Weekends and Living Bridges

My First ‘Misadventure’

I had my first example of an actual misstep worthy of reporting back this week but I couldn’t think of a way to naturally fit it into what the majority of the post is about so I will just state it here at the beginning and beg forgiveness for not integrating it smoothly.

Now I have mentioned that being in the hospital is our first chance as students to speak to real patients, but obviously the hospital isn’t going to let us loose with no idea how to speak to people that are sick or what sort of questions to ask so the pre-clinical section of our degree is spent learning those interview techniques by practising with other students. We take turns playing the patient and the other plays the doctor interviewing them, which works great except for the obvious pitfall that the ‘patient’ doesn’t actually look sick and so when they come in and complain ‘oh I feel over and cut my arm open’ you cannot actually see which arm is affected and so you always have to ask the question ‘which arm is the problem?’ even if it should be bleeding obvious in real life.

I am sure that my university would be proud to learn that their training sunk in so well that this week I was interviewing a patient who had had a limb amputation, sitting right in front of me, and I asked him which limb had been removed….

Now the normal programming

I’ve started writing this a lot later in the night than I would have liked but I actually haven’t had the time until now, I was too busy handling some left over uni related stuff and even when I thought I had it all done something else came up. I suppose I could naively call this my first taste of the medical life and how it swallows up your free time but I somehow get the feeling that it has to become a little bit more onerous before I truly have any grounds to complain. I did after all enjoy everything I was doing, even if it did take most of two days to complete.

This week was really interesting because I started to get a sense for how different people in my course have handled the transition into a hospital environment. I also had my first chance to catch up with  friends that are assigned to different hospitals, and gain their impressions of how students in those environments and approaching the change. All very different and if you are saying to yourself ‘Oh surely there are many different approaches, but they can co-exist’ then you have not met medical students. Throughout our undergraduate and pre-clinical years we have been confronted with defined goals and knowledge to rote learn, delivered in structured packages (i.e. lectures) and then given a certain date which to spew forth everything we have rote learnt (i.e. exams). This tends to promote a very straight forward and intense way of dealing with educational challenges that is probably the root of most of the difficulties with the transition.

For some, the new backdrop of a hospital doesn’t change anything at all and so even in the first weeks in the hospital it is time to write a 15 page paper on obscure lung infections and memorise the exceedingly rare of side effects of medications that were discontinued in the 50s. In the most part, actually interacting with a patient is simply a distraction from absorbing every scrap of knowledge necessary to be worthy of the title of doctor. For other students the new setting does mean things have to change, and this realisation is yet another departure point. For instance, some see the sheer amount of information and learning we have in front of us is a source of despair and for others it is just something to be approached incrementally with the assurance that we will all get to the end eventually. And of course there are many other reactions as well, but it would simply be boring to list more.

The source of what I would probably call tension between these loosely defined groups is that as students everyone constantly crave any sort of approval that they are doing well, specifically doing better than other students. If one student sees another student approaching their learning in another way, so begins an Olympic level passive aggressive sport of “Oh have you only arrived now? Was there traffic or did you just only want to arrive at 9am?”, “I was just putting some brief notes together for [Condition X]. Oh you haven’t heard of it?” and “I am practically part of the neurosurgical team now, everybody loves me”. As you can probably tell from my examples I definitely more on the Learning Slowly side of things and cannot really stand the worst offenders from the other camp, but I will confess that I also felt the need to have some reassurance that my approach was the right one. That is why I found it reassuring the hear from more senior medical students this week that people like the neurosurgery’s ‘newest team member’ up there can go f*** themselves.

I suppose it may seem discordant with what I wrote last week, so I suppose that I should clarify that this week alot of people decided that there were no tigers hiding anywhere and that’s where the divergence started. I don’t mean to say that enthusiasm or hard work is in anyway inappropriate or wrong, because once again I am very enthusiastic about being here. And at the end of the day I don’t even really mind that other people are doing things other ways, I only get bothered when they start pressing my face in it in an order to derive some self assurance.

Now to close, I will explain the title of the post. Like I said I very much believe that becoming a doctor is a gradual process that has only begun, not something I can just work at 80 hours a week starting now and then be immediately perfect. To continue our metaphor last week, it is like walking through our verdant new world and coming across a river. On one side is where we sit now, and on the other side is the far off (and currently unattainable) world where we are doctors.

It hit me during a class this week where my tutor (an incredibly talented physician who is most definitely a role model) walked our small group through some ethical scenarios and then took us to see some patients and teach us how to examine some things to assess a patient’s health. This came after a morning of lectures on prescriptions and how to approach diagnosis of a patient with stomach pain. The variation in what we were doing and the quick pace that we were switching between these different modes of thoughts reminded of something I had read about a while back: the living root bridges that are woven together out of branches of a tree in a certain part of India. I then went back and read it again and learnt that the entire process of growing a new one of these bridges takes about 15 years, which is roughly the time it takes to go from being a first year medical student all the way through to a fully qualified specialist.

To take the metaphor even a little further, my research (read: Wikipedia) says that if the tree receives the correct care and nutrition then it can last for many hundreds of years. Something I will interpret as meaning that if the medical student manages to care for themselves they can have a very long lasting impact on people indeed, particularly in regards to mental health which is something I’d like to discuss in an entirely separate post.

So this is where I will leave us for this week, I continue to explore the new vistas, but no longer wander aimlessly. I have settled into how I will study and approach my clinical years (at least for now) and I will now set up camp around the nascent roots that will slowly grow into the bridge to carry me into the land over the river and into Doctor-dom (may need to come up with a better name for it). I will report back if I have any more encounters with the natives (read: the more intense of the other medical students)

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