3:30 a.m. – Wake up.
4:00 a.m. – Leave apartment.
4:15 a.m. – Arrive at hospital.
4:20 a.m. – Print out the patient list.
4:20 – 5:25 a.m. – Split the list of 50 patients with your partner, go to a computer and write down for every patient their 24-hr vital signs, any reported fevers and what was done, what post-op day it is, what day of antibiotics and indications, discharge criteria, etc.
5:29 a.m. – Walk into a secluded conference room where all the interns and upper levels are and sit at the back silently with the other students.
5:30 a.m. – Morning rounds begin with the overnight residents reporting new admissions and updates on existing patients. Then the team takes the elevator to the first patient floor, sees every patient in about 1-3 minutes apiece, and repeat the process by furiously walking down the stairwell to the next patient floor and the ones after that.
7:30 a.m. – Surgeries begin for the day.
That was my morning routine for one month during my surgery rotation.
What time did I usually get home? 7 p.m. 8 p.m. The latest was 10:30 p.m. after a complicated Heller myotomy.
What time did I sleep? 11 p.m. or midnight, depending on how much I studied for my Surgery Shelf Exam and how much I fought with my body not to sleep so I could review more.
I was not coherent for many of my wakeful hours, and being pimped in the OR on questions I did not always know the answers to was sometimes anxiety-provoking. With that said, the OR is by far one of the most exhilarating places you can be on Earth at any moment in time. I’ve seen heart valve replacements, heart transplants, ACL repairs.
At times, the OR environment can be quite curious.
One time, I was told by a resident at the end of the case to “close the patient.” He handed me some pick-ups and suture.
“I’ve never done this before. Can you show me?” I said.
“Go ahead and try. I need to type the op note before the next surgery,” he said quickly.
Without saying another word, he stepped away from the OR table, took off his gown, tossed it in the trash, and went to the computer. I asked the nurse if she could show me, and thankfully, she did.
At another time, I scrubbed in for a series of cases with one of the top surgeons in the state. There was no resident for second-assist. The second-assist was me. I had the rare opportunity to navigate the camera during minimally invasive abdominal surgeries, got to use the Bovie, and closed for each case. That was by far the best day on the rotation.
On my last day, I breathed a sigh of relief that I survived. And for the first time in 31 days, I slept. For twelve hours. Uninterrupted. No dreams. No nightmares.
For as long as I can remember, I wanted to be a surgeon — someone who can fix a problem and see immediate results. I would receive instant gratification from patients and their loved ones. But it wasn’t until I completed my internal medicine rotation that I realized that my passion was in IM.
I’ve always loved meeting new people and getting to hear their stories. To follow patients during their hospital stays and to do whatever I could as a student to make sure they received the most optimal care possible was a privilege. Every day after rounds, I would speak to my patients about whatever was on their minds. Oftentimes, we didn’t talk about anything related to medicine. It would be instead talking about sports, food, family, politics, or just life in general.
I know how hard it is to be a patient. I was a patient once, and I’ve had family members who have been in the hospital. To be in a perpetual state of vulnerability and to hand over the keys to doctors is daunting. How can I work together with my physician so that we are both on the same page, yet both of us are understanding of our respective viewpoints?
It all comes down to communication and for those in the medical field to take that extra step in getting to know the patient. After completing my internal medicine rotation, I knew that IM was the field where I could be fully engaged in every patient interaction and develop comfortable rapport with patients, staff, and colleagues. IM is where I can work closely with patients both in the short term and the long run. IM is where I can treat patients holistically in a team environment with peers from other medical services, social workers, nurses, PAs, OT, PT, and other allied health professionals. It is easy to forget that medicine is more than just the MDs. It takes every person that a patient interacts with to bring a patient from Day 1 in the hospital to the day the patient returns home.
A resident once told me, “You must truly know that your field of choice, whether it be surgery or internal medicine, is what you want to do for the rest of your life. Because if it isn’t, you will not be truly happy. As you gain more years of experience, you will take on more and more responsibility. A higher patient load. And sooner or later, you will make your fair share of mistakes. Some much bigger and more severe than others, and every mistake ultimately will affect the care of your patients in some capacity. And every time you make a mistake, and even when you are honest with your attendings that you made it, you pray that you are not penalized and that your patient was not hurt by your own doing.”
“Would you have chosen a different field? Would you consider switching?” I asked.
“Never. This is where my passion lies. Always follow your passion, and you will be more than OK.”
Ton La, Jr. is a medical student and can be reached on LinkedIn.
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