I am mid-way through my first clinical clerkship, neurology. I have learned a huge amount, and I am indebted to the medical school faculty and the residents who have taken a lot of time out to teach me. I started out on the neurological in-patient team. When someone is hospitalized for a neurological condition, this is often for pretty serious reasons: strokes, brain tumors, sudden paralysis, continuous seizures, uncontrollable twitching or thrashing movements, encephalitis, meningitis, etc. Most of these can be pretty scary to the patients and their families. For example, imagine for a second that someone you love is admitted to the hospital due to sudden onset cognitive and behavioral changes, and the hospital staff are busy running around taking blood and maybe doing a spinal tap, and doing things like CT, MRI and EEG, but they don’t have a diagnosis yet. When you see someone who was fine a few days ago, not be able to answer what year it is or who is president, or not be able to name an object like a pen or even perhaps acknowledge their own arm, it can be quite disturbing.
My first week, after long days, perhaps 13+ hours, helping to take care of patients and their families, I often found it hard to get to sleep at night. Despite a whole day running around the hospital, being physically exhausted, mentally fatigued from trying to learn so much new material (like how to interpret MRI scans), and somewhat emotionally drained from the continuous stress of trying to make sure I was doing the right thing, I was still threshing around in bed as I worried about the patients. Some were specifically patients I was assigned to follow and examine every day, some were just patients that we rounded on every day and I heard discussed and had looked at their medical charts. I was worried about how they were doing that night, how they were going to do long term. Worried about what if one of the scary blood tests came back positive. Worried that some of their symptoms were going to be permanent or even were going to get worse. Worried how they would be able to get by once they left the hospital.
After a long, exhausting week of this, I had a weekend day off. I went to some large get-togethers and parties, with all non-medical people. It was strange to hear people talking about the details of their lives: what new thing they wanted to buy at Home Depot, what hike they wanted to go one, what vacation trip they were planning. It was almost surreal, and I felt sort of like a split person. Part of me was talking about why the pasta salad was so good and alternative recipes, and the other part of me was worrying about whether Mr. A would be able to use his arm again and be able to work to support his family or whether Mrs. B would recover the ability to speak.
Later, I was helping work the grill and trying to keep track of when to flip different food, while at the same time part of me was thinking about if young Miss C would ever regain consciousness and recognize her family. A few times I took out my phone and used the app which let me access the EMR system to see how they were doing. As I chatted about the World Cup, I felt like I was pretending to be part of the happy world of healthy people. How could I be so petty as to worry about which local restaurants are good, when I should be doing research to see if I can find a way to help Mrs. D’s husband walk again.
This was not sustainable, and by the end of my second week, I was sleeping deeply and well (partly because of long days, with lots of exercise running around the hospital). I was waking up in the morning feeling rested, not with a pit of dread in my stomach that something terrible might have happened to one of my patients during the night. As the names and faces of patients change, new people are admitted, previous patients are discharged, it becomes a bit of a blur. Maybe that bit of blur helps.
This weekend, I have another day off, and today I’m going to a couple museums and the park and out to lunch. It will be a fun, and relaxing day. Tomorrow, I’ll be working in the out-patient neurology clinics. I’m trying hard to learn to take care of people, but sometimes I also need to get some fresh air and sunshine for myself. I’ll be back in the hospital on Monday morning.
As a disclaimer, I made some vague anonymous references to patients, none of these represent actual patients, and are just stand-ins for the sake or preserving privacy of actual families.