In addition to my two “excursions”, I also shadowed and volunteered throughout the summer. I volunteered at the Alzheimer’s Association, and shadowed at the local West Chester Hospital.
During this time, I learned on a physical and emotional level, and the lessons have stuck.
The issue I always faced, being a gung-ho debater, was motivating kids. They would practice tirelessly, but shut down during tournament time. I was a stereotypical “hot-blooded young man” when it came to debate, so getting fired up was never an issue.
However, not everyone worked that way. Especially not my debaters. That stumped me: why wouldn’t they fire up? Most people, if losing a debate, fight back with more vigor. I thought that was what everyone did.
I talked about this with my dad (naturally over a game of ping-pong), and he told me that people are different (obviously), but also that what most people want is not for me to talk to them, but for me to LISTEN TO THEM. I did listen to them, but I never to the extent that they would spit up what it was that bothered them. I was never able to do that with my kids, because by that time I was already in college, but I tried that now…
Electrocardiology: 10 hours
Pediatric Neurology: 8 hours
Otolaryngology: 5 hours
Knee, Heart, and General Surgery: 8 hours
Free Clinic Shadowing: 8 hours
Pulmonology Outpatient: 12 hours
ICU: 4 hours
Neonatal/Perinatal ICU: 2 hours
Emergency Medicine: 15 hours
Cumulative: 69 hours
- Cliche, I know, but professionalism applies here. I wanted to get close with the patients, to understand their problems, but that isn’t my job. My job is to leave myself out of it. Granted I will be compassionate, but if I even slip with the professionalism, a can of worms opens up in the relationship, and I put a pressure on myself where I cannot treat people properly. I must alternate between clinical and medical questions, as I have noticed that this combination gets right to the point while also building rapport. Patients may not be seen for a while (6 month+ gaps in between visits), so it is critical to be attentive and get as much as you can from each visit, so that you can build on relationships even after long absences.
- Nobody is treated differently, regardless of whether or not they have a doctoral degree or not. I anticipated that when interacting with PhD’s in the field who came in with heart or brain problems, that we could skip some of the explanatory portions of the appointment (assuming they understood what they had). While they may know what they have, there needs to be a uniformity in the way doctors talk to their patients, and there is. They treat everyone the same, and it makes things less complicated. As such, I will do the same.
- In outpatient (where I’ve shadowed a neurologist for a week, and this cardiologist for a week), I learned that there tend to be commonalities between every patient, or rather drugs/diseases that appear every time (from my time, it’s been Keppra for epilepsy, Coumadin, Toprol, Lisinopril, and Omeprazole for the heart, albuterol and Stiolto for anything respiratory). Of course, specifics depend on the specialty, but no doubt there appears to be a lean towards certain medications.
- Medicine here seems to be more reactive as opposed to proactive. It’s disheartening, even though we are doing the right thing. Far fewer patients need to be here. In addition, the answer to less-than-effective medication is seemingly more aggressive medication. However, good lifestyle choices need to be emphasized and encouraged as the only ways in which medication can be effective, or else no change will occur.
- The schedule defies the typical workweek, as generally it involves a lot of choice (again, just a conclusion from what I’ve seen). However, the hours are busy and generally exhausting, though not in a bad way. Communication with the nurses and the staff is of vital importance, and notes cannot get backed up, even if that means a bit of a delay for patients.
- Keeping updated with software is pivotal. This is a constantly changing field. Failure to do so can result in either dependency or inadequacy, neither of which are acceptable. This isn’t something most people think about when trying to become doctors, but something they realize they have to do afterwards. As my PI said once, “That which we are not, we become”.
- ICU functions in an interesting manner, as collaborative rounds are used and conversation and communication between doctors is critical. This is different from outpatient, as patients are not conscious often and precautions need to be taken when meeting with patients. Extensive communication among staff regarding orders, tests, and scans is required, along with a more intensive workday. This feels more congested and less laid-back than I have seen. In addition, I learned about Advanced Practice Nurses and the categories they fall into: cRNA, or Nurse Anesthetist, NS, or Nurse Specialist, NM, or Midwife, and Nurse Practitioners, which fall into two categories: Primary Care and acute. These were distinctions that I had not previously encountered and I was grateful to have my ignorance cleared. The roles of nurses blend with those of doctors, which I knew. While nurses do get patient to patient interaction, the responsibility and the final decision-making does clearly rest with the doctor, along with comprehensive knowledge of many conditions. These are reasons why I want to pursue a career as a physician as opposed to that of a nurse or any sub-specialty.
- I was truly impressed and shocked with what I saw in the neonatal ICU. These children looked so small and fragile, and had such elaborate equipment set up that I couldn’t help but feel sorry for them. I witnessed a gastroschisis and the subsequent attempt to fix it, along with an understanding of the importance of the job and how much small actions influence future trajectory. In addition, I was able to determine more of the difference between adults and children with regards to healthcare, and how systems that work in adults completely differ in children. This includes the knowledge that fever causes temperature increases in adults but drops it in children. Because children cannot communicate, this makes the cause of the problem difficult to discern. It could be an infection, or just the window being open. Such sensitivities make this different than other specialties, which made me quite interested in it.
- Witnessed sickle cell crisis, motor vehicle crush victim, herpes, meningitis, ultrasound of ventral hernia, vomiting, sexual assault victims, self-mutilation victim, pyelonephritis (incredibly painful), woman rushed in with accelerated breathing, man rushed in with possible brain injury, clear alcoholism issue, inability to restrain bowels. In addition, person with eye damage, pulmonary embolism, etc.
Where I learned about myself:
I was in with a patient who was rather large and struggling to breathe because of weight. Some heart tissue had died, and thus a permanent decrease in functionality had resulted, resulting in a shortness of breath. This was especially frustrating for the patient, who was not comforted by the alternative therapies option (transplant). The medication was frustrating the patient, who didn’t want to continue it even though it was the only option. This, coupled with some miscommunication from the patient’s primary care physician, resulted in much angst directed at the cardiologist and the staff despite no culpability. The cardiologist and the staff handled this completely unreasonable situation professionally, and the problem was resolved.
That brought me back to what my father said: that people aren’t mad at you, but are simply venting their frustrations onto you. You have no right to snap back.
I was already a patient individual but that’s when it all clicked.
Later on, in the Solid Tumor Clinic, I was shadowing and was faced with a heartbreaking situation: the diagnosis of cancer. This was to a person struggling with financial times, and now had relapsed. How was the patient going to handle this news? Most people don’t plan for cancer in the first place, and never want to have to plan for it after beating it once. Heck, most people can’t produce around $400 of cash at this very moment in America. The doctor handled this case as tenderly as he could. As in the previous example, he took some verbal abuse, but was incredibly kind and supportive. From this particular instance, I learned another seemingly obvious point that I had never consciously recognized: doctors are beacons of hope, and at any given time need to be at once realistic with yet supportive of the patient. That means portraying yourself as supremely confident in the face of this adversity, and it means that you have to have a game plan ready for the patient to follow treatment-wise, because they will cling onto what you say with their life.
Alzheimer’s Association: Summer 2017 + Autumn 2018 + Spring 2019 (106 + 12 + 2 + 3 +3) (as of 4/9/19)
Rardin Free Clinic: 72 hours (as of 4/9/19)
James Cancer Hospital: 110 hours (as of 4/18/19)
OSU Disabilities Services Notetaker: 64 hours (2/8/19)
Total: 372 hours
- The data that a large organization has to deal with is staggering. 40,000 entries and manual editing is a nightmare. More importantly, optimization is not just a want in this sector, it’s a NEED. I’ve researched all about the VA’s technological despair during my debate days, but seeing a situation like it and working in it was stunning and quite unexpected.
- The planning that goes behind an event, such as a walk, takes a tremendous amount of labor that not many people see, whether that be putting together folders, folding brochures, and transporting large quantities of walk materials like crates of supplies, large banners, and unwieldy stands.
- Most people are unwilling to answer phone calls, or if they do, stay on them for an extended period of time regardless of the call’s purpose. Generally, phone calling is a highly inefficient way of reaching people, and a more efficient route needs to be discovered before the phone calls turn into a time sink that drain people.
- DO NOT EXPECT EVERYONE to follow your advice, or be diligent about what they are supposed to do, whether this be fulfilling a commitment made, or simply listening to the best mode of action. People are stubborn.
- Non-profits can be as competitive as your greedy Silicon Valley start-up.
What I learned and dealt with emotionally:
I was simply performing a routine set of calls to ensure that donors and sponsors were keen on their commitment to support the walk, when I ran into a lady with a unique problem. Both of her parents suffered from some stage of Alzheimer’s, and she and her sister dedicated an immense amount of time to the cause. That wasn’t the struggle. The struggle was when she mentioned that an “undercover” cop showed up at one of her yard sales to raise money for the cause, and began questioning her integrity. This was clearly the man’s fault, yet I was being rebuked for that reason. After over half an hour of abuse, I finally managed to help calm the lady down, because I understood her concern. I then redirected her issues towards my superiors, who successfully dealt with the issue.
While I never impress myself because I have extremely high expectations, I couldn’t help but feel a little bit more mature, as I had followed my father’s advice and stayed calm in the face of so much anger. While I didn’t learn anything distinctly new here, it surely reinforced the concepts I had been taught, and allowed me to grow as a human.