Family & Friends-
I find myself with a few minutes this morning and figured it would be an ideal time to try and catch up on my letter/journal. I think last time I wrote anything I was on my Anesthesiology rotation. This month I’m on Family Medicine and it is 180° change from anesthesia (a good thing in my opinion – sorry Jared!) In fact, I’m enjoying myself on Family Med so much that barring a big surprise on my remaining rotations, I think Family Med is what I’ll end up going into. I guess what remains to be seen is how I feel about the idea of going into surgery when I’m on that rotation – but for now I think Family Med is the ticket!
Part of what I’ve enjoyed this month is the increased interaction I’ve had with people and patients compared to my time in anesthesia. I find that anytime you interact regularly with people, especially as it relates to their health, you get a lot of unique and memorable experiences. Add to that, the fact that I’m still in the VERY steep part of the learning curve and there are some downright humorous moments (in retrospect of course…they didn’t feel all that funny at the time!)
Okay, before I relate any of the actual stories, let me paint a picture of what Eric Brimhall, student doctor, must look like to patients:
First, because I’ve discovered through painful experience that I can only wear my current brand of contacts for a few consecutive hours before my eyeballs want to explode, I’ve been forced to wear my glasses to work every day. Many of you know how much I loathe having to wear my glasses, because when I got them a few years ago, I made the worst purchasing decision of my life and I got transition lenses (the kind that get dark in the sun). Let me stand as a cautionary tale to anyone considering transition lenses! Personally, I would like the opportunity to meet the guy who invented transition lenses (and the lady who sold them to me) in town square at high noon for a duel! Why are they so bad? #1, They get ¾ dark – but not all the way dark – under pretty much any light source. This takes about 0.00001 nanoseconds. However (and this leads me to reason #2) they take a good 20 minutes to get back to mostly clear (notice the word “mostly” – they don’t actually ever get completely clear!). What this means is that I walk around virtually all day with partially dark glasses, and all I would need to round out the nerd outfit would be a pair of chums to keep them firmly attached to my head!
Now that you can picture my glasses, imagine them on a lanky guy with dark circles under his eyes from lack of sleep and a white coat with pockets bulging from an assortment of student-related items. At any given time (any med student/residents/doctors out there will know what I’m talking about!) I have a stethoscope, a penlight, a reflex hammer, a PDA, 3 pocket-sized reference guides, a stack of printed journal articles, some flashcards, a Powerbar, 6 pens, something like $1.28 in loose change, a Ziploc baggie with a few emergency Excedrine pills, a pocket calculator, and approximately 1 million 3x5 index cards with scribbled reminders…okay more like 20 or 30 index cards…but you get the picture! Underneath all of that is a pretty normal assortment of shoes, socks, Dockers, ID Badges, pager, shirt and tie.
Now that you have an idea of what I must look like to a patient when I walk into a room for the first time, let me share some of my more memorable moments from the month.
Due to HIPAA regulations, I have to be careful about telling this story. I’ll have to leave some details out, but I’ll do my best to convey the spirit of the moment.
The regular procedure we follow when a patient comes in is that I will go into the room, and get a History & Physical (H&P) and then come back out, present my findings to the attending, tell him what I think is going on, tell him/her what I think we should do and then we visit the patient together. The attending does his/her own H&P, makes his/her own assessment and plan and then we talk over the points on which I was right and those on which I was wrong and then I make a list of things I need to look up on my own time. Then I write a progress note on the encounter, detailing what happened and summarizing what the doctor thinks is going on with the patient and what we plan to do to help.
On my second day of the rotation I was asked by my attending to go talk to a family and get an H&P. We had just left a different room and I didn’t have time to read the patient’s chart before I walked in. Also, because it was only my second day I was still trying to get a sense of how to smoothly get the information I needed (let’s just say I hadn’t figured it out yet and I wasn’t smooth at all). Upon walking into the room I was confronted by (here is where I need to be careful about HIPAA) a particular person I recognized and that person’s spouse and daughter. They were there because the daughter had an injury that was healing very strangely. The reason this was a little disconcerting for me was because one of the parents has a lot of influence over how my dean’s letter eventually turns out (several people are involved in the dean’s letter process, and they all have considerable say over how the letter eventually turns out). Anyway, the point is that this was one of those rare moments where you NEED to shine!
After getting over my initial shock I did my best to put together a decent H&P. I asked every question I could think of…and probably asked a few of them twice in my nervousness! Then I did a focused physical exam and had to admit that I had absolutely no clue what was going on with this little girl. Like a shamed puppy with its tail between its legs, I went out and had to tell the attending that I had no idea what was going on with this girl. We went back in together and I had one of those mixed bitter-sweet moments when the doctor said he had never seen something like this before. Bitter because it meant the girl and her family didn’t get the answer they were hoping for, but sweet because even this doctor with 25 years of experience had no idea what was going on – making me look less stupid.
Anyway, we referred the girl to the plastic surgery folks, and I’m confident they’ll know what to do.
A few days later, I was with a different attending and we were running pretty far behind schedule. In order to try and catch up a bit the two of us went into a room together instead of having me go in alone first.
The lady we were there to see is in her 80’s and showing signs of advancing Alzheimer’s disease. She was there with her daughter who did most of the coherent talking. The old lady, I’ll call her Mrs. Johnson (bless her heart), took one look at skinny little me and decided that I was to be the target of her affections for the remainder of the appointment. She began by telling me what a “handsome young man” I was (which would have been slightly flattering if she had been 60 years younger and not a patient). I did my best to laugh it off, (“Oh, Mrs. Johnson, you are just trying to get me in trouble!”) but she was relentless! In the presence of her daughter and the attending physician she proceeded to tell me that we should leave right then, get in the car, go for a drive and then “park”. Not only was I a little flabbergasted and embarrassed, I was shocked that an octogenarian with advancing Alzheimer’s disease would know how to use innuendo like that! (perhaps that one has been around longer than I suspect…who knows!?!)
Anyway, for the remainder of the appointment I had to balance attempting to learn and be attentive to what the doctor was saying and appropriately deal with the flirtations of this lady! When all was said and done I think everyone except Mrs. Johnson walked out of that room feeling a little awkward and embarrassed.
My next story happened yesterday and I’m still blushing a little bit as I think back on my mortification at the time, but I think this story needs a little bit of a preface.
Let me state right now that all things OB or GYN (obstetrics or gynecology) I am stupid at! Being a single mormon male has not given me much experience in these areas, and all I can do when I encounter OB/GYN stuff at this point is to furrow my eyebrows, nod sagely and try and keep my jaw from dropping or my face from flushing! I can hardly imagine the kind of stories I’ll be able to relate come December when I’m on my OB/GYN rotation…
Anyway, yesterday my attending told me to go in and do a prenatal exam on a lady in her 3rd trimester. I have never done one of these – in fact I’ve never seen someone do one of these! My entire experience on what I’m supposed to do is based on a 1 page sheet I glance at as I walk down the hall toward the fateful exam room. I preemptively furrow my eyebrows and begin my sage-like nodding even as I walk in the room and introduce myself. I then go through a list of very personal questions and just pray that I’m not visibly blushing. My flow of speech is interrupted every 2 nanoseconds with an “umm” and it is painfully obvious that I’m green and very nervous about all of this. I get through all of the questions and now it is time for the exam. (“umm…just take a seat up here and I’ll, umm, do a quick exam”).
Fortunately for me (and the patient), my sheet doesn’t say that I need to perform a pelvic exam, and right now this sheet is scripture to me, but it does say I need to use the dopler machine to get the fetal heart rate. The device is simple enough but in my near catatonic nervousness it might as well be mission control. I put that part of the exam off until last, but it looms over me like a Sword of Damocles. Finally after stumbling through the rest of the exam I can no longer put off the dreaded dopler. Asking the patient to lie down on the exam table and expose her swollen abdomen, I grab the bottle of ultrasound gel off the counter. This bottle resembles the ketchup or mustard bottles that you would see at any roadside café. All I need to do is turn the bottle upside down, shake the gel to where the spout is and squeeze the gel out. Unfortunately, the type of plastic the bottle is made of is the kind that gets brittle with age and apparently this bottle has been sitting on the counter for a long time because as I shake the bottle and begin to squeeze the bottle explodes sending gel-shrapnel flying in all directions! I’m completely mortified! (“umm…sorry…let me get you a tissue and we can wipe up some of this gel!”)
I guess the bottle exploding did get the gel I needed onto the lady’s abdomen and I quickly get the fetal heart rate and scamper out of the room as quickly as possible to inform the nurses that we’ll be needing a new bottle of ultrasound gel in that room (they all have a good laugh when I tell them the story).
Okay, enough embarrassing stories from work! The only other news I can think of was from Labor Day. I went with a group of ward members to an old rock quarry that has filled with water to do some cliff jumping. It was fun and relatively safe! One of the coolest things we did was lunch! The quarry we went to was right next to a very small little town – kind of a quintessential small American place. They had a rag-tag parade down Main Street that was absolutely charming despite its obvious make-shift nature. My favorite “float” (actually a trailer being pulled behind a Ford F-150) had several WWII vets in uniform doing nothing but wave to the crowd (very appropriate in my opinion even though it was Labor Day and not Veteran’s Day). To me no amount of ostentatious decoration or fanfare could have better captured what I love and admire about this country and the people who have sacrificed to make it what it is. A while ago I went on a WWII reading spurt that included Tom Brokaw’s “The Greatest Generation”, James Bradley’s “Flags of Our Fathers”, and Jeff Shaara’s “The Rising Tide”…My admiration and gratitude only continues to grow.
Lunch itself was memorable in the sense that it captured small town America so well for me! The small park right off Main Street where the Rotary Club set up their grills had several rows of picnic tables crammed with locals in their cotton dresses and overalls. The biggest entertainment was a lady dressed up as a clown who was tying long skinny balloons into different animal shapes for a crowd of kids. I ate a fantastically unhealthy meal of fried chicken and $.25 chocolate ice-cream cones – and loved every bite! We all got sunburned and had to keep swiping away the ants and hornets intent on stealing as much of our meal as they could carry. As common place as this scene is, it was a charming and memorable holiday!
Love you all and hope you are doing well!
-Eric
