Tuesday, May 10, 2011

Written Directly from the Belly of the Beast

I haven't been updating much and for that I apologize. This really should be the time I update because I've been having the most negative experiences lately. I think people prefer reading about the horror stories of medical training, rather than the good. Since I'm currently on a horrible rotation where I'm kept for hours without having anything to do I might as well update. So, let's start from he very beginning. (a very good place to start)
A little while ago I had my pediatrics rotation in an ER. I hadn't been looking forward to this for two reasons.  1)  I don't have a knack for peds.  2)  I already kind of knew the preceptor and I didn't anticipate us meshing well.
Let me first say that I don't dislike children. However, it seems that if you do not have a strong love and appreciation for children, which increases exponentially the younger they are, then you are not a "kid person." This is a little unfair. It's kind of like the opposite for geriatric patients. The assumed default feeling towards geriatrics is a negative one, but if you don't hold this bias then you're automatically a "old people person." Whatever, if people want to see me as a hater of children and lover of old people then so be it. In my eyes though they're all the same. I don't necessarily like one group more than the other purely based off age. I prefer puppies above all of them.
The children themselves were easy. Children don't give long histories, and generally don't have complicated histories. They don't go on and on about vague symptoms that have gone on for months. Their parents on the other hand are a different story. I swear I think people become dumber when they have children. People were bringing in kids cause they have a temp of 99 for less than a day (temps start at 100.4, no exceptions), or because they vomited once 6 hours ago but have successfully eaten since. It was so odd. My family would never bring kids to a doctor for these things, even if it was their first kid. My grandmother laughed at the things people brought kids in for. Or you would have parents bringing there kids in too late. Why didn't you bring the kid in when the temp was 104? What was it about 106 that finally made you bring them in. Oh it was the fact that WERE NO LONGER RESPONSIVE?! But it's true what they say. Parents are worse than the kids. Overall I didn't dislike peds. I feel fairly competent in the ER setting with children, and wouldn't run away from them like many other ER providers.  Can they tolerate fluids? Does their fever respond to motrin? These are the big questions.
My preceptor wasn't as bad as I expected, but don't let that fool you. I'm still not a fan of his. As far as providing patient care he was fabulous. I learned a lot from him and he was a great teacher. However, his personal demeanor left much to be desired. This man thought he was the greatest doctor of all time. He constantly talked about all the shit he did in his mother country. How he single handily ran an entire hospital his first year after med school. Along with this he was also very quick to criticize everyone else. You were a moron if you didn't something wrong, and he would let you and everyone else know it. He had zero patience for ineptitude.
He especially had a special type of contempt for PAs. If they did something he didn't like it was much worse than if a physician did something he didn't agree with. For instance, one physician did an entire septic workup on a child that in reality didn't even have a fever. He very discreetly went up to that physician and gave his input and didn't make a big show about it. However, if a PA came up to him at 11:50PM and asked if he was done seeing patients he WENT OFF on them.  His shift ended at 12AM and he would condescendingly ask, "If I wasn't hear then what would you do with that patient? You would see them. You can see them now even if I am here. I have 10 minutes left. I'm not seeing more patients." This occured with a PA that had worked with him one time before. He went on and on speaking audibly to himself about how outrageous that the PA tried to get out of doing work.
He would also complain about how the PAs never saw any peds patient when he was there. He said they should be seeing all the injury patients that don't require his expertise.  He however didn't care of the the EM docs didn't see peds patients. You see in his eyes, PAs are suppose to do all the work the docs don't want to do. Docs have the privledge of choosing who they want to see. In short, this guy was an ass.
In addition to this he was also nasty to the nurses and techs. One story that stands out was when I went to see a patient and they complained that the bed wasn't made. I looked at the sheet and indeed the sheet looked soiled. In my head I thought it was just a permanent stain, but I left to tell someone it needed to be changed. When my preceotor asked why I wasn't seeing the patient I told him that the sheet needed to be changed, and he started going on a tirade. He searched out the tech who was suppose to change the sheet. She had been told by the nurse that it was changed. I witnessed this. The nurse indeed said she had changed the sheet, and I believe she did. However, the preceptor continued giving it to the tech. He went as far as to say, "I don't change the sheets in my own home? Do you really expect me to change them here?!" Wow. That was just about the rudest thing I ever heard.
This preceptor also could not stop talking about his kids. He pushed his kids so hard that it made me pitty them. He expected only 110% from them. It was very much like that WSJ article on "Chinese Mothers." I do believe there is something to that philosophy, but you don't need to tell me everything there is to know about your kids. Save it. I didn't ask. He was also very defensive when a doc asked me about the high school I went to becuase it's consider very prestigous where I'm from. My preceptor could not handle the fact that my high school was considered better than his kid's. As if it somehow reflected poorly on his kids. I defused that situation by saying, "My school's minimum student performance was just higher than other schools. It by no means means that kids at other schools can't out perform kids from my school. You just couldn't coast by as easily at mine." He excepted that explanation.
I use this guy as a life lesson. I hope to never turn into him. I'm pretty sure that won't happen, since I already never talk about my accomplishments, and down play any praise I receive. Horray Catholic guilt.
Next post: Surgery

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