December 5, 2013

• It’s been such a busy year! And I have been contemplating what I should post about for my official first post on Xanga 2.0. I felt like it should be something important, so I felt kind of lost wavering on what was worthy of a first post…though technically I still have all my hundreds of posts from before.

  Do people still post/read here though? Or is it ghost town-y? >_<! I'm not a huge fan of this whole wordpress-thing…haven't really had the luxury to explore how it works. :/

  I feel like I've lost all my ability to articulate properly "in real life" (though I technically count internet as "IRL" since what I post here is in fact real experiences, and the friends I've met are real too – I hope!), because currently I spend most of my writing time working on patient notes…"Patient is a x-years old fe\male with a past medical history of…Patient stated…patient reports that…patient described…on examination it was found that…". I'm currently on my primary care rotation which has been okayish. Some days are awful – I had a couple bad days when I did not feel like I connected well with patients (i.e. patients who were coming in only for lab work, so there wasn't much to talk about, or impatient patients – fancy that!), but then other days are a lot better.

  Honestly, I'm feeling a little worn out from primary care. One of my preceptors/attendings is kind of slow moving (and so am I), so we get behind with patients; so instead of working on notes in the clinic and making them wait, I try to see the patients back to back. But that means I have to take almost all of patient notes home to write. And I like to spend a lot of time on my notes, besides being detail oriented, because then whoever sees them next will have a clearer idea of how they were when they saw me, or what concerns the patient had, and thus to see if they got better at all. A lot of notes I have read from previous people just weren't as clear or helpful, so I prefer to spend the time so that hopefully it will benefit the patient later on. But it is exhausting, because then I am in clinic from about 8AM until 5-7PM (depends), and then I spend a couple more hours writing notes, and then I need to study still on top of that, and then sleep/eat/take care of whatever other thing in life.

  But this week was refreshing. I had my women's health week this week. And although I'm not particularly interested in "women’s health” in the sense of wanting to OB/GYN – I haven’t ruled it out, but I also don’t have it high on my fields of interest. But anyways, Monday was kind of meh, but Tuesday and Wednesday were really nice. Tuesday I got to go to Moffitt Cancer center and scrubbed in on a few cases with Dr. Laronga. I mostly just observed, and did a little retracting and knot cutting, nothing fancy, but it was very interesting nonetheless…

  (Digression, but relevant:) While I was on my surgery rotation (which, by the way, I LOVED) I got to scrub in on a mastectomy/reconstruction. I got to help out a fair amount, because there was no resident helping out with the reconstruction portion of the case, but as for the mastectomy portion, I felt kind of stressed out/dissatisfied with the results…I felt like the surgeons rushed it a too much and didn’t really do a great/clean appearing job…and then the plastic surgeon was in a rush because he was running late for an unspecified planned event, so though he was annoyed at the mediocre mastectomy, he didn’t really try to fix their work. He kind of brushed it off because the patient was getting tissue expanders and was going to have to come back in a few months for revision anyways. So when he finished, her breasts looked pretty uneven and quite lumpy. I was pretty upset with how they finished it, but I’m not really in any place to say anything – and I didn’t really know any better since it had been the first mastectomy/reconstruction I had seen, so I didn’t know if maybe that was just the best that they could do?

  One of the other surgeons that works at Moffitt and is one of our professors once said (paraphrased) – “you should treat patients as you would like your mother to be treated” – and watching how careful Dr. Laronga and her fellow were with the patients at Moffitt was just so much more reassuring than what I saw at TGH. Sure, there are so many excuses that one might argue: Moffitt is also has a much better reputation than TGH and is also specifically a cancer center, TGH is a teaching hospital, the surgeons at TGH were general+plastics whereas at Moffitt the surgeons performing the surgery were surgical oncologist specializing in the breast, and the patient population that goes to Moffitt has better insurance, but still. It is frustrating to see the disparity between the results when you hope to work under the previously paraphrased mantra. It isn’t even just a cosmetic concern, but also health: it was important to have removed all the breast tissue during the mastectomy because of possibility of recurrence…

  Then Wednesday I got to work again with Dr. Laronga, except this time in her breast clinic – where we see patients being consulted for surgery, or for follow up. Again, the compassion she demonstrated towards her patients was remarkable. This topic actually hits very, very close to home because my own mom is a breast cancer survivor. And I feel bad because she was struggling at a time when we were all still very young/in elementary school, so we weren’t with her for her doctors appointments, and I really hope we behaved well enough…my memory from that time is somewhat foggy. And I just hope we were supportive enough…but seeing these women struggling with their diagnosis, prognoses/unknown prognoses, determination, strength, and fear – I wondered how things were for my mom, and just hoped that the doctors that treated her were this kind and reassuring to here. I just hoped. And it was so evident by the end of each visit that all these women felt better – maybe not about their prognoses (Dr. L always was frank) – but comforted because they felt safe knowing they were in good caring hands. And the confidence the women had in her, and the compassion that she demonstrated…I just felt so overwhelmed emotionally because I desperately hoped that that was how my mom was treated; and I hope so much that that is the sort of doctor I can one day be.

  It’s just such a struggle though – medicine is adulterated by money (often run as a business, sadly…but then there are problems like insurance, law suits, etc.), bureaucracy (hugely inefficient in so many ways),…I’m scared that people will get lost in those factors and forget the people they are treating.

  • 10:52 pm
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