Shadowing.

That word is enough to make a medical student cringe. You see, the vast majority of certain rotations is spent standing behind a real doctor as they see their own patients for 10 straight hours, trying as hard as possible to prevent your eyes from glazing over. The third year medical student quickly learns how to act interested in everything.

Shadowing is incredibly boring. It can be fine if you’ve got a great doc to follow – especially in specialty clinics which can be way over your head – but usually it’s the most boring thing you can do. Especially since we’re overworked and tired as it is.

End Prologue.

I’m on my outpatient medicine rotation right now, which I love… I think I’ll actually end up in this field. This month, however, the afternoons are filled with – you guessed it – shadowing clinics. Roommate and I decided we would drive out to LA and go to Magic Mountain because we’ve both got a free weekend. LA is pretty far from where I am, so I figured I’d just ditch my afternoon clinic today so we could leave early and not be driving until 4AM.

I should mention that I think every student on outpatient has skipped at least one afternoon clinic, if not more.

Normally this wouldn’t be a problem; a shadowing student is far from integral to the successful workings of a clinic. In fact, all we really ever do is slow the docs down. Usually they don’t even know we’re supposed to be there. Unfortunately, this particular clinic was staffed by an attending who is known for being a hardass. In addition, unbeknownst to me, there were also 2 patients specifically scheduled for the med student to see†.

I got paged by the Internal Medicine Clerkship Director asking me where the hell I was. Now, instead of doing the smart thing and saying that I was running late and that I’d be there in 10 minutes, for some reason I blew my common sense fuse. Instead I said that I was ditching so that I could drive to LA without being up all night.

Shitstorm.

I have absolutely no idea what the consequences are going to be, especially since when I bolted over to the clinic I was told to get out by aforementioned Hardass Attending, who looked really, really pissed off. I can see a couple ways that this will go down.

1) Clerkship Director decides to dock me a sick day, then berates me about ditching.
2) Hardass Attending calls Clerkship Director to complain, who has to apologize and then berates me about ditching††.
3) Same as #2, but with Hardass Attending telling Clerkship Director they don’t want med students at their clinic any more.

#3 would result in some pretty big problems for me. I really hope it doesn’t come to that… ‘course, this is all my own damn fault.

† This never happens, unless you’re in a rural area where they can use all the help they can get. Usually the onus is on you to ask to see a patient before the doc goes in.
††Clerkship Director also governs Clerkship Grades.

I found this in my drafts and figured that since I’m rather nonprolific as of late, I may as well dust this one off too and add it to the blog. Looking back on it months later, I still feel like reviewing this CT was one of the most rewarding things I’ve ever done for someone. As a side note, I’ve now gone through films with quite a few patients and they always seem to enjoy being told about what they’re looking at… I know I would.

The other day we saw a very nice 53 year old hispanic single mother with 4 kids who works room service at a motel. It’s fairly obvious that she’s poor and uneducated, and doing everything she can to make ends meet. Last week she felt something funny in her stomach and went to the ER, where a “mass” was found next to her ovaries and she was referred to our clinic. As an aside, a “mass” next to the ovaries in a 50-something is cancer until proven otherwise. As the med student I was asked to go interview her.

The second I walked in the room, she asked “what’s a mass”? It’s difficult to describe, but it wasn’t “I’m worried it’s cancer” … it was more “I don’t know what they meant by ‘mass’ “. She had brought the CT scan with her on CD.

After talking with her for a few minutes, it became obvious that she wasn’t concerned as with the “mass” as much as she couldn’t read the CT scan. Her daughter had pulled it up on her laptop, but neither of them knew what they were looking at.

I brought the doc in and we examined her, finding a huge mass on pelvic exam. My doc took the easy route (for now) by telling her we’d get a high-resolution ultrasound, rather than saying “odds are you’ve got cancer”.

As we were getting ready to leave the room, I remembered the CT scan. Neither of us had gone over it with her. I had nothing better to do, so we reviewed it together for 15 minutes, pointing out her bones, liver, intestines – anything she wanted to know about. I’d like to think it made a difference, because she looked much more at ease by the time I left. I think she was more worried about the CT at that point than her mass.

I know she won’t, but I hope she does ok.

Roommate is on his Pediatrics rotation right now, and while all you readers out there may think it’s all fun and games, think again.

Y’see, any illnesses that Kids have are immediately passed on to Roommate, unless he’s fortunate enough to have gotten it while younger. Apparently neither he nor I were lucky enough, because we’ve both been moribund since Saturday. I suppose the only thanks I have is that my cold doesn’t include a sore throat (I hate you, sore throats).

Have fun diagnosing! I’m running a fever, chills, productive cough, and horrendous nasal discharge. I’m staying home from work tomorrow, which is the adult version of playing hooky.

I found this post lingering around in my drafts, originally written while I was on OB/GYN. I still remember this patient like I saw her yesterday… I hope she’s doing well.

Today I saw a 65 year old woman who was referred to our clinic for an uncomfortable feeling of fullness after eating. She’s a fitness nut – she’s worked out at least once a day, every day, her whole life. Her family has a nasty history of coronary artery disease, so she took it into her own hands to stay healthy early on.

She eats better than anyone I’ve ever talked to – green, leafy veggies, nuts, fruits, the occasional grilled chicken. She looks fantastic – I’d peg her at 49, max, if I had to guess. She loves to run, gets up at 5 AM to savor the sunrise. Healthy, healthy, healthy. Huge smile, sparkling blue eyes, perfect teeth. Not a single prior illness listed in her chart.

Her CT scan revealed frank, corrosive, highly metastatic ovarian cancer.

3 of her equally beautiful daughters were in the room with her to receive the news. The four held hands and cried, heads bowed together in a circle of love and grief. One daughter, tears coursing down her face, hugged the doctor and thanked her for her compassion.

It was a beautiful moment, but this is no Hollywood movie. There will be no happy ending – but it’s comforting to know that there will be so many people there for her, loving and supporting her to the end.

I know most of my classmates have already had this experience (Roommate, I’m looking at you), but a few days ago on my internal medicine rotation – which, by the way, I’m loving – I really, really felt like a doc for the first time ever.

It was one of those basic, simple moments; I interviewed a patient, took a full history and physical, presented to my attending, and told him what my assessment and plan were. He nodded, and asked if I had my prescription pad with me; he’s the first doc I’ve worked with who insists that all med students carry around prescriptions.

I pulled out my prescription pad, wrote out 3 drugs, and watched as he signed them and handed them back to me. I went back in the room and explained what they were for. Patient thanked me (referring to me as “Doctor Zac” in the process… more on that bizarre phenomenon in a later post).

So, there you go… I felt like I legitimately worked someone up and treated them. Small, but significant.