Delirium is a bread-and-butter presentation. The differential writes itself — stroke, infection, intoxication, electrolyte imbalances, shock, organ failure. The intellectual exercise this invites was practically invented for medical students, even if the final diagnosis (dehydration secondary to gastroenteritis) and its treatment (fluids) were relatively mundane.
For the smaller challenges of medicine, like fitting an entire person’s pertinent medical status in the half-inch gap between names on the patient list.
There was an elderly man suffering from late-stage Parkinson’s dementia. There was a patient with schizophrenia experiencing a COPD exacerbation. Then, there was Mrs. G, who was admitted for immune thrombocytopenia. She was a retired teacher who spent her time volunteering at her church and caring for family members.
Nothing is quite as strange as the first day of your surgery clerkship. It isn’t just the shock of seeing a living human intentionally cut-open or the unforgettable smell of cautery for the first time — even just getting into the operating room can be an obstacle.
In my third year of medical school, I was taking care of an elderly patient who had been in and out of the hospital multiple times in one month. Upon his third admission, my exasperated attending threw up his hands and said, “Who am I, Sisyphus?” I understood how he felt. Like the mythological Greek king rolling his boulder up the hill — only to have it roll back down again, ad infinitum — no matter what we did to manage this patient, he always returned to the hospital sicker than before.
Despite its omnipresence, Time seemed to be in reliably short supply throughout the year. I keenly felt its absence: less time to cook and clean. Less time to exercise; less time to date. Less time to read and to write.
A Silver Bullet / The tiny guns held by my little action figures / still remind me of that god forsaken trigger.
As physicians, it is our responsibility to understand these serious implications and to help these patients live as fully as possible. A patient is not just his or her numbers — their vitals or their lab values. A patient is not just an MRI reading or a CT scan finding. Every individual has a mind, and we must take into account mental health when treating these patients because if left untreated, they can have dire consequences. More importantly as people — as humans of society — we must not stigmatize these illnesses.
Patients don’t always have to let us into their rooms. As medical students, I think we don’t give enough acknowledgement or praise to the vulnerable individuals that allow flocks of medical students to bumble around their bedside. But our perceived ineptness is the last thing on the patient’s mind; a friendly face that is willing to listen to their story is just as important.
“Great, six weeks of crazy people!” This is the sort of attitude with which I went into my psychiatry rotation. Couple this with the fact that while most schools only have four required weeks of psychiatry, my school has six weeks. Of course, I would have more free time compared to other rotations — it is called “psychation” for a reason — but at what cost? Mental illness was something that made me uncomfortable.
Friday afternoon psychiatry didactic sessions are a holy time among medical students. A golden weekend rapidly approaches and the afternoon, typically spent trudging through paperwork, is instead spent listening to residents talk with minimal effort required to listen. At the end of a frantic third year of rotating, sometimes it’s nice to just set the busy work down and take it all in. Granted, I’ll actually have to learn the info at some point before the test, but for one afternoon it’s nice to be passive.
The beginning of third year clerkships is an exciting time for medical students. The first step of my licensing exam was finally behind me and now I could focus on applying the knowledge into a clinical context. I had heard a lot of stories about the third year of medical school. Perhaps what stood out most were the reflections shared with me when people witnessed death for the first time. From full codes to hospice patients, something about death seemed to draw out the most intense emotions and thoughts that can change lives forever. Although I always try to do the best for my patients, I knew it was inevitable that I would come across death. I wondered what profound thoughts and reflections I would have when I experienced it for the first time. It wasn’t too long before I was called to do CPR in the emergency department and I found it did not play out as I expected.