Resident Physician Contributing Writer
Ohio State University Werner Medical Center
Rohan M. Modi, MD is a resident physician at the Ohio State University Wexner Medical Center. Inspired by the writings of Atul Gawande, Rohan is interested in understanding the illness experience from the patient's perspective and centering medical care around the patient's values and priorities. He plans to incorporate these sentiments in his future career in Gastroenterology and clinical research.
While there is always an intrinsic desire to root for patient recovery and ultimate survival, I struggled immensely with the decision to pursue invasive measures. This is a poem that helped depict my feelings for this patient encounter.
It really doesn’t take much to remind you just how human you are. I utilize the adjective “human” because most believe, both inside and outside of the confines of the medical community, that physicians are entitled and even expected to behave in somewhat robotic ways, with the long hours and constant absorption and dispensation of medical knowledge that often comes with performing the job and doing so well.
Realizing that we have both inpatient and outpatient months, which require different skill sets, I feel that it would be better to split these lists into both outpatient and inpatient suggestions. After a few month of being on outpatient rotations, here is my list of eight things to master in order to break the successful intern barrier in the outpatient world.
Twenty minutes of cardiopulmonary resuscitation. Fifteen beats per minute. Seven nurses. Five doctors. Three paramedics. Two anesthesiologists. One transcriber and me. And then the eerie silence of the trauma room as the death was called.
“Hey hey! How are you?” someone calls out as I walk into the fluorescently lit emergency department I call home. “Living the dream,” is my habitual answer, and it’s only half facetious.
Everyone warns you that intern year is hard. It’s a year of little sleep, a rollercoaster of emotions both good and bad. Frustration and guilt in wanting to know everything now because everything you don’t know might be what matters for this patient, this time. And tremendous successes. Some of the things I did this year, I really can’t believe I was able to do. And survive.
Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother — although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense of helplessness I felt due to my lack of medical knowledge fueled my desire to help and serve others as a physician.
A surgical resident writes: “Several recent studies suggest current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?”
Have you ever had that experience when you think what you’re doing is futile, and that thought goes through your mind: “Why am I doing this? I’m torturing him. This feels wrong.”
I feel like there are so many things to work on in medicine. I need to be more efficient at taking a history; I need to gather morning data more quickly; I should be better at chart review when I get a new admission; I need to be more thorough at following up on labs; I could write the H&P more quickly, and so on. I also feel, from time to time, I do poorly on one thing — maybe I stay at work way too long writing my H&P — and then I obsess over how I can get faster at it.
It’s 2 a.m., and the patient’s blood pressure is beginning to rapidly decrease. Every IV line is occupied by an antibiotic or IV fluids, and we are in need of a vasoactive medication. The nurse comes to my computer and sternly states, “We can no longer avoid it. I think the patient needs a central line.” I quickly say “okay,” but I don’t move. I am momentarily frozen by my unease with the bedside procedure ahead.
In an ideal world we would all die at home with our loved ones caring for us, slowly slipping away in our sleep into the placid beyond. But why doesn’t it happen this way? There’s a dignity to that way because of its organic simplicity. It’s how people used to die prior to modern medicine and before we started needing to always “fix the problem.”
Resident Physician Contributing Writer
University of Pennsylvania
Adrienne is a graduating fourth-year medical student at Georgetown who will be starting residency in general surgery at the University of Pennsylvania. She is interested in surgical oncology and is passionate about the role that palliative care can have for the multi-disciplinary care of oncologic surgery patients.
