Rotations Two and Three

I want to take a few minutes and try to catch up with the end of the semester that has led up to what has been a fantastic break. This will be my stuff, but we will get some pics on really soon!

At this point I have officially finished 3 of my rotations that are required for my graduation. I already posted a blog that outlined my experiences with psychiatry. The next full month was OB-Gyn in Hartford, which required a 45-minute, one-way commute each day. Prior to the rotation I had some real trepidation, but once I got started I was amazed at how much I enjoyed it. During the first two weeks I had the chance to do a whole host of firsts: see a C-section from the other side of the "curtain," watch two sets of twins born, help deliver a placenta, scrub in for a surgery and staple a wound shut, sleep in the hospital while on call, and best of all I actually got to deliver three babies (with the doctor next to me, of course!). Every time it is a miracle, and every time it is amazing that the baby actually makes it out, and every time it is hard to believe that the babies seem so perfect. If only every baby could be as cute as Audrey...

The next two weeks were not quite the highlight of the first two. I pretty well made up my mind that a gynecology clinic was not in my future career! It was still a pleasure to meet new people and be of service, but thank goodness for people who want to do it for a living!

The next month I did a whirlwind pediatrics rotation. For 12 straight days I hung out on the pediatrics inpatient floor at the Yale New Haven Hospital wing for infants and toddlers. While there I followed patients of my own, and was intimately involved in their care. I helped make decisions on medicines to prescribe, ordered specialty consults, spoke with parents and relatives, and presented patients to the team. On a rare occasion I got coughed on or pooped on. Here was a typical day on the floor:

7:00 Morning Signout: the person who was on all night informs each resident (doctors in training) what happened with their patients the previous night.

7:30 See the Patients: This was a quick interaction, usually only for about 5 to 10 minutes (enough to listen to lungs and heart and get an update from the parents).

8:30 Morning Rounds: Discuss each patient in detail with the nurses present. The resident or student in charge of the patient presented their history and current status to the team, then proposes what should be done for them that day. The team would then chime in with suggestions or the teaching doctor (attending) would take a minute to give some instruction. This is where the residents and students do a bulk of their learning.

11:00 Consultation Time: Coordinate care with specialists, contact pediatricians, order medications from the pharmacy, scream at the imaging department for not sending somebody to do an X-ray, discharge patients and write notes for the day (each patient gets a "note" written by everyone who sees them, every day, which describes what was seen and what is needed). Every note is a legal document, and they are considered an important part of the learning process, as they require that you critically think about the condition, treatment, etc. This part of the day was always very hectic, and it always kind of felt like the floor of Wall Street to me in our conference room.

11:30 Sign-Out Rounds: The resident who was on all night tells the new resident on call what is happening with their patients. He/she was then finally able to go home after 32 hours.

12:00 Lunch Conference: Class combined with lunch (only rarely was it provided).

1:00 Patient Management Time: This is where we had the most time to actually be with patients and their families. This is also when we were checking in new patients, spending time with the teaching attending, or a few times a week we had class.

4:30 Daily Sign-Out: everyone signs out their patients to that night's resident on call. Most nights I was able to leave for home by 5:00, unless I was on call with the resident. If I was on call I stayed until I checked in a new patient, usually by 8:00.

Inpatient was good for learning, but I enjoyed the pediatric clinic far more, because it felt like I spent more time with the kids. It was exciting to see the patient first, do the required physical, make a diagnosis, then have the attending “double check” my work. This typically meant she would make sure I didn’t miss anything, teach me about diseases/rashes I had never seen, and help me understand the best medications to prescribe. The teaching felt very one-on-one, and I really enjoyed the doctors I worked with.

Whew, made it! Pics coming soon!