Saturday, November 12, 2005

thank you and med student ramblings (with no knitting content)

Thank you for all of the thoughts, prayers, and comments left when I shared the news of the death of my “aunt.” It means the world to know that others are thinking about her family and I thank you for the support. I’ve spent lots of “quality” time with my family over the past few days and my brothers and I have talked about what would happen if either or both of our parents died, and we’ve had a lot of heart-to-heart time. It’s been a silver lining.

I’ve been knitting, but have nothing to show pictures of right now. It seems that a lot of little things in progress makes for not-so-great knit blogging fodder. However, I have much to say about being a med student and medicine…

What I learned this week:
- the trend of labors this week was long first stages (the dilation of the cervix from 0-10 cm) and very, very short second stages (the pushing of the baby out of the birth canal). (Any predictions for next week’s trends?)
- a woman who just a mere minute ago who was in Immense Pain will look at me as soon as her baby is born and say “I feel SO MUCH better now.”
- Most of the time, babies enter the world when they are ready. Sometimes though, they need some help, and that is not anyone’s fault when this happens. Some mothers will need some reassurance that it is not their fault, and the more they hear that all is well, the better.
- some nurses will drive me crazy. I’m learning how to work with people that I cannot stand being around.
- Being on call with obstetrics is much more fun then being on call with other sorts of medicine.

I was excited to start my ob/gyn rotation because I (not-so-secretly) love obstetrics. The first three days were quiet; there were a few non-stress tests that I helped set up and interpret, and a saw a few interesting gyn surgeries. (I had the option to scrub in and assist but thought it best to watch from afar the first day in the OR; given my past experience with surgery I thought I should check and make sure I could keep my legs under me.)

The doctors I’m working with all remarked that it was slower then normal but assured me that it’d pick up. “When it rains, it pours” was repeated over and over again and I was reminded not to use the “Q” word. (regardless of what I was told not to do I’ll admit that I sat alone at one of the nurses stations and chanted “it sure is quiet” over and over again.) There was one early, early morning delivery, but things moved too fast for them to page me and I was “new” enough that they didn’t think to call me as soon as she came into labor and delivery.

Thursday I had made arrangements to be excused from the rotation for the funeral services. Knowing that things would probably happen the second I wasn’t there, I told them that I’d probably be home again by 3pm and they were welcome to page me if there was some action. When it rains, it pours indeed as two babes arrived that morning and when I answered my pager that afternoon three more babes were on the way. I arrived just in time to watch a baby girl emerge into the world before I befriended one of the other patients and helped her change position, walk, get into the hot tub, re-hook up the monitors and then (eventually) helped welcome her son to the world. As soon as he was set I ran downstairs to join up with the couple who were going to meet their first child via a c-section. I didn’t get home again till after 11pm but it was well worth it!

I’d been waiting for a baby to arrive so that I could complete my own greeting-card’esque-afterschoolspecial’ish-lionking “circle’o’life” thinking in that life and death cycle together. It took the first few days for me to remember that I’m not really one to subscribe to such ideas and the irony of me waiting and waiting wasn’t lost. (I suppose it helps to know me personally for the irony to be clear; I buck trends and am more used to taking things as they come. I was simply impatient waiting for some action!) Turns out I don’t need to witness a little one entering the world and breathing and crying for the first time for me to appreciate life; it’s a lesson I won’t forget anytime soon and was better learned without a pending birth.

The language of medicine is very different from social language and literature and my rotations are serving as an education for what I am supposed to say and chart. For instance, in my medicine rotation I learned that when patients answer “no” to a question that I ask them (such as: “do you have any chest pain or shortness of breath?”) I have to chart it as “patient denies chest pain.” (actually it looks more like this: pt denies (insert a circle with a line through it here) CP/SOB.) Usually the word “denies” is seen as a bad thing – insurance claims are “denied” and it’s an awful thing; it can conjure up a tv drama courtroom scene where a lawyer questioning someone throws the word around with undertones of negativity. Pts deny illegal drug use, wt gain/losses and all symptoms. It’s all considered subjective data and though I can take them at their word I can’t say for sure if what they say is “true” or not because I have not seen the activity with my own eyes. (as opposed to more objective information that I can gather: lab and test results, physical exam findings and appearances.)

Maria made a point that a mom delivers a baby, the doctors (and in my case, the med student) simply assists. This is true, but in talking with doctors and reading through charts and other forms of patient literature, it is common to see that the doctor delivers the baby. I could argue with them until I’m out of breath, but I’m one person with a lot less training and experience then many of the folks I’m working with, and in these cases I simply have to adopt phrases that are used. I don’t like saying that a person (who is a patient or pt) “denies” anything, but it’s what is said/written. I’m learning all of the abbreviations that once looked like Greek and may sometimes look like obscene derogatory words.

The other aspect of medicine that is becoming blatantly clear to me is the financial end of the process. A hospital is a form of a business, and they have people to market the benefits of picking that hospital over other ones. When a person enters the hospital they are assigned an account number and everything that they are there for (a short stay, or a test, or an operation, etc) is recorded and “charged” to their account. Things as simple as a meal to a short stay in a hospital room (for an observation for an hour or so) are all charged, and it’s an important aspect of the nursing care for the patient. I’ve also heard comments from doctors (throughout the last 3+ months that I’ve been in offices/clinics/hospitals) that they are not being reimbursed enough from some insurance programs, therefore they’ve closed their practices to people with some types of insurance. It’s hard for me to hear because the folks enrolled in those programs are the same people who are not making enough money to afford a trip to the doctor’s office, and they are often the ones who need the most care. If they were able to get into a doctor when they first got sick (a relatively inexpensive visit in the scheme of medical things) then they might not get sicker and require more interventions (a hospital stay for instance) if the disease/illness progresses. (I am going to refrain from diving into the political commentary on how little an increase in funding it would take for some federal programs to allow for more people to have access to preventative care and medications to keep them healthy, especially when some programs are being cut while we’re spending billions on a war that I do no support…)

At this point in my training, the idea of being in a solo practice is nothing short of a potential nightmare. I don’t want to worry about how many patients I’m seeing each day so that I can afford to pay back my loans and office overhead (let’s not even begin the discussion of malpractice insurance and how someday, regardless of what I do, I will probably (statistically) be sued), let alone be in a call pool that eat up my evenings/nights and weekends. I have much more to learn about the financial and business end of medicine and I’m uncomfortable both with what I know and what I will need to learn. I just want to apply my years of classes and hands-on experience to help people feel better, die with dignity and enter the world with joy.


Blogger Holly said...

Kristen...lovely post. Referring to your very last line...may we all be blessed to find a doctor with the same attitude you have.

11:14 PM  
Blogger Norma said...

If that's rambling.....ramble away, dear....

11:33 PM  
Blogger Nikki said...

You might feel a little topsy-turvy right now, but your writing makes perfect sense to me.

I'm glad to see you back here, and I'm glad that your rotation is going well.

And about the whole mess of billing, getting sued, etc....come to Canada! ;o) The insurance thing just isn't an issue, and although we do get sued, it's a much more unusual event. We'd be happy to have you!!

12:01 AM  
Blogger Sandysknitting said...

Kristin, I loved this little glimpse into your world. I can't imagine anything more gratifying than escorting a baby into the world. So many possiblities! I do know the flip side of that joy is heartache but hopefully there is more joy than not in that department.
Thanks for sharing!

8:02 AM  
Blogger margene said...

You did make the circle in just a short time. You will have a very fullfilling doubt.

2:28 PM  
Blogger Kathy said...

May you keep that sense of wonder and joy along with a dash of healthy skepticism. The world truly does need more doctors who think like you do. Bravo :-)

2:44 AM  
Blogger Liz said...

Stay in the state and you can be my doctor. :)
I love your last line...keep that as your personal credo.

6:30 AM  
Blogger US magazine finatic said...

Like your site. I happen to going to "knitting night" with some of my fellow med students tonight! We all learned how to knit during our ON/GYN rotations and we still get together occasionally to "stitch and bitch"!

5:11 PM  

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