On making the rounds

I spent six mornings this week in the hospital. The extra set of morning rounds to make up for the missed Monday after the van debacle. As one friend put it, both an entirely fair punishment and the worst thing in the world. I finished Friday lecture with a small sense of dread, knowing that I would have to wake up early the next morning to round on patients with my attending on a Saturday.

Generally, I find rounds tedious at best, anxious at worst. Some aspects might change. Perhaps the team only rounds on new patients in the service. Maybe you round on patients while seated in a conference room and then you quickly check in on them after verbally reviewing the lists.

But the aspect that never really changes is the patient room filled with bodies: medical students, residents, attending, family members, the patient in the bed, and perhaps another set of family members with a patient on the other side of a thin curtain. The encounter feels like a performance with the resident or attending speaking to the family. I’ve only seen a handful of truly earnest human interactions while on rounds.

Then, there’s the aspect of discussing patient cases. I have earned the skill of zoning out mentally while appearing engaged. I might only present on one or two patients, get pimped on a handful of other cases and syndromes, but generally I stand there and try to stay alert and oriented while the intern learns from the attending.

I know I should focus. I know there are learning opportunities that pass me by because I am too busy trying to stretch my aching back without attracting attention. It is incredibly difficult to stay engaged in such an odd group dynamic.

And so, when I arrived on Saturday morning to make up my missed day, I realized that I was alone. No residents that day: the weekend resident fell ill with a hopping fever, so only attendings on the pediatric floor. No other medical students to soak up attention or absorb the pimping questions. Just myself and an incredibly intelligent physician, seeing over a dozen patients.

I loved the experience. Instead of the presentation performance that I had grown accustomed, as medical students bumble through a description of the physical exam and the residents incorporate all changes overnight to show that they are paying attention, this attending gave me a succinct and to-the-point presentation on each case before we walked in the room.

I got to see how a practicing physician actually collated and synthesizes information. Up until this point in my education, I hadn’t really seen how an attending would present, because we focus on presenting to them. A small and significant turning of the tables.

It feels like trying to learn how to dance ballet without seeing a ballet dancer perform. I am told what the movements should look like, but I haven’t seen them myself. I am coached regularly without seeing a true practitioner, just other students around my level. There are certain aspects of grace and ease that define a good dancer, and you need to see that in order to begin imitating it.

And so, I learned how a brilliant physician might perform. I utilized the opportunity to soak up the attention, to ask questions and to write down some of the many things I need to learn. I actually enjoyed rounding.

It reminds me of the shift away from the classroom and towards the clinic during the shift from second to third year. I felt like an apprentice trying to learn, rather than a student getting by. I wish that more of medicine had this mentor/apprentice model. I would learn so much more.

And finally, I appreciate what life will be like after graduating medical school and practicing as a resident. The pace and level of interaction with the attending felt right. I look forward to the discomfort of my intern year.

The cost of this optimism? One Saturday morning in the hospital.

Emotionally, I am feeling better than I have in quite some time. I feel like I have emotional reserves and they are topped up.
Physically, I am coasting off the movement practices of winter break. Not very stiff thanks to some massage and floating this week. I feel good.
Spiritually, I feel strong. I will sit in ceremony a few weeks from now and I am looking forward to the crucible experience. It has been a long time.
Relationally, I haven’t had much of a chance to connect with the people around me. I could blame the long week with the 12hr days. I know that the responsibility lies in myself to keep these relationships going.


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