Picking the Right Program for you

“And say: My Lord! Cause me to come in with a firm incoming and to go out with a firm outgoing. And give me from your presence a sustaining power” -the Holy Quran, chapter 17, verse 80

Now that I’m a fourth year who can sit on the “elite” table at our school clinic and pass off patient charts to the third years, I have the privilege of bestowing knowledge from my experiences “abroad”. Although I didn’t rotate through hospitals outside of PA and NJ, it really does feel as though I was traveling and school feels like home. Although as students we always complained and couldn’t wait to experience the outside world, you can’t help but form an attachment to your home base for the past 4 years. On the other hand, externships are great opportunities to view how different hospitals and attendings treat their patients, meeting new residents and students, and the overall academic focus. Some programs are clinic heavy, and cover several private practices, while others have the bare minimum. Some attendings let students participate in the surgical procedure, while others don’t let the residents touch the knife until their second year. I’ve been to places where journal club is an impromptu, “whenever we have time kind of thing”, and places where there were presentations and radiology rounds twice a week. It really varies from place to place, and as I tell the lower classmen, you don’t really know what you want until you experience it. Personally, I at first wanted a “country club” residency, where I had a decent 7-5 shift, barely on call, mix of clinic and surgery, and not a lot of trauma. However, Alhamdulillah I had a change of heart and ended up choosing programs that had a decent amount of trauma, some with more clinic than others, and enough on call time without being excessive. No regrets there, as I found out that I absolutely loved trauma and ranked my top choices as trauma heavy programs.

Another consideration that some students don’t realize is rotating at a teaching hospital vs a non-teaching hospital. I am personally a fan of teaching hospitals, all 5 of my externships were of those sort. I enjoy academics and having patient encounters transformed into lessons, so that is what I chose (sounds absolutely nerdy right now, I know). However, that isn’t the environment for everyone, as some people have had enough of school and want something a bit different. There is also a lot of teaching other residents and students involved (hence the name, “teaching hospital”), so that is something to take into consideration.

A pearl of advice that I’ll share is to be honest with yourself, yet at the same time, don’t put yourself down. Am I speaking in riddles or contradicting myself? Not really. So some programs are big names, famous hospitals which big time physicians trained at. These programs have a reputation of only matching potential residents who were at the top of their class, or only want brilliant individuals. There are people who may think that they are it good enough, and won’t take the chance, even if they are sincerely interested in the program. My advice is to give it a shot. We are all brilliant individuals to have made it this far, and for you not to think that aren’t good enough is a lack of confidence that a future physician should not have. At the same time, if you are ranked pretty low of your class, it isn’t the smartest idea to waste an opportunity at a program that specifically requires for you to be in the top 10%. I almost didn’t extern at a certain program, thinking that I didn’t have a good chance. I almost let it go by, but I’m glad I took the opportunity and alhamdulillah, now it’s my top ranked program 🙂

In short, be honest with yourself about what you want to get out of a program. Be a little aggressive, but keep a sound head on your shoulders. Hang tight, there’s more to come InshaAllah!

The 4th year!

     It’s been about a year since I last updated and what a year it has been! Since then, I finished my 3rd year courses, started my 4th year off with a clinic month, and survived 5 externships! I really did not appreciate what upperclassmen and residents meant when they said that “you are the smartest and at your peak at January..then it all goes downhill from here!”. The amount of knowledge that you gain from outside rotations serves to enhance your learning experience. For instance, as dumb as it may sound, I did not really understand the concept of absorbable vs non-absorbable sutures. Yea I could tell you that Vicryl takes 80-120 days to be absorbed and that you should use Prolene to close skin in infection cases because it’s least reactive, but those were just facts I memorized. However, after a few surgeries it made sense as to why you should close the capsule with absorbable vs skin with non-absorbable, or use Monocril for a cosmetically pleasing scar. Little things like that just click after seeing it in front of you.

     The biggest issue I faced when starting 4th year was adjusting to the approach of externships. My classmates and I were well versed in clinic, we had great skills and could work fast, but a hospital rotation is a whole different ball park, especially when you are aiming to please residents, attendings, the director of the program, and a whole number of other people. It’s pretty difficult to get used to an entirely new system every 4-5 weeks. You spend a whole month learning what is expected of you, adjusting to multiple personalities of the residents, trying not to get lost in the hospital or while commuting to different surgical centers, and then..it’s over. You say farewell and move on to start at a new place with new faces with new convoluted directions all over again. Repeat five times and you are ready to take a well deserved break. Let alone studying for procedures the night before and trying to squeeze in studying for Step 2 and interviews. Oh, and did I mention to keep a smile on your face? Not a painful grimace despite your painful kidney stone due to dehydration or stomach growling because you haven’t eaten since before rounding at 6 AM. 🙂

     Despite the…enticing portrayal that I have painted in your mind with my description of externships, it isn’t always like that. They’re actually quite a lot of fun in the fact that you have moved on to a completely different step in your life and are learning things that you want to learn, not force fed on a PowerPoint in the classroom. Even if you make a mistake in the OR or don’t know the answer to a question, it isn’t the end of the world. The upcoming posts InshaAllah will cover some tips and quips I’ve picked up over the past several months. ‘Till next time!

The Hourglass

You are nothing but a collection of days, once those days have passed, so will you– Hasan AlBasri

For anyone in the health field, death is an ever present theme. Like a hidden antagonist, it lurks in the shadows, sometimes striking when least expected. It is an unfortunate daily occcurence for patients to expire in the emergency department, yet a young and healthy person suddenly taking a turn for the worse is not uncommon either. As Muslims, we are constantly reminding ourselves of death. Not because we are morbid species, but because like all genuine and true fears, they need to be acknowledged and dealt with head on. During my month rounding on the pulmonology floor, I watched 3 people approach death in different scenarios.

It was the second week of our rounds on the floor, and like most teaching hospitals, the attending physician and residents change every other week. We made our way down the hall, stopping by each room and giving the new members of the team the updates and a quick bio of each patient.  Once we reached the last room of the west wing, we entered the room, spoke to the patient, and watched as the attending checked his heart and lung sounds before discussing with us the changes he wanted to implement in the patient’s drug regime. The attending shared with us that the patient’s prognosis was not stable, and that the man himself had, in the worst case scenario, expressed wishes for DNR/DNI (do not resuscitate, do not intubate), yet the order had not been approved by the computer system. We then proceeded to the east wing to continue rounding on the patients there. Less than ten minutes later, the residents’ beepers went off as a code blue was announced.   We rushed to the room and discovered that it was our patient that we had just examined. Prior to beginning resuctitation manuevars, the patient’s chart was checked, and subhanaAllah, the DNR/DNI order had just been approved. As the hospital staff called the family to inform them of the unfortunate news, the attending kept repeating to himself, “I cant believe that just happened..we were just talking to him!”. Although he has seen death many times, this scene was absolutely shocking to him. To think, while we were standing in his room, the Angel of Death was with us, waiting for the man to take his last breath!

The second encounter was with a woman who had undergone numeous surgeries and was transferred to our unit after suffering from aspiration pneumonia. She was extremely depressed, did not want to move from her bed, and constantly asked if she was dying while taking copius amounts of pain narcotics. Day after day she underwent the same routine; her pneumonia resolved but her psychiatric status declined. One afternoon she suddenly decided that she had enough and wanted to die. She refused the oxygen that she was dependent on and with her family present, denied resusctitation or intubation. Her narcotics were administered, and she passed away.

During what we later dubbed “morbidity week”, another patient was admitted with a severe case of pneumonia. Normally, a healthy patient would be able to take a course of strong antibiotics and fight off the infection. However, with an underlying lung disease restricting his breathing, the prognosis was not great. Palliative care, which I previously had never heard of as a branch of medicine, was involved and began to help the family make end of life choices. Surprisingly, the next day, the man was feeling and looking a lot better. He ordered breakfast, talked with the medical team, and watched television. We were pleased and thought that perhaps he might just pull through this time. Two days later, his health declined and he began worsening each day, until his family decided t withdrae everything but the oxygen and pain medications. When I returned to the hospital on Monday, I looked at the patient list and was not surprised not to find his name there.

When you are involved in health care, you have to be prepared to deal with death. One of my classmates declares that she chose podiatric surgery since she won’t have to deal with dying patients, but I beg to differ. Sure, we aren’t the docs who prescribe antidiuretics for a volume overloaded heart failure patient, or attempt to remove an aneurysym without inducing a stroke, but we have our share of risks too. My patient may die while I’m amputating his limb to save him from a raging osteomyelitis infection. Or she may expire under my care when treating her arterial ulcers worsened by her decreased cardiac output. Or they may suffer a DVT when immobilized after a reconstructive surgery despite anticoaguant therapy as a consequnce of Virchow’s triad. At the end of the day, we’re nothing but an hourglass turned upside down, with the descent of each grain of salt towards the bottom marking the approach to the end of our story.

Internal Med

“The best of people are those that bring most benefit to the rest of mankind.” -Prophet Mohamed (sallalAllah aleyhi wa salam)


Its amazing to realize that in less than 4 months inshaAllah, I’ll be starting my final year of podiatric med school! SubhanAllah, it literally feels like a few weeks ago that I was fumbling in clinic and had no idea how to use a Doppler machine for pulses. This month I am on my internal medicine rotation, which is also my very first rotation where I examine in-house patients. It is a VERY different experience than the traditional podiatry out patient clinic that I’m used to, but as always, I so enjoy a challenge!

The first of February, seven of my classmates and I gathered in a conference room at the medical school building and attended an orientation, in which we were informed that we were randomly selected into a department within the hospital. At the end of the talk, we each were presented with a packet and instructed to find our names and placements. Everyone was silently praying to be placed in cardiology, as we had heard from the fourth years that it was the most interesting rotation with the most flexible time frame (AKA 9-12 PM). However, I opened the packet and found that I was placed in pulmonology, which was according to the upper years the second best. Across from me on the table my best friend groaned; she was placed in general medicine, which was the toughest with the longest hours. I really could not complain!

Right after we figured out our placements, we were handed a list of the residents’ phone numbers and instructed to contact our residents to meet and officially begin our rotation. Although I had months of experience at our school clinic and the VA rotation, I still felt nervous when calling my resident and rushing to meet my team on the floor, where they had already began rounds. I had never attended hospital rounds, and was honestly worried about what was expected of me. Although I have conducted a full history and physical exam, I don’t feel as confident with the other parts of the exam as compared to the lower extremity aspect. Thats just me personally, but as I began this rotation, my ultimate goal was to walk out of the comfort zone and learn as much as I could.

After the first two days, I settled into the routine and learned the ropes bit by bit. I was assigned a patient to examine, read reports on, and present to the team everyday. I arrive at the hospital by 8 AM, where I look up the lab work for the morning, specifically the BMP and CBC. I also make it a point to jot down any meds that the patient is taking, especially if there have been any changes. Next, I check the patent’s chart for any overnight changes, respiratory adjustments, and nursing notes. I then examine the patent, ask the pertinent questions, then make my way to a side table where my team and I meet up until the attendant arrives for rounds around 9. We then commence rounding on all the patients on the list (usually 13 or 14) and in between discuss medications, treatments, articles with evidence based medicine, and generally anything to do with the pulmonary system of the body. We also joke and share anecdotes, while making a to do list of what the attending would like for us to do, such as follow up appointments for discharged patients and D/Cing orders (basically means to cancel them…that was a new vocal word for me!).

Although I was expecting the atmosphere to be strictly and forebodingly academic, I was pleasantly surprised to find that it is quite the opposite. My team is made up of the attending (who is that stereotypical doctor who wants everything in tip top shape), a fellow (who tries to turn everything into an educational amusement park), two residents (who discreetly roll their eyes when the attendant makes unnecessary demands or a patient’s family member is overly nosy), a fourth year med student and myself. A strangely dysfunctional family that make everything work out quite nicely at the end 🙂

The advantage of rotating at a hospital is that you are exposed to a wide variety of patients . From the lady who has no nose due to chronic cocaine snorting to the COPD patient who suffers from smoke inhalation when his drunk son almost burned the house down, I’ve me quite a few characters with outrageous stories. I’ve also learned not to get emotionally attached to the patients as well. For instance, one our patients was suffering from end stage COPD, and suddenly had hameturia. Lo and behold, we consulted urology who discovers that she had a malignant bladder mass. After several discussions back and forth, we decided to take the risk of anesthesia and have the mass removed. With not a bit of trepidation, I checked her chart the day after the procedure while mentally preparing myself that she had not made it through the night. She’s doing well now alhamdulillah, but you have to always expect the unexpected. Something I learned from day 1: in real life, you will RARELY have a textbook patient!

As the month goes on, I hope to continue enjoying the people and the academics, while repeating the words of a recently discharged patient who always had an upbeat attitude, “Jolly good, jolly good!”.

Consistency

“The most beloved actions to Allah are those performed consistently even if they are few”- Prophet Mohamed (SAW)

 

To be consistent is the closest you can get to accuracy. Practice makes perfect. Watch one, do one, teach one. All of us are familiar with these old adages, as they’ve been repeated constantly to us over the years. From learning how to ride a bike, to mastering algebraic equations, the idea of consistency has been strongly enforced as part of our learning process. When we started our clinical rotations, these overused expressions were once again reinforced. Although we sighed and grumbled why we were expected to listen to the same instructions of how to conduct a history and physical exam, it really proved to be true. Once you get into the habit of performing the same physical maneuvers in the same order each time, it’ll become second nature for you.

Starting from when we first began seeing standardized patients (actors) last year, we were introduced to the concept of NLDOCAT. Basically, it’s a mnemonic for figuring out the history of the present illness. Nature, location, duration, onset, causation, aggravating factors, and treatment. After listening to it for a few hundred times, it kinda just rolls off your tongue, which is how it should be when you see a patient. When we first stated those workshops in second year, I made it a habit to write it on my scrap paper before I introduced myself to the patient. Now when I see a patient, I just automatically ask them to describe the pain, use 1 finger to point at the location, how long has it been occurring, when did it start,  recall any event or trauma that may have caused it, what makes it worse or better, and any attempted treatment.

As any well-trained physician will tell you, if you got a good history then you’ve got the diagnosis. Once you have gathered as much info about the HPI as you can, you should automatically start thinking of differential diagnoses. This is something else that comes with practice. At my first couple tries at this, I could only think of the most obvious diagnosis. My mind drew a blank for others, and I didn’t think it made a difference since I “knew the answer”. However, in real life situations, there are rarely textbook patients. You should always have 3 differentials and be able to support them with your HPI and physical exam info. Every good lawyer has evidence to back up his client, and every good doctor should have evidence to back up his diagnosis.

Next stop is the past medical, surgical, social, family history, medications, and allergies. These are extremely important to aiding you in your diagnosis, and can lead you onto the track for an additional differential diagnosis in case you’re stuck. Just as an aside, even if you are seeing an established patient, you should always ask these questions. No, its not because they could be miraculously cured from diabetes since their last appointment six months ago, but because there are sometimes mistakes in the charting. I’ve had several incidents in the clinic where I’ve noticed discrepancies in the chart when verifying it with the patient. An extra minute could save you a whole lot of time down the road.

Right before you get to the physical exam, remember to ask the review of systems, which consist of yes or no answers for any headaches, fever, chills, shakes, nausea, vomiting, urination, rashes or blisters, and muscle pain. Again, its one of those things that you just memorize and can eventually say it in your sleep.

All that’s left is the VOND, vascular, orthopedic, neurological and dermatological exam. Find a system that works for you. I mentally recite VOND to myself each time, then start by taking pulses, capillary refill time, notice the absence or presence of digital hair, and look for any redness  or swelling. Then I check for any calluses, ulcers, lesions, and how the nails look. After that I test for manual muscle testing and joint range of movement, before I check for peripheral nerve sensation with a monofilament.

The other day, we all had the afternoon off from clinic to review a case study in preparation for our clinical boards this summer inshaAllah. After the case was read to us, we all discussed the case while going through all I mentioned above. Although when we first started seeing patients seven months ago we stammered and referred to our notes, forgetting things and going back to it at the oddest moments, eventually we got it down and were able to recite it effortlessly alhamdulillah. It sounds like a lot, but in reality, this becomes imprinted in your mind after doing it over and over again. If you are persistent you will get it, but if you are consistent you will keep it 🙂

My month at the VA!

Allah will give you more than you’ve expected– Unknown

So this post will be a little mix of everything, including an update on scrubbing in! This month is my first outside rotation, which is at the Veterans Affair Hospital in Philadelphia. We had the option to do a general podiatry rotation at our school clinic which is a 10AM -2:30 shift, or to rotate at the VA from 7 AM-4 PM. I honestly wanted the experience of an outside rotation prior to my externships next year inshaAllah, despite the fact that it’s longer hours and much more work. But the way that I looked at it was that there are new faces, new patients, new places!

The first day of my rotation, I entered the VA Hospital with trepidation, equally excited and nervous. The prospect of dealing with old gunshot wounds and shrapnel injuries, with the added experience of the OR, was what really interested me in this rotation. On the other hand, I was unsure of how a military establishment in West Philly might view a hijabi girl in skirt scrubs, especially in light of recent events. I renewed my intention that I was here to learn and to represent a good image of my religion. If anyone expressed any negative opinions to me, I would take it in stride and ignore the ignorance. We’re bound to have some unpleasant experiences anyway, so I planned to use any as practice for any future encounters.

However, I was in for some pleasant surprises. As I made my way into the building and to the podiatry floor at 6:30 AM, no one gave me any suspicious glances. In fact, they smiled and granted me a good morning. The physicians and residents were very welcoming and eager to teach. After the rules of the outpatient clinic were explained, the supervisor on the floor took me aside to speak with me. She told me that she knew each of the patients on the appointment lists, and advised me to check with her prior to taking a patient to the examination room. She knew which patient were “inappropriate” and could say hurtful comments about Muslims. She also related a story to me about a hijabi medical student in another department who was verbally abused by a patient several months ago, and how the police were involved. For that reason, she related to me that many of the veterans suffered from PTSD and had flashbacks, so if any did mention anything to not take it personal. True to her word, this entire week she has made sure that I have not taken any of those types of patients, and instead has one of the two other students, both males, to examine them instead.

Alhamdulillah,the patients themselves have been so far very pleasant experiences. Some of them have been quirky but funny characters that enjoy sharing their stories with the student doctors. Others have more unfortunate stories to tell that remind you to thank Allah SWT for the blessings that He has bestowed upon us. One patient told me that he has been shot at, stabbed and suffered frostbite in which several of his toes were amputated, yet he is extremely sensitive and a crybaby when it comes to any treatment of his fungal toenails. Another patient informed me that he was recently diagnosed with throat cancer, and this is is the one of the very last times that he would ever speak as his voice box is to be surgically removed very soon. A blind veteran and former engineer described to me his work in Vietnam and how he never saw his wife, children or grandchildren. Not to be paranoid, but his story caused me to wonder if he knew that he was being treated by a Muslim female wearing hijab, would he have dealt with me any differently?

An additional bonus to rotating at the VA is that as students, we have the opportunity to scrub in to the surgeries that are scheduled every Wednesday. For those who have read my previous post about scrubbing in, you know the struggles that I have endured during my OR rotation. So when the resident asked me if I could scrub in, I told her that I needed to keep my hijab on and that no male could view my arms when I scrubbed in. To my pleasant surprise, they worked with my requirements. I placed a surgical cap on my hijab, and the circulator placed a sterile towel around my neck to cover the hijab (yes it looked like a bib but fashion doesn’t matter in the OR!). I was the last of the surgical team to scrub in, and when I entered through the OR door the males hd their backs turned until I slipped into my surgical gown. Once the surgery was over, I waited until the other team members broke sterile field and one held my scrub jacket while the other took off my gown to ensure that I was covered.

Alhamdulillah, my experience at the VA has been way better than I expected. I was prepared to face some hostility, and not a little prejudice, but have met some great people, both physicians and patients. However, the month is still young, and I may have to endure some unpleasant situations, but at least I have an idea of how things will run when I start externships next year inshaAllah.

Reflections of a year

And verily the latter portion will be better than the former– Quran, (93:4)

“This time last year, everything was so different”.

I came across that quote a few days ago and took a few moments to ponder how that applied to me. Last December, I was in my second year, studying for finals, worrying about boards, trying to figure out if I wanted to apply for residencies all over the US or to stick to the NorthEast, and having a dreaded fear of third year coursework. Fear of the unknown was the correct definition for my feelings at that time. I didn’t know if I was going to be able to keep up my grades while performing well in clinic, or would the load be too much for me to bear. On top of all that, I was worried about how I would be able to continue commuting when there was less time to study yet more to study for. Plus, it was when I first had the idea to start this blog! Alhamdulillah, it all went well, but there were definitely many difficult yet interesting experiences that helped me mature this past year.

The spring of the second year wasn’t bad at all, exams came and went and everyone moved on. Fast forward to June, trying to juggle Ramadan while studying for boards was a test of its own. Fasting is never hard, but attempting to catch Taraweeh every night and concentrate on muscle innervations and subtypes of bacteria while operating on 2 hours of sleep was not an easy task. It seems like just yesterday that it was the first week of July and one of the secretaries was warning me about third year coursework, saying that she felt bad for my class for what we’ll have to endure.

15 classes, ranging from dermatology to pediatric orthopedics to reconstructive surgery, were taught. As an added bonus, if something was taught in class and a patient just happened to exhibit that particular clinical case, you were expected to be able to identify it, research it, and be prepared to discuss it. A classmate of mine did not Doppler the non-palpable pulses of a patient. After a harsh scolding by the clinician, she had a presentation prepared the next day about PVD. I once had a new patient in the clinic from the ER who had an ankle fracture. I had to obtain her X-rays, then classify the fracture and present treatment options. Like all new things, it was tough and hard to get used to in the beginning.

In between working in clinic for 4-5 hours every morning, then rushing to classes and exams until 6 PM, we had to make a list of the top 5 residency programs that we wanted to extern at, then apply and wait for their verdict. Everyone has their own opinion of how to go about choosing a residency; location is a factor for some, while others consider long hours vs a family friendly program, and still others don’t care where they are as long as they receive the best training. Since my interest is pediatrics, I looked into ped focused programs, which were in Virginia and Florida. But after a lot of research and reading externship evaluations, I decided to apply to only NJ programs that had a nice mix of peds and surgery. The general advice is that you should try to match at a residency where you would eventually like to practice. So I guess you could say that I looked at location 🙂

Last week, I walked out of my very last academic exam ever. Alhamdulillah, it was such an incredible feeling to realize that I never have to sit and study for an exam again (besides future boards!). From now on, any knowledge I learn I can apply directly to the clinical situations that I come across. I can focus on my clinical skills, and use every patient that I encounter as one step more to becoming a better physician. When I look back at last December, my first year, and even my college years, I really would not have imagined to have reached this point. I gave up a lot to reach this point, but was it worth it? Absolutely. But when someone asks if I would do it all again… let’s just say I’m glad that it’s over 😉

Controlling Your Emotions

Assalamualikum! Yes I’m still alive:) I apologize for not posting in the past few months, third year has been brutal with exams and clinic alhamdulillah, but the worst ( I hope!) is over for now… 6 more weeks and I’ll have taken my final academic exam! Thank you to all those who continued to visit my blog, I’ll post regularly from now on inshaAllah and will respond to the comments ASAP:)

Those who spend [in Allah’s Cause – deeds of charity, alms, etc.] in prosperity and in adversity, who repress anger, and who pardon men; verily, Allah loves Al-Muhsinun (the good-doers). -Surah Al-Imran, aya 134

        Anger is an emotion that all of us have experienced at one time or another. Whether it was for a simple reason, such as missing the exit on the turnpike, or a more complex issue, such as being unfairly denied one of your rights, we have all been disappointed and upset. However, how we deal with our heightened emotions during these moments is what defines us. Its easy to simply curse or break a vase and walk away, but it takes a strong person to control themselves during difficult moments.

I always assumed that controlling your anger was simple; just hold your tongue and wait for it all to blow off, no big deal. Like most issues in our lives, its easier said than done. I had a first hand experience with this a few months ago when I first started my clinical rotations. It was my second day in the wound care module, and frankly speaking, I had no idea what I was doing. When the secretary announced that a chart was up, I ran to the desk to take the patient, excited to show off my skills and newly acquired (yet limited) medical knowledge. It only took a few minutes after introducing myself and beginning the initial patient history that I realized that this patient was not what one would call a walk in the park. In reply to my standard protocol question, “so what brings you here today, sir?”, I received a grumbled reply, “my feet of course!”. I patiently asked what was wrong with his feet and received again another muttered reply, “ulcers”.

We continued in this vein for a while, with either monosyllable answers or an angry glare, and occasional mutterings of that no one has ever asked him these questions before. He rolled his eyes and sighed when I measured his blood pressure, pursed his lips when I asked him how often he changed the dressings on his ulcers, and was frequently questioned by him as to what I was doing and ordered to change my gloves every few minutes. I bore all this with an impassive face and tried to keep my expression neutral as I received these ridiculous orders and was ordered to confirm what I was doing with the attending physician for every step I took. During one of my trips down the hallway a fourth year glanced at the chart in my hand and groaned, “That’s the patient from hell”. Ouch. I had already figured that out quite a while ago. When I finally gathered the supplies to clean the patient’s wounds and dress the ulcers, I returned to the room and proceeded to open the sterile dressing pack. Just as I began to remove the dressing, the patient screamed, “You’ve contaminated it!”, and in my shock I dropped it in the garbage. This elicited another round of shouting from the patient along with an order to retrieve the attending physician, who walked in and questioned what occurred. Within in a few minutes he began to shout at me as well. Apparently the dressing pack that I threw away costs $50 apiece and is hard get by. Whoops.

During this entirely embarrassing and humiliating episode, I honestly felt as though I wished the ground to swallow me. I almost snapped at the patient and wanted to walk away while the physician berated me, but I plastered a smile on my face and apologized to both the physician and patient and acknowledged my mistake without arguing. Little did I know that the attending was watching my face for any emotions or negative expressions.

After I wrote up the patient’s home instructions and sent him on his merry way, I prepared to enter the lion’s den, also known as meeting with the attending to discuss the case. I entered the office and began to apologize again, but the attending waved his hand and told me that he was also at fault for not informing me that this particular dressing was expensive and required a special technique when applying it to the wounds. With a lift of his eyebrow he also said, “and you did well in there”. If I had gotten angry and allowed my emotions to get the better of me, then I probably would not have received that bit of praise. Instead, I would have had a prolonged negative experience and may have jeopardized my clinical grade. A two hour experience taught me a lifetime lesson. Although I received the scolding that my mother never gave me, at least I learned that I am able to hold myself back when angry and in a difficult situation.

Clinic time!

Alhamdulillah, I survived my first week of clinic and third year! It was exhausting and interesting, and really quite unlike what I expected. It feels strange that after spending two years in the classroom and learning about various subjects related to medicine, to suddenly be thrust into an examining room with a patient. You are expected to be able to automatically switch from student mode into the physician role, complete with thinking of differential diagnoses as soon as the patient describes their chief complaint. It’s not easy. Especially if your first rotation is tough and has many patients being seen by several clinicians.

My rotation this month is at the Wound Care center at the clinic in our school. Its one of those rotations that has a reputation for being tough and extremely busy, especially while still studying for the boards. My first day was memorable to say the least. My fellow group members and I arrived before 8 AM and attended a short orientation that consisted of learning where some of the vast amount of supplies are located. As soon as it was 8:30, the clinicians instructed us to “grab a chart and let’s get going!”. We all held the patients’ charts in our hands and really didn’t know what to do for a few minutes; all the knowledge of those practice sessions with standardized patients flew out of the window and all what was left was anxiety. Were we really to be trusted-I mean expected- to examine a real patient with infected ulcers? Debride hyperkeratotic lesions on a diabetic patient? Examine a patient with MRSA alone? We really were not expecting to hit the ground running, but as we found out soon, there’s no time to waste in wound care!

Eventually, we were able to gather our wits and examine our patients. After a few halting starts and several mistakes, we were able to gain some sort of system. Those of us currently without a patient cleaned and prepped rooms, while the others tried to finish their charts in order to help their group members later. We had to learn the ropes while climbing, especially as there was only one fourth year available in our module who was not very helpful. Yes, we did get scolded by the attendings and we did get lost while searching for a dressing or topical cream, but we managed to make it work.

As most of us, myself included, had an injection workshop in between clinic on that first day, we left the clinic, attending the lecture, returned to the clinic as soon as the lecture was over, then left the clinic again to attend the lab, before finally returning to the clinic at the end of the day to finish our charts. We were finally finished at 4 PM. Straight, without a single break. Its’s 12 PM already? But you still have a incomplete chart, and there are five more people waiting to be seen. Welcome to the real world, where your patient takes priority over everything.

It was a crazy, adrenaline running high, oh my God I don’t know what I’m doing kind of day, but alhamdulillah it was over. Every day since then, we have been exposed to a myriad of wounds and procedures, so that each day is a new experience for us. In just five days, I’ve seen some cases that I have only read about in books, and others that I would have never imagined. I’ve learned to question why Dr. A does a procedure this way, and why Dr. B won’t do it that way. I’ve learned to stop by the supply desk early to grab a pair of bandage scissors to keep in my pocket for those “just in case” moments. I’ve picked up on the fact that when your attending says to come at a certain time, to arrive 15 minutes earlier. I’ve mastered the task of running after the clinician so he can sign the chart before he disappears to another module for half an hour. I’ve discovered that by asking your patient their history while performing their physical exam can save you a whole lot of valuable time. And I’ve realized that no matter how much I thought I knew, I have barely scratched the surface. Although I will probably be called out on yet another mistake tomorrow morning, I’ll take it in stride and enjoy the experience while trying to learn the most I can this month inshaAllah.