First month of M4 year: done.
Emergency Medicine was a wild rotation. It was a great way for me to hone my H&P skills to under 15 minutes (which will come in handy for my upcoming USMLE Step 2 CS exam), and it gave me the chance to see all sorts of medical conditions, from the acutely psychotic to the acutely traumatic (flexing both my mind and my suturing skills). For the most part, the rotation was a microcosm of my entire clinical education with one large exception: it was the first time I had seen a patient die.
Less than a week into the rotation, within the first ten minutes of my shift, our team was notified of an incoming patient: 21-year-old female with a history of heroin abuse presenting in cardiac arrest. She had been found down and unresponsive for an unknown period of time. The doctors, nurses, and techs were ready to receive the patient in the resuscitation bay when EMS came in, performing chest compressions and bag ventilating. It was not looking good. After the team quickly moved her from the stretcher to the bed I started continuing chest compressions, the only thing a med student is usually qualified to do in that situation. I remember thinking how terribly young this person was. She had an eyebrow and lip piercing, and a tattoo of a bird on her arm. Completely unresponsive. As is standard protocol in the ED, we used trauma scissors in order to cut off all clothing when she arrived to give us IV access. About halfway into the resuscitation attempt, the team laid a sheet over her lower body as the patient's mother came into the room to be at her daughter's side while chest compressions were still going on. Twenty minutes after the patient's arrival, with her heart only twitching on ultrasound despite medications and CPR, we informed the mother that we had to call it. She couldn't bear to look up from her daughter's hand. All we could do (all I could do) was move on for the rest of the shift.
In some ways, medical students are trained to handle emotionally-charged situations like this through simulated patients. Part of the Emergency Medicine rotation, for example, is completing a Standardized Patient Interaction on Breaking Bad News. I certainly appreciated the feedback I received from the volunteer who played the role of a wife whose husband had just passed away in the ER (make sure all relevant persons are present and accounted for, use the deceased patient's full name and address the relatives by name, offer family members the chance to see their loved one). I also was relieved that I could keep my emotions under control during that exercise, and was happy to hear that I apparently have a soothing voice and demeanor. However, I feel like these lessons are designed more for a physician-in-training's future patients than for the physician-in-training. The communication techniques and tips help doctors console patients, but how can doctors frame these experiences for themselves?
For me, taking part in my first code revealed the brokenness of the world in a way I had not known before. I will never know when, how, or why that 21-year-old woman became addicted to heroin. I will never know if our resuscitation efforts were futile from the beginning. What I am thankful for, though, is the chance to contrast the brokenness I experienced that day with a vision of what the world could be. Just a couple of days after that ER shift, Phi Rho friends and I took a trip to the movie theater, a rare treat for busy med students. We not only bonded as a group, but also bonded with a subletter from the UK, Mandeep.
At first glance, this simple display of friendship might seem insufficient to balance out the tragedy of a needless death. I guess my point is that we (med students, physicians, humans) shouldn't discount these happy moments as any less real or meaningful. Why do I have this conviction? Well, going to the movies that day, Laurel mentioned how she participated in an autopsy of a 20-something woman from St. Joe's who had died a couple of days ago. Sure enough, upon further questioning, I found out it was my patient. Taking that story full circle, the juxtaposition of brokenness and renewal, helped me realize that happy moments like the one I was experiencing at that time were still worthy goals to aim for, goals for us and for our patients. No matter what specialty my classmates and I choose, we can do our part to help renew others, even if the renewal is as simple as enjoying a trip to the movies with friends.
[Renewal (and sunshine) finally in Ann Arbor]
In other news, residency applications are starting to loom over the M4 class. I have my Dean's Letter appointment this coming Wednesday, which basically consists of going over comments from my clinical evaluations and reviewing a draft personal statement/CV. In writing my personal statement rough draft, all I could say was thank goodness for this blog. Turns out my online ruminations were helpful reminders of why I want to go into Psychiatry, and my path to committing to that specialty. This weekend I drive to Chicago for my USMLE Step 2 CS exam, then comes 3-4 weeks of vacation...to study for the Step 2 CK portion of the test.
Med school life, fo' sho'.