Medical Student Progress Note: Trauma Surgery

Patient: Kay Isandos

Chief Complaint: the surgery service is insane

History: Patient is on Hospital Day 1 s/p one day on trauma service. She complains that rounds are run so quickly she is not able to orient herself to the patient before she is racing to the next room, but admits it’s a great physical and mental workout. She was unable to scrub into the OR today because her assigned laparoscopic cholecystectomy was bumped for an appendectomy. She is hopeful that she can scrub tomorrow, but reports still feeling very confused about the various surgeries and the expectations on the service.

She reports palpitations and some abdominal discomfort, but admits it was likely due to nervousness surrounding a Trauma, Priority Level 2 today. She participated insofar as she met a patient and provided him with several warm blankets before radiology took over and she was sent back to clinic, realizing her anxiety was pointless.

In the clinic, she was able to see three patients, though she struggled to compile the short, to-the-point presentations desired by attending surgeons when dealing with multiple patients who presented for follow-up for multiple gunshot wounds. Additionally, she was able to complete her first hernia exam successfully.

Her afternoon is described as “crazy,” rated 9/10 in severity and radiating to her personal life as well. She denies associated nausea or syncope. She is happy to have been released from her work early today, leaving plenty of time to study, study, study, and study.

Past Medical History: Has already completed OB/GYN, Peds, Family, and Psych.

Medications: Caffeine qday

Social History: Non-smoker, non-drinker. ?poor sleep and eating habits.

Pertinent Physical Exam:

  • Vitals: Occasional tachycardia, otherwise wnl.
  • General: Young female in no acute distress. Tired-appearing.
  • HEENT: Dark circles under eyes, but PERRL.
  • Cardiac: RRR, normal S1/S2
  • Respiratory: Lungs clear to auscultation bilaterally.
  • Abd: Hyperactive bowel sounds audible without stethoscope
  • Psych: No evidence of depression. Possibly delusional.

Assessment: 24F third year medical student with acute anxiety and significant confusion due to new involvement on the trauma surgery service. This is likely to improve without intervention in the near future, though if it does not, she has been advised to avoid surgery as a future career.

Plan:
-Continue caffeine PRN for sleepiness.
-Eat and sleep whenever possible.
-Study as much as possible to increase knowledge base and reduce confusion. Consult with residents when textbooks fail to appropriately treat problem.
-Consult with other medical students on the team when feeling overwhelmed.
-Continue participation on trauma service at 5 AM tomorrow and for the rest of the month, until service is understood and pt is able to roll with the punches.

I survived my first day! If not clearly evident from above, my brain is still spinning and trying to make sense of an incredibly busy day on a brand new service. But I tend to feel uncomfortable in the first few days… here’s hoping that things calm down (at least, in all the right ways) from here.

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