医学生日记2016年4月11日 - 家庭晚餐

医学生日记2016年4月11日 - 家庭晚餐

阿山 （庞静译）

 

这个周末是医学院第三年第一个六星期一轮的见习结束。我完成了分科手术见习，下周一就开始普外手术见习。因为大家这个周末都空下来了，是一个好机会，我们诊断技术学习小组决定凑在一起办一个家庭式晚餐。我们小组有六个学生和一个老师。刚上医学院的头半年，我们每个星期都一起干活。我们的老师，几乎全靠她一个人，教会了我们所有的门诊诊断技术。我们把我们这个小组当成了医学院的小家庭。自从开始见习，我们被分到不同的科室，几乎谁都见不着谁。

 

我们去了老师的家，她给我们做了晚饭。大家见习期间特别忙，这顿饭应该是见习以来最好的一顿饭。虽然是普普通通自家煮的饭菜，但是我们能坐在一起享用，感觉棒极了。我们从第一道开胃菜开始，有烘烤的布里奶酪饼干，葫萝卜配黄瓜酸奶酱，还有葡萄酒。主菜是帕马森烤鸡，草莓芝麻菜沙拉，和刚刚出炉的大蒜面包。甜点是加了冰激凌的葫萝卜蛋糕。这顿饭最精彩的部分是我们彼此分享了这六个星期的故事。下面我就讲一点大家的故事。

 

最囧的时刻

 

当然了，有些故事每个人都特别想听。我一定得在我们当中分享我的最囧时刻。我当时在一个泌尿科的前列腺切除手术现场。前列腺切除之后，必须检查一下直肠部分是否在手术中碰伤。这个检查就是带上手套，手指从肛门伸进，摸索直肠，然后看看手套上是否沾了血迹。这件任务通常都留给手术室中最菜鸟级的见习生，所以自然就轮到我了。当时现场是一个无菌手术的设置，所有地方都是用无菌蓝单子盖着，只留出了肚子上面手术操作的那个小方块。而且，没有眼神相助，要从那个角度把手指插入肛门已经不易。再加上那个患者还是个胖子，我根本不知道我摸到了什么或者没摸到什么。我的手在蓝单子下面胡乱摸索，总觉得手夹在肥肉之间，折腾了足足两分钟，手术室内的人都盯着我、、、我说“我找不到肛门”。这时候，屋里所有人都大笑起来，我自己也没忍住。轮到那个菜鸟级的住院医来试。有了前车之鉴，他必须把胳膊更深入蓝单子下面。最后，他找到了，只用了一分钟。我用了整整两分钟，一无所获。第二天结束时，整个科室都听说了我的洋相。掌刀医生甚至还把这事跟病人说了。至少病人和我能一起笑话这档子事了。

 

最恶的住院医

 

我们当中有三个人在普外手术，他们特别急着要分享和他们一起干活的住院医的故事。每个手术小组都由一个住院医的头儿带着。他们每个人好像都对一个特别的住院医头儿有故事。现在轮到我悠哉地坐着听我的同学讲令人心颤的故事了。

 

显然，这个住院医头儿对人的生硬粗暴犯浑已经有名了。我们当中一个女孩讲述了第一个星期跟他的遭遇。我们班另一个同学和她一起被分到了他的手下。那个同学向他报告病人的情况，这个头儿转向我的朋友说：“你能不能让她闭嘴，替我翻译？我绝对不和傻瓜讲话。”

 

我们的另一个朋友描述了他与这个住院医头儿的第一次相碰。他也是向他报告病人的情况，说到一天前做的X光片。头儿打断他说：“不对，X光片是两天前照的，不是一天前。别用错误信息浪费我的时间。这就好比说你妈妈以前很迷人。这跟说你妈妈现在很迷人不一样。这对处理方案能造成很大不同。你妈妈以前迷人，我却有可能和她上床，而她现在也许很丑了。”

 

说这么多了，我们老师也讲了一个关于他的故事。老师是儿科医生。这个住院医头儿的老婆正好在医院里生孩子。我们老师去祝贺他们，并且进行新生儿检查。那傢伙对老师说：“别在这烦我们了，你又不是一个真正的医生。”

 

这些故事让我有几点受益。首先，也是最重要的，当我出错的时候（意料之中的），我周围的人都能帮助我，既能教我，又有幽默感。其次，能力越强，越能够逃避行为规范的约束。我听说这个住院医头儿是学校培养出来的最棒的手术医生之一，今年（2016年）就已经收到15封针对他的控告信，他在他自己的老师们面前依然这么肆无忌惮，他的老师们也没有对他怎么样。

 

工作时间的违规

 

见习刚开始时，管理部门很清楚给我们讲了工作时间的规定和遵守条例。这些条例已经反反复复地被管理部门印到我们脑子里了。条例如下：

 

每星期在医院工作不能超过80小时。

 

每星期至少有一天休息。

 

每天工作排班至少有10小时在医院之外的间隔。

 

管理部门告诉我们要记住这些规定，为了满足这些规定，只需要简单地说“得回家了”或者“晚点来”。管理部门说学校的教授医生们都明白这回事。

 

我自己只违反了规定一次，那次手术晚上九点才完，第二天一早六点我就来了。那纯粹是我个人的选择，我想看完手术，第二天也想参加报名会。那天跟我一起干活的同学跟我有同样的问题，他就要求第二天八点才来。老师们一点也没为难他。可是，我自己却对我的同学遵守规定有很多想法。我跟他一样，仅仅丢了一个小时，他的要求多了一个小时。事后，一个住院医跟我说他们一直都在违反他们自己工作时间的规定，他们都不说。并不是因为负责医生们会批评他们，而是他们同伙之间会彼此指责。

 

我的俩个在普外手术的同伴违规比我们严重多了。有一个傢伙在血管手术科，平均每星期工作100小时。他从来没向系里报告过工作违规的事。一方面，他觉得科里医生们已经没兴趣教他，不愿带着他，他不想让他们有任何借口以为他又懒又没兴趣。另一方面，如果有别的同学看到这种情形，他宁愿告诫自己“忍住了”。

 

另一个女孩天天从早晨四点工作到晚上九点。她也从来没有报告过她工作时间违规。她的理由是她想成为团队中的一员，做为学生，要想如此，无论团队什么时候工作，你必须在场，不然，你就可能失去机会。第二条理由是还有一个同学跟她一块。如果她去报告违规，那么有两种可能性：别人会认为她懒，还可能导致也不想失去学习机会的同伴失去机会；或者她的同伴会认为她懒惰软弱。

 

总之，我们是医学院的学生，能自己给自己定规矩。虽然有明文规定，大部分教授医生们也都明白。但是，我们这些学生似乎都知道对我们的期望是什么，我们的标准是什么。有时候有些人确实想遵守他们的工作时间规定，这种时候，我们班级就会无视规定，非常不公正地评判人家的工作态度和人家的品行。

 

结论

 

总的来说晚餐很棒，我们医学院的小家庭有机会彼此交流。不管那些独立事件，我们看上去都很好，这使我们的老师很高兴。她曾经担心我们承受不了，情绪低落。这种担心其中一部分也是基于她自己在藤校受教经历的不同时间和文化。

 

星期一我们三人要到普外手术见习，另三人开始分科手术见习。再有六个星期，我们就渡过了医学院最难的阶段了。

 

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.