Tuesday, June 28, 2016

Beware of People Wearing Short Lab Coats

She looks even younger than I do, which is because she's not an actual medical school student. 

People who wear short lab coats are typically medical school students. It behooves you to remember this, particularly in the next few weeks, as teaching hospitals everywhere have been inundated with rookie third-year medical students. There's nothing unusual about this year.  The same thing happens from mid-to-late June of each year.

We've been trained to insert IVs and to perform a few other routine procedures. Everything else we need to know, which is a whole hell of a lot even in my case, and I'm arguably one of the higher-functioning third-year med students a patient might encounter, we will learn at the expense of our patients.  Isn't that a comforting thought? 

If you're planning to be injured, ill, or otherwise in need of hospital services for the next month or so in particular, it may be in your best interest to steer clear of teaching hospitals. Perhaps, however, you are the adventurous sort of person, who likes to live close to the edge and enjoys the opportunity to roll the dice and to take his or her chances on occasion. If so, come on in! We'll be more than happy to practice on you!

I've survived the first two days of my rotation in the surgery clerkship.  I inserted  six IVs (on the first try fives times and on the second try once) and scrubbed in for eight surgeries including two appendectomies (one laparoscopic and one w/ laparotomy), two cholecystectomies, three miscellaneous intestinal surgeries (one with colostomy, which should be resected following healing of the lower colon), and one pancreatiduodenectomy.  

Third-year medical students are on the very lowest of the low rung of the patient care ladder, ranking somewhere beneath candy stripers  (everyone actually treats us as though we know less  than hospital volunteers except that except that they expect us to insert IVS). In fairness, they shouldn't treat us as though we know much, since we don't. I would like to think, on the other hand, that most of us already know how little we know and don't have to be reminded of it multiple times every half hour. I may be wrong there, though. If we didn't know our places, some of us might grow complacent. 

Not only are we the lowest of pond scum in this place. We also have to be on duty before anyone else in the surgical team. Nurses work whatever shifts they work irrespective of scheduled surgery times. MDs and future MDs arrive in reverse order of our rank and importance. We're expected to be here at least ninety minutes before our first surgeries, and are expected to know everything about the patients including history and current stats in order to update fourth-year students, who update residents, who update attending physicians.  

Those who outrank and supervise the other third-year students and me are a microcosm of relatively-educated-to-educated society as a whole. Some have over-sized egos or are otherwise jerks,  some are in-between, and some are nice and go out of their way to be helpful. This is what I would have expected. 

It's exhausting work, but it's also incredibly exciting. I'll share more when I get twenty-four consecutive hours off in a few days.


  1. Oh, Alexis!! This brings back memories.
    Amazingly enough patients trust nervous and bumbling students and interns. Thankfully the pyramid of supervision-or hierarchy if you will- catches the most outrageous cock-ups.
    Don't overlook ,not only how much you learn from your mistakes,but from observation and listening to colleague's decompress after their misadventures.

    I basically lived in the ER or the emergency OT during my final clinical years. So many things learnt in so many areas- terminology,jargon,clinical skills, assessment criteria, management choices,character assessment of both patients and fellows. You learn who is a good clinician when you see them under pressure, you learn who treats people badly and then know to avoid them.

    It's character building to realize that you are at the bottom of the heap. Don't overlook how much you can learn from senior RN's. As an intern I quickly learned that getting on well with the RN's on a unit reduced the number of nuisance calls I received plus a senior RN has usually been through your problem before and will help out if you are not an egotistic*#1@.

    Quarantine your strength. I know you are an insomniac, so you have to learn the essential survival skill.I soon learned to fall asleep immediately, wake when paged and go back to sleep again.Wish I could still do it.

    Look forward to hearing more of the Adventures of Alexis in HospitalLand.

    1. It's certainly character-building to be at the bottom of any heap, but I was at least thoroughly prepared to be at the bottom of this one.

      I really need to learn the art of falling asleep quickly and easily.

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  3. There is a strict hierarchy in the doctor world and god help anyone who tries to alter it, even for a moment. It is somewhat hilarious to others, mostly nurses, and offers quite a bit of entertainment for the money.

    1. Yep, that hierarchy is etched on a stone tablet. It is to be endured. This, too, shall pass.

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  6. When I did my first social work internship, I worked at a medical clinic affiliated with the university. It was to provide services in rural South Carolina (although it wasn't really in a place that was that rural). Anyway, it provided training for many health services students, including medical students. I always found them interesting to talk to.