Spelunking

During orientation week of my first year of medical school, one of the deans spoke to us about the rigors we would face. He used the typical analogies – this is a marathon, not a sprint – to encourage us to find our own balance and make time for things like exercise and visits with family. But sometimes, he warned us, sometimes, we would need to "go into the cave and get it done."

I went into the cave in July. After finishing out third year with my surgery rotation, celebrating Tay’s and my first wedding anniversary, using my vacation week to move to a new apartment, and absorbing the news of my dad’s prostate cancer diagnosis, I had three weeks to prepare for Step 2 of the United States Medical Licensing Exam, a 9-hour, 352-question multiple-choice extravaganza of clinical knowledge and reasoning on which a passing score is required for graduation and which score can have a sizable impact on one’s residency prospects. So, after the first week of study, I packed my bags and took myself to Vermont.

Possibly more harrowing than preparing for the test was the prospect of living in near-total solitude for fifteen days. It’s quiet up there in the summertime. Other than going out for runs and walks and the occasional foray to the grocery store, I wouldn’t be interacting with anyone. It’s funny how, back in the days of bad roommates, I couldn’t wait to live on my own, was bursting at the seams to establish my own domain. Now I’ve lived with Tay for four years. I wasn’t sure how I would do with so much time and space for my wandering thoughts.

Fast-forward to the day the scores were released and Tay, knowing I would put off looking at my score for weeks if given the chance, took charge and looked at it (just like last year) and you will know that I learned a good bit of medicine up there. But I also learned a number of things about myself that feel somehow both arbitrary and important to know:

-I can change my own tire, though I might need a little help loosening the lugnuts. Apparently I paid attention to my dad’s lesson that day in the driveway more than ten years ago.

-I’m still kind of afraid of the dark, or at least of going to bed knowing I’m alone in the building. (Yes, even in Vermont.) I never thought I’d be so comforted to hear what I’m pretty sure was drunken Czech floating over from two balconies away.

-I have no idea if I’m allergic to bee stings, and suddenly this hole in my knowledge grew to seem incredibly egregious as I considered the potential consequences should I happen to be stung by a bee and happen to in fact be allergic and happen to feel my throat closing with no one nearby to call 911 or give me an emergency tracheostomy…. Witness the limitless creativity that results when I off-load my test anxiety onto every aspect of normal life.

-I might consider getting a [small, subtle, classic and classily-placed] tattoo, assuming I can decide on a design that I will love for the rest of my life and get over my fears of getting Hep C.

-Finally, the lesson with actual ramifications: Writing will always soothe me. It will always inspire joy. Even when I’m alone in my cave of concentration and solitude, balancing the desire to close the curtains against what was likely a firecracker but could be imagined as a gunshot (stop laughing) with the need to let in the comforting sounds of boisterous Eastern European revelry (apparently they did not think it sounded like a gunshot), writing will do wonders. It might be a poem - which is how I calmed myself the night before my exam - or an essay contemplating the decision to ink or not to ink. I might not initially feel that I have much to say, or that saying it deserves precedence over the ever-expanding list of other things I "should" be doing. But if I can just let myself start, or get myself to start, it will carry me through every time.

Experience

You know you’ve gotten the hang of third year, of functioning on rotations, of being a good “clerk” (that term that appears in the written descriptions of your role on each service but that you’ve never ever heard anyone actually use in reference to you), when you arrive at the hospital at 5:15am to find out which patients you’ll need to present on rounds, which will begin at 6am. You’re already planning how you will log into the electronic medical record system and quickly scan your patients’ lab values for anything abnormal or notable and copy their vital signs and I’s and O’s (in’s and out’s, which is just what it sounds like – a record of the quantity each has taken in and excreted throughout the past 24 hours) right onto the page you already snagged from each of their medical records on which to write your note (no reason to waste time and pen-strokes jotting numbers onto scrap paper first and then transcribing them into the note when by now you know exactly how far down in your note to write them, leaving enough space above to record the overnight events and the patient’s status this morning) before scurrying off to examine the patients themselves. You’re aiming for only one computer log-in this morning - it’s so irritating to have to go find a computer and watch seconds tick by as it processes your username and password for a second time after you’ve seen the patients and have realized while scribbling your notes that you forgot to pull up the report of that chest x-ray that one of them had overnight.

You punch in the first patient’s medical record and squint at the abbreviation indicating her location in the hospital. Instead of the expected series of three numbers preceded by an N or a P for the North or Potter sections where most of the surgical patients reside, next to the name you see ADMH05. Huh?

You’ll do the other patient first, you decide, scanning the chart for his history and what surgery he had so you have some clue where to focus your brief examine and pointed questions. When you finish his note, you ask a nurse which area this cryptic bed location indicates, and she tells you it’s the Hoag building. Excellent; you know just how to get there. You run down three flights of stairs to the first level, where all of the building’s sections interconnect, and head up to the 5th floor. You scan the large board across from the nursing station, but the patient’s name isn’t listed.

You check with a nurse – there’s no such patient on this floor. She gamely checks the computer, translating the location code as Potter rather than Hoag, so back downstairs and over to Potter you go. You find the right section, find the patient, and find out that the patient is hard of hearing. Trying not to rush, you remind yourself to keep the pitch of your voice low rather than high because high-pitched hearing is usually what goes first. You ask the patient how she’s doing, whether she has any pain and if she’s peeing and pooping without problems. You grab the chart and copy down the vital signs, then run back over to the North building to finish writing your notes.

At which point you realize that you don’t have the I’s and O’s for this second patient. The residents are going to want this information on rounds, which will start right at 6:00am. Which is five minutes from now. There’s no getting around it; you need the numbers. “I couldn’t find them” won’t cut it. You log back into the computer, but they’re not listed there. You hesitate for half a second, then turn and dash back downstairs, back over to the Potter building, back to the patient’s chart. You flip through the sections of the chart until you find the I’s and O’s, copy them down, then run back to the third floor of North. It’s 5:58. You have time for two more sentences of your note and one deep breath. And then it’s time for rounds, and you’re ready.