Saturday, December 11, 2010

Pink Hats, 12: The Medical Student Pipeline

Never stand when you can sit, never sit when you can lie down, and never pass up an opportunity to eat because you don't know when you'll get another, was the advice his best friend, an MD psychiatrist, passed along to him from his third year, which was given to him by a fourth year student who'd gotten it from her intern. 

That's how things work in medicine. Not quite a pipeline but close -- you could call it an oral tradition. Composed of wisdom, humor, and hopefully, sound common sense, Jung would describe it as the mythology of medicine, a body of useful tidbits that works its way into the psyche and helps transform dreamers into initiates.

Day Two of his rotation burned up his breakfast glucose faster than a speeding bullet, and Chuck was grateful the matronly cafeteria employee who filled his plate believed in generous portions. He was deep into his macaroni and low-fat cheese -- the cheapest entree on the menu -- with a side of salad and apple pie, when Jessie set down her tray and asked, "Mind if I join you?"

"No, by all means, do. How are things with you?" He was surprised at the company, thinking she could have chosen the doc's lounge, instead.

"Busy, as usual. I just had to steal a few minutes, though, to nosh down a sandwich -- I was bonking big time. How about you? How's your second day with Dr. Bob going?"

"Amazing. We saw three colds, a case of croup, four of impetigo, one kid with measles, and, as he puts it, a whole lot of distraught, at-their-wits-end parents, as well as a rule/out case of pneumonia before he said, 'Get out of here, go get lunch, and I'll see you in 30 minutes.' I don't know much yet, but when my attending says, 'eat,' I make it a point of doing exactly as I'm told," he said, smiling.

She nodded knowingly, wiping an errant smear of mayo with a the tip of her middle finger. "I can identify and believe me, that's smart. He'll have you working up your own patients sooner than you realize and time will get even more precious. My suggestion is, familiarize yourself with the most common childhood diseases -- he won't give you a 'zebra,' not at first. If he thinks you can handle it later on, maybe. Keep in mind, with him, how well you know your patients is as important as how well you treat them. In his book, kids are first of all, people. But I'm guessing that might not be much trouble for you."

"Why do you say that?" he asked, taking a sip of Pepsi One.

"Well, you're an older student. Even if you haven't had any medical experience, you've have life experience and that gives you a distinct advantage when dealing with parents. They'll assume you more than you do, which means they'll be less inclined to regard you as 'merely a student.' That was something I had to overcome in my rotations."

"I was a therapist -- psycho -- before medical school, but I'm 'as green as a boy can be,' as Mark Cohn would say, when it comes to physical medicine."

"I like that song, too, and your experience as a therapist will help you immensely since you already know how to listen, presumably. Parents will appreciate you listening to them, but do it with their kids, too. Doctors don't listen to kids nearly enough. So, look for clue words, ask pertinent questions, summarize to make sure you're all on the same page, write up your notes carefully, and you'll be fine. You'll learn more than you ever thought possible and have fun at the same time."

"Thanks for the advice -- and the encouragement. How long have you known Bob? He insisted I use his first name -- 'If I can call you Chuck, it's only fair for you to call me Bob. Besides, if I can persuade you to become a pediatrician, one day we'll be colleagues.'"

"That's good. Since med school, like you." She concentrated on her sandwich, washing it down with iced tea, and hoping he'd leave it at that.

The brevity of her response struck him as curious, but since she wasn't paying for therapy, he decided to drop it for the moment and changed the subject. "One thing, it was really cool seeing the twins with him yesterday. I was blown away by how much they've grown."

"Oh, they have, and thanks to you and your dog -- it's a Lab, isn't it? I've got one, too -- they've become the darlings of the peds unit. You did a four-oh job that day, in case no one's told you. Seriously. Bob told me about the EMT report -- you saved their lives."

He used his last forkful of apple pie to hide his self-consciousness and said, not having quite finished chewing, "Well --" munch, "it was --" sorry, let me finish this." Munch, swallow, sip of Pepsi. "It was scary, that's for sure. You know how it goes, first you've got that parasympathetic response and you think you're going to wet your pants, then the sympathetic kicks in and the adrenaline flows. The truth is, I didn't do much at all, it seems like. The guys from the fire department were terrific -- I have never in my life been so glad to hear a siren. Oh -- yeah, he's a Lab, a yellow one -- Chester."

Finished with her sandwich, she drained her tea, and started to get up. "Mine's Black -- Sam, and we're all glad to have you here, especially Bob and I. That's why I decided to eat in the cafeteria, I saw you come in and thought it would be an opportunity to say so. Anyway, thanks for the table -- I'm sure we'll talk again." I can't believe I said, 'Bob and I' -- me and my big mouth.

"That is so thoughtful of you to say, it really means a lot." As she walked away he mused, Mm, 'especially Bob and I' -- what's that about, I wonder...?"

(Creative Commons image of the Old Victorian Wing of Maine Medical Center, misfitgirl via Flickr)
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