醫學生日記2016年4月11日 - 家庭晚餐

醫學生日記2016年4月11日 - 家庭晚餐

阿山 （龐靜譯）

 

這個周末是醫學院第三年第一個六星期一輪的見習結束。我完成了分科手術見習，下周一就開始普外手術見習。因為大家這個周末都空下來了，是一個好機會，我們診斷技術學習小組決定湊在一起辦一個家庭式晚餐。我們小組有六個學生和一個老師。剛上醫學院的頭半年，我們每個星期都一起幹活。我們的老師，幾乎全靠她一個人，教會了我們所有的門診診斷技術。我們把我們這個小組當成了醫學院的小家庭。自從開始見習，我們被分到不同的科室，幾乎誰都見不著誰。

 

我們去了老師的家，她給我們做了晚飯。大家見習期間特別忙，這頓飯應該是見習以來最好的一頓飯。雖然是普普通通自家煮的飯菜，但是我們能坐在一起享用，感覺棒極了。我們從第一道開胃菜開始，有烘烤的布裏奶酪餅幹，葫蘿卜配黃瓜酸奶醬，還有葡萄酒。主菜是帕馬森烤雞，草莓芝麻菜沙拉，和剛剛出爐的大蒜麵包。甜點是加了冰激淩的葫蘿卜蛋糕。這頓飯最精彩的部分是我們彼此分享了這六個星期的故事。下麵我就講一點大家的故事。

 

最囧的時刻

 

當然了，有些故事每個人都特別想聽。我一定得在我們當中分享我的最囧時刻。我當時在一個泌尿科的前列腺切除手術現場。前列腺切除之後，必須檢查一下直腸部分是否在手術中碰傷。這個檢查就是帶上手套，手指從肛門伸進，摸索直腸，然後看看手套上是否沾了血跡。這件任務通常都留給手術室中最菜鳥級的見習生，所以自然就輪到我了。當時現場是一個無菌手術的設置，所有地方都是用無菌藍單子蓋著，隻留出了肚子上麵手術操作的那個小方塊。而且，沒有眼神相助，要從那個角度把手指插入肛門已經不易。再加上那個患者還是個胖子，我根本不知道我摸到了什麽或者沒摸到什麽。我的手在藍單子下麵胡亂摸索，總覺得手夾在肥肉之間，折騰了足足兩分鍾，手術室內的人都盯著我、、、我說“我找不到肛門”。這時候，屋裏所有人都大笑起來，我自己也沒忍住。輪到那個菜鳥級的住院醫來試。有了前車之鑒，他必須把胳膊更深入藍單子下麵。最後，他找到了，隻用了一分鍾。我用了整整兩分鍾，一無所獲。第二天結束時，整個科室都聽說了我的洋相。掌刀醫生甚至還把這事跟病人說了。至少病人和我能一起笑話這檔子事了。

 

最惡的住院醫

 

我們當中有三個人在普外手術，他們特別急著要分享和他們一起幹活的住院醫的故事。每個手術小組都由一個住院醫的頭兒帶著。他們每個人好像都對一個特別的住院醫頭兒有故事。現在輪到我悠哉地坐著聽我的同學講令人心顫的故事了。

 

顯然，這個住院醫頭兒對人的生硬粗暴犯渾已經有名了。我們當中一個女孩講述了第一個星期跟他的遭遇。我們班另一個同學和她一起被分到了他的手下。那個同學向他報告病人的情況，這個頭兒轉向我的朋友說：“你能不能讓她閉嘴，替我翻譯？我絕對不和傻瓜講話。”

 

我們的另一個朋友描述了他與這個住院醫頭兒的第一次相碰。他也是向他報告病人的情況，說到一天前做的X光片。頭兒打斷他說：“不對，X光片是兩天前照的，不是一天前。別用錯誤信息浪費我的時間。這就好比說你媽媽以前很迷人。這跟說你媽媽現在很迷人不一樣。這對處理方案能造成很大不同。你媽媽以前迷人，我卻有可能和她上床，而她現在也許很醜了。”

 

說這麽多了，我們老師也講了一個關於他的故事。老師是兒科醫生。這個住院醫頭兒的老婆正好在醫院裏生孩子。我們老師去祝賀他們，並且進行新生兒檢查。那傢夥對老師說：“別在這煩我們了，你又不是一個真正的醫生。”

 

這些故事讓我有幾點受益。首先，也是最重要的，當我出錯的時候（意料之中的），我周圍的人都能幫助我，既能教我，又有幽默感。其次，能力越強，越能夠逃避行為規範的約束。我聽說這個住院醫頭兒是學校培養出來的最棒的手術醫生之一，今年（2016年）就已經收到15封針對他的控告信，他在他自己的老師們麵前依然這麽肆無忌憚，他的老師們也沒有對他怎麽樣。

 

工作時間的違規

 

見習剛開始時，管理部門很清楚給我們講了工作時間的規定和遵守條例。這些條例已經反反複複地被管理部門印到我們腦子裏了。條例如下：

 

每星期在醫院工作不能超過80小時。

 

每星期至少有一天休息。

 

每天工作排班至少有10小時在醫院之外的間隔。

 

管理部門告訴我們要記住這些規定，為了滿足這些規定，隻需要簡單地說“得回家了”或者“晚點來”。管理部門說學校的教授醫生們都明白這回事。

 

我自己隻違反了規定一次，那次手術晚上九點才完，第二天一早六點我就來了。那純粹是我個人的選擇，我想看完手術，第二天也想參加報名會。那天跟我一起幹活的同學跟我有同樣的問題，他就要求第二天八點才來。老師們一點也沒為難他。可是，我自己卻對我的同學遵守規定有很多想法。我跟他一樣，僅僅丟了一個小時，他的要求多了一個小時。事後，一個住院醫跟我說他們一直都在違反他們自己工作時間的規定，他們都不說。並不是因為負責醫生們會批評他們，而是他們同夥之間會彼此指責。

 

我的倆個在普外手術的同伴違規比我們嚴重多了。有一個傢夥在血管手術科，平均每星期工作100小時。他從來沒向係裏報告過工作違規的事。一方麵，他覺得科裏醫生們已經沒興趣教他，不願帶著他，他不想讓他們有任何借口以為他又懶又沒興趣。另一方麵，如果有別的同學看到這種情形，他寧願告誡自己“忍住了”。

 

另一個女孩天天從早晨四點工作到晚上九點。她也從來沒有報告過她工作時間違規。她的理由是她想成為團隊中的一員，做為學生，要想如此，無論團隊什麽時候工作，你必須在場，不然，你就可能失去機會。第二條理由是還有一個同學跟她一塊。如果她去報告違規，那麽有兩種可能性：別人會認為她懶，還可能導致也不想失去學習機會的同伴失去機會；或者她的同伴會認為她懶惰軟弱。

 

總之，我們是醫學院的學生，能自己給自己定規矩。雖然有明文規定，大部分教授醫生們也都明白。但是，我們這些學生似乎都知道對我們的期望是什麽，我們的標準是什麽。有時候有些人確實想遵守他們的工作時間規定，這種時候，我們班級就會無視規定，非常不公正地評判人家的工作態度和人家的品行。

 

結論

 

總的來說晚餐很棒，我們醫學院的小家庭有機會彼此交流。不管那些獨立事件，我們看上去都很好，這使我們的老師很高興。她曾經擔心我們承受不了，情緒低落。這種擔心其中一部分也是基於她自己在藤校受教經曆的不同時間和文化。

 

星期一我們三人要到普外手術見習，另三人開始分科手術見習。再有六個星期，我們就渡過了醫學院最難的階段了。

 

Sunday April 11, 2016 – Family Dinner

 

This weekend was the end of the first 6-week block of third year. I finished the surgical subspecialties rotation, and on Monday, I will be starting general surgery. Since everybody had the weekend off, my clinical small group decided it would be a good time to get together and have “family dinner”. Our clinical small groups consisted of 6 students and one mentor. We worked together every week for the first half of med school. Our mentor almost singlehandedly taught us the learning of all of our clinical skills. We really think of this small group as our med school family. Since the start of our rotations, we were all placed on different surgical services and haven’t been able to see each other much. 

 

We went to our mentor’s house and she cooked dinner for all of us. Especially since we were all very busy on our surgery rotations, this was probably the best meal we all had since starting rotations. It was a fairly simple home-cooked meal, but it was wonderful to be able to sit down and enjoy it all together. We had starting appetizers with some baked brie cheese with crackers, carrots with a cucumber dill yogurt dip, and some wine. The main meal was chicken parmesan, strawberry arugula salad, and fresh baked garlic bread. Dessert was carrot cake with ice cream. But definitely the best part of the meal was getting to share all of our stories from the past 6 weeks. I’m highlighting some of those stories here.

 

Most embarrassing moment

These were of course the stories that everybody wanted to hear the most. Amongst us, I definitely had the most embarrassing moment to share. I was in on an open prostatectomy with urology. After the prostate had been removed, somebody needed to check if the rectum had been injured during surgery. This is achieved by sticking a clean gloved finger into the anus, doing a finger sweep, and checking if there is any blood on the glove. Tasks like this are typically reserved for the most junior trainees in the room, hence it was my task to do this. Now, there was a challenge in that this was still a sterile surgical field. Everything was covered by the sterile blue drape with only a small square opening over the abdomen where they were operating. It was already an unusual angle to try to be sticking a finger into an anus without any visual direction. On top of that, our patient was a rather fat man, so I couldn’t exactly tell what I was or wasn’t feeling. All of this added to a solid two minutes of me, with my hand stuck somewhere underneath the blue drapes and sandwiched in some fat rolls, everybody in the room looking at me… and I say “I can’t find the anus”. At this moment, everybody in the room bursts out laughing and I can’t help myself either. The junior resident takes a try. In my defense, he had to get up to his elbows deep underneath the drape to find the anus. But he managed to find it in about a minute and I required 2 minutes to find nothing. By the end of the next day, the entire department had heard about my hilarious mishap. The attending surgeon even rushed to tell the patient about it. At least the patient and I were able to have a good laugh about it.

 

The Worst Resident

There were three in the group that started with general surgery, and they were eager to share stories about the different residents they worked with. Different surgical teams are led by chief residents, and everybody seemed to have a story about one specific chief resident. Here was my turn to sit back and listen to my classmates’ horror stories. 

 

This chief resident apparently had built a reputation for being a rude abrasive “asshole” to people. One girl from our group described her first week working with him. She and one other of our classmates were assigned to work with him. As our other classmate was giving him a patient update, the chief resident turned to my friend and said: “Can you please tell her to shut up and translate for me? I never learned to speak idiot.”

 

A second guy from our group described one of his first interactions with this same chief resident. He was also giving a patient update, and reported on an X-ray taken 1 day prior. The chief resident interrupted him and said: “No, the X-ray was taken 2 days ago, not 1 day ago. Don’t waste my time with wrong information. This is like saying your mom used to be attractive. It’s different than saying your mom is currently attractive. It makes a big difference in treatment plan. I would have sex with your mom when she used to be attractive. She’s probably too ugly now.”

 

On top of all of this, our mentor even had a story to share about him. She is a pediatrician, and this chief resident’s wife had just given birth at the hospital. Our mentor went in to congratulate them on their birth and perform the newborn examination. She was told to “stop annoying them, she wasn’t a real doctor anyways.”

 

I am getting several takeaways from these stories. First and foremost, I am very thankful that the people around me were able to be supportive and humorous and educational when I made a mistake, as is expected in the course of medical education. Secondly, the greater your talent and capabilities, the more you can get away with in terms of behavior. I have heard that this chief residents is one of the most amazing surgeons that the program has produced, that there have been formal complaints filed against him at least 15 times just in 2016 and he has never been addressed, and that he behaves the same way in front of his own attending surgeons and mentors and they never take action against him. 

 

Work hour violations

The very beginning of our rotations, they faculty and administration clearly explained what our work hour rules and protections were. These guidelines were repeatedly hammered into our heads whenever administration contacted us. The general guidelines are: 

 

We are not to exceed 80 hours per week in the hospital.

We are to have at least 1 full day off per week.

We are to have at least 10 hours outside the hospital between every work shift.

 

We were told that all faculty were aware of these restrictions and we could simply just speak up about going home or coming in later to stay in compliance. We were assured that all faculty would be understanding of this situation.

 

I personally violated the work hour restrictions only once, when I stayed until 9pm in a surgery and came in at 6am the next day. I had personally made the choice that I wanted to stay in the surgery and be able to attend rounds the next day. That same day, one of my classmates on the same rotation with me was in a similar situation, and he requested if he could come in at 8am instead. He received no difficulty from the faculty. However, it was myself who was heavily judging him for invoking this rule. I was in the same situation as him, we were only losing 1 hour, and he had actually requested an extra hour. Later, the residents told me that they were constantly violating their own work hour guidelines, and none of them ever spoke up about it. It was never because the attending physicians would blame them, it was because their own peers would eviscerate them. 

 

Two of my peers on general surgery experienced much more grievous violations to their work hours. One guy averaged 100 hours per week on vascular surgery. He never once spoke up to the department about this work hour violation. Partly, he felt that the doctors on the team were already disinterested in teaching and including him, he did not want to give them any possible reason to believe more that he might be disinterested and lazy. Secondly, he felt that if were another student looking in on this situation, he would tell himself to “just suck it up and tough it out”. 

 

The other girl routinely worked from 4am to 9pm. She never reported her work hour violations either. Her reasoning was that she wanted to be a functioning member of the team, and to do so as a medical student, you have to be present whenever the team is working or you might miss out on opportunities. The second line of reasoning was that there was a second medical student on service with her. If she was to report her work hour violations, it would either: make herself look lazy compared to the other student, force the other student who might also not want to miss out on learning opportunities to miss experiences, or have the other student think she was being lazy and weak.

 

The overarching theme is that we as medical students can be very self-policing as a student body. There are institutional rules in place and faculty for the most part are understanding of them. However, it seems that the medical students have our own beliefs of what our expectations are and to what standard we should be upheld. In the event that somebody does seek to protect their own work hours, incidences have shown that our class will, ruthlessly and highly unfairly, cast negative judgment upon that person’s work ethic and character. 

 

Conclusion

Overall, it was a wonderful dinner and a chance to catch up with my medical school family. Other than those isolated incidents, we all had positive outlooks, which made our mentor very happy. She was very concerned that we would be too overwhelmed or unhappy, partly based on her own experiences training in a different time and culture at an Ivy League medical school. 

Three of us start general surgery on Monday. The other three start the surgical subspecialties. 6 more weeks and we are done with the most difficult block of medical school.