![\"IMG_3980\"](\"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/IMG_3980-1024x562.jpg\")
Morning report at 7am every day.<\/p><\/div>\n
7:40am: Pre-Rounds<\/strong><\/p>\nWhat is it? Interns do paperwork, write up notes, and review latest test\u00a0results for their patients.\u00a0<\/em><\/p>\nAt 7:40am, we went up to the medical floors to do pre-rounds. One of the interns told me about one of the more difficult patients on the floor. I logged into the electronic medical record, Meditech, for the first time to look up more information on the patient. It\u2019s difficult to navigate\u00a0Meditech, so I just flipped through the patients\u2019 binder full of paper notes instead.<\/p>\n
![\"IMG_3384\"](\"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/IMG_3384-1024x768.jpg\")
Learning to use Meditech, an electronic medical record, during our orientation. Plenty more of my thoughts on Meditech are coming in the future.<\/p><\/div>\n
8:15am, Medical Grand Rounds <\/strong><\/p>\nWhat is it? This is the weekly meeting where all the clinicians in the hospital come together to learn about new research or\u00a0updated guidelines on a new topic.\u00a0<\/em><\/p>\nToday two senior residents presented their research. The first talk was about some basic science I did not understand. Something about\u00a0SHP-2\u00a0and regulations and expressions. The second talk was on frailty<\/em> as an objective measure of wellness and frailty\u2019s correlation to patient mortality.<\/p>\n![\"IMG_3622\"](\"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/IMG_3622-1024x488.jpg\")
Weekly Grand Rounds meeting for all of the hospital’s clinicians.<\/p><\/div>\n
9:30am, Rounds on Patients<\/strong><\/p>\nWe –\u00a0the attending doctor, the senior resident, two\u00a0interns, and us three students – talked about and visited our patients on the floor. The first patient\u00a0was an elderly gentleman who came to the hospital for GI bleeding. He got a colonoscopy where they ablated 4 different bleeding sites in his intestines. He was getting discharged to go home. We went in to see him. The attending doctor recommended he start back on his baby aspirin and regular exercise in about 3 days to protect\u00a0his heart. The patient\u00a0asked the doctor what type of exercise he should do? No heavy exertions that would build up pressure in his heart, she\u00a0said. The patient\u00a0showed us how he bench presses his pillow every morning to stay in shape. Nice and slow and steady. The doctor smiled and said that exercise should be just fine.<\/p>\n
Another patient was a 35 year old male with hypoxia and shortness of breath. The doctors believed he was euvolemic but he was morbidly obese so it was hard to tell. Radiographic findings include diffuse ground glass appearance throughout lung on CT. None of the doctors were\u00a0quite sure what\u2019s wrong with him yet. Differentials include hypersensitivity pneumonitis, sarcoidosis, or pulmonary vasculitis, among others.<\/p>\n
<\/p>\n
11:00am, Operating Room\u00a0<\/strong><\/p>\nI went down to OR to see a patient have a bronchoscopy<\/strong>. This procedure is generally done in a normal room but, because of the patient\u2019s sleep apnea, the doctors were concerned about potential airway collapse during the procedure and wanted to ensure they had a way to help him breath. He was put under anesthesia as I arrived in the OR. The five doctors and nurses in the OR had never met each other before and did not know each other\u2019s names. The main pulmonologist had to teach and give directions and meet everyone\u00a0all while pushing a big tube down\u00a0someone\u2019s throat and into their lung.<\/p>\nThe pulmonologist and the scrub nurse spent quite a while trying to figure out the bronchoscopy forcep. To give you an idea of the tool I’m discussing, the forceps look something like this (I\u2019m not sure if this was the model but you get the general idea).<\/p>\n
![\"Screen](\"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/Screen-Shot-2016-08-19-at-3.15.48-AM.png\")
Bronchoscopy forceps (ref: jiuhongmed.en.made-in-china.com)<\/p><\/div>\n
The doctors pushes the end with the little jaws into the patient\u2019s lungs. The scrub nurse controls the \u201cplunger end\u201d. In one plunger position, the jaws are closed. In the other plunger position, the jaws are open. The forceps are\u00a0used to take bites of tissue from the inside of the patient’s lungs to later analyze\u00a0under the microscope.\u00a0It did not seem like the nurse\u00a0had ever done this procedure before. And the problem\u00a0is that once the forceps go into someone\u2019s throat, you can\u2019t see what position the forceps’ jaws are in. One time she had the jaws in the open position while going down the patient’s throat which would have easily gotten stuck along the way, ripped something, and caused bleeding.<\/p>\n
All the confusion and time spent by the doctor and nurse to figure out the forceps could have been avoided if the plunger had a little printed arrow with the word “OPEN” to indicate which plunger position\u00a0opened the jaws.<\/p>\n
12pm, Noon Conference <\/strong><\/p>\nWhat is it? Noon conference is a daily lunch time conference for interns\/residents to learn about certain medical topics from physicians in the hospital <\/em><\/p>\nI unsuited myself from the bunny suit and ran up to Noon Conference. Tuna fish sandwiches and some salad and cookies. And, of course, coffee. I learned about nystagmus<\/strong>, rapid uncontrolled repetitive eye movements, and what the possible types and causes are and how to approach them in patients.<\/p>\n![\"IMG_3596\"](\"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/IMG_3596-1024x526.jpg\")
Daily noon conference for trainees (interns and residents) to learn about various topics in medicine.<\/p><\/div>\n
1pm, Medical Wards<\/strong><\/p>\nI went back up to the medical wards to interview my first patient ever (!). I took his history and basic vitals. Mr. M\u00a0and his wife were very lovely people and I loved talking to them. Mr. M\u00a0is over 80\u00a0years old and had a heart attack 15 days ago. He had been discharged for his heart attack but was now admitted once again for extreme fatigue and decreased kidney function.<\/p>\n
<\/p>\n
2:15pm, Library<\/strong><\/p>\nI thank Mr. M\u00a0and his wife profusely for their time and rush down to the library to write up my notes about Mr. M.<\/p>\n
<\/p>\n
3pm, Conference Room<\/strong><\/p>\nCheryl, my classmate, and I\u00a0meet with our preceptor (an experienced attending doctor). We went over the histories of each of our\u00a0patients and discussed the cases\u00a0all together. The preceptor gave us feedback on how to improve our presentations and write-ups. Then we went up to the medical floors to examine the\u00a0patients we had each interviewed all together. Cheryl’s patient was an elderly\u00a0lady who had had IBS for 40+ years. She was admitted for what she described as the worst episode of diarrhea she’s ever had in her life.<\/p>\n
<\/p>\n
5:30pm,\u00a0End of the Day<\/strong><\/p>\nI go home and write\u00a0up a multi-page writeup of my patient Mr. M, everything I learned about him, and I research what should be done next for his situation.<\/p>\n
\nPhew\u2026 I\u2019ve seen so many different conditions and so many different patients in just these first 4 days. Today, my first day interviewing a patient felt especially like a whirlwind. The experience\u00a0reminds me of\u00a0learning how to drive. My mom would instruct\u00a0me when we were on the road, \u201cYou must be aware of your surroundings! Look at everything!\u201d and I would get exhausted looking at everything.<\/p>\n
I\u2019d look at the leaves on the trees, the color of the cars, the painting of lines on the highway. I’d look at the cars on the other side of the highway, the squirrels across the street, and the teenager\u00a0mowing the lawn. I\u2019d get home from a drive and be exhausted. Hospital rotations\u00a0feel just like this right now. I\u2019m not sure the feeling will ever go away. At some point in their career doctors probably get to a point where their job feels like\u00a0driving a car once you know how to drive a car, i.e. second nature.<\/p>\n
Pattern recognition and muscle memory are\u00a0really important. These cognitive shortcuts allow us to drive and allow doctors to do their job. Yet for taking care of humans, pattern recognition can also be dangerous. One should never\u00a0assume someone’s diagnosis based on the first few symptoms that seem to fit a pattern. But that’s easier said than done\u00a0when there’s only 8 minutes to figure out what to do\u00a0with a patient.\u00a0“When you hear hoofbeats, think horses not zebras,” they teach in medical school. I wonder, though,\u00a0how do physicians remain open to zebras throughout the decades of their career?<\/p>\n
![\"IMG_3839\"](\"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/IMG_3839-1024x768.jpg\")
My amazing ward team<\/p><\/div>\n","protected":false},"excerpt":{"rendered":"
Day 4 of being on the wards. Day 1 of interviewing a patient by myself (!). The amount I saw today was overwhelming. 7am: Morning Report What is it? The daily meeting where overnight residents tell the day time\u00a0residents what happened to all the\u00a0patients overnight. The supervising senior physician will sometimes give a […]<\/p>\n","protected":false},"author":1,"featured_media":1697,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"ngg_post_thumbnail":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[22,8],"tags":[],"class_list":["post-1686","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-engineerinthewards","category-blog"],"jetpack_featured_media_url":"https:\/\/linacolucci.com\/wp-content\/uploads\/2016\/08\/IMG_3596.jpg","jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/posts\/1686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/comments?post=1686"}],"version-history":[{"count":10,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/posts\/1686\/revisions"}],"predecessor-version":[{"id":1710,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/posts\/1686\/revisions\/1710"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/media\/1697"}],"wp:attachment":[{"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/media?parent=1686"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/categories?post=1686"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/linacolucci.com\/wp-json\/wp\/v2\/tags?post=1686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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