Sunday, 22 September 2013

On Patients and Privilege

I've been a bad blogger, I know. It's been almost two weeks since I've posted - school has been so busy, and by the end of the night when I'm done my prep for the next day all I want to do is put my computer away. I'll try to be better and post more often though.

So, on Friday my tutorial group got to see our first patients. Whoa. Now, I should clarify here: when I say that we got to see our first patients, I don't mean that we treated anyone - far from it! In clinical skills, we're currently working on history taking, so when our preceptor walked into the room to start our session, the first thing he said was "so, are you ready to head to the wards?". We knew that we might be interacting with patients this week, so we had all prepared checklists for history taking, but we figured that we might sit and go over them for a while before jumping right in. Luckily, our preceptor took us to the room of an incredibly friendly patient who was willing to sit there for half an hour and let us ask all kinds of questions in order to put together a history. This particular patient was hoping to be discharged this weekend, so we all appreciated the fact that they were so willing to answer questions that they had probably answered 10 times just to help us learn, without any real benefit for themselves. (I apologize if I'm being super vague here, I just want to make sure not to give away any details). So, in a nutshell, best first patient ever. The other students in my group and I all have a few pages of hastily scribbled notes, and have instructions to type them up into actual histories that we can bring to class and present next week. Then, we might even get to go talk to more patients!

After we had taken our patient's history, our preceptor decided to take us down to the unit where our other preceptor was working to see if she had any patients we could talk to (for clinical skills, our group is lucky enough to be taught by a team of two amazing doctors who have been teaching students together for 10 years). Instead, we got there and found out that she was in the middle of a procedure, and actually asked for an assist from preceptor #1! Luckily for us, that meant that we got to go into the room and observe, as long as we followed two simple rules: 1) stay out of the way, and 2) don't talk. Haha. Easy enough. So, we got to watch them work for half an hour trying to place a femoral line. So cool.

After the procedure was over, our preceptors decided that in order for us to know what questions to ask a patient, we need to also have a solid clinical background, so they took us into a conference room and pulled up a bunch of lab tests to go over with us (echocardiograms, x-rays, CTs, etc). It was a great learning opportunity, and I was proud of myself that when they asked spontaneous questions I actually got a couple of them right. Woohoo!

The story of my afternoon does have a point, though, other than just a narrative of my day. It was a really interesting experience, getting to walk into restricted areas of the hospital without anyone questioning me (an ID badge is a powerful thing). I'm not going to lie, I did a little happy dance as I walked past the volunteer check in desk without actually having to check in, haha. I was talking to some of my fellow students about it, though, and we were all pretty conscious of the transition we're going through, from pre-med wannabes to actual, legitimate, medical students. It's a really privileged position that we're in. People trust us, just because we're a part of the medical profession. We took a history from a patient, and the patient answered every question we asked without hesitation, because we're med students. We get to go into patient rooms and observe procedures, because we're med students and we have to learn. People trust us and are willing to open up to us, because (as they keep telling us at school) we're the newest members of a trusted profession. It's an amazing feeling, but it's also a lot of responsibility.

A story that, to me, exemplifies what most of us are feeling right now was told by one of my favourite authors, Louise Penny, when my mom and I saw her speak in January. Louise's husband is a retired doctor, and he's the former Director of Hematology at the Montreal Children's Hospital (aka he took care of children with cancer for the majority of his career). I actually had the opportunity to meet him this past week, when I saw Louise speak once again, this time with an amazing friend who got Louise to sign a book for me. Anyway, Michael is an incredibly sweet man, and Louise always talks about how wonderful he is and what an appreciation he has for life after seeing every day at work how valuable life really is. Back in January, Louise was telling the audience a story of a Christmas party that she and Michael were attending at the Children's Hospital not long after they had met (at this point, I believe Michael was still the Director of Hematology). All of the children who were inpatients at the time and their families were enjoying the festivities, when Louise noticed Michael standing with his back to the room, looking at the wall. She went over to find out what he was doing, and she noticed that he was crying. When Louise asked him what was wrong, he replied that he knew which of the children in the room wouldn't still be alive for next year's Christmas party.

Whoa. I know I didn't write that nearly as well as Louise told it (which is why she's the New York Times bestselling author and I'm not), but let me tell you, there was not a single dry eye in the room when she was done (and I'm misting up a bit now as I rewrite this). My point is, doctors are trusted with a tremendous amount of privilege and responsibility. People invite us into their lives, sometimes the very worst moments of their lives, and they trust us to take care of them. Patients answer our questions, and let medical students watch as they have a procedure done. It's a crazy thing.

I know that this week was just the tip of the iceberg, and as time goes on I'll become more and more involved with patients. What I hope, though, is that I never forget this feeling of privilege at the beginning of medical school. I understand that to do your job well as a doctor you have to find a way to stay professionally detached, but I think it will be important to remember how lucky we all are to be part of the medical world.

Now, I think this might have been a bit of an unintentional downer, so I'll end with one last plug for Louise Penny and her books - you can read more about her here. I'm also happy to lend my copies out if anyone wants to get into the series.

I promise to try to write more often, though my posts may not always be this long. Thanks for stopping by my little corner of the internet. :)

Monday, 9 September 2013

One week down, 129 to go.

Well, somehow the first week of classes has come and gone. I'm not really sure where the week went, but really, that seems to be the story of my life lately, so that's nothing new.

I have a ton of ideas for things to write here (and somehow, not enough time to write them all, haha), so I think today I'll just give you an idea of what a typical(ish) week looks like in the life of a med student at my school.

Last Monday was Labour Day, so we had the day off and I got to see some of my family at our annual BBQ (hi to any of you who are reading!). It was really nice to get to see everyone, but unfortunately having Monday off just meant that they squished five days of classes into four days, so it was a busy week!

My school is really big on PBL (which stands for problem-based learning - my school is also really big on acronyms), so instead of traditional lectures, we do a lot of our learning independently. The PBL format is great for me, having just spent two years doing self-directed learning in grad school, so I can study on my terms. I learn way better when I have to teach something to myself and actually understand it, as opposed to being fed the information in a lecture (and let's face it, during the lectures some inevitable internet-surfing occurs). So, we have two three-hour tutorials per week, in which we get assigned case studies that we're expected to research, then we go to tutorial and talk them over (all while our tutor, who is a doctor, makes sure we're on the right track and covering all the important points). My tutorial group is really awesome - I don't think I could have asked for a better group to work with. Unfortunately we're only together for the first 13 weeks of school, then we get reassigned to other groups, but I'm really glad that we have a strong group to start off.

In addition to the tutorials twice a week, our tutorial group has a three-hour clinical skills session at the hospital with our preceptors, who are doctors. In clinical skills, we're going to learn things like history taking and patient exams... and we might be working with real patients as early as this week! EEK! I mean, it's not like we actually have any real responsibility at this point (can you imagine someone treating you who has had a whole week of medical education, haha?), but it's crazy to think we will be interacting with patients right from the beginning. For the most part, from what I hear, the people we'll be working with are patients who are kind of bored and have agreed to let us come in and practice taking a history, so hopefully it won't be too intimidating. :)

We also have a class called Professional Competencies (or ProComp, since we like acronyms so much), which we jokingly refer to as the hugs and feelings class. Really, though, it's probably one of the most valuable classes I'll take during med school. We work with the same small group of 10 students and two facilitators for the 15 months leading up to clerkship (which is in-hospital training, for anyone who doesn't know), and in this class we'll be talking about the non-medical aspects of being a doctor - professionalism, ethics, and anything else that you can think of. ProComp is kind of the 'bedside manner' class - we'll be practicing all kinds of things, ranging from introducing ourselves to patients to practicing breaking bad news to a patient (which sounds terrifying, so I'm glad we get to practice on each other before we have to do it for real).

Lastly, we have sessions in the anatomy lab, which are also self-directed, and we have some sporadic "large group sessions", (also known as LGS), which I think is just a fancy term for lectures, haha! All in all, my schedule is pretty full, but still has room for some extra curriculars and electives and hopefully spending some time with Matt when his schedule and mine line up!

Well, that's a typical week in the life of me. As it stands now, I have Tuesday and Thursday afternoons off of scheduled classes (which probably means they'll be spent in the anatomy lab), and some mornings if we don't have an LGS scheduled.

I'll try to write more soon - heck, I could write an entire post about today (which included the day starting off with being subpoenaed to testify in court in November, fighting to get a refund on some stuff I bought online that never showed up, and returning home tonight to many many fire trucks outside my apartment building - apparently there was a fire at the sub place on the ground floor). In the meantime, though, I'll leave you with a photo of what my life currently looks like - books, and more books. Yay, respirology.

Thanks for reading! I'll try to be better at this blogging thing and post more frequently.