On to the OR. The last 2.5 weeks of my surgery rotation were spent assisting in the OR and taking care of patients on the floor. There were four other medical students with me and the last three days I was there, there was also another PA student. Each day we would round with the residents, go to morning report, and spend the rest of the day checking in on patients and following up on all the labs and imaging and whatever other things the patients needed. Each surgical case was supposed to have a student, and typically each student was assigned to one case if there were enough to go around for the day. As students we were to prepare for rounds, which were at 6 a.m., to present to the chief resident. I normally arrived at the hospital a little before 5 a.m. so that I would have time to change into my scrubs and read up on my patients and go see them before rounds started, and on most days I had two or three patients that I chose to follow.
The first day I knew that we were going to have rounds but I did not really know how the medical students worked and I didn’t know the situation of any of the patients. I was given one patient to present and I spent a good half hour looking through the patient’s chart, though I didn’t really know what to look for to adequately prepare for rounds. The chief that day had a reputation for being tough and short-tempered when he didn’t find something satisfactory or he found people to be lacking in competency. I was one of the last to present, and when my turn came, I started my first sentence strong…and then that’s pretty much where I ended my presentation. I was scared the chief was going to rip me apart, but he just looked at me, sighed, and said one of the interns (first year residents) would teach me how to properly present. It also helped that one of the medical students came to my rescue and told the chief it was my first day so I should get a pass. At the end of the day the students would split up the patient list so that we knew who we were going to present the next day. Since one of the students went home during the day because she was coming off of a 24-hour shift, we split up the patients without her and assumed she would pick up the rest. But the next morning, after I had already started preparing my presentations for my assigned patients, the student came and told me that one of my patients was actually hers so I had to take a new patient. In that moment I thought I was going to break down and cry. I was so nervous about presenting to the chief after failing the day before, and after I had worked so hard on perfecting my presentation, I had to rip it apart and start over for a new patient. But it turned out that that day we got a new chief who came from a different hospital, so that day the chief from the day before presented mostly all the patients to update the new chief. God is so merciful! By the third morning I was getting the hang of presenting.
The thing about presenting a patient is that anyone can read a chart especially if they have a lot of time on their hands; the main point of presenting is to update coworkers of any important information and to come up with a plan to appropriately manage the patient. Our goal was not to show how well we could read or gather information. The goal was to take the given information and use it to assess if the patient was healing well or not, if the patient needed any new or additional labs or imaging, if the patient needed new or additional medical management or therapy, and if the patient was ready to go home. Many times I would feel like I wasn’t really learning much through presenting. I didn’t really learn in those 2.5 weeks what labs or imaging I should order for each situation we encountered. I didn’t really come to know when it was appropriate to change a patient’s medication or when a patient was ready to go home. I didn’t come to a full understanding of how to properly manage a patient from pre-op to intra-op to post-op to discharge. What I did learn was that everything you do, every test you order, every medication you administer should be in the patient’s best interest, and it should be done with the goal of getting the patient out of the hospital and back to their normal lives as much as possible. In every situation, do your part in full completion and do not rely on others to get back to you about your patient. Your patient is your responsibility so you are the one who has to make sure the patient gets all the necessary tests done, is healing well, is not uncomfortable, is getting the adequate care, and so on and so forth. Other healthcare professionals (such as nurses, phlebotomists, imaging technicians and radiologists, therapists, etc.) are busy, and often things fall through the cracks so you have to personally make sure every aspect of the management is followed through accurately and thoroughly so that your patient gets the care he or she needs.