On Service (Part I)

When a physician begins a period of time – be it a week or a month or anything in between depending on the physician and the practice setting – taking care of a group of patients in the hospital (which could mean those on a certain floor of the hospital, a certain subset of that floor, or the patients scattered throughout the hospital on whose cases a subspecialty service, such as cardiology, is being consulted), it is known as “going on service.” Like any transition, this one takes time. For the first day or so, the physician must work hard to learn the ins and outs of each patient assigned to him or her, which can be exceedingly complicated given that some patients’ lengths of stay may already be measuring in weeks or months. In addition to learning the medical details, the doctor will gradually get to know the patients’ personalities and complicating factors – which ones downplay their pain, which ones have complex social situations involving certain family members who must receive daily updates while certain others most decidedly must not.

The same is true, to a lesser extent, as a medical student. When I join a service, either at the start of a new rotation or, during the longer rotations of third year, when we switched every two weeks so as to experience a variety of patients and care teams, I am confronted by a census (a list of the patients assigned to the team of one or more residents and an attending physician) that initially appears insurmountable (defining “surmounting” here as becoming familiar enough so that a face, a chief complaint, and a general hospital course become attached to each name). Rounds on the first day involve frantic scribbles of basic facts next to each: “CHF, on Lasix.” “Diabetes – endocrine consulting.” “Sickle cell – monitor for acute chest.” At the end of the day, the names on the list are only vaguely more familiar than before. Most ring a bell; few conjure up the image of a person and the gist of his or her story. By the third day, however, as we stop outside each patient’s door, I am usually somewhat startled to find facts floating into the forefront of my mind – a basic diagnosis, a general treatment plan, a face; perhaps a notable exam finding. By the end of the week, however, I generally know each patient and backstory, and have forgotten that these names ever rang foreign to my ears.

Conceived several months ago, this post was originally intended to segue into an examination of another type of service and the parallel nature of becoming accustomed to a different set of individuals. Last spring, I began volunteering at a local animal shelter, where I take homeless dogs out for walks and socialization. Once a week (though admittedly and heartbreakingly less often as I spend time doing rotations in different cities), we explore a path winding through trees, stride the length of a neighboring empty lot, or play off-leash in an enclosed dog run. The first time I consulted the list of names on the checklist where volunteers record which dogs they have walked on a particular day, it told me nothing; not which dogs were new and which still lingered, unadopted, after months; not what size collar and what thickness leash to collect from the supply area before heading out to greet a new friend; not which dogs were small and especially cute and thus likely to still get walked by others if I prioritized those who were larger or less traditionally cute.

But after only a few visits, I had learned some names and personalities. There was the pitbull who had both a collar embroidered with skulls and crossbones and a daisy-printed bandana around her neck, who regularly halted our walks to roll on her back in the grass, soliciting a belly-rub. There was the mix (part pitbull, but larger and with stripes, which Tay firmly asserted was less dog than tiger), who jumped in circles in her pen whenever I approached, and who made hilarious snorting sounds as she explored the olfactory phenomena that existed outside of the shelter. There was the tiny little chihuahua-like lady who supported herself on her stick-like front legs while squatting, so that her back legs were largely airborne whenever she peed. And there was the older, calm, loving female whose gait had an odd bobbing quality due to the large mass on her front leg but who soldiered on, forever stretching out our walks for as long as she could persuade my soft heart to allow. (Yes, ok, we can do one more lap around the path.)