Throughout my undergraduate and now graduate medical education I've had many positive experiences and some negative.
WORST MEDICAL STUDENT EXPERIENCES:
-Towards the end of my OB clerkship I delivered an infant (ironically through clear fluid) with a noted meconium staining. I managed to suction on the perineum my attending summoned neonatology and I delivered the shoulders and body. Neonatology felt the aspiration was likely in utero, the infant went to NICU, required O2 briefly but went home 3 days later. At the time I felt like this was such a horrible outcome. In retrospect as a MedPeds resident who has seen MAS infants end up on the oscillator with bilateral chest tubes I realize that my infant's "horrible outcome" was mild in the spectrum.
-On my pediatrics month I saw an adolescent in after hours clinic who seemed to be practically a textbook case of for lymphoma. My attending felt lymphoma was unlikely but we proceeded with the workup anyway "to be sure". When the biopsy results came back days later he told me that I had been correct. I had a brief moment of "excitement about making the correct diagnosis. It quickly became bittersweet as I thought of the treatment and prognosis of my patient. Through out my education I've had many more bittersweet diagnostic moments.
BEST MEDICAL STUDENT EXPERIENCES:
-The OB chair telling me towards the end of the rotation that he thought my communication skills and ability to work with patients were excellent. As a resident I try to remember this and challenge myself even at the end of a long day. My call schedule is not my patient's fault.
-My surgery clerkship. I learned a lot (good surgeons know a lot of medicine) and got to do a lot. Anatomy came alive! It was really a great 3 months. Although surgery was never my intended specialty I'm definitely a stronger physician for my experiences as a student. It's for this reason that I've elected to do 2 months of surgery during my residency training not with the goal of doing surgery (although I have learned some useful hints with approaching difficult central lines, and had more opportunity to place chest tubes--which I will need to do as a rural practitioner) but with being a stronger clinician.
SCARIEST RESIDENCY EXPERIENCES: ?! Good Learning Experiences ?!
-During a NICU month recently we were called to a STAT c-section for a 24 week infant due to placental abruption. The neonatology attending on call was en route as we were handed a limp, bruised infant without heart rate or any respiratory effort. Resuscitation began and we managed restore the heart rate. I intubated successfully and we gave surfactant through the ET tube. I took a deep breath and allowed my heart rate to return to near normal. Our attending arrived as we were heading to NICU to place our lines. I think I will always find challenging neonatal resuscitations a bit scary, however, as a I will function as a rural I realize how imperative these stabilization skills are.
-Intubating a woman with a massive variceal bleed as I suctioned copious amounts of blood and then localized the cords and successfully passed the ET tube. This was also one of the earlier codes I ran as an upper level and our code team worked together well. In spite of requiring 100% FiO2 and 2 pressors overnight the patient was subsequently extubated without new neurologic deficits a week later.
LEARNING MOMENTS: ?Humbling moments?
-Our service acuity increased dramatically in the days immediately before Thanksgiving. Reluctantly I agreed with my service staff that I should forego my planned day off. I started the morning hoping to be done in time to join some friends and family for the traditional meal. Things did not go as planned and I was finishing placing a central line in our ICU as Thanksgiving dinner began without me. While waiting for x-ray to confirm position I readied to depart hoping to perhaps arrive for dessert. The x-ray showed that my pt's IJ catheter tip was into the atrium. I sighed and removed my coat and glumly went to assemble materials to pull back and resuture the line. Coming out of our physician work room I ran into the pt's husband who must have sensed my frustration. "Is everything alright doctor?" his voice was trembling. I took a deep breath. Reality check. I'm talking to a man who is likely losing his wife and I'm upset that I'm going to be detained by another 15 minutes (providing radiology is marginally cooperative about reshooting the xray) to reposition her central line. I explained things to her husband, repositioned and secured her central line, confirmed placement, informed her husband that the line was in good position, and solemnly walked out into the now dark night. I suppose that it's how we communicate when things get challenging and frustrating that really defines us. I'll continue to challenge myself to live up to that OB chair from medical school days words.
-Really listening to my pediatric hem-onc patients was eye-opening and quite humbling.
(Close second was observing OR in optho, but I didn't get to DO anything that time 
