Archive for tag: patients

Doctors (Almost) as Patients

I HATE being injured. I REALLY hate it. Inevitably, the doctor becomes the patient. And everything that you hear about doctors being horrible patients -- is completely and utterly true. We're non-compliant, cranky, and just generally difficult. And if you can imagine the worst of the worst patients -- that would be me.

Why am I telling you this? Well, on Saturday, I hurt my back. I've done it before, but this time seemed to be worse. There's something extremely humbling about not being able to do all the things you normally do: get in and out of a chair, put on pants, walk. We don't think about it. They've become second nature; we take them for granted. And even as (almost) doctors, even though we've maybe felt the pain before, it's really easy to forget how it feels.

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I hobbled into the office Monday morning, and declared, "I need to be seen by whomever is available as soon as possible." People cleared their schedules. They juggled patients. People gave up their treatment times to help me (Thanks, Dave). I sat and filled out the same paperwork we give to patients. Where is the pain? Does it radiate? What does it feel like? If you've ever been on the filling out end of these papers, I'm sure you know what I mean when I say -- trying to fit how you feel into a form or a diagram is HARD. I still wrote in the margins.

When my time came, my intern took me back into the patient rooms and I sat and experienced everything that our patients experience: the waiting, the orthopedic tests (some confounding and some painful), the range of motion, the poking and prodding. She drew up a treatment plan, the doc looked it over, and she went to work.

I'll spare everyone the details, but after a few adjustments and some soft tissue work, I was sent on my way, to do that to a patient myself.

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It never hurts to be reminded what it feels like. I'm doing better -- getting a little bit better every day. I'm grateful that there's a whole team of people here to take care of me, which is helping me take care of everybody else.

Special thanks to Leslie, this week, for getting me back on my feet.

Have a great one everyone! I'll be taking part IV boards this weekend, along with many of my classmates. Good luck to everyone!

Better Late Than Never

I find myself having the hardest time believing that school is almost over. As I sit here contemplating what to write, my mind wanders over things like jobs, moving, and what will happen next. It's terrifying, and exciting. It also feels like the most daunting prospect I've ever come across.

I'm starting to look at job postings. In some ways it seems presumptuous. After all, it's about 6 months away. And at the same time, I can't help but look. How early is too early to apply? Maybe I should buy someone's practice. Is that really something that I can accomplish? Maybe I should just work somewhere for a while rather than try to make things move on my own. I just can't quite wrap my head around all of this just yet. There are so many decisions to make. Where do I begin?

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Meanwhile, back at the ranch...

We've had nearly record high numbers of patients at the clinic for the last couple of weeks. We were shy about 8 last week. Given the number of cancelations and no-shows that we had, we would have far surpassed the clinic's highest record. We're lucky to have all of the SPC students and faculty, as well as the other NUHS students and faculty as our patient base. It allows us to see a wide variety of people with an even wider variety of conditions: from eczema to complex neurological syndromes. Rarely a day goes by without something unusual. My patients keep me guessing, and laughing. I really appreciate the sense of humor in many of them. Even in the midst of pain, they still find time for a smile. It makes my day go that much easier.

Last week, Julia, Dr. Jourdan, and myself hosted an NUHS booth at SPC's career day. We were tucked back in the back, but got a chance to let a few people know about the school, what we do, and what we offer to other students there. Most of the students at the career fair were nurses. That didn't stop them from picking up brochures about the school. We're thinking that maybe we'll end up with a couple of new students from the day. We've already had a few start as patients. It's great to get a chance to talk to people, have them get excited about what we do, and then see them bring it to fruition.

I guess that's what it's all about, right? Getting your foot in the door? Maybe that brings me back to looking for a job. I've had people come out of the woodwork in the strangest of places, offering me information or connections. As much as I loathe the concept of networking (yes, I mean that), having conversations with people and finding out there's some type of mutual interest -- now that's making a connection.

Hope everyone has a great week. I'll be working and studying for Part IV boards. We're getting closer...

Where Does Time Go?

Do you ever feel like there aren't enough hours in the day? Or how you got to the end of the day when it all flew by so fast? This is what it feels like, when I'm busy. The days when I have 3 patients in the clinic (which is the most I've had so far) seem to fly. There's barely enough time to get all of the paperwork done: chief complaint, history of present illness... I find that on those days, it feels like maybe 2-3 hours have passed, and then the shift is over. How did that happen?

There are a million things that I want to go over with patients. I take LONG histories; really long ones. I ask questions that nobody ever asks (and often have to spend time explaining why I'm asking them). This piece of information is important for that. I need to know that so I can tailor it for them so I can help them get better. It never fails. Of course, it's hard to go through all of that, feel like I haven't left something out, and still get everything covered.

Of course, one of the great downsides to asking all of those questions is having to write down all of those notes. I write books in my patient files. In a way, I feel sorry for my clinician having to read all of these notes, and then on the other hand, I like being thorough.

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A chalkboard used by Nobel Peace Prize winner Linus Pauling

Clinic is cooking along. I have a few regular patients, and new patients coming in here and there. My favorites will always be those with complex problems, especially functional ones. These patients need so much more time. Their appointments seem to go by even faster than the more simple ones. What changes can we make? Are there things that can be changed? What are the parameters that we're working with? So many questions, so little time to ask and answer them.

Research is ongoing. I'm trying to squeeze in articles when I can, or when I have any free time. Right now I'm reading one about xenobiotics and autoimmune disorders. Sometimes I think my head will explode, or at least want to bang it into the wall when I can't remember what a specific interleukin does (even though I've looked it up 9,000 times already). Really I just love it, and can see why people go into research full time. Although, the application of it is exciting in and of itself. If only I could know "everything." Of course we'd find new things to learn and explore, and learn that things that we knew before were completely and totally wrong, and have to learn them all over again - differently. I guess that's why we're scientists.

The photo above is from one of Linus Pauling's chalkboards. If you're not familiar with Linus Pauling, he was the only person to be awarded two unshared Nobel Peace Prizes. He was a brilliant chemist/biochemist and activist, and completely changed the way we think about human biochemistry. He was a huge advocate of "orthomolecular medicine" (which we now know as functional medicine), vitamin therapies, and supplementation. I'm absolutely fascinated by his work, and have had one of his books sitting on my bookshelf for many months. If only I had the time to read it.

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OK, Everybody, go learn something really cool (and then tell me about it so I can learn too). But in case you're burnt out and don't want to learn anything, enjoy some Moose yoga. I wish I could stretch some of my patients out like that!

Have a Great Week, Everybody!!!!

Life's Kaleidoscope

The trimester is coming to a close, and I can honestly say it's flown by. We're all scrambling to meet deadlines in the clinic: this many of this, that many of that. It hardly seems that about 12 weeks ago we were terrified we'd be horrible at this. Truth be told, I didn't think anything about deadlines and numbers and paperwork (OK, well I did think about paperwork a little bit). That's probably why I'm scrambling now.

The last couple of weeks have been discussions about who is transitioning to the other clinic, and some talks about where we'll end up. Half of our crew is moving to the other clinic. It's unlikely that I'll see them very often. Perhaps we'll have seminars or training sessions of some sort, or get together outside of school (although we don't do that now). But in a few weeks, there will be another big transition for all of us. Some of us have been together, nearly every day, for about 3 years. This will be something really new.

Newness. It reminds me of my theory about Maslow's Hierarchy from last week. Incidentally, I've been working some more on that, but I'll spare you all the details. I had the pleasure to discuss it with two of my fellow interns today, the concept of new ideas. We were talking about my theory, and about other theories -- things in medicine and science that seem to have been left behind. We were discussing the idea that there are no new ideas.

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Image by http://mladavid.deviantart.com

Mark Twain said:

"There is no such thing as a new idea. It is impossible. We simply take a lot of old ideas and put them into a sort of mental kaleidoscope. We give them a turn and they make new and curious combinations. We keep on turning and making new combinations indefinitely, but they are the same old pieces of colored glass that have been in use through all the ages."

I grew up not far from good ol' Mark Twain's stomping grounds, but between you and me, his writing always made me crazy. No matter how much I tried, I couldn't understand the dialect he wrote. I'm not sure that I agree with Mark; it seems we're discovering new things all the time. From god particles to medicines, we strive and learn how to change, adapt, and understand the world around us.

If the last 12 weeks in the clinic have taught me anything, it's that we have no standard approach to treating anything. We have to be willing to come up with new ideas, or at the very least, new applications for old ideas. For every patient that comes in, even if they have the "same" diagnosis, what works for each one of them is likely to be something completely different.

I'm fairly certain that our discussion today came to the conclusion that there has to be something new. There has to be a pursuit of Science that crosses boundaries into new territories, that bypasses the need for a randomized controlled trial of everything, and simply embraces discovery for the sake of discovery, and implementation for the benefit of the whole. Perhaps we're all idealists. I see no problem with that. Being idealistic just promotes my love of the field and my hope for making a difference.

Neil deGrasse Tyson, in his series "Cosmos" said:

"To make this journey, we'll need imagination, but imagination alone is not enough because the reality of nature is far more wondrous than anything we can imagine."

OK, Neil. I'll take that one to heart. The greatest theories come from crazy idealists.

I wish you all many great new discoveries. May your kaleidoscope always look just a little bit different.

Patients and Patience

You're not behind the desk, you're sitting in the chair next to it. Waiting. Waiting, for what seems like FOREVER for them to come look at you, examine you, swab, cut, bleed, sample, whatever you. They're taking forever. You feel wretched. Everything aches, stings, hurts. You're tired from staying up all night worrying, hurting, stressing. You only want to know what's going on and you feel like you're simply the only person on the face of the planet, and no one is able or willing to help you.

I'm trying to explain what it feels like to be sick -- to be frustrated with the status of the medical profession and confused and angry and scared. I'm trying to explain what it feels like, no matter how melodramatic it may be, to feel like someone else has control over your health, what's wrong, and if and when you'll get better. There's a feeling of being completely helpless that comes with being sick -- when there's pain, when there's no observable pattern or relatively easy diagnosis, or when it just seems to drag on forever. It's a feeling that no one seems to understand -- like being held hostage by something or someone and being powerless to do anything about it. And it doesn't go away -- that feeling -- until there's some grasp over the problem, like some answer, lab result, diagnosis, something, ANYTHING that seems to give some control over the situation.

If you, as a person, have never felt this way, count yourself lucky. But many others can't say that. Our patients likely can't say that. They come to us hoping for understanding and compassion, and the willingness and ability to find out what's wrong. I only hope that they find it.

It's hard to be the patient when you're used to being the physician. It's also hard to be a physician when you've never been a patient. William Hurt, in a 1991 movie called "The Doctor" illustrated just this. Having been an important, influential physician, he finds himself with cancer -- and realizes just how horrible of a physician (no matter how skilled) he (and some of his colleagues) could be.

People come to us in their worst conditions. They're not always in a good mood. They're not always understanding of our limitations as physicians (or students). They come to us seeking help and advice -- and of course, our expertise. Finding answers is what we're supposed to do. It's what our training is based in and what we've been working towards for our academic/professional careers.

But all of that training only provides a fraction of what our patients need from us. They need our compassion and understanding. This isn't taught in school. It comes from within, and unfortunately, it comes from experience.

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(Image source: hopeinhealingblog.wordpress.com)

For some of us, it's been sickness that has made us this way -- or abuse, or poverty, or just LIFE. For others, it's those things that are in the process of making them that way.

Be kind to each other this week, Everybody. Have a great one.