Most of you know that I am in my fourth year of medical school.This means two things:
1) I am purportedly at the peak of my clinical skills as a med student; and
2) I am absolutely terrified of the leap I will have to make next year when I actually graduate and have a "M.D." after my name.
As I approach the end of med school, I find myself torn between those two thoughts. On the one hand, I am excited to finally be able to take charge and provide direct care for my patients. On the other hand, it is terrifying to think that I must soon accept full responsibility for all of my medical decisions.
Nothing like volunteering in a relief mission to put things in perspective...
Earlier this morning, Adam, Ana, and I decided the best thing to do was to keep working in our respective areas so we could keep some continiuity of care for the patients. When I arrived back at the White Tent, I was greeted by the nurse I had worked with the day before, who immediately told me that our attending physician had just been assigned to go help with relief efforts in Port-Au-Prince. "It's just you and me today, I'm afraid," she told me. "Oh, and we have a new nurse today, who still has to learn the ropes. God help us..."
The significance of this didn't hit me until after I had helped the nurse take morning vital signs.
Ever since the heart-warming exchanges from yesterday's time in the tent, I found myself looking forward to any sort of patient contact I could have. Taking vital signs was a good excuse, since it allowed me to lay hands on every patient and at least impart a little laughter to their ordeal by speaking to them in my horrible Creole. Today, however, things were different from the moment I found a patient who had a slight fever. What resulted was the following exchange I had with the nurse:
Me: "I think this patient is feverish. His temp is 100.8."
Nurse: "Oh...okay. I'll make a note of it and tell the doctor when she..."
Me: "Wait, I thought the doc was in Port au Prince today."
Nurse: "Oops, you're right. So...what do you think we should do?"
I looked back at the nurse to see if she were joking. When she stared back at me in all due seriousness, I snapped back to attention. We ended up giving him Tylenol as I asked the patient questions and looked back in the chart for clues. Silently, I found myself cursing at the haphazardly-organized charts, which contained patient notes scrawled on everything from napkins and index cards to legal-sized paper. When all was said and done, I couldn't figure out if he had a new infection from his leg wound, or if he was developing a clot in his leg. Both scenarios were quite possible, but unable to do anything else at the moment, I decided to check back on the patient later and move on.
Over the course of the morning, I would move back-and-forth between the feverish patient, another patient with severe eye pain, as well as a post-op patient who was severely nauseated. I found myself particularly concerned with the eye pain patient, since I was able to see a huge area of pus that seemed to ooze out of her pupil. It was clear to me her eye was badly infected...perhaps to the point that she might need IV antibiotics as well as an opthalmologist to save her eyesight. Not knowing what else to do, I ran to the pharmacy and grabbed a couple of bottles of antibiotic eyedrops from a bin I had seen a couple of days before. Inside, I prayed that she wouldn't lose her vision...or more importantly, that my small intervention was the right thing to do.
As if in response to my silent plea for help, a doctor did manage to stop by our tent late in the morning. The doctor, who in reality was a second-year family medicine resident on her first day of duty, had just been appointed "medical director" of the tent patients that morning and was making rounds to get to know everyone. When I told her about the eye pain patient, she seemed very concerned. After examining the eye itself, the doctor sighed. "Don't worry," she told me. "What you did certainly did not harm her, but I think she needs an eye specialist. Who knows if we're going to be able to get one out here..."
After that, the doctor left, leaving me to fend for myself for most of the afternoon. During this time, the nurses and I managed a patient with a near-syncopal episode during physical therapy, a woman who was having a spontaneous abortion, and the post-op man from the morning (who began vomiting that afternoon due to lack of a proper bowel regimen). Things were amazingly chaotic. As I ran to the pharmacy, drew up my own IV meds, administered medication doses to patients, and tried to work together with the nurses to make sure everyone was stable--I gained a whole new level of appreciation for the potential experience I would have next year as an intern.
But just as I was getting too complacent with my new role as an ad-hoc attending physician, I made the crucial mistake of forgetting a key lesson: "always expect the unexpected." Indeed, the winds around the tents had been picking up that entire afternoon, beating aggressively against the walls of the tents as they coursed through the area. My tent, the White tent, shook dangerously with each passing gust. It was the flimsiest of all tents, and I could see the patients and their families cringe with every movement and swaying of the tent.
As I was drawing up a final set of IV meds, a particularly strong gust of wind came through and knocked down a huge wooden bench of supplies that had been anchoring the tent down. Boxes fell directly on my ankle, causing a sharp pain in my foot. I watched helplessly as the wind buffeted the wall back and fourth. At one point, I glanced down at a male patient who was trying his hardest to have a bowel movement on the bedpan. "Is the tent going to fall down on me?" he asked me slowly in Creole, holding tightly to his bedpan. "I don't know," I responded gravely, not quite knowing what else to say.
Luckily, several other volunteers had heard about our plight and offered to help put new stakes in the ground so that the tent could stay put. And my foot was fine...only amounting to a number of superficial abrasions. By the time the nursing shift ended at 8pm, I saw the real attending physician enter the tent out of the corner of my eye. Apparently, the group from Port Au Prince was able to come back earlier than they thought.
Feeling thankful, I heaved a sigh of relief, gave the attending physician an account of what had happened that day, and left the tent, grateful to come back to my role as a fourth-year medical student.
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