I am - of course - pressed for time, still I want to try and write down the details of the past two days before I forget everything.
So, yesterday started at aroud 7:50am, when I met Nema and Borat in full medstudent gear
outside the building where we were supposed to hand our checks in. $26 per month each for something called a "health service fee", $200 as collateral for the pager we'd receive as well as $10 air service fee. Luckily, CS had been so kind as to provide these checks for me in exchange for cash (since I get cash without any fees here as opposed to money orders).Anyway, we waited outside the offices for as long as seemed appropriate and entered them at 8am sharp with two other visiting medstudents - one other actually from Stuttgart, studying in Berlin. Must have felt like a German invasion to the one guy from the U of Michigan. Rightfully so.
We received paperwork entitling us to pick up our IDs and pagers
and all of us together went a few blocks south to pick them up.
Note the back of the ID in the meantime.
After that, we entered the main hospital building and called what we assumed was a secretary in the internal medicine department from the main lobby. I only got voicemail, but when Borat tried a while later he actually got said secretary. She was very nice and gave us pager numbers of members of the teams we'd be with.
We paged them in turn - I was actually given the numbers of my resident and fellow, somehow the secretary seemed to know that the resident wouldn't really be the one I'd need. I spoke to the resident first, also a nice guy, who explained to me though that he had clinic duty this morning and that I should page the fellow. After I had done that, Nema paged her own team and picked up on the first return call. After my fellow, Jenn and Nema had taken about a minute to find out they were talking to each other in error, Nema handed me the phone and Jenn explained that she was swamped with consults and that I should come up to her onto the ward.
Right there I was glad CS had given us a rudimentary tour of the medical wards, because I almost didn't get lost on the way there. Anyway, when I was on the ward and asked for Jenn, she was indeed there.
Pretty much right off the bat Jenn reminded me of "the cute resident" in New York. She talks faster than I can think, only interrupted by her almost continuously beeping pager. After a quick hello and an even quicker introduction to the computer system she apologized and explained that she had just started on the service today. That meant she was just handed a stock of 18 patients that she needed to get semi-acquainted with plus three new requests for consults this morning. She apologized again but asked me to see one of the three patients right away, she wouldn't have time to explain things right now.
Ummmm, kay.
She gave me a "nephrology initial inpatient consultation" sheet, wrote name, medical record number and room number in the top right corner and gave me directions towards where she'd be. It was quarter past ten by now and she said I had until quarter to noon to get this patient's history and see why she was hypercalcemic and in acute renal failure. She gave me a quick rundown on the patient's story, including the fact that she was deaf and mute. Great.
So I headed down to her floor and took about an hour to work through the stuff I could find in her chart and on the computer. After I had her chief complaint, history of present illness, past history, family history, social history, allergies, medication, review of symptoms (since I wasn't going to be able to talk to her), vital signs, lab values and radiology reports all assembled from somewhere and copied onto my sheet, I actually went in to examine her. Of course, she immediately started talking to me. Or trying to. She mumbled incomprehensibly and pointed to both her feet alternatingly. My gesturing in response didn't help much. It wasn't going to work this way.
I went back out and found the nurses that had worked with her, asking them whether they understood what she said or had found another way of communication. They hadn't. So this actually wasn't going to work.
Oh well.
Using gestures, I could kind of make her do just about what I needed her to in order to give her a quick physical. I jotted down what I had found and then paged Jenn again, it was now about a quarter to noon. She asked me whether I knew how to get urine from her foley for "us" to look at. Well, uhm, I didn't really. So she came up and took the urine, then we rushed down incredibly convoluted corridors to her office, dropping the urine in a room on the way and making another quick pit stop at the dialysis unit where she apparently also had to do something. She took a stack of paper from her office and led me to a conference room, where a lot of people in white coats were already sitting.
I didn't take in much of the scene anymore since there was pizza on the table. Mmmmmh. Jenn told the group who I was and the attending at the head of the table invited me to grab some pizza and a soda, have a seat and enjoy the show. I complied most willingly.
The "show" was actually Jenn handing out pieces of paper that showed nothing but the age, gender and lab values over time of two patients. The residents and fellows at the table took turns to look at some of these values and give their opinions on it. I munched pizza happily. They tried to find a diagnosis and guessed at what was happening to the patient in terms of course of the illness and treatment outcome based only on the lab values, primarily electrolytes.
These guys knew what they were talking about.
I was for the most part barely able to keep up with them, actually still thrown off by the mere fact that they call Na "sodium" and K "potassium", which I should really have gotten used to by now. They were using lots of other abbreviations, presumably kidney stuff, only part of which I could figure out on my own. Naturally, I was never called upon by the attending to contribute anything to the discussion and I didn't. Maybe I should have, because the group spent a considerable amount of time discussing some "outlying" values at one time point of the second patient. They were apparently so wrapped up in their theories on the electrolytes and why this was going up here and dropping there that they didn't notice that at this time point that they found so particularly strange, everything was lower than before except for sodium and chloride, which were higher.
As I'm sure is evident to you now, this blood draw had been watered down by mere saline solution. I didn't dare to chime in on such a high-class meeting on my very first day so I listened to their discussions on these strange, aberrant values until someone else slapped themselves on the forehead and found the technical, yet simple answer. See, mom? I can shut up! ;)
That conference was over at around 1:15pm. Jenn told me on the way out that "rounds" would be at 1:30pm. Not knowing anything about how things would work here, I asked who is actually rouding with whom. She said "the attending with us". Ah great so I'd get to present my patient right away .. thanks for the warning.
When we sat in the attending's office a short time later we were joined by the resident who had thereby finished his clinic duties for the week. As it turned out, the attending was also new on the service so he would have to hear about all the patients. He wanted to start with the new ones though. Ah great.
At least, Jenn also had a patient to present so I happily left it to her to start off. And she did. It was pretty quick, but the attending - while seemingly a very friendly but also extremely competent guy - kept asking her difficult "teaching" questions. I was trying to listen and follow for most of the time, but I was distracted by my own case that I was thinking about and growing ever wearier of presenting later. At the point where I additionally glanced up to one of the frames hanging in the attending's office that showed he was one of "America's top physicians", he shot a question at me. "What else could it be, Philip?"
No clue. This is not my league. At that point I wasn't even sure whether I could roughly point at a person's kidneys.
When I admitted that I had no idea, it luckily didn't seem a big deal.
After Jenn's presentation, they were both looking at me expectingly. Thankfully, the attending said after a short pause, "don't worry, I won't be as hard on you as I was on her".
And he wasn't. It went quite OK. And as he asked me a few more questions - some of which I was even able to get partially right he seemed overjoyed.
After we had discussed the patients for today, we actually went to see most of them on the floors. This gave me a chance to get more acquainted with the resident. A rather quiet but very friendly guy - future cardiologist - who later on gave me a run down on what conferences to be at at which times in order to get through the week with the maximum amount of free food. My kind of guy!
After rounding, the day was over. At about 4pm. When I asked when and where I'd have to be the next morning, Jenn said I could come "whenever I wanted", I'd just have to check in on my patient again and it'd be nice if I touched base with her some time around 8:30 or 9. Hooray :D
So I went home happy.
This was going to be the last day that Trillian was in the US, so I called around and we arranged for a little impromptu party at Nema's place.
We bought some drinks and had a lot of fun together until Trillian and I felt that we couldn't keep Nema up anymore at 12:30, since her day would apparently start at 7:30 the next morning.
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