On senioritis and communication

The attending asked me if I would speak with him. I uncrossed my legs in the uncomfortable office chair and threw my feet back into shoes without tying them. Then, I shuffled out of the resident workroom and toward a small table with a wilting poinsettia as the centerpiece.

The attending sat down and quickly called me out for being a lazy fourth year. I didn’t prepare the follow-up presentations for ‘staler’ patients on the list. They were stable and I didn’t feel like putting in the effort.

Like that mentor figure saying they’re not angry, just disappointed, is how this felt.

And after that long and weird day, I came home to my partner and tagged her out of Joonsu duties. She’d shortly leave to Philly to pick up her mom, who will be staying with us for the next week. I was frazzled and didn’t have the patience that I would like myself to practice. I let out some much needed tears of frustration and we seemed to move past the hiccup.

After Mackenzi left, Joonsu had a 45min meltdown. So many screams and so many baby tears.

Gladly, he fell asleep into a deep slumber after working himself into such a lather. I wish I had the skills to soothe him out of a baby-panic. I will learn them eventually, I’m sure.

And while he slept, I thought about the past two weeks on the Medicine service. I forgot how much effort can go into the clerical aspects of doctoring: the time spent on a laptop clicking through tabs and typing out data. Most of the time, it felt like.

Then I thought about my patients over the past two weeks. They were all non- or under-communicative. Advanced dementia making follow-up conversations an exercise in reintroduction. Intellectual disability forcing me to question everything I elicit on interview. Altered mental status so I mostly assess changes in awareness while testing the limits of my medical Spanish.

I left for paternity leave feeling like I had a sharp scalpel and trusty forceps on my Mayo tray: my voice and my ears. I had confidence talking with patients and with their family. I enjoyed long and winding conversations that had a therapeutic arc to them. I could walk out of a room feeling like I had done some good.

And two weeks into my medicine rotation? I couldn’t flex this even once. My trustiest suite of skills did me no good. A sailor in a landlocked nation. A psychiatrist on a medicine service.

So I was right to feel like I spent so much time on the clerical aspects of medicine.

I had.

The patient interviews had a far lower yield than simply combing the EMR and assembling the relevant information. Taking the humanity out of medicine.

I’m surprised at how much communication means for my emotional investment in patients. If my patient can’t remember me, how can I pour myself into their care? Does it make me a bad physician if non-communication loosens my moral obligation?

Or is it because I’m still wearing the third year clerkship hat, trying to perform the song and dance of medicine instead of running a floor like an intern. If these people depended on my decisions, then wouldn’t I step up? I might not enjoy an hour-long conversation with them, but I would juggle their medications, discuss their case with nursing, and handle updating the family.

And I guess that will be my job next year: do the work and don’t fuck up. The soul-searching conversations can wait until I am further along and back on the psych floors.

And even there, I won’t reach everyone.


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