good clerks should be seen and not heard

It took me a while to figure out, but it's now clear to me that one of the reasons that I haven't gotten along well with my residents is that they prefer yes men.

Any independent thought or questions are discouraged.

it's always safe to blame the med student

In a 30 hour call shift I managed to get stern words from a circulating nurse who was watching me like a hawk and waiting for me to contaminate myself, a resident from another service who didn't like how I was presenting someone else's case and my own resident who thought I should have woken her up this morning. Presumably with a mint on the pillow.

Of these 3, guess which one actually apologised for being an ass?

The one who actually had a point.

I didn't do a very good job of presenting the case for referral to the resident, I didn't really know the patient. But he still came down to the ED to apologise for being an ass.

The other 2, actually in the wrong, are just jerks I guess.

find the toaster in the tree

Back before the days of enlightenment in surgery, the parathyroid glands from thyroidectomies were re-implanted into the forearm. They'd get smooshed and attached to a superficial muscle.

Our most interesting case today was a woman whose parathyroids are working overtime and needed out. Her transplanted glands were in her forearm and palpable from the surface. Trying to find them reminded me of those Chickadee pages where you have to find a list of objects in weird places like bunnies in a mailbox. We had to hunt to find which blobs were glands not fat or muscle.

Is it weird that it was amazing fun?

yay laproscopic splenectomy!

did you know they mash the spleen into tiny pieces to get it up through the trocar holes? really weird. looks like chunky pepper soup.

Second rule of medicine

Everyone knows the first rule of medicine is to do no harm.

The second is that if you are a sweet wonderful person, nothing will go well for you and your cancer won't be resectable.

If you're an a-hole, the bullet will miss everything vital, even though it comes close.

I don't know anything

Every day I spend on clerkship is another day I realise that I have a huge amount left to learn.

Also, some omentum looks like melted cheddar cheese on toast.

A day of extremes

I'm on general surgery right now. It's 4 weeks long and usually thought of as the hardest month of clerkship. I've been having a hard time with my residents who are very anxious to learn everything about surgery, which is great, but it often gets in the way of my own learning. like a fool, I cried and told my senior that he was ruining clerkship for me. I was on call that night and had a brilliant experience.

Unfortunately, the family med program here isn't very popular so there are lots of spots open in the second round of CaRMS. This leaves lots of rooms for students who had their medical training outside of Canada. Many of these are Canadians trained abroad.

These residents have less training in the way our hospitals work making it incredibly difficult for them to stay on top of clinical skills as well as what is happening. They end up being difficult to learn from. Clerks on their off rotation services often end up picking up the slack.

Back to my call night.

I was on with a family resident who is lovely but has difficulty with keeping on top of incoming patients. I ended up spending quite a bit of time doing her job. As one of my seniors said, I was playing the part of the junior that night. From having no responsibility to lots. Awesome!

I've really liked my pediatric experience so I get as many of those consults as I can. This night there were 2 in a row, both were ?appendicitis. Both had LRQ pain x24 hrs, nausea, felt generally crummy. The physical exams I did were identical. Positive psoas, obturator, and McBurneys sign. I figured both were appies.

Then my senior came downand asked the female 2 questions I'd missed. Has this happened before? Tell me about you periods. That pt had an ovarian cyst, the other appendicitis. What a great learning experience!!!

Then the senior taught while walking to the next task.

As long as I get to keep learning, I'm going to keep loving clerkship.