What was your worst clinical expeience?

[ilovepath]

In other words....what is an experience that made you say...this clinical sht just ain't for me?

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[djmd]

In other words....what is an experience that made you say...this clinical sht just ain't for me?

Medicine AI, one of my parents paged me (on my day off!) to ask about insurance covering her CPAP...
It was the realuization that 80% of medicine has nothing to do with disease.

 

[stormjen]

Scooping feces out of a cup in Family Medicine clinic with the stench filling the room, while pretending to not smell it and making pleasant conversation with the owner of the feces.

At least when you have to deal with poop in Pathology, you can complain about it and wear a mask.

 

[yaah]

1) On OB, a woman giving birth brought her doula and her pseudo-hippy husband to her delivery, as well as a holier than thou attitude and plans of taking the placenta to bury it in her yard. She also brought a mirror so she could watch the miracle. Then when the started pushing, she started pooping, and things got very uncomfortable from there. Soon the mirror was in the corner, the doula was reduced to holding her hand, the husband was cowering in the corner, and I was wiping up ****. Then the miracle came and they named it something unpronouncable which meant "strength" or something in a language of which she knew one word.

2) On OB, I was elected (because I was tall, male, and available at the time) to scrub in with two OBs who were doing a c-section on a woman who was more mountain than woman. 400+ pounds and all of it in her abdomen. Guess whose job it was to retract?

3) In surgery, I had to scrub in on a diverticulitis case. While scrubbing in, the surgeon yelled at me for not turning off the water while I scrubbed my hands with soap (because I was wasting it). Then, during the surgery (patient was in lithotomy position) he put me between her rather large legs with the suction and told me that if any stool came out of the colon and into the patient's abdomen, that I would die. Then when it came close because since the patient had cancer and not diverticulitis, and the cancer was obstructing and causing a dilated colon, and when he cut it it was under tension, he threw the cautery at the nurse. But then he let me close the skin with staples so it was alright.

4) in OB, I was sent to see a patient post C-section. Her abdomen was very tense, red, and swollen around her incision. I thought it was probably infected, and possibly there was an abscess. The resident thought not. The attending then showed up, said, "there is an obvious abscess here" and drained about a liter of brown pus. The resident then said, "We didn't think it was an abscess" and then WE got a lecture about how to diagnose abscesses.

5) I had a patient on neurology who kept me in the room for an hour and a half while she recounted the entire story of her syncopal episode, which included getting up to get an apple, starting to eat the apple, and then waking up hours later downstairs (she had been upstairs) on a couch with bruises. The main point she wanted me to understand was that she could not find the apple. Her bruises were secondary. But doctor, I couldn't find the apple. Repeat x10.

 

[djmd]

Then the miracle came and they named it something unpronouncable which meant "strength" or something in a language of which she knew one word.

Usul, it means the "the strong base of a pillar".

 

[Zuwie]

well, where do I start?
Anyway, since the apple thing was brought up, I'll tell you about this old talkative guy on whom I had to do a "five minute" H&P before his operation.
Me: Do you have any allergies?
Guy: Well, there was this one time when I went to my doctor and he said I may have a heart condition and said I should get this test, my wife said no but i said yes, then I finally convinced her and I come to this place which i don't really like and say I need to get this test and they say I need this insurance and I didn't have it so...
Nurse, present in the room, interrupting: He had an angiography and was allergic to the contrast dye.
Guy: You people just don't want to listen to me, as usual

 

[ilovepath]

vf

 

[Gut Shot]

The moment I realized that clinical medicine isn't for me:

First rotation of third year (surgery), day one: alarm clock goes off at 4:45 am.

That was it.

 

[b&ierstiefel]

The moment I realized that clinical medicine isn't for me:

First rotation of third year (surgery), day one: alarm clock goes off at 4:45 am.

That was it.

 

[Zuwie]

The moment I realized that clinical medicine isn't for me:

First rotation of third year (surgery), day one: alarm clock goes off at 4:45 am.

That was it.

4:45? Luxury! Mine went off at 3:30 am! I had to factor in the 20 min driving and 30min getting out of bed. Plus we had to be there earlier to do the "pre-round" thingy of recording a bunch of vitals and other crap on your patients. I hated it, it was totally pointless, educational value=0, plus an overly anal classmate criticized me for making single-sided instead of double-sided copies, like it compromized patient care in any way.
Oh, and here is a funny video unrelated to medicine. You don't need to understand what they say, it's on some very serious topic:

http://www.fazed.org/video/?id=120

Sometimes your patients make you laugh and you have to try very hard to repress it...

 

[Mrbojangles]

1) On OB, a woman giving birth brought her doula and her pseudo-hippy husband to her delivery, as well as a holier than thou attitude and plans of taking the placenta to bury it in her yard. She also brought a mirror so she could watch the miracle. Then when the started pushing, she started pooping, and things got very uncomfortable from there. Soon the mirror was in the corner, the doula was reduced to holding her hand, the husband was cowering in the corner, and I was wiping up ****. Then the miracle came and they named it something unpronouncable which meant "strength" or something in a language of which she knew one word.

Isn't burying the placenta a Hmong thing? I'm geussing the woman wasn't Hmong.

Some of my highlights includes changing ulcer dressings on diabetic patients at the VA. Funny how now in pathology when we get amputations they don't nearly smell as bad.

 

[Cougarblue]

I just could not resist when I saw this post. After finally finishing the six weeks of Hades which were general surgery I started on orthopaedics. I was excited as I thought that I might enjoy ortho. A small sampling of comments from my first day on the joint service, "Oh G**, not another med student." "I had the med student last time, you take him...." Yes, I did indeed feel welcome. This was the general feeling throughout my three weeks on the service.

The highlight, however, came during my third week. One of the attendings, whom I had completed ten cases with, and who never once had spoken to me or made eye contact, was doing a total hip. I was being a dutiful little med student, holding whatever was shoved into my hands. Well, our fine attending slipped while reaming out the acetabulum and smashed my fingers, which were holding a retractor. I, quite naturally, let go of the retractor. My attending turns to me and speaks for the first time saying gruffly, "I need you to hold that." I responded quite reasonably, "I am planning on it, but you just smashed my fingers." His sarcastic rejoinder, "WELCOME TO ORTHO!HA, HA, HA!" Safe to say, ortho was quickly crossed off of my list.

 

[yaah]

I just could not resist when I saw this post. After finally finishing the six weeks of Hades which were general surgery I started on orthopaedics. I was excited as I thought that I might enjoy ortho. A small sampling of comments from my first day on the joint service, "Oh G**, not another med student." "I had the med student last time, you take him...." Yes, I did indeed feel welcome. This was the general feeling throughout my three weeks on the service.

Don't you always wonder what these people were like as med students? I am forever wondering that whenever I see a prick attending or resident. They were probably complaining back then about attendings not treating them with respect or not letting them do anything, or whatever.

 

[JaneDough]

I was on call during surgery, and we had to do an I and D on a HUGE abscess on the sacrum of a HUGE man. After we finished that bad boy (at 1 am), I went and took a shower because I felt like the stink was literally coating my skin. Yuck.

Second worst- I and D of an abscess on a scrotum.

I think I just really hate the way anaerobes smell. And packing the Butts and scrotums of big fat guys with gauze.

 

[djmd]

I
The highlight, however, came during my third week. One of the attendings, whom I had completed ten cases with, and who never once had spoken to me or made eye contact, was doing a total hip. I was being a dutiful little med student, holding whatever was shoved into my hands. Well, our fine attending slipped while reaming out the acetabulum and smashed my fingers, which were holding a retractor. I, quite naturally, let go of the retractor. My attending turns to me and speaks for the first time saying gruffly, "I need you to hold that." ...

Reminds me of one day in surgery, it was toard the end of my rotation, and this particular surgeon had a habit of wanting you to do thing before he asked. Like cutting his suture line. After he had finished tieing it off he would pull back holding it taunt, and say "cut". On this day the suregon and the fellow were closing, and the suregon stopped tieing off hsi side, and pull up. He was apparently about to insult the fellow for somethign he was doing. I saw the standard signal and bang, cut the line. He was quite surprised, because he had wanted to put in an couple more ties, but it held and he told the fellow "You are lucky, I was about to chew you out, but the MS distracted me, and now I don't remember what you were doing wrong."
He was an Ok guy, and understood why I had done what I did. Thankfully.

 

[Brian Pavlovitz]

1) First day of surgery: 2 patients with fornier's gangrene on our "team". Imagine the look on our faces waltzing in to THOSE rooms. And, you guessed it, our job was to "change the dressings" every AM. And don't forget while on call!

2) Surgery: being on call for the sole purpose of writing down AM vitals for the whole floor.

3) Surgery: being disciplined countless times: "Why pathology? You don't like people, do you? You won't make any money doing pathology..." Funny--you're miserable and the Pathologists I know are pretty happy. AND they have a life outside of work. None of them are poor, either. Yeah, you're right, I probably should go into something else...

4) OB: ATTITUDE! Oh yeah, and vaginal deliveries...

5) IM: Two words: Patient rounds!!

 

[deschutes]

Saturday, 2AM: Wandering down a subterranean maze of hospital corridors trying to find the Gen Surg clinical clerk call room.

Internal Med was definitely the worst.

The 4AM mini-lectures on how to treat hyperkalemia, and nodding off every time the resident got paged. After spending 3 hours admitting the usual "68 y/o male with multiple medical problems". Kill me.

The ortho superstar off-service resident on Internal Med who wrote 5-page admission notes and thought I could show more interest in the relevancy of clinical medicine to my study of pathology. Kill me.

Oh and yeah I might look Asian. But I don't speak "Asian". And I don't have some special instant cultural bond with Asian patients.

"Hey, can you come in here and tell our Chinese patient he's got pancreatic cancer?"
Um, no.

The rage wells up in me just thinking about it.

Moral of the story is: You hate your life? It can always be worse.

 

[Zuwie]

Deschutes reminded me of the fact that as a Russian speaker I was often asked to translate for Polish-speaking patients. Sure, Russian, Polish - whatever, it's all some kind of Slavic gibberish, right?

 

[Zuwie]

Cutting sutures is something I'll forever miss!

 

[Zuwie]

A small sampling of comments from my first day on the joint service, "Oh G**, not another med student." "I had the med student last time, you take him...." Yes, I did indeed feel welcome. This was the general feeling throughout my three weeks on the service.

When I was in surgery I was sitting in the room waiting for a joint med student-resident conference, when chief resident announced "The first ten minutes are for residents only, so would all med students step out?" And they actually waited for all the med students to step out before they started! Because you see, the great and powerful surgery residents need to discuss their plans for world domination without any dirty, stinking, lowly med students overhearing them

 

[Pingu]

What turned me on to path and off to clinical medicine was the following:

Imagine if you will, a 350 pound woman with a dehissent (sp?) abdominal wound and multiple small bowel fistulas which opened to her abdominal cavity. Now imagine the same woman, who was supposed to be NPO so her fistulas would heal, taking a lovely trip to the caf in her too small gown and the workers there actually serving her, even though patients weren't allowed to be served without some note giving permission. Imagine tamales and seven-up heading straight through the fistula...imagine who got to clean and repack her the multiple times this happened, all while she thrust pamphlets at me, because she was a jehovahs witness.

 

[deschutes]

Doing chart reviews for autopsies reminds me of another thing I hated about clinical medicine - Bad handwriting!!

 

[ilovepath]

My med school has preceptors that really belittle mewhen I tell them about my path decision. The 'you don't like ppl' thing comes really from the most malicious preceptors which don't have a ny pt rapport. I really don't get that, dont' think I ever will. I've heard the $ thing across the board about path and don't understand it. I thought only really surgeons/radiologists made more.
The ironic thing is that I think our path program is pretty good based on what I heard--USF (tampa); If you guys hear otherwise let me know...I know a lot of residency program quality is kindof hearsay.

 

[drPLUM]

I've heard the $ thing across the board about path and don't understand it. I thought only really surgeons/radiologists made more.

I think this comes from the fact that academic path salaries are low compared to academic salaries in other fields and I don't really know why this is. If you spend you're whole life in a academic institution you might not know that private practice pathologists make pretty decent income. But ssshhhh! don't tell anyone. Lets keep that to ourselves.

That also reminds me. I had a guy going into general medicine tell me path didn't pay very much and I was like dude you are doing gen med... pot meet kettle.

 

[ilovepath]

yeah i don't think these drs know what the fck theyre talking about...if the avg path salary is 200k that's not bad compared to all these other specialties talking sht.
i had a pt today in fp clinic that i was super nice to. i kindly asked her if she had any problems we didnt cover. she looked at me and her jaw dropped like i asked her something obscene. she said 'pts have sxs not problems'. every day i'm reminded why working in clinic is like working at a starbucks....i didn't make her late foamy enough.
yes, tell asymptomatic cancer pts who find out their cancer by an incidental ct/mri that they have sxs and not problems. if it's not a problem why are you cutting it out?
she was one of those pts that was like--why am i being examined by a med student? where's my dr? i think i get about one of those a month

 

[drPLUM]

working in clinic is like working at a starbucks....i didn't make her latte foamy enough

I can't tell you how I've longed to put my thoughts on clinic into words but never could find the right ones. Clinic is like working retail or sales or something along those lines- good for some types of people but I can't stand it.

Plus I just got back from a Starbucks around the corner from my house that had a line out the door of people mad because they haven't had their caffiene fix yet today. Whoa! I'd rather gross a million small biopsies than be working there today.

 

[ilovepath]

not only as a medstudent i'm a fcking starbucks barista, I'm never really taught anything. i don't know what your collective experience is, but outside of internal medicine which @ my school is 1 mo; there are NO impromptu lectures from attendings/residents. esp in fp clinic they only care about giving the pts their hctz/metformin/lipitor and getting them out the door. ALL of my learning is done through reading--I hope path electives/residency will be a lot better.