Tuesday, September 27, 2011

The Last Week of My Sub-I

I spent a few days during the final week of my Sub-I working at a women's crisis clinic which offers free ultrasound, counseling, and prenatal care.  While I was there, I met a woman who came in at eleven weeks gestation for her first ultrasound.  She had one young child at home and lived with her long-time boyfriend. She was very nervous during the ultrasound and joked about how many babies we saw on the screen. At first we saw only one gestational sac, but as the ultrasound tech continued to look we noticed a second baby. When the patient started crying, I was not sure what to think. I initially thought they were tears of joy until she sobbed "this is not good". She started talking about how she did not think that she could handle twins. It would be too much. I tried to console her and just held her hand while the tech completed the ultrasound. 
Afterward, I had a chance to sit with her and talk about her concerns for this pregnancy.  Her support system really only consisted of a sister who lived in another state. Her boyfriend was not supportive. He had been pressuring her daily about getting  an abortion. Now, she was afraid to tell him she was having twins for fear that he would become angry and kick her out of the house. His reasoning was that now wasn't a good time for him. It was hard for me to believe what I was hearing.  This woman was genuinely afraid of the reaction of her boyfriend.  She denied any history of physical abuse, but she believed that he would put her out on the street if he knew she was having twins.  She had nowhere to go.
She stayed at the clinic while a social worker contacted a local women's shelter. By the time she was ready to leave, she had made the decision not to tell him about the ultrasound until she had an alternative housing plan. The tech gave the woman her cell phone and told her she could stay with her if anything bad happened before she could make other arrangements. When she walked out the door, the ultrasound tech and I shared a hug and a tear for our patient. I don't know how things turned out for her, but I think about her often. I hope she is safe.
The third and fourth year are so different. You leave behind hypothetical patients and standardized tests and begin spending your time with real patients who have real tragedies. It is very difficult, sometimes, to separate the emotions that you feel at work from your personal life.  I have cried a few times after a particularly difficult day, but I think that's healthy. Hopefully, we all went into this field because we are compassionate.  The important thing is to do as much for you patients as you possibly can, and take comfort in that when you fall asleep at night. 

Monday, September 12, 2011

The Sub I continues

I spent the third week of my sub-I with the medicine team. I am really impressed with the training opportunities that are available in their residency program. And the residents are really smart. The first year residents (interns) are bright and efficient-they always seem to know the next step. I hope to be half that good when I start residency! The staff in this program are all very approachable and ready to teach. I haven’t seen anyone talking down to the residents, nor have I seen any friction between the residents themselves.

I have been paying close attention to these interactions because I want a residency program that will encourage learning and be a relatively happy place to work. The residents at this program seem truly happy and satisfied with their program. There are a lot of different personalities, styles, and belief systems, but I think since people are generally content with the way they are treated by the program, it is easy for them to work together regardless of their differences. Each attending that I have worked with has made a point to learn my name. I have been writing progress notes and even orders (they have to be signed by a real doctor) which has been excellent training for me. Everything here has been in a paper chart, but I’m getting the hang of it now. (Of course, just in time to leave!)

Earlier in the week I joined a few of the girls for dinner. It was nice to sit down and relax with them outside of work. I thought it would be good for me to hear what my potential future colleagues are complaining about when they are on their off time. It could give me clues to the obstacles that I might face later on in my training. This group didn’t really have any complaints. In fact, we spent most of our time figuring out all of the things that we had in common. On Friday, one of the residents arranged for everyone to attend a baseball game. My husband, Matt, drove in so he could meet everyone. It was so much fun to spend time with the residents outside of the hospital.

I highly recommend that students rotating through their sub-internship go to these extra activities. There may be times when you are exhausted, but it is a wonderful opportunity for you to learn about the people you might be working with later on in residency. Plus, it gives them an opportunity to see you let your hair down (a little)!