bothered me that much (yet). I think my body is quickly adjusting to this new lifestyle of waking up before dawn and going to sleep at the same bedtime I used to have when I was like 10. In addition, I was able pick up a new patient on my second day, but I struggled on my presentation because he had multiple co-morbidities that needed to be addressed in addition to his chief complaint of chest pain. Turns out he had a stomach bleed that I was able to see via an esophagogastroduodenoscopy. (EGD) (Try saying that five times fast.) We had to take care of that before getting to the chest pain he had, which hadn’t bothered him ever since his stay in the hospital. I stayed with this patient until I left the unit on Friday and as for my first patient, he was discharged on Thursday. As the week progressed, I found that I was getting better at giving presentations, I was getting more accustomed to the flow of rounds, I was learning a lot more about asking pertinent questions & performing pertinent physical exams, I was bonding quite a bit with my patients, and I was running around with my classmate trying to watch various procedures being done on multiple patients. We were able to watch a Foley catheter being put in as well as two heart stents being placed in the cath lab, but we missed the placement of two arterial lines and a thoracentesis. Darn. The team was also very gracious to us in answering any questions we had, chatting with us on the topic of choosing specialties and in giving us very helpful tips on necessary third-year skills. They were also getting a laugh at how enthusiastic we were about this new lifestyle. Before I knew it, it was Friday afternoon and we were leaving the team that we had befriended pretty quickly. My classmate and I were legitimately sad to have to leave them because we had been having such a great time with them. But alas, we must continue to expand our medical horizons!

Overall, my first week of third-year has been a great one! I’ve already learned so much and I was made aware of just how much more information I need to learn. I also found myself thinking about various things like how much medicine has changed over time and how amazing procedures such as PCIs can save someone from heart damage in 20 minutes while a heart attack 100 years ago was, as far as I know, pretty much a death sentence. I also noticed myself often thinking about both the patient and their family’s perspective in the hospital in parallel with my own perspective as a third-year medical student and just how different our worlds were in the moments that I saw them during rounds. No wonder many doctors have written countless books about their experiences in the hospital…this type of stuff really gets you into deep thought. I could personally write a narrative on the thoughts I had while helping to take care of the two patients I was assigned to this past week. And that’s just after a week of being in the hospital. Who knows what I’ll come across these next twelve months and in the foreseeable future as I continue my medical education.

But as for now, I’m done with this post. I gotta review some Cardiology for this upcoming week lol. I hope you enjoyed reading this! Have a wonderful week!

“One can choose to go back toward safety or forward toward growth. Growth must be chosen again and again; fear must be overcome again and again.” – Abraham Maslow

– Black Man, M.D.

P.S. – Today is the two-year anniversary of my one and only acceptance to medical school! Shoutout to the Wake Forest School of Medicine for taking good care of me! I’ll be forced to (literally) repay the favor to the government for temporarily funding my education, but this is one investment that I’ll voluntarily (though quite begrudingly) go into debt for!

Final Push!

TEN MORE DAYS.

That’s what’s separating me from now and freedom. Well, freedom from anatomy. Biochemistry is right around the corner but we won’t talk about that right now. Just ten days. Granted, I gotta take two different tests in this ten-day span but at this point I don’t even care. I’ve finally developed a study groove in anatomy and I plan on finishing strong. Bring on test #4. Bring on that CAS Cumulative Final Exam. Speaking of which, who’s idea was it to have a cumulative final exam on 12 weeks of jam-packed anatomy FOUR DAYS AFTER our fourth exam?? Like, how could someone possibly cram details of the whole body in four days, especially right after taking an exam? I don’t know what kind of games they playing or what they’re smoking. But it’s gotta be done. So this is what I’m going to do. I’ll give it my all once again on my next exam this Friday and then I won’t stress about the final. Sure I’ll study during the four days before it, but I’m not going to kill myself over it. As a matter of fact, I’ll mix some Bernie Mac Show, Netflix movies, college football and FIFA into my studying. That’s the beauty of pass/fail y’all. If I do decent enough on the test before my final, I don’t have to worry about scoring high. Shiii, it may even be possible to score a zero on the final and still pass the class. Granted, I’m not scoring a zero…I literally won’t allow myself to tank a test on purpose lol. But I also won’t spend 18 hours a day trying to digest material that I spent the last 11 weeks learning at an accelerated pace. You see, I’m convinced they’re playing mind tricks y’all. Alongside learning the art of medicine, I’m convinced some of the faculty wanna see us stress and struggle as well as observe how we handle all the stress they put on us. They not gonna stress me tho! No suhhh, NOT ME!! I’m really about to be on that “work smarter, not harder” grind during the four days before the final. They really got me all f-ed up if they think ima be posted in the library studying till 6 AM like it was the USMLE Step 1 exam.

So yeah, ten more days and I’m done with anatomy. It’s come to the point where I’ll be unconsciously naming muscle groups in my head while I’m lifting weights. I even go as far as trying to figure out what arteries and nerves supply the muscles I’m working on. That’s when you know it’s gone too far. Anatomy has taken over my life y’all. 😳 If I had this same study mentality in college, I know for a fact that I would’ve gotten summa cum laude. But I also had a much bigger social life in college, and I wouldn’t give that up for the world lol. Enough about anatomy. In regards to the practical skills that I will actually use as a doctor, I’m finding that I’m starting to feel more confident in patient interviewing. I don’t know what it is about taking a patient’s history, but I was having a good amount of trouble at first trying to keep a conversation flowing while remembering what specific questions to ask and how to specifically ask them. So I ended up getting additional practice with my clinical skills coaches, because although I’ve been told my personality has been helping me with my patients, my patient interviewing skills were pretty sub-par. Which means your boy can only go up from here and shoot for Most Improved! The more I practice patient-interviewing, the more I realize that the whole process is a game, in a way. You see, you gotta go in there hella confident and have the purpose of getting the patient to trust you while you are getting to know the patient. Confidence is key because even if you are only four months into medical school, the patient is going to see you as a doctor of some sort since you have a white coat on. Then as you’re learning from the patient, you gotta hit the key points of the interview:

  • When did your symptoms first start?
  • How long have you been dealing with your pain?
  • Where exactly is the pain located/Where is the pain radiating?
  • How would you describe the pain? (Quality of pain)
  • On a scale of 1-10, how bad is the pain? (Quantity/Severity)
  • What are some activities that alleviate the pain?
  • What are some activities that aggravate the pain?
  • What are some associated symptoms of your condition?
  • How is the pain impacting your quality of life?
  • What were you doing when you first noticed the pain?
  • Have you had any past experiences with your current condition?

And each time questions are answered in the interview, you get points. The more points you get, the better your chances of winning the game when you have to give a patient presentation. Trick is, you have to ask these questions without coming across as cold or disassociated from the patient’s emotions. You have to let the patient have some control over the interview and show them that you care if you want to get as much information as possible. But you see how hard it is to remember all that while trying to hold a regular conversation with the patient?? Okay maybe you don’t, but I found it very challenging. And that’s just the history-taking portion! In real life, I’ll have to do a physical exam, a separate family and social history, a past medical history, a review of systems and a treatment plan.

I think my problem was that I gave the patient way too much time to talk about his/her life and that I couldn’t necessarily redirect the interview to where I needed it to go. Hell, the last two patients I interviewed ended up crying mid-way thru the conversation. That’s where my empathy skills shined bright. It goes to show how human the patients are and how as doctors we have to remember that we are treating more than a disease; we’re treating a human being with a disease that is impacting his/her overall life. I definitely plan on keeping my empathetic skills strong, and I’m glad to say that I’ve been recently doing better gleaning vital information from the patients I’ve been interviewing. As a matter of fact, one of the patients I interviewed made me promise to her that I would keep my bedside manner and active listening skills as I grow into a doctor. So I intend on keeping that promise.

I mentioned patient presentations earlier. That’s when you go to your team and present to them the information you got from the patient. I had to do that for the first time last Thursday and mannn was that a challenge. My clinical skills coach didn’t even give me time to gather my thoughts 😐. There’s actually a certain way you have to present patients and the presentation comes with certain terminology. I was forced to think quick and use the notes I hastily scribbled down during the interview to come up with a presentation. I’m not sure if that’s how patient presentations work though, I could have sworn doctors had more time to organize their notes before presenting…

Oh and I am also currently learning how to do patient write-ups, which is where we write a formal description of the patient that includes the answers to all the questions that we asked them in the history-taking portion of the patient interview. The overall write-up also includes the other parts of the patient encounter such as the physical exam review, the family and social history, the past medical history, the review of systems and the treatment plan for the patient. But we’re taking baby steps right now, so I’ve only done the HPI (history of present illness), family/social history and review of systems portions. I thought it was simple enough to write a description of the patient, but I’ve been ripped both times I’ve submitted a write-up so far lol. I’m not sure if my coach is just being hard on me or if my write-ups actually suck, because I genuinely thought I was doing a good job on those. 😅 Well we all gotta start somewhere right? I’d rather suck and learn valuable advice now than go into my third-year with no prior clinical experience. Shoutout to Wake for having us interact with patients often throughout our first two years of medical school, this experience is really helping me out.

Alright, I’m finished.

Thanksgiving needs to hurry on up and get here.

Have an incredible week everyone! Stay positive and focused on your goals! Be blessed!

– Black Man, M.D.

P.S. Shoutout to everyone back in Miami that got tapped into Iron Arrow!! I was very excited to see all of the new members of the tribe! I wish I was there for the tappings and for Homecoming…nevertheless, Welcome to the Tribe! Y’all deserve it!!!