This is the really sappy entry, as requested by Prof. Edelsack...

This week features "comments" from Professor Edelsack. Just to give you a glimpse of his...succinct-ness.

Time to hustle on that paper!!

Week #7: Just when everything starts to settle, Fieldwork ends.

Over the past 2 months, most of the floor staff has already asked me when my clerkship ends. I figure that it’s because they’re accustomed to the 2 Sophie students’ quick in and out during the year, so they are prepared knowing that we’ll leave.

This week, it became apparent that as the deadline approaches, many people whom I’ve became close to are also dreading it. Patients don’t get this problem, because most of them come back in 3 months, when I’m already long gone, although there is one family whom I’ve kept seeing for the past few weeks that I will miss.

Basically, Priya and I have decided to hand out “Thank You” cards to all the PCAs, nurses, doctors, and administrative staff who have helped us so much during our experience. Also, I promised the entire floor that I will come back with brownies and cookies (baked by me, of course) some time this year.

It’s difficult to sum up how I’ll tell everybody I am leaving, but here’s a list of people at Gouverneur that I will truly remember. Some people have given me their cell phone numbers, so it is possible that I can still keep in touch with them. JUST, DON’T MAKE PROMISES YOU MAY NOT BE ABLE TO KEEP, BETTER TO SAY NOTHING AND DO SOMETHING

• LuLu – I have been working with her since Day 2, and I have not only learned a great deal of clinical procedures (e.g. urine dipstick, peak flow, BP, working MISYS and unity) from her, but we also learned a lot about each other from all the time I spent in Team 3. She also let me share her locker, a brave thing to do indeed.
• Eddie – He works in the adjacent Team, but occasionally he’ll stop by and we’d chat about anything from my Type-A personality, patients, to music and writing. He revealed a lot about my personality (work ethic, temperament) that I had never realized, but he was able to observe because apparently, he is also an only child. He mentions that my “unique” work pace is commendable, and that definitely boosted my confidence when working with PCAs, patients, and doctors.
• Drs. Song, Coun, Goodrich, Liu, Robles, Hanley, and Stevens –
  Many of them let me shadow, and seeing actual patient-doctor interactions was the most enlightening aspect of my fieldwork experience. Observing their interviewing skills definitely prepared me for the flurry of patients (of different personalities, languages, size and shape) I was about to interview and survey. Dr. Coun was remarkable in that we discussed medical topics outside of the hospital that we were both interested in (pharmaceutical industry, “bad medicine,” etc.). Dr. Robles let us barge in at any time to take her brochures, since she works at the diabetes and weight management clinic.
  Of course, Dr. Stevens actually came out to be a very good preceptor. Not only was he knowledgeable, but he is willing to offer ideas and feedback on our community project. This month when I was finally able to catch up and talk to him, I felt more comfortable and less anxious about expressing my own opinions on certain things. I was relieved and surprised that he was so nice and accepting to me. I can also tell that he enjoyed talking to me more once I’ve opened up. If I have the time, I will definitely try to continue working with him if there is another opportunity to do so.
• Luisa the PCA and Carmen the receptionist – for kindly spending so much time looking over our Spanish surveys and correcting any errors. Editing takes major skills, I tell you.
• The Patients – There is one family (a mother-and-son duo) who visited Dr. Song numerous times since June, and every time they are there, they recognize me and immediately rely on me to see the doctor (sometimes patients don’t schedule appointments). Sometimes they nag because of the wait time, and LuLu prefers to not deal with them (understandable, since she’s been working for a long time). Dr. Song have told me that the son have mental problems that cause him to be extremely nervous around people (hence, his pulse and BP shot up the first time I met him and did intake). I remember last week when they were at the clinic again, and the son had some trouble drinking from the water fountain. I really wanted them to feel that we care, so I simply offered him a plastic cup to drink from. He was really glad about that and when I saw them again today; he was noticeably less stressed out (as seen by his vitals) and looked somewhat comfortable. At least that is better than sweating beads and having a sky-high heart rate: I felt like I made a tiny difference and the family felt the effects. I don’t know how to tell them I am leaving, though…not that I know whether I’ll see them ever again after today.

I’m getting Priya a small gift for being so kind (and tolerant) of my work ethics. As for Dr. Stevens, I hope he needs extra cough drops (he’s been sounding ill for the entire summer, and I noticed that his bowl of cough drops in his office tends to always refill itself…).

Basically, fieldwork will be pure fun after the community project is complete (not that the project isn’t rewarding). As I’ve stated before, just when everything starts to settle, Fieldwork ends. Just when I’m starting to enjoy the fun, I have to move on. This upsets me. I’m going to give this week a 2. YOU COULD CONSIDER STAYING ON IN AUGUST IF YOU WANT MORE EXPERIENCE. MAYBE YOU SHOULD TAKE THE TIME OFF AND RELAX….YOUR CHOICE…..

The Start of Week 7

I'm about to relive the horrors of all-nighters and panic attacks that my poor, poor soul underwent during my CHA era. I have exactly a week left to write up a kick-ass intro, methods (which includes statistical SPSS mumbo-jumbo, ugh), results (pending once survey #100 comes home), and a long, worthy discussion...with the help of Priya, of course.

And I've wasted the entire weekend figuring out what to do, once again. Don't do this, readers!

I guess it is time for me to dig out all the articles I went through this past month. Yikes, wish me luck.

Week #6 Assessment: On the home stretch…

This week gets a 3 for the three measly responses I received on my first day of survey administration, which was definitely not the best start. Fortunately, Priya and I made better progress and got more than 70 surveys done in 4 days. 100 surveys are possible, after all! Besides administering surveys, we also had a chance to talk to and educate patients on cholesterol.

Also, the department was running out of cholesterol brochures, but I got a refill shipment in 2 days and allowed us to distribute colored, user-friendly literature that people actually read through while waiting for their doctor…so much better than giving patients old, unattractive Xeroxed copies.

That was basically what we did all week long. Plus breaking the copy machine and draining printer toners from all those revisions and copying.

Community Project & Subjective: Survey etiquette and patient education (or educated?)

At the conclusion of last week, I was desperate because I still haven’t started surveying, and I had 3 weeks to rack in a considerable number of questionnaires. Based on the disappointing results from the pilot (and realizing how difficult it was to circle the floor “preying” on patients), we decided to try a new method and administer surveys to all intake patients in a particular team. I started working at Dr. Song’s team to target the Asian population, but realized that I always wasn’t so lucky because of her remarkable speed when seeing patients. Rarely do her patients have time after their visits, because many of them have to rush to their next appointments.

Priya gladly helped me looked for more patients, since her side of the floor is always bustling with Hispanic patients. When I was walking down the hallway, most of them looked bored from waiting. Surprisingly, some of them are eager to fill out the survey as I approached them with a clipboard. Usually, they are literate and can do the survey on their own, but most of the patients prefer someone to read and talk to in the process. One of the best things that happened this week was gaining attention from patients nearby who were more than willing and interested in being surveyed. All of them were happy after I gave them literature. As a result, we were able to get over 30 surveys completed on a single Thursday.

Residents spend more time with each patient, which corresponds to patient wait time. This gave me more time to spend with patients on the survey, as opposed to the rush on other days. Although it was quiet on Friday, I had the chance to sit down with curious patients and educate them on cholesterol and heart disease. One patient admitted that she would probably throw out the brochure I gave her if I didn’t explain to her the correct answers to the knowledge portion on the survey she had taken. Hearing this, I felt satisfied that I finally took a refreshing initiative to do more than the administer-and-thank routine.

The few things I was annoyed at was how we wasted some time editing minor grammatical errors that could have been corrected by hand on the surveys, and how utterly disorganized we were with our papers and brochures because we each have our own “survey kits” of blank questionnaires and literature. On Friday, I couldn’t stand it anymore, so I got some manila folders from the administrative office, and proceeded to reorganize our materials. A paid intern from another summer work program volunteered to help me with that (plus miscellaneous photocopying and assembling cholesterol literature handouts), since all he was only sitting around and playing games on his phone, anyways.

Subjective: Feeling accomplished.

The one thing I fear about administering surveys is being rejected, but I feel a lot better thanking them anyway and giving them literature. That way, they no longer feel harassed, and in some ways, I’ve done my job by educating them.

Patients are also happy when they are able to understand what they think are advanced medical topics. I realized this week that a lot goes into translating medical mumbo-jumbo into accurate laymen’s terms with popular appeal.

So this week, my community project experience is also the subjective portion.

5 down, 2 to go...

Week #5 Assessment: Not too shabby, though it could be better.

It was difficult to rate this week, since I sacrificed some patient time towards burying myself in the office working on my survey, so I didn’t do as many patient intakes as I did weeks prior. However, I did start to talk to patients a lot more whenever I’m with them. Some of them can get really chatty and personally, I really enjoy this “exhibition” of human personalities.

Since this afternoon, the finalized survey was translated, reviewed, approved, then tested on some patients, edited it (yet again) to shorten it, reviewed, reviewed again, then FINALLY…re-finalized. I was somewhat disappointed that my partner and I weren’t able to put the survey in full throttle, but work is work. This weekend will be laying out the framework (variables, coding, SPSS, Helena, etc.) so data entry would hopefully be (somewhat of) a breeze.

Now that everything seems so prospective, this week deserves a very nice 2.

Community Project: Translating and goals…

My relation with Dr. Stevens improved this week (or maybe because everyone is tired after 7PM on Thursday), and we finally had a friendly discussion on who/what/where the project should be aimed at. After making some minor changes on our draft survey, he proposed an idea that we could make posters and Plan of Action forms for cholesterol, just like what Gouverneur & NYCDOHMH did for hypertension and diabetes. I also had a neat idea to revise the current hypertension focus group program so that it includes aspects on cholesterol. A whole group on cholesterol is ideal, but I didn’t want to venture so far without knowing how these patient education programs get funded.

My goodness, how cool would it be to see an actual intervention taking place after our project? No more dusty, unused brochures stashed behind an old shelf, I hope.

For now, we are going to order nyc.gov health bulletins and tri-fold brochures to distribute to patients post-survey. Plus, we’re planning to package these pamphlets nicely (paper clip, topped with a high-quality, $0.15 ballpoint pen from Staples®) beforehand. Our idea was patient appreciation and quite possibly, interest from onlookers at the sight of “incentives” being given out around the ward.

One of the big problems we encountered when thinking about our goals was the ambiguity and complexity of the topic. Unlike diabetes, which emphasizes A1C as a crucial factor, topics such as hypertension or cholesterol tend to be repetitive in terms of variables. All 3 focus on LDL. HTN and cholesterol both involve physical activity and medication use. Maybe I can center on specific variables on a lipid panel, but the aforementioned variables are seemingly important, too.

That was why our survey ended up being too thorough and became “Jeopardy”. My current concerns are the length, the relevance of some seemingly necessary variables, and the time it takes for an intake patient to complete it without complaints (or a doctor barging in and interrupting the session). Priya’s first survey participant already complained about the length, so just as I was getting Dr. Hanley’s approval, I had to immediately run back to shorten it and salvage only the obviously important questions. In the process, I was able to remove several questions which I realized were repetitive. So after being re-finalized (for the final time), surveying will officially being on Monday morning: I decided to take my off-day to administer them.

If it’s something I learned from this week, it’s how to be nice when approaching patients (a lot of practice done during intakes), and how to modify language settings on my home computer so I that can type Chinese characters using pinyin without copying and pasting from an online dictionary. It was a pain to translate by doing the latter at Gouverneur, where I was not allowed to access most websites or tweak administrative options.

Professionally, I shouldn’t leave a mess in the office whenever I go out to lunch, or leave Lulu’s locker wide open after I’m done storing my possessions. Keep those in mind, Salina!

Subjective: Connections and a surprise.

After talking to a number of patients, reading journal articles, seeing stacks of prescriptions for hypertension, diabetes, and cholesterol medication always coming out of the printer one after another, and seeing virtually no distinct “line” that separates guidelines for each disease; I’ve concluded that most patients had to go through the torture of managing pills and foreign lifestyle changes because they fail to fully understand that they’re all connected: having one disease increase one’s risk for another, and vice versa. Besides explaining to patients what this triple threat is, physicians and educators absolutely need to acknowledge this interrelationship.

Personally, I feel that those Plans of Action should be given out separately and as a conglomerate, if necessary. Patients need to know that even though they’re in the clear for blood pressure, 150 mg/dL of LDL in their bloodstreams is still not good news.

Now, here is the story of the week:

Several weeks ago, Dr. Song gave me a copy of an old Chinese pamphlet about cholesterol that she claimed to give out to patients occasionally. The information is very friendly (with an anthropomorphic “healthy heart” mascot waving his hands on the cover), focused and concise, but the Xeroxed format didn’t give it a favorable impression. This is not the worst part.

You see, Xerox machines are remarkable tools, because some of the most primitive pranks and practical jokes relied on them. Who knows how many times that pamphlet had been duplicated, but lo and behold, too subtle to be noticed by the unsuspecting patient, were 2 middle fingers drawn on the mascot’s hands and blackened teeth, making the mascot look less healthy than he was supposed to portray. I figured that someone must have drawn them on the original and they were consequently passed on. I had forgotten about notifying Dr. Song until on Thursday, when I had to use it to look up some Chinese terminology.

I decided that I’ll show it to Clara, the head nurse. On my way to her office, I bumped into Dr. Hanley and a medical student. Their reaction was classic: mouth wide open, and stifled hysteria. By then, we were all trying not to burst out laughing.

Dr. Song’s response was a disappointed one. “A malicious, malicious prank,” she sighed.

When one nurse found out, she proceeded to rant about all types of problems she encountered in the hospital, especially those dealing with race. She went into the clashes between Latino and Chinese groups, where both staff and patients were involved. Currently, most doctors are being relocated to different locations on the floor based primarily on their language proficiency, so both Spanish- and Chinese-speaking patients can be better served by staff who speaks their native tongue. The nurse wholeheartedly supports this, reasoning that this was done based on necessity. Unfortunately, many people still use this as an excuse for being discriminatory, especially since one Team booth out of the entire floor had been renovated while the rest are furnished with decade-old furniture and are wearing down with age. Some are jealous, accusing this move biased and preferential.

I am so impressed that she speaks out not just at me, but publicly throughout the hospital. Of course, she has gotten criticized and judged based on her race, but this does not let her down one bit. She told me that she is willing to do this until she retires.

I plan on letting my passion for medicine run its course. I always felt like that is the only thing that cannot be readily destroyed. After hearing her stories, I start worrying not what my true interest really is, but how I’m going to survive in the workplace under all this pressure. Actually, any workplace.

To all future HMS II takers: