The Medical Apprentice

Growing up, my street was on a bit of a hill.  It was annoying to lose a ball into the road and have it stop rolling a dozen houses down.  Learning to ride a bike was especially challenging.  During the training wheel transition I had plenty of near misses (and full-blown crashes) with trees, fire hydrants, and mailboxes.  Though I got plenty of scrapes and bruises along the way, in the end I somehow managed to master the two-wheel art. 

This week I’ve felt my educational “training wheels” begin to loosen.  My classmates and I submitted our applications for residency, and some have already started to receive invitations to interview.  This month I am doing an acting internship (AI) in the Pediatric Intensive Care Unit (PICU).  AI’s are chances for 4^th year students to assume the roles and responsibilities of 1^st year residents (aka interns).  We have the opportunity to manage a larger number of patients and be more involved in the day-to-day plan of care than a student normally would. 

I’m working in the PICU at Toledo Children’s Hospital.  At first I was a bit nervous about starting in an area that took care of the most critically ill little ones in the hospital.  It certainly felt like I was jumping into the deep end of the pool.  However I’ve managed to stay afloat so far and learn a great deal.  The majority of the kids I saw this week had respiratory problems including pertussis, croup, and status asthmaticus.  Fortunately I was able to see most of the little whoopers, croupers, and wheezers improve enough to leave the unit.

As a student it seems I am constantly reminded of how “green” I remain in many areas.  I wrote almost all the orders for my patients this week, with an attending physician co-signing them.  While there are plenty of equations and protocols for calculating fluids and medication doses, so much of practicing medicine is based on experience and that clinical “gut” instinct.  Is this child ready to be taken off continuous aerosol treatments?  Should I recheck his potassium level in 6 or 12 hours?  Do the steroids alone account for this high blood sugar?  Luckily I have gotten some great practical advice from my preceptors and some tremendous nurses.  Perhaps realizing just how much there is to learn is the most authentic “intern” experience one can have.

I’m glad to have this acting internship to give me a preview of what residency will be like.  There’s a mix of exhilaration and a bit of terror that comes with removing training wheels.  I look forward to what this month has in store for me (while hopefully avoiding wayward trees or fire hydrants in the process!)

For this final month of my surgery rotation I am working in the Surgical Intensive Care Unit (SICU) at UTMC.  This unit takes care of some of the most critically ill patients in the hospital, ranging from trauma patients to those recovering from open heart surgery.  This isn’t my first time in the SICU, though my role has certainly changed a bit since my first visit. 

During my sophomore year as a pre-med I spent an afternoon a week volunteering in the emergency department at what was then the MCO Hospital.  I was stationed mainly at the front desk, helping to check patients in and assisting family members.  When trauma patients arrived I was sometimes allowed to observe in the room, and it was certainly an eye-opening experience.  I really enjoyed volunteering.  It helped remind me of my goals and allowed me to see the forest through the trees (and by trees I meant the ball-and-stick molecular models of organic chemistry).  However, as a volunteer I also had a very uncomfortable job from time to time. 

Trauma patients are whisked to UTMC via ambulance and helicopter from sometimes great distances (i.e. Lima).  Depending on the circumstances, it could be hours from the time the family is notified to when they arrive at the hospital.  This meant that patients were often in surgery or the SICU when their families arrived in the emergency department.  So as a volunteer one of my jobs was to escort families upstairs to the SICU.  It might seem strange, but that simple task would be the most uncomfortable.  Families would be very anxious and distressed, made worse by the fact that they often had little information regarding the condition of their loved one.  As I escorted them through the hospital lobby, then upstairs and down a long hallway, they would ask me a multitude of questions.

Is he alive?

Will she wake up?

Will he ever walk again?

What about the friends who were in the car with her?

Not only did I not know what was going on with the patient, but I also had no expertise or the authority to comment on what happened.  It was awful to feel so helpless and unable to provide comfort to people standing a few feet away.  All I could do was walk with them to the rooms of their loved ones.  That brief walk felt like an eternity.

So to say the least it’s nice to have a different role this time around in the SICU.  It is certainly a challenge to be working with patients having multiple complex medical issues.  I think this month will teach me a lot about how to talk to patients and families about these conditions.  The best docs can treat the clinical complexities while also making sure the needs of the family are being met.  After all, a devastating accident or illness affects more than just the person in the hospital bed.  I think this represents more of the art of medicine, something learned best through experience.