June 18, 2013

I wonder if I changed in the night

“I wonder if I've been changed in the night. Let me think. 
Was I the same when I got up this morning? 
I almost think I can remember feeling a little different. 
But if I'm not the same, the next question is 'Who in the world am I?' Ah, that's the great puzzle!” 
- Lewis Carroll in Alice in Wonderland

and so it's begun...
this past Saturday began my first week of orientation as an intern in Obstetrics and Gynecology - and I don't know if I've ever been so excited and so nervous. We started with a two day course in Advanced Cardiac Life Support (ACLS) which is learning the skills and protocols that skilled health care providers (read: not the medical students we just were) use to save someone's life after s/he has suffered a cardiac arrest.  As part of this, we had to run a mock MEGACODE, which meant that we were given a scenario of a patient suffering a cardiac arrest and had to be in charge of making all the decisions, assigning tasks to the rest of the team, and adjust as things changed.  Even though it was just a (very sophisticated) mannequin, it felt more real than (almost) anything I've done in medical school.

after that, we started a long (and not always exciting) orientation to all the things that we should know or start to think about as interns.  Some of these are covered in any new employee orientation, regardless of your field, including how to get paid, how to sign-up for parking, etc.  But others are decidedly unique to medicine, such as Emergency Disaster Preparedness, Burnout and its Consequences for You and Your Patients, and Risk Management.  As part of the last part - which is normally a pretty dry lecture about how to minimize risks by maximizing systems, our CMO showed us the following video of a mother talking about the medical mistakes that led to the death of her young daughter at one of the best hospitals in the country:

Later, we had a panel discussion with the program directors of a bunch of different fields and they showered us with words of wisdom.  I'm going to write them down here in hopes that I can come back to this when I'm in the thick of residency:

(1) Don't take it personally.  
No patient is having their favorite day if they're coming into the hospital.

(2) Greet people warmly everywhere you go in the hospital.

(3) Remember to keep reading.  
If you skimp on reading because it doesn't feel like you have time, soon you feel like you don't know enough and that knowing enough is out of your control.  This program director suggested reading 7-10 hours each week (!!)

(4) Know when to ask for help
(this one seems critical, but also very, very tricky)

(5)  Don't be so self-important.  
Remember that even though your life will be super hard, it doesn't drop you off the hook for taking care of the people you love or the rest of your life stuff.

(6) Sit down.
not only because they'll be plenty of time to stand, but also because it reminds you (and your patient) that in that moment, s/he is the most important thing - not whatever you have to do next.

We ended today with a scavenger hunt around DC in the rain - taking photos at some of the most famous places in the world, and hanging in monuments dedicated to amazing people (Einstein, FDR, MLK jr, to name a few), giving me some perspective on contributing to society.
I ended the day with a very happy happy hour with all my co-interns - so wild to think that I'll be sharing insane, crazy, exciting, terrifying, sad, and exhilarating moments with these ladies for the next four years:

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