Have you ever heard of blogging requirements? Usually, I think while I type, so I feel like this is such a tempting way to slack off on my entries and simply lace an outline with transitions and complete sentences.
Anyways, I managed to pull off 28.5 hours this week. I worked alongside Lulu, a patient care associate (PCA), and did mostly intakes. Besides that, I shadowed a bunch of doctors, drove my partner close to insanity, and spoke some of the worst Spanish and Mandarin in the clinic.
Monday
The first day is always scary, and it's no surprise that I was so nervous that I couldn't speak properly. Actually, I forgot how to talk, period.
Clara, the head nurse, was amazing and so helpful to both Priya and me. Right from the start, she took us on a tour around the floor, introduced us to the PCAs, nurses, and doctors, and even took us out to lunch and showed us around the neighborhood. I got the feeling that she was more comfortable around me, since we both speak Cantonese. Eventually, she'd talk about hospital issues, such as the bleakness of the dim, understaffed clinic, or how the ladder separating RN's and LPN's is virtually gone. Apparently, the only difference a nursing school education makes is a set of keys to the narcotics cabinet. It's funny how we're always trying to destroy social class every where else, but yet we also strive to preserve our occupational class: in the end, anything we do revolves around our own benefit. Imagine evening out physician salaries.
I can imagine working as the head nurse in a place as dingy as Gouverneur. The soporific gray- and maroon-themed atmosphere is far from energizing. I feel almost embarrassed walking down the hallways in my leather heels (which made a LOT of noise, by the way); every time I take a step, the clacking echoed and the morning patients, who were quietly sitting on the side and waiting for their name to be called, woke up and cast a curious (sometimes annoyed) glance.
The visitors' kids were ridiculously bored by the ward, which is why they absolutely love climbing and jumping on the orange plastic chairs that bordered the hallways. I occasionally see patient care associates (PCA) jump out of their booths to curb them from making such a racket.
In the morning, I shadowed Dr. Goodrich, who sees Spanish-speaking patients. Initially, I thought it was a family clinic, but then I realized that "internal medicine" includes not only adults, but an overwhelming number of elders, too. I was surprised at several reasons:
- DIABETES DIABETES DIABETES. Every patient in that room suffers from Type II Diabetes, or some type of complication from it. During my shadowing, Dr. Goodrich proceeded to show me how he reviews their digitalized charts on the Gouverneur/Bellevue MISYS program, which I thought was so cool because it eradicated atrocious penmanship and made the system paper-free. Most of their blood sugars are nicely controlled, but some wildly fluctuated. With many of the cases, hypertension and mixed hyperlipidemia tagged along.
- MEDS! Dr. Goodrich starts each visit by asking for their medication. Patients will either hand him a thick stack of prescriptions, or empty their stash of pill bottles. His first patient even took out a potpourri of wintergreen analgesics for his rheumatoid arthritic shoulder. Another phenomenon I observed was the remarkable similarities of the drug list each patient usually had: 70/30 insulin, Atenolol, Lipitor, 81-mg aspirin...all medication designed for DM II, high cholesterol, and BP management. A lot of the visits were for the purpose of changing the dosage, too. This is mostly because there was no change in their health. Some patients admitted that they were "lazy" to take all the pills. Nobody complained about side effects, which is what my Community Project is about.
Overall, it was exciting to shadow Dr. Goodrich. I observed a cortisone shot administered to the arthritic shoulder patient! I never knew there was a...militaristic technique for applying iodine beforehand. "Spiral out and make a sterilized zone," as Dr. Goodrich said.
Professionally, I shouldn't have sat while shadowing. Dr. Goodrich also seemed pretty shocked I didn't have at least 10 minutes' worth of questions. Shadowing is serious stuff, as I'd now think of it as the precursor to actual rotations. I gotta stop messing around and start preparing myself next time.
Tuesday & Wednesday
I actually had to write out the weekly log requirements in my notebook so I can have a filter to work with if I experience sensory overload like I always do.
I focused on patient intake on both days, so I worked with Lulu, a really cool patient care associate (PCA) who works at different "teams" (Gouv have teams of doctors situated at different sectors throughout the clinic floor).
On Wednesday, I was at Team 3 with Dr. Song (who knew Kathy Zhang and had kids who went to Stuy, coincidentally). I did only vitals that day: weight, pulse, and blood pressure. I was on a nervous high with my first patient, who spoke Mandarin and was somewhat confused as to where to go for his appointment. I tried really hard to speak in bad Mandarin, directing him to the room and telling him what I'll be doing. Lulu had to check my BP readings several times, and got different readings each time she checked. I was even more embarrassed when Dr. Song manually changed the BP reading on the printout I had prepared for her as part of the intake process.
The 2nd day also introduced me to the world of pharmaceutical reps, when an Asian Crestor rep visited each team. Apparently, HHC (the public corporation that includes Gouv & Bellevue) prohibits drug sample distribution, but long-term (or should I say recurrent?) drug reps who have familiarized themselves with the hospital employees often come around and "chat" on why other drugs are weak. They'd also pass around their laptops so the staff can update their information (can anyone guess why? haha). The guy teamed up with Clara and tried to persuade me into dermatology and just about any lucrative specialty. Interestingly, they also lamented the downfall of primary care.
At the end of their visit, the nurses often ask him for pens. He'd then leave a handful on the table that the staff would happily devour. I got a Crestor pen as a "treat," that I am planning on happily destroying during my fieldwork presentation.
Just adhering to recurring themes, Clara showed me how to do a microfilament test to check limb and appendage sensitivity for diabetics. Hopefully, I get to actually do the test on a patient later this month.
On Wednesday, Dr. Selina Siu (same name!) was seeing a mixed variety of Asian and Latino patients. My highlight was a random group of Russian-speaking lifeguards who barged into Team 6 for their mandatory physicals, all needing urine and vision tests, plus their vitals taken. I was pretty excited to learn how to do urine dipstick, but after locking myself in the utility room and waiting 30-second intervals for each square on the stick to change color SIX TIMES, the stench of cups and cups of pee got to me.
Thursday
We finally met up with Drs. Stevens and Hanley, as they've instructed us to do some literature search in advance. I was already pretty frustrated at the fact that Dr. Stevens deferred our earlier scheduled meeting because he had to "run off to a meeting". I understand how busy the Chiefs of Medicine can be, but that's unprofessional and borderline irresponsible, if you ask me.
Priya and I piloted a draft questionnaire that Dr. Steven initially prepared on clinic patients. Thursdays are especially busy, and the clinic is opened until 7 (i.e. 10-hour shift!). We had some problems communicating with Hispanic patients, but we solicited some common trends by some semi-structured interviewing:
- Patients are paranoid about cholesterol meds' side effects. A Hispanic patient even claimed to get stomach pains and nail fungus after taking her medication.
- If they have high cholesterol, they would consider medications as their last resort.
Generally, there were some mixed answers when asked about adherence. While most would discontinue and tell their physicians if they experience side effects, others would discontinue secretly for the fear of upsetting their doctors. One person even proudly proclaimed that he would listen to his cardiologist no matter what. Overall, I think this is good information for revising our questionnaire. During lunch, Priya and I stumbled across a lot of problems while trying to write our statement of purpose, objectives, and target population. I was even a bit frustrated because while the target population is patients, employees and health professionals, the survey is patient-oriented. In the end, we fixed up our objectives and revised the format of the survey, which puts us roughly 2 weeks ahead of schedule, whoohoo!
In general, I could also sense that Priya was intimidated by Gouverneur; if the patients didn't speak Chinese, it was Spanish. Very rarely did we meet patients who spoke purely English. Luckily, I'm in a better position, but speaking merely coarse chunks of Mandarin and Spanish poses problems for me, too. And I do admit I was being a bit inconsiderate towards her, giving her some of my worst attitudes when we hit a road block. But I feel that fieldwork is all about responsiveness and initiative, which is why I tried take advantage of the "first week" and drove myself to my limits. Actually, it felt pretty good. This could be the onset of target-driven workaholism, how great is that?
Overall, Priya and I are still interviewing in pairs: I maintain the eye contact while Priya takes meticulous notes. I feel like this is a great system to get information, while keeping ourselves vivid so that the patient doesn't feel like they're talking to an automated blood pressure computer in drug stores.
Friday
I shadowed Dr. Song today for her morning patients. I admire her a lot because she could speak Mandarin and Cantonese - a remarkable skill in this clinic. All her patients were Chinese, and my Mandarin slowly improved as I learn basic terms, such as "blood pressure," "pulse," and "medical student". The third one is often used to introduce myself before each patient: another professional habit I eventually got used to since the first day.
Learning about interviewing and probing patients was the most rewarding experience this week. Strangely, her whole list of patients complained of pain in different parts of the body. Besides physical exams and questioning (duration, type, and degree of pain), she also showed me how she isolates "real" cases that requires attention and "nonspecific" cases where she could clearly tell that the patient was "stacking complaints" - a habit where patients would start reporting miscellaneous ailments gradually, instead of immediately, for the sake of receiving additional diagnoses, medication, and a sense of reassurance. She told me the patient seemed depressed, which is interesting because most of these Chinese elderly patients live alone and suffer from depressive episodes. A few days ago, one patient waiting for a doctor was wailing in the hallways for the doctor not being on time. I felt like I wanted to run over there and tell her it will be alright.
“In Conclusion”…
On a 1-5 scale, I'd give this week a 3, since I felt like Priya and I could've gotten so much more responses (we got roughly 15). Also, my team work attitude wasn't the greatest, and Clara had to advise me to bring a white coat and my stethoscope to fieldwork from now on (buzz word: professional attire!). I absolutely despise wearing a long white coat before I'm an MD, though. I can't escape onlookers on the hallways seeing me gracefully walk down the aisle, which was really my attempt to not limp: my shoes were killing me.
I’m giving myself a deadline of next week to perfect all the nuts and bolts of professionalism. Amazingly, I got to work on time every day. Now that is an accomplishment.
Oh, I also lived with this for the entire week. As a result, my right lower lip was swollen, and I couldn't talk or smile properly. :(
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