November 18, 2009

My first month of internal medicine ended abruptly at 11:30 AM today, when our attending physician suddenly decided to send us home. "You guys have class until the afternoon anyway," she said, "and there's really no point." We were already running late, so we packed up our stuff, thanked our team and everyone we ran into, and ran off.

It felt so anticlimatic.

The hospital had become our second home. For the last few weeks, we worked twelve or thirteen hour days, and ate and breathed and lived on the floors. We learned to stride the corridors with confidence, and we knew which floors had the best copiers. I sent my teammate at least one desperate page, HELP I AM STUCK IN THE STAIRWELL PLEASE LET ME OUT K THANKS. I wanted to say goodbye to my favorite consulting physicians, nurses, and techs, and to say thanks for the teaching-- and for putting up with our incompetence.



We had finally settled in, and now we'll be thrown into a completely new setting to start all over again. And if this isn't jarring enough for us as med students, I can't even imagine what our patients are feeling. Suddenly we are here, and suddenly we are gone.

In many ways, it's not fair that everyone is subjected to the constant shifts in the system, but the patient by far suffers the most. We switched attendings twice during our month, resulting in many confused looks the next day. The patients would ask where Dr. So-and-So is, and why suddenly he or she has been replaced by someone else. If the attending didn't get a chance to say goodbye, I found myself in the awkward position of explaining the system and assuring the patient of the new physician's competence, but in many ways, the feeling of abandonment is hard to shake for everyone involved.



There is already a bewildering number of people involved in the care of a patient. The patients sit in the center of a complicated network of personnel. There are the nurses, who change shifts every twelve hours, and not always the same nurse comes every day. There are an equally bewildering number of techs, who support the patients and nursing staff. There are phlebotomists, which some of my patients have not-so-fondly called "vampires, and other technicians for EKGs or special tests. We have the patient transport team, who ferries the patient around in a variety of neat-looking wheelchairs. Social services and case managers address a variety of issues, as do chaplains. There's also a group of support staff who we don't normally think of coming into contact with the patient, but they do anyway-- for example, the janitorial service, who maintain their own rounds through the hospital.

And then there are the medical teams. We were the internal medicine service, and we liked to think of ourselves as the heart of the hospital, but in reality we were constantly paging colleagues and friends to consult on patients. There's cardiology and infectious disease and nutrition and physical therapy and occupational therapy and a gazillion other "specialty" services. Each team, in turn, will often have an attending and residents.

All of this is further confused by throwing us students, medical and nursing and pharmaceutical, into the mix, and it's very quickly easy to imagine how a patient with a complicated set of problems could run into many, many people throughout any given day. Suddenly, "Have you seen your cardiologist yet" is not always a simple question to answer.

I'd like to think that as medical students, we play a part in navigating this maze of personnel. We sit down with the patient, explain the teams and the tests, and just what everybody means. Often, I find myself explaining roles, and reminding patients who exactly is that handsome tall doctor who is always walking around with me (answer: my intern, and yes, it's confusing because I actually work for my intern, not the other way around). Our strongest role is probably as navigators, and for patients who face heaven, hell, and in between, it is always hard to say goodbye.