[Album: good kid, m.A.A.d city]
"But I can never write my wrongs unless I write them down for real."
"P.S."
Just finished Week 2 of my Neurology Rotation -- well into the swing of things, more or less.
As much as I like to fly off into the comfy fluff of unspoken emotions and heart -warming/-breaking stories I realize one can't be so airy as to lose sight of and acquaintance with ever-so-reassuring solid ground. I hope to veer slightly back towards practicality and reality. This is not to say that the wonderful Hippos I try to find along the way are irrelevant, but that they do somewhat lose value when concrete events are ignored.
I could reflect on the death of a patient forever -- which I thankfully, have not personally experienced yet. I could tease apart and attempt to decipher the whirlwind of emotions and the facial expressions of everyone around me that say so much without a single verbal utterance. But when it comes down to it, I would rather have been skilled or tactful enough to have saved that life. That requires Crates.
"You live life on an everyday basis."
I suppose what I'm trying to say is that the intangibles are important and necessary in my humblest opinion. Yet despite their vital nature it does represent a type of wishful thinking that has difficulty manifesting in our reality of disease and various injustices. I've been getting carried away with the Hippos, admittedly because of my deep bias favoring them.
Like Anakin Skywalker's destiny it's time to bring balance to the Force.
(Nerd Reference: Star Wars)
It's appropriate, as this past week has been full of slightly sobering realities. The Crates we have learned up to this point have been purely academic -- symptoms, medications, statistics, etc. Now that we are in the hospitals and out on the wards there are other Crates to pay attention to lest we miss them altogether. Politics exist and the teamwork required of modern medical practice is, more often not, plagued by the double-edge of social tension and clashing identities.
It's time to deflate a little. Air can be thin when too far up.
"I mean I write poems in these songs, dedicated to you when...
you're in the mood for Empathy, there's blood in my pen."
crate --
:::Consults and Progress Notes
The most obvious Crates are all the symptoms, lab tests, and other clinical signs that we attempt to memorize and recognize within our Patients -- all in an effort to alleviate or avert illness.
All well and good. But from the surgically inclined specialty of OB/GYN to the uniquely subjective nature of Psychiatry I have finally spent considerable time in the relatively conventional inpatient world of Neurology. With that comes the monolithic reality of job duties and paperwork.
Physicians do not simply live in a House M.D.-like world where they can sit in rooms of glass and metal contemplating diagnoses all day errday. Yes, differentials and discussions are made but documentation is key and central to the practical reality of Physicians and other healthcare professionals. Like other professions it's not as glamorous as media and pop culture make it seem.
In fact, what I've realized and experienced thus far has me convinced that more and more of a Physician's time is spent pouring over laboratory results, diagnostic images, and notes from others rather than actual face time with the Patients themselves. This is before the Physicians go ahead and write their own daily Progress Note. The process takes forever. And it's repeated all day errday.
The added responsibility of Consultation adds another dimension. The various specialties that make up modern Medicine not only have an obligation to the Patients within their service but also lend their knowledge and insight to Physicians in other fields when needed. That package deal comes with even more note sifting and literature searches -- so much so that Physicians can effectively be described as data miners if one wants to get technical.
The most obvious Crates are all the symptoms, lab tests, and other clinical signs that we attempt to memorize and recognize within our Patients -- all in an effort to alleviate or avert illness.
All well and good. But from the surgically inclined specialty of OB/GYN to the uniquely subjective nature of Psychiatry I have finally spent considerable time in the relatively conventional inpatient world of Neurology. With that comes the monolithic reality of job duties and paperwork.
Physicians do not simply live in a House M.D.-like world where they can sit in rooms of glass and metal contemplating diagnoses all day errday. Yes, differentials and discussions are made but documentation is key and central to the practical reality of Physicians and other healthcare professionals. Like other professions it's not as glamorous as media and pop culture make it seem.
"They say conversation rule a nation, I can tell."
In fact, what I've realized and experienced thus far has me convinced that more and more of a Physician's time is spent pouring over laboratory results, diagnostic images, and notes from others rather than actual face time with the Patients themselves. This is before the Physicians go ahead and write their own daily Progress Note. The process takes forever. And it's repeated all day errday.
The added responsibility of Consultation adds another dimension. The various specialties that make up modern Medicine not only have an obligation to the Patients within their service but also lend their knowledge and insight to Physicians in other fields when needed. That package deal comes with even more note sifting and literature searches -- so much so that Physicians can effectively be described as data miners if one wants to get technical.
"Everytime I write these words, they become a Taboo."
It's a lot of work, but there's no way around it as far as I can tell. Documentation is everything these days, with multiple Physicians in multiple specialties from multiple facilities working on the same Patient. I am not even going to delve heavily into the legal implications that can result from shoddy records and Physician dictations that are any less than pristine and meticulous.
It's a lot of work. Welcome back to Earth.
"Read slow and you'll find, gold mines in these lines.
Sincerely, yours truly...
...and right before you go blind"
"P.S."
hippo --
:::Teamwork and Division of Labor
It's a lot of work. It's also, as aforementioned, not anywhere close to the satisfying drama of Dr. Meredith Grey's life or the comedic antics of Zach Braff and Donald Faison on Scrubs.
Modern Medicine is a team sport. A good thing. Though where before it may have been a pleasing innovation in the healthcare field, it is nowadays, seemingly, a core requirement -- Physicians can no longer operate solo like the practitioners of old.
"And they say communication save relations, I can tell."
Above everything we are and always will be Human. We are social creatures for all the double edges that it comes with. Patients have the ability to annoy us. Our fellow colleagues can annoy us. Sometimes we have bad days -- we lose our keys, we argue with significant others, we get pimples on the most visible and prominent parts of our face. Life happens. Human life happens.
On more than one occasion this past week I have heard my Residents vent about life, about inefficiencies within the system, about other Residents or healthcare professionals not picking up the slack. They are not complainers by any extreme means, nor are they particularly diva-ish drama queens. More often than not I agreed with them...or at least saw where they were coming from and could not blame them for what they say and feel.
"A fatal attraction is common.
And what we have in common is pain."
These are far from the facts and figures I've originally described as the Crates we are here to learn concerning Medicine. It's far, even, from the Consults and Progress Notes -- those tangibles -- that I've described above. These are the raw Hippos that I can only now see and appreciate as a 3rd year medical student on the wards...the need to interpret social situations and balance the tight rope of one's personal viewpoints alongside the 9 billion others that exist in this world.
Sometimes we have to put aside differences to keep everything smooth. To ensure that Patients receive quality care. Sometimes we have to take a time out and let our closest companions know what is going through our minds before we supernova explode -- even though we know nothing will change. Sometimes we need to suck it up and grow up so that we can let others know how and what we feel....so we can finally finish that darn Progress Note and hopefully see that next Consultation.
Maybe at that point I could get lunch...maybe? Want to join?
"Every second, every minute, man I swear that she can get it."
Even with all this seemingly 'harsh' reality it still stands that nothing can overshadow this profession in my mind. In fact, it may be all this conflict and hidden turmoil that partially attracts me even more towards this calling. Physicians, after all, take an oath to take care of People. Human Beings.
And who better to take care of them than us Humans with our wonderful inefficiencies?
Yes, I want to take care of my fellow men and women. But in doing so I don't want to give up my Humanity. That package deal comes with complaints, and he-said/she-saids, and late-night delirious laughter. It comes with others. And I would hate to be alone. Who will laugh at my not-funny jokes?
So I'll take it.
It's nice to feel solid ground from time to time.
"Poetic Justice, put it in a song."
When you figure out you need someone.
When you figure out it's alright here in the City.
And you don't run from where we come from.
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