Success is Like a Leaky Faucet

As a medical student, I am constantly learning… from books, from preceptors, from other students. But by far the best lessons are those from my patients themselves:

Mr. Farmer: Getting old… it’s not fun.

Me: Everyone in this place tells me not to get old.

Mr. F: Honey, you can try, but I don’t think it’s going to work. All you can do is NEVER smoke, only drink a little, work hard, and be happy.

Me: Got it. Good advice.

Mr. F: OH! And never go to bed mad. It’s like building a wall between you and Mr. Right. Nobody likes walls in bed.

Me: I’ll keep that in mind.

Mr. F: AND remember that success takes time. If you have a leaky faucet and it’s juuuuuust a drip, if you put a cup underneath it, it’ll fill eventually. Always remember the leaky faucet.

Drip, drip, drip.

——

Ms. Smith: Here’s my advice for you, honey. Do good now, and stay the hell away from pizza!

Apparently, pizza is bad.

The One with the Grandmother

She fussed over me just the way a grandmother should.

“You’re just adorable. And you’re going to be a doctor! Wow! Lots of luck to you!” my  elderly patient gushed, taking my hand in hers.

Then she paused, the smile wiped from her face.

“No ring yet?” she asked, gazing at my left hand.

I shook my head.

“Honey, you’re going to get much too busy. You better hurry up.”

And with that, she left, leaving me to wonder if she’ll be right.

The One Where We Almost Didn’t Talk About It

“So… how have you been lately?” I begin, fingers lingering over the keyboard in anticipation.

“Pretty good,” she responds.

I breathe a sigh of relief and continue with my agenda for her annual physical exam: Do you want a flu shot? You know, you’re due for your Pap smear. Any new medical problems you’re aware of, for you or your family? How’s your diet been? What kind of exercise are you getting? Are you smoking? What about alcohol? Your blood pressure looks great today! 

All of her answers thus far qualify as “boring,” that is, lacking in any detail that could fully engage a medical student.

Until I tackle the review of systems, a method we often use to unveil symptoms that the patient may have forgotten to mention or that we forgot to ask: Fevers lately? What about chills? Change in appetite? Headaches? Cough? Chest pain? Trouble breathing? Do you ever feel your heart beating fast or funny?

“Oh, actually…” Laura begins.

Damn.

“Actually what?” I prompt.

“So I’ve just been feeling really anxious. I start shaking and my palms sweat and I can feel my heart beating really quickly,” she continues.

“How often?”

“Oh, I don’t know. Like 4-5 times a week, maybe?”

I pause, looking up at her for a second, evaluating in my head: Is this problem life-threatening? Is it imperative to treat right now? 

No, not really. I’m going to have to go there.

“I’m really sorry, but I have to ask you something kind of silly. Do you have a deductable insurance plan?” I interrupt.

She looks at me quizzically. “Yeah, I think so.”

I sigh. “So this is really stupid, but I’ve been told to ask: your physical exam is free with your insurance plan. But if we’re going to talk about this anxiety today, we have to bill it as a separate visit, and you might receive a bill for it. Knowing that, do you still want to talk about this today? Or would you like to save it for another time?”

Laura shrugs. “I’m already here.”

I nod. “Okay. Let’s talk about this more.”

——————

A friend recently asked my roommate and me for our opinions on the problems within the healthcare system, and this was among the stories that popped into my head.

You always read in The Reader’s Digest or hear on the news that you should record all of the issues you want to bring up with the doctor. And yet my preceptor has warned me that often the patients choose to discuss these issues not realizing that they may have to get billed for them at an appointment they thought was free health maintenance. So I’m forced to evaluate if the issue MUST be discussed immediately, and if not, I have to ask.

Though I realize that there is always a charge for visiting the doctor, it irks me that I have to stop a patient in the middle of their explanation to remind them that if we’re going to bring this up with the doctor, she has to be willing to foot the bill. Otherwise, we’re not going to even open that door… and that to me, seems kind of wrong.

So that, among dozens of other issues that would take hours to articulate, is what is wrong with the healthcare system.

Just don’t ask me how to fix it.

The One With the First Day of Fall

“Guess what it’s made out of!” Nurse Jane challenged with a smirk, pointing to the work of art she’d just taped to my preceptor’s computer.

My preceptor groaned. “Pee. You made a tree out of pee.”

Happy Autumn, everyone! Hope it’s full of apples, pumpkins, and not too much pee.

The One With the Club Sandwich

Dr. Family: Today is a meeting CLUB sandwich. Do you know what that means?

Me: …no?

Dr. F: It’s a meeting in the morning, a meeting in the evening, and then we toss one in the middle at lunch.

Me: Oh.

Dr. F: Except you know what would make it SO much better?

Me: What?

Dr. F: Bacon. Because everything’s better with bacon.

…so true. Except for coronary artery disease.

The One With A Lot Left to Learn

I used to live with friends from college who weren’t in medical school, and one of my favorite things about it was that I could escape from other people stressing out about the same exams, which helped me to moderate my own stress level.

So I was a bit wary this year when I moved to a new apartment with new roommates, including one of my classmates. But he’s on a different schedule than me, so it’s been great. I get to keep up with a good friend who I wouldn’t otherwise see, I have someone who understands and commiserates when I come home whining about long hours or frustrating patients, and I get to trade funny stories of comical patient interactions.

In short, the situation wasn’t the least bit stressful until the other day: I was in the kitchen, and my roommate emerged from his room, neurology practice questions in hand.

“How many of these have you heard of?” he asked, pointing at a list of about twelve neurological diseases.

Kluver-Bucy Syndrome. Meige’s Syndrome. Hallervorden-Spatz Disease. Lennox-Gastaut Syndrome. Shy-Drager Syndrome…

I scanned the book, probably with an expression along these lines:

Umm… what?

“These are all made up,” I declare.

Because there can’t possibly be at least twelve diseases I know nothing about, right?

The One That Still Strikes Fear Into My Heart

I rarely study on my own campus. Something about watching other people study (or at least, pretend to study) the same things as me just gives me anxiety. Either that or I wind up having social hour with the eighteen classmates who I haven’t seen in months who just happen to be there.

But yesterday, I decided that since I was in the area, I’d study on campus. I walked into an empty classroom to find THIS:

image

To this day, I still immediately cringe when I see this diagram, and I’m thrust back to my first year medical student days, before I’d embraced the glory of pass/fail, before I’d recognized that whatever I didn’t learn now, I’d learn twenty-seven more times in the next four years, before I’d adjusted my study strategies to be more amenable to medical school, before I’d ever survived the ominous “anatomy lab practicals.”

…I also become more than slightly disgusted with the fact that there is no way I’d be able to replicate this from memory now, just two years later.

Godspeed, MS 1’s. Godspeed.