By Alyssa Brown
“Wrong, Wrong, Wrong, Wrong”, called the attending from his swivel chair. It was my first day of third year. I had been placed at the Veterans Association hospital (VA) for a cardiology rotation. It was the last week of June, so our residents were well prepared for anything that came their way. Looking at it from their point of view, they went from having almost fully fourth-year medical students, who were prepared, knew what to do and what not to do, to two fresh out of Step1 third-years, who had no idea at all. I remember googling the night before, what to put in the pockets of my white coat. I scrolled through reddit and student doctor network looking for a sign or post to assuage my nerves. I found no salvation there.
I had shadowed/precepted plenty during first and second year, probably to an absurd degree, but this was different. I was being graded. Plus, I usually was shadowing in the operating room—give me a gown and gloves, and I would have been 100000x more comfortable than I was in that tiny workroom at the VA. We had texted our upper level resident the day before, and she told us to find the workroom on the fourth floor in the cardiology workroom at 7am. No other real instructions. We showed up with our brand new white coats—pockets bulging with papers, pens, snacks, reflex hammers, penlights, eye charts, Pocket Medicine, Maxwell’s Quick Medical Reference, small clipboard, extra hair ties, bobby pins, Band-Aids, and gum. My coat probably weighed ten pounds. Did I need any of this? The short answer was no, but I’ll get back to the story.
I met my classmate early to try to find the workroom. We circled the fourth floor for thirty minutes trying to find the workroom before we gave up and called the resident. We could hear the phone ring, so we followed it to an unmarked broom closet. We were welcomed with a “rounds are in thirty minutes, look up these patients that you’ll be presenting.”
First off, I had not practiced presenting in any formal sense, so what was I supposed to say? Also, we still had not figured out how to log onto the computer. Instead of the patient I was supposed to present, I found a different patient of the same name in Arizona. It was going well, clearly. Seven thirty came in the blink of an eye. The attending, an older physician, and his fellow appeared in the room. I had no idea how they were even going to fit in the room honestly. They looked at our two fresh faces, and they must have smelled blood in the water. The attending decided to start with me. “Please present your patient.”
I had about two things written down because of the confusion over finding his record on the medical records system. I started, and I barely got a sentence in before he said, “wrong, wrong, wrong, wrong.” The resident tried to come to my aid, and she stated that we were brand new third year medical students. That did not faze him. I started again, and I got the same result. One of the residents rolled her eyes, and she began the presentation. I was embarrassed to say the least. I was so excited to start third year and see patients, and I was not expecting to be berated the first day. I was expecting the residents to help us and gently nudge us in the right direction. This did not happen, and I do not blame them. I should have been more prepared, and I did learn eventually. Don’t worry, you will learn too. The first few times are hard, but don’t beat yourself up too much. Here’s some of my advice to avoid a hard transition.
1. White Coat Pockets: By the end of third year, my white coat was down to the essentials. I had my favorite pens, granola bar, stethoscope, lube (we could never find it), sterile gloves, and usually the patient list plus some small scratch paper. If I was on surgery, I also kept ten dollars and my credit card with me. These are my essentials, everyone’s pockets are different. Some items were rotation dependent, like the reflex hammer. By the end of third year, I wanted to have everything I needed but nothing I didn’t. I highly recommend ordering the coat to not be fitted. They do not stretch much, and they do sometimes shrink in the wash. I wish mine had been larger, so I felt more comfortable. Also, having lots of stuff in the pockets makes it smaller (FYI).
2. Shoes: Okay ladies, some of y’all impress me by trotting around in heels all day. You’re amazing. I will be honest though, I am not one of those women I admire. I wore comfortable loafers or clogs. Did it look fashionable? No. Was I comfortable? Yes. Also, don’t make the same mistake I made. If you are going to go to the OR, don’t forget to bring comfortable clogs or sneakers. I had to wear my ballet flats (covered in shoe covers) through a Whipple, which was not ideal. On that note, compression socks were my best friends during surgery rotation. I did not buy the expensive ones. I got the cheap five-pack, but they do really help.
3. Be self-sufficient and efficient: “Show me a student from the “best medical school” who only triples my work and I will kiss his feet.” This is a popular quote from House of God, and I always tried to remember it during my third year. My goal was to avoid slowing down the team. From calling to get records from another hospital, answering pages, or getting the ultrasound for the team, sometimes the work isn’t the most glamorous, but you are helping the team and the patient. I learned a lot from doing these seemingly smaller jobs, and the residents would give me more responsibilities because they trusted me to get things done. Also, the team is there to take care of the patient. Yes, your education and rotation is important for you, but at the end of the day, the patient comes first. I feel like sometimes students forget that. On that note, don’t be afraid to ask questions, but be aware if someone is working on something and wait until it is a good time for them. It is a balancing act sometimes, but it is worth it, and you’ll get the hang of it.
4. Enjoy third year: Everyone has bad days. This includes your residents, fellows, attendings, and fellow medical students. There will be bad days. There will be days that will never seem to end. There will be days where you get done early and get to see the sun. There will also be days that you aren’t sure if you can do medicine anymore. There are patients that will die, and these will hurt. The days are long, and sleep is a premium. This is also what you sat in class for two years to do. Remember that when you’re bleary eyed driving home from a call shift wondering why you do this. You will find what makes you tick and what makes you love medicine. There are so many highs and lows, but you will meet so many people and so many patients. This is what filled me up. We all make mistakes and look dumb sometimes, and that is okay. If you ever start feeling sorry for yourself, remember we’ve all been there, and keep close to your friends.
I could fill pages (or AWS Blog posts) with advice and things I wished I had done better. Third year will be full of happy and sad memories, but there is one thing to always remember. Every hospital has a room full of crackers and peanut butter. Always find that room.
Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from the University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not buried in lab work, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Twitter @Alyssa_B_MDPhD and on Instagram at @Alyssa_B_FutureMDPhD
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