Some days there is no rush to medical school finish line

by Chelsey Baldwin
College of Medicine

Editor's note: Chelsey Baldwin of Little River is a third-year medical student. This column follows the journey of her class in becoming doctors.

For the past two years of medical school, I was always focused on the end. I always had the feeling that if I could just get through this test, finish that paper, or just be done with the boards everything would be OK. I would be able to reclaim my life.

All students eventually find themselves surrounded by residents, fellows and attending physicians that continuously push them to stay up on new guidelines and practices. The realization finally settles in, though, that there is no clear-cut end point.

I remember the snicker of a fifth-year resident who overheard a patient asking how much longer I had before I was done. This is not to belittle the highlights along the way. I want that long white coat and two bold initials after my name as much as any other student. Yet, there have been experiences since my debut in the wards that have humbled this student into begging for more training before graduation day. Those experiences make the lengthy process of producing a physician, worthy of the title an enjoyable one.

My third rotation of the year was split into two three-week rotations. The first three weeks, I was placed at an outpatient internal medicine clinic in Mount Pleasant with Richard Mills, M.D., who was adored by his patients and students for being an incredibly intelligent and kind-hearted man. His office was affiliated with Roper Hospital, which was my first experience away from MUSC.

The differences were many, from my perspective, especially when I visited their affiliated hospitals. They weren't accustomed to a constant stream of medical students rotating through. They weren't accustomed to anyone streaming through. The halls were mostly empty — no attending physicians with their flock of residents and medical students in sight. There was no swarm of nurses buzzing down the wards and no patients walking the halls as staff cheered them along. People were scarce as I made my way through the hospital.

This could be demonstrated no better than when I went to visit Ms. Wright (*The specifics of patient conversation have been modified to protect the anonymity of patients) during my morning rounds. I usually rounded by myself on two to three patients in the morning, knowing that Dr. Mills and I would cross paths after he had finished with his patients at the downtown hospital.

This particular morning as I wrote out my note, Ms. Wright's nurse sought me out. "She's having chest pain. You need to go look at her," she said. I turned to her, hopefully without my face conveying my inner thoughts of panic. Why would she ask me? A medical student would never be asked to respond to chest pain in the wards at MedU.

I turned to see if, by some miracle, I could see a glimmer of the jolly Dr. Mills coming down the hall. I could not. "OK," was all I could muster as she ushered me toward Ms. Wright's door.

I ran through the list of people I would scramble to contact should something serious be going on as we walked. Then I thought back to the tests I had just reviewed on Ms. Wright. Her ECG was fine, as of this morning. Someone had also ordered troponins, indicators of acute cardiac injury, and they were normal as well. I walked into the room to find Ms. Wright, a frail woman in her 80s, sitting in her bed with her daughter-in-law, just as I had left them 20 minutes before.

"Ms. Wright, I understand you're having chest discomfort. Can you tell me what's going on?" I said. "Who said, I don't understand what's going on?" she said defensively. Mrs. Wright had misplaced her hearing aids two days previously, so communication had been a struggle. I sat on her bed and placed her hands in mine to orient her, as I had seen my mentors do before.

"Tell me about your chest," I prompted her. "It started burning," she told me. I remembered her daughter-in-law had requested she get protonix, an acid reflux medication. I asked the nurse if this had ever been added. She shook her head no.

"Ms. Wright, did it start burning after you ate?" I asked. "Yes," she hissed. "It has been that way since I got admitted here." I nearly went limp with relief.

"It hurts my chest," she went on, likely the same comment that provoked the ECG and troponins that morning. After reassuring her daughter-in-law that I thought this was due to heartburn, I scurried to the hallway to phone Dr. Mills. He chuckled saying that he had dealt with the same complaint earlier and had come to the same conclusion.

As I hung up the phone, I was astonished at my undeniable relief that Ms. Wright's heart was not the culprit. The sweat underneath my work attire was evidence that I needed the training between a novice third-year and graduation day.
However, not every experience that makes a medical student grateful for training involves a moment of terror. Some experiences are pure fun. I love thinking back to the days on evening rounds of head and neck surgery service. A team of three medical students, a research fellow and an intern, lead by a second-year otolaryngology resident dropped in on Mr. Heinz. We pulled a drain from his surgical wound and remained to hold pressure for a few minutes because of his blood-thinning medications.

We decided that rather than stare at Mr. Heinz in his bed, we should entertain ourselves with a game. The intern proposed a memory game. The rules were simple: one must say all the words, in the same order stated before their turn, plus add a word. We started out simple, aware that our company had been through a rather traumatic surgery.

Orange.

Orange. Flower.

Orange. Flower. Banana.

Orange. Flower. Banana. Chrysanthemum.

"What?" we barked back at the cheeky second-year resident, who obviously ignored the pattern of words we put forth. Our patient only made it to the second round before tripping over the newly added tongue-twisting words. Words that our competitive spirits wouldn't let us omit and his pain medications wouldn't allow him to remember. By the end we were all laughing. We checked to make sure the bleeding had stop and thanked Mr. Heinz for putting up with us. On days like those, there is no rush to the finish.

Friday, Nov. 30, 2012