The learning curve was very steep during Surgery, which was my first clerkship of the year. I didn't enjoy this clerkship. I didn't like being in the OR (at all), I grew tired of waking up at 3:30 every day to get to the hospital by 5 to pre-round on my patient(s) for our 6:30 rounds. I hated that rounds were so short, and there weren't many learning opportunities for students to grow (I never once presented a patient to an attending on rounds). When I started Neurology after what felt like 2 months of torture on Surgery, I fell in love all over again with the field. I have officially decided to pursue a career in Neurology.After Neurology I completed a Pediatric Radiology elective for one month and currently I am on my Internal Medicine clerkship, which I am loving so far. Why? Because there's no OR time, I get to wake up later because rounds usually aren't until 8:30/9, I present to attendings and consistently receive constructive feedback, and I'm able to see a variety of patients, some with very unique medical conditions. For example, we had a patient with no history of liver disease who presented with elevated levels of ammonia that were causing episodes of confusion; unfortunately, no one knew what was wrong with her, but some lab results strongly suggested that she had a rare genetic condition. We had another patient who presented with swelling of his penis; the Infectious Disease team believed that he had a very rare sexually transmitted infection. Last year there were only 7 known documented cases of this particular STI in the United States.
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Our primary goals were to treat her headaches (which occurred due to the CSF leaks and decreased intracranial pressure), seizures (which started for the first time in her life after she gave birth), and the brain bleed (we needed to monitor it). To treat her headaches, our plan was to consult the anesthesia team to place a “blood patch” over the torn lining of her subarachnoid space in order to halt the CSF leaks. For her seizures, we started her on continuous 24-hour electroencephalography (EEG) monitoring to closely watch the electrical activity of her brain and ensure that the seizures would not recur. As for her brain bleed, which initiated her seizures, we watched her closely for any change in symptoms or physical examination findings that would indicate repeat imaging of her brain.
Understandably, she was anxious about the complexity of her medical concerns and was ultimately afraid that another seizure would occur. During rounds each morning, she and her boyfriend asked many questions about the seizures and how they tied into everything else that was going on with her neurologically. After rounds and completing my notes, I would return to her room to ask how she was feeling and if she had any concerns or questions. She and her boyfriend had a few, and her mother had many. Her parents were from Mexico and spoke little English. Her father stopped by briefly every day to check in on her, but oftentimes had to quickly return to work. During rounds, our nurse practitioner helped interpret the etiology and pathophysiology of the patient's condition to the mother. When I returned to the room in the afternoon, the mother began asking me the same questions we’d just clarified that morning.
It was during my interaction with this patient, her boyfriend and her parents that I came to realize the profound confusion and anxiety that can accompany encounters with patients and their loved ones who do not have a basic understanding of conditions that our healthcare teams see on a regular basis. I cannot forget the deep concern and fear on her mother's face as she repeated the questions she’d asked earlier on rounds: “Que causó el sangramiento en el cerebro de mi hija?” [What caused my daughter’s brain bleed?], “Por qué tiene dolor de cabeza?” [Why does she have headaches?] “Las convulsiones volverán a occurir?” [Are the seizures going to happen again?].
This patient's medical narrative was complex, thus her mother’s numerous questions were understandable. She and her boyfriend’s questions were brief, and though still concerned, they seemed to have a better grasp of the situation. However, because of the language barrier, the patient's mother still had gaps in her understanding. I was determined to help her grasp what was going on. I answered her questions carefully in Spanish, giving as much detail as was necessary about the pathophysiologies of her daughter's pertinent symptoms (headaches and seizures).
I found it incredibly gratifying to clarify the patient's medical conditions to her and her family during what was a confusing and anxiety-inducing time for all of them. She was terrified that the seizures would recur. I felt that it was a privilege to be present with her during this time of distress. I clarified what was going on, took her hand in my own, and reassured her that, after our discussions on rounds with the attending, everything was going to be ok.
As a physician-in-training, I am learning the tremendous difference that love, deep empathy, and genuine concern can make in patient care. I believe that medicine is about seeing one’s family in others and treating them as such. It is important to value the culture, background, and ideals of patients and their families. Without mutual respect and understanding, endeavors to bring about positive impacts are futile. I believe that the central goal of medicine is to reach and effectively treat individuals in need with an attitude of patience, gentleness, and kindness; this goal describes the basis for my drive to become a physician.
