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Medical Schools, Patient Care, Stanford Medicine Unplugged

What happens when you can’t communicate with your patient?

What happens when you can’t communicate with your patient?

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

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Over the past eight months, I’ve rotated at the Palo Alto VA, Santa Clara Kaiser, Stanford outpatient family medicine and pediatrics clinics, and most recently, at Santa Clara Valley. At the VA and Kaiser, all my patients spoke English. Occasionally, at Stanford’s outpatient sites, our patients spoke a language other than English; however, this never felt like a barrier to care because Stanford had phone interpreters available, as well as iPads on wheels that you could use to videoconference in an interpreter. These resources made it feel as though the interpreter was right there in the room with us. And indeed, they could not only hear the patient’s words but also see their expressions, adding an extra dimension to the interpreting services they generously provided.

Valley, however, felt like a different world. As a county hospital, Valley doesn’t often have the luxury of flashy resources. I spent this past month there, on my general surgery/trauma rotation. On morning rounds each day, we would check on each one of our patients, asking whether their pain was under control, if they were able to eat post-surgery, if they had walked around the ward to get back to their baseline activity level, and more. These rounds would take place as early as 6:15 a.m., and they were efficient, since operating room cases would begin at 7:30 a.m.

At various point in the month, our Valley team had patients who spoke only Spanish, only Korean, only Cantonese, and only Vietnamese. Sometimes, we got lucky, and a member of the nursing staff spoke one of these languages. But at other times, we worked through hand gestures and simple words to try and ascertain patient pain, symptoms, etc. Phone interpreters were an option, but the early timing and rapid pace of rounds made it cumbersome to call an interpreter. We usually circled back in the afternoon with a phone interpreter – and if we happened to have multiple traumas that came into the hospital that day, it would be later rather than earlier that we returned to the patient’s bedside. Putting myself in patients’ shoes, I imagine how frustrating it must have been for them, to feel both dependent on the medical team for care as well as helpless to communicate how they felt and what they wanted.

I began to think about how this problem could be fixed, and my thoughts took me back to my middle and high-school years. In middle school, I was required to take at least one foreign language. I chose Spanish and continued taking Spanish throughout high school (then promptly forgot everything when I went to college, making me rather useless on surgery rounds). Wouldn’t it be useful to have a similar language requirement in medical school? I don’t mean a comprehensive foreign language course. Instead, I think it would be meaningful to know key words and phrases – Do you have pain? Are you able to eat? Where does it hurt? – in, let’s say, the ten most common languages spoken in the particular geographic region a medical school is located in.

I know, I know, medical school curricula are already teeming with courses and requirements, and adding a language requirement feels like just one extra thing. But, if it makes a valuable difference in patient care, isn’t it a worthwhile addition? It’s certainly something to ponder. As for me, I just downloaded Duolingo on my iPad, so if you catch me awkwardly practicing my Spanish out loud in any one of my favorite Palo Alto cafés, you’ll know why!

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics. 

Photo courtesy of Bill Pugin, The Sign Language Company

Education, Stanford Medicine Unplugged

My struggles with the third-year of med school – and the words that helped me

My struggles with the third-year of med school - and the words that helped me

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

495524570_415c91b283_z“I remember how hard it was to be a third-year medical student,” one of my residents once said to me. “You have to appear constantly enthusiastic. You feel continuously judged and evaluated. And worst of all, you know, deep inside, that if you were to get a cold or something and not show up one day, not one bit of the daily workflow would change because as far as pivotal people on the team go, you aren’t one of them.”

And with those words, my resident smiled and let me go home early, while she and the other residents stayed to finish up last-minute tasks and sign out to the night team. I was too excited about getting out early to think much about what she said that day (golden rule of third year: if your resident sends you home early, don’t argue. Count your blessings, and go home). But more and more, her words have begun to resonate with me – they summarize so well what I’ve struggled with as a third-year med student.

On a day-to-day basis, third year is awesome. The patients I’ve met have been absolutely incredible, and I’ve been so grateful for the stories they share and their willingness to teach me about their medical conditions. When I first started third year, spending time with patients was more than fulfilling for me, and I felt lucky that, as the medical student on the team, I had more time than others to do that. But, after a couple months on the wards, I felt myself growing a little restless – I wanted to do more to contribute to patient care in a meaningful way.

The trouble is that, as a student, it’s often difficult to do more. For instance, on some rotations, my classmates and I were told that we didn’t need to write notes, because they couldn’t be used as official patient notes anyway. At first, I rejoiced – writing notes, while at first novel and exciting, quickly becomes a tedious chore. But then, I realized that not writing a note meant one less way I could contribute to the team. On other rotations, even when we did write notes, the Epic medical student note template would have red, bolded text at the top that said something like, “Medical student notes are for educational purposes only. No part of this note may be copied or used.” That made me feel even less worthwhile – why was I spending time writing this note if it was very obviously not usable?

Ironically, this lack of a defined medical student role is also one of the greatest blessings of third year because it relieves you of responsibility. There were many days on my medicine rotation where our team was swamped with admissions, but since I was already carrying three or four patients of my own, my team would let me go home early, while they stayed to work till late hours, often past midnight.

But that doesn’t make it easier to come to terms with the fact that as a medical student, finding meaningful ways to contribute to the team is sometimes challenging.

I mentioned my unease to one of my faculty mentors, who gave me a piece of advice I’ve tried hard to incorporate into third year: “Your job as a medical student is to make yourself two things: teachable and indispensable. Be an excited learner, call consults, follow up on studies for patients, offer to update discharge summaries, give presentations and teach the team. Make it so that if you’re not there, the team feels the weight of your absence.”

Of course, what my mentor told me is easier said than done. But it’s helped me increase my sense of self-worth as the medical student on the team – and if any of you readers are or will soon be third/fourth year medical students, maybe it’ll help you as well. No doubt, something else that’ll help me feel better is a little vacation to reset after six straight months of clerkships – so it’s off to winter break for me! Happy Holidays and early Happy New Year to all of you!

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics. 

Photo by Adrian Clark

Education, Pediatrics, Stanford Medicine Unplugged

Empathy and the darker side of pediatrics

Empathy and the darker side of pediatrics

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

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I’m currently just over halfway through my pediatrics rotation, having recently finished up four weeks on inpatient peds and just started my month of outpatient peds.

Before this rotation, when I thought about pediatric medicine, I thought about diagnoses like asthma, croup, foreign body ingestions, and rashes. I never really thought about child abuse, or – as the medical terminology goes – “non-accidental trauma.” And yet, I saw all too much of it this past month on the wards.

Our 6 a.m. sign out one morning went something like, “Patient X, here for NAT, steadily improving, currently in CPS (Child Protective Services) custody, awaiting foster family placement.” When we met this young patient later that same morning, I found a strong mix of emotions stirring inside me: first disbelief, then overwhelming sadness, then – rapidly – anger.

How could ANY parent do this to their baby? This question repeated itself in my mind, over and over and over. I literally could not wrap my head around it. Here is this beautiful, helpless little human being – what could possibly make someone do harm to this child?

I was distressed and distracted throughout rounds that morning, until finally – unable to stay quiet – I confided my thoughts to one of the other members on the medical team, who said: “I know it feels hard to understand. But, take just a moment, and think about it from the parents’ perspective: They are no longer allowed to visit their own child. And they have to explain to literally everyone they know – friends, family, colleagues, other children in the home – why they no longer have their baby.”

Her words stunned me into momentary silence. Never had I thought to empathize with the parents of our NAT patient.

Somehow, I had taken that 2-minute sound bite uttered during morning sign-out and transformed it into a mental battlefield, with the health-care team on one side, fighting valiantly to protect this child, and the parents on the other, a medical story of “good” vs. “evil.” But my fellow team member was right: This situation was awful all around. These parents no longer had a child, the child no longer had parents, and sometimes – if the patient had siblings – the siblings too were taken into CPS custody.

This experience taught me how absolutely vital it is to find ways to empathize with every patient and every family, no matter what the circumstances. 

I feel like this is particularly relevant in the inpatient setting, where we see patients for days – which sometimes become weeks and months – at a time. We connect with our patients: They’re often the first people we see when we get into the hospital and the last ones we see when we leave. We feel like we know all about them, about their families, about their values. But we don’t.

We’re witnessing this small window of their lives that has brought them to the hospital. And as easy as it is sometimes to ask question and judge – particularly in the setting of something as sensitive as child abuse – it’s not our place to do so.

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics. 

Photo by 3rdparty

Education, Patient Care, Rural Health, Stanford Medicine Unplugged

Two weeks in Humboldt County, Calif.: Insight into rural medicine

Two weeks in Humboldt County, Calif.: Insight into rural medicine

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Hamsika among trees

As part of the family medicine clinical rotation here at Stanford, students have the option of spending two weeks doing a “rural medicine” track in Humboldt, a small 150,000-person county that is about a 5- to 6-hour drive north of Palo Alto. Each month, up to two medical students can volunteer to be in Humboldt, and Stanford takes care of arranging for hosts, clinic preceptors, and pretty much everything else. I had heard from upperclassmen that this track was “amazing” and “unique” and that I should “do it!!!” And so, three weeks ago, I found myself downloading an audiobook version of Aziz Ansari’s Modern Romance to keep me company as I made the long drive to Fortuna, California.

I’m not sure what I expected to see when I got there. For some reason, I had this dramatic idea that I would be spending two weeks with no cell phone service, spotty access to Internet, no Starbucks visible in a 10-mile radius, and paper medical records instead of an EMR. The reality wasn’t quite so bleak (in fact, the very first sign I saw in Fortuna pointed toward a Starbucks, and I had zero trouble with cell phone service and Internet access), but it was still a jarringly different experience from my first three months of rotations, spent in Palo Alto and Santa Clara.

First and most noticeable was the shortage of physicians. Everyone talks about the physician shortage and the need for primary care physicians, but it wasn’t until I got to Humboldt that I first saw this need manifest. In the clinic where I was working, there was one family medicine physician – total. Each day, he saw 25 or more patients and did everything from diabetes care to trigger point injections to skin cancer. There were poignant moments in clinic, when it was clear that a patient needed specialist care, but there simply wasn’t anyone to refer the patient to. The nearest specialist care center was UCSF, five hours away. Moreover, it was sometimes difficult to access patients’ past medical records, or records from other clinics. The EMR in Fortuna was just a few years old, and in fact, there was one day of clinic when my preceptor and I explicitly dedicated time to transferring patients’ past medical history from paper records into the EMR.

Contrast this to the second half of my family medicine rotation, which I spent at a Stanford-affiliated clinic. Over the course of 1 week in this clinic, I worked with five different family medicine preceptors, and there were still more physicians at the clinic with whom I had not worked with directly. We saw between 12 and 15 patients a day and had the luxury of scheduling in 40-minute time blocks whenever a patient needed the extra time. I had no trouble accessing patient’s medical records, not only within Stanford but from outside institutions they had been seen in in the past. Test results popped up in Epic (Stanford’s EMR) in a timely manner, with lovely color-coded labels and notifications whenever a patient was due for a vaccine. And when we needed specialist care, it was just a click away.

If I’m honest with myself (and I hope I don’t regret saying this publicly), I felt much more at ease in the latter clinic environment, where I was able to pend orders for any test I thought a patient needed, trend patients’ lab values, and declare confidently that I thought a patient could benefit from such-and-such specialist care, knowing that it was a viable option rather than a hopeful suggestion. My first two years of medical school trained me to think about what diagnoses were possible, then immediately what labs and imaging studies were needed to work these diagnoses up. I was lost in the world of rural medicine when sometimes the test to work something up was not an option. My time in Humboldt gave me much-needed perspective – not only into how far medicine has come but also what medicine was once like, and where I stand in the middle of it all.

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo of Hamsika Chandrasekar by John and Jean Montgomery

Education, Medical Schools, Palliative Care, Patient Care, Stanford Medicine Unplugged

When Mr. Bailey passed away: A student’s story

When Mr. Bailey passed away: A student's story

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged categoryCertain details in this entry have been omitted or changed, and all names have been altered to protect the identity of those involved.

387521264_d1cd33d574_zBrief life update, since it’s been more than 3 months since I’ve last posted on SMS Unplugged:

  • I disappeared for most of April through the end of May to study for and take Step 1, which – for anyone who hasn’t heard of this test – is a pretty brutal, not to mention expensive (~$590!! One of many reasons why med students are poor), 8-hour exam that tests broad concepts of medicine (biochem, immunology, organ systems, etc.) and is widely heralded one of the most important tests for residency admission.
  • I started clerkships at the end of June, with my first clerkship being in internal medicine. The rest of this entry describes one of the most poignant experiences from my first month and a half on rotations.

It was just another call day, when all of a sudden, an overhead announcement rang through the ward: “Code Blue, respond to Room 281. Repeat – Code Blue, respond to Room 281.” Instantly, the atmosphere in our team room turned serious: We knew it was one of our patients, Mr. Bailey, there. As a group, we sprinted towards Room 281. Disorganized, panicked thoughts were running through my head – oh-my-god-what-happened-to-our-patient, thank-goodness-I’m-wearing-sneakers-and-scrubs-today-there’s-no-way-I-could-run-like-this-in-flats, oh-my-god-what-happened-to-our-patient, oh-my-god.

When we got to the room, there were at least 8 people there already, with more trickling in. Our patient was covered in wires, IV lines, a face mask for oxygen. My resident stepped up to the bed and began telling everyone else about our patient’s past medical history, what we were treating him for, how his clinical course had been. I stood in the back, with the single-minded goal of keeping out of everyone’s way. For the next several minutes, at least a dozen people worked to bring Mr. Bailey back to life – and when I left the room, they had succeeded.

I walked back to the team room in a bit of a haze, the relief beginning to course through me, mixed in with remaining vestiges of adrenaline. I had only met Mr. Bailey once before, as he was primarily being followed by another member of my team. From our daily morning rounds, however, I knew he was incredibly sick. We estimated that he only had a few months left. When I met him that one time, it was so clear to see that he was struggling, to breathe, to keep his state of mind. Still, I thought it would be months, not days before he passed away.

The morning after the code, I came into the hospital at the usual time, pre-rounded on my own patients, and headed back to the team room to prep my presentation and notes for rounds. As I walked back to the team room, I ran into another team member, who asked me, “Did you hear about Mr. Bailey?” “No,” I said. “He died last night.”

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Education, Stanford Medicine Unplugged

“Us” and “them”: Losing the patient perspective

“Us” and “them”: Losing the patient perspective

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

holding hands - smallThis past Saturday, I received a call from a close friend from college that went something like this:

Friend: “Hey… so I’m in the ER right now, and I didn’t know who else to call.”
Me: “WHAT?! OH MY GOD WHAT HAPPENED?!”
Friend: “They think I have appendicitis.”
Me: “Ohhhhh – oh my gosh, thank goodness. I thought it was something really bad.” (nervous, relieved laugh)
Friend: “Wait, why are you laughing? I’m freaking out right now. What if my appendix explodes inside me? I’m so scared.”

A flush instantly spread across my face. I felt terrible.

In my head, appendicitis was relatively low on the list of all the possible horrible things that could have happened to my friend. I knew it was a common condition, that an appendectomy was a straightforward procedure, with minimal risk, and that of all the body parts to lose, the appendix wasn’t the worst by far.

When my friend mentioned that he might have appendicitis, my mental reaction was to think of all the factors that go into that diagnosis, and I was bursting to ask if he had guarding or rebound tenderness, and if the doctor’s said anything about McBurney point. (Side note – I’m currently studying for Step 1 – not that that excuses my impulse to run through a mental illness script). When that flush washed over my face, it was because I was shocked at myself: Why did I not – first and foremost – put myself in his shoes and try to feel the same pain and panic he was feeling?

I immediately apologized – again and again and again. Over the next few minutes, he asked me questions about appendicitis, how likely it was that his appendix would rupture, and more. At the end of the phone call, we had made plans to meet the next day, after his surgery, and my friend was calm. I, however, felt unsettled, and so guilty.

At our “Transition to Clerkships” retreat this past Friday, we sat in small groups and reflected on our individual hopes and fears for clinics. One of my fears was that I might become jaded or desensitized to patients’ conditions and not react with the empathy my classmates and I have cultivated and practiced so carefully. This incident with my friend brought that fear to the forefront of my mind.

I think that in many ways, it is a blessing for a physician to be somewhat desensitized to human suffering (after all, I can’t be fainting all over the place, can I?). But I also think there’s value in reflecting on how we can work to retain and prioritize that element of emotion that makes us human and that makes a doctor someone who is kind and trustworthy. As I move into clerkships this June, I sincerely hope I’m able to find that balance.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by george ruiz

Education, Stanford Medicine Unplugged

Why does “just doing medical school” feel like it’s not enough?

Why does “just doing medical school” feel like it’s not enough?

stethoscope on book - 560

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A friend from home came to visit me a while back. I hadn’t seen this friend in years, so we traipsed off campus, to a café I love, and nursed our lattes as we caught up on each other’s lives. She told me about her recent travels, highlights from her college years, her plans for the next several months and more. And then she turned to me and asked me what I was up to these days. I described what my typical day was like – workout, go to classes, study, repeat.

When I was done, she asked – “So… outside of med school, what else are you involved in at Stanford? Start-ups? Student organizations? Research?”

I felt a slight flush come over my cheeks and found myself saying, almost sheepishly, “I’m mostly just focusing on med school.” Just. Just med school. 

We continued our chat, but when I came home later, my thoughts wandered back to that “just” and why I felt so guilty about not having many outside commitments in medical school.

I knew part of it was the knowledge that I had never been a one-task kind of girl. In high school, there was debate, science Olympiad, Indian classical dance, and more. In college, there was Camp Kesem, a fusion dance team and research. I poured hours and hours into each and every one of these activities, but something in me shifted when I came to medical school.

That mental transition was and continues to be such a difficult one for me. I know Stanford is an incredible place – with start-ups blossoming every which way and the word “innovation” being uttered somewhere on campus every minute (probably not an exaggeration). Everyone around me seems so impressive – with multiple research publications, various awards to their name, travels abroad to assist with surgeries, and so on. Don’t get me wrong, I love this passion at Stanford, this drive to change the world – it’s why I came here, and why I hope to stay here as long as possible.

But it’s also easy to look at every other person and wonder how they’re doing it all, and more than that, wonder why graduating  not only with an MD (after all, everyone in the class gets one of those!) but also a string of additional achievements, feels like the baseline expectation for med students.

In just a few weeks, my classmates and I are going to be done with our pre-clerkship years and those of us who aren’t taking one or more research years (myself included) will directly transition to clerkships. I can’t wait to spend hours speaking with patients, working in a team to figure out diagnoses, and brainstorming treatment plans. I can’t wait to experience that excitement when I realize what aspect of medicine I want to practice for the rest of my life and feel that puzzle piece slide snugly into place inside me.

And I can’t wait for the moment when I can leave out the “just,” to see that same friend and happily say, “I’m mostly focusing on med school. And I wouldn’t change a thing.”

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by Dr.Farouk

Stanford Medicine Unplugged

Six thousand words to describe my decidedly non-medical winter break

Six thousand words to describe my decidedly non-medical winter break

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

This past winter break was all about me NOT being a medical student. For three blissful weeks, I didn’t have a copy of First Aid for the USMLE Step 1 anywhere near me, I didn’t log on to Coursework (Stanford’s online course system), and I barely checked my email. This is a snapshot, worth 6,000 words, of what happened instead.

Top left: I met up with a friend from high school and we baked bread from scratch! I’m not much of a baker, so the fact that this bread ended up being edible is a huge accomplishment. My younger brother ate pretty much half the loaf all by himself, which could only be a good sign.

Top middle: New Year’s Eve was spent playing a cutthroat game of Pictionary. Sadly, my team lost. But on the plus side, the game helped me stay up past my 10 PM bedtime to ring in the New Year!

Top right: Under my mom’s guidance, I managed to FINALLY learn how to make my own lattes – not that that has prevented me from spending $3 a day on coffee from the med café…

Bottom left: This picture, taken in front of Universal Studios in LA, will very likely be my only red carpet moment for a while.

Bottom middle: I got to spend an entire day with these two adorable twins. They’re entranced by a show called Peppa Pig. If you haven’t seen this show, I highly recommend you check it out on YouTube!

Bottom right: During my time in the LA area, I went with friends to not only Universal but also Downtown Disney, where we stopped by the LEGO store and created this masterpiece – and left it there for the next person to find and wonder who the heck I am.

Thus passed my winter break. And now, back to the grind – just 9 weeks till my classmates and I are done with our pre-clerkship years!

(Side note: I was struggling for a blog idea, when I remembered this entry, written by a fellow MIT alum – Elizabeth C. – back when we were both blogging for MIT admissions. All credit for this entry idea goes to her!)

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photos by Hamsika Chandrasekar

Education, Emergency Medicine, Patient Care, Stanford Medicine Unplugged

Role reversal: How I went from med student to ED patient in under two minutes

Role reversal: How I went from med student to ED patient in under two minutes

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

emergency sign - smallAs part of the second-year clinical skills course, each member of my class is required to complete two 8-hour Emergency Department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the ED, staff knew me not as a medical student, but as a recently discharged patient, grasping paperwork with my official diagnosis: “syncope and collapse.”

It was 30 minutes into my ED shift, while I was watching a pelvic exam (ironic, given my post a couple weeks ago), when I began to feel a little dizzy. I’ve fainted twice before – once in high school after getting my blood drawn, and once when watching a C-section at a clinic in India – so I recognized the signs: feeling a little hot, starting to see black dots, slightly swaying. I tried to fight off the sensation by breathing slowly, but I could tell it wasn’t working. At the earliest possible opportunity, I turned to the attending in the room, saying, “Is it okay if I leave? I’m feeling lightheaded.”

I barely waited to hear her response before I bolted out of the room and found the closest stool to sit on. Bad call. The stool had no back to it, and next thing I knew, I was on the ground. When I opened my eyes, there were at least five  nurses around me, one whom matter-of-factly said, “Honey, you just became a patient.” Another nurse quietly slipped my hospital badge off my jacket, returning two minutes later with a medical bracelet that she fastened around my wrist.

My memory of those early moments is a little shaky, but I do remember saying over and over again, “I’m so sorry, I’m so sorry.” I felt awful that I had come to the ED to learn from the patients, physicians, and staff – without being a burden – but had ended up being another patient for whom they had to provide care. The nurses and attendings immediately normalized the situation, telling me repeatedly that this is a common occurrence in the ED and that many of them had had this happen to them as well. Their assurances made me feel so much better.

The efficiency of the events that followed totally impressed me. The nurse helping me to the bed did the fastest history on me I’ve ever heard, all while hooking me up to a BP cuff and a pulse oximeter. Did I have allergies? (Nope.) Did I  have diabetes? (Nope.) When was the last time I ate? (That morning). Any other medical conditions that I’m being treated for? (Nope.) Any family history of cardiac conditions? (Nope.)

The attending who was with me when I initially felt lightheaded came in at that point and asked, “Has this happened to you before?” and when I told her about the C-section, joked, “ObGyn probably isn’t your favorite thing, huh?” She then laid out the plan for what would happen next: an EKG, a glucose stick, and a blood test, to check for cardiac abnormalities, low blood sugar, and anemia, respectively. Within 30 minutes, all three of these had been done, and I even got a bonus ultrasound thrown in by someone who was practicing recognizing cardiac pathology (not that I had any). Noticing my scrubs and med student badge, this person took the time to show me each ultrasound image, pointing out the various heart chambers, valves, and the location where my IVC entered my right atrium.

By 2 PM, my tests were all back, everything was normal, and I was able to laugh about the entire situation: Somehow, I had come into the ED hoping to practice blood draws and EKGs but came out having them done to me instead. Just another day in the life of a med student.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by zoomar

 

Education, Stanford Medicine Unplugged, Women's Health

Learning the pelvic exam with Project Prepare

Learning the pelvic exam with Project Prepare

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

This past Friday, half my class crowded into a small room in the basement of the Li Ka Shing Center. When we walked in, we saw our names written on the board, under one of the following headings: “Male Pelvic Exam,” “Female Pelvic Exam,” and “Female Breast Exam.”

It felt like a safe space to make mistakes, ask questions, and fumble a little bit – without feeling like I was in over my head

For many of us, this was our first session of Project Prepare – a 3-session, 8-hour course designed to teach medical students how to provide supportive care for patients in the area of sexual health. (The history of the program is included in this article.) The teachers in Project Prepare take the dual role of patient and educator, using their own bodies to help students learn how to perform pelvic and breast exams.

This was my first day of the course, and I was scheduled to do the female pelvic exam session with a patient-educator whom I’ll call Stacie. I had heard from other classmates who had already done this session that it was “intense” and that it took some time to emotionally recover afterwards. I’d heard from others that it was “incredible;” one classmate even said it made her to want to be a Project Prepare patient-educator herself. The many mixed messages rolled together in my mind and distilled into a single overwhelming sense of anxiety.

But Stacie made everything so easy. She didn’t beat around the bush about how awkward or uncomfortable the experience could be. The first thing she asked us was, “What have you heard about Project Prepare?” and when I said I’d heard it was “intense,” she responded, “Why do you think that is?” In doing so, she set the tone for the rest of the afternoon: gentle, filled with open-ended questions and non-judgmental responses.

Over the next three hours, Stacie guided a fellow classmate and me through the exam techniques and word choice that accompany the 5-part female pelvic exam. She pointed out nuances that would never have otherwise crossed my mind, like how saying “that’s perfect” and “great” are fine in other parts of a medical interview or exam but painfully awkward and even inappropriate in the context of a pelvic exam.

After the session, I looked up Project Prepare, curious as to how many medical schools invite the team to their campuses. I was surprised to see that only Stanford, Touro University College of Osteopathic Medicine (both in CA and NV), Kaiser, and UCSF are on Project Prepare’s list of clientele. Though I still have two sessions left, it is so clear to me that Project Prepare is a unique, effective way of teaching students the pelvic and breast exams. As a medical student, the idea of doing these delicate exams for the first time on a real patient (one who is not simultaneously a trained educator) is terrifying. I had this experience last year, at Stanford’s Arbor Free Clinic, where I performed my first pap smear, with the guidance of an attending physician. I recall how scared I felt that I might hurt my patient and somehow “mess up.” In contrast, my experience with Project Prepare felt like a safe space to make mistakes, ask questions, and fumble a little bit – without feeling like I was in over my head.

This week, I have two more sessions with the Project Prepare teaching team, and this time, my feelings leading up to the sessions are colored with excitement rather than anxiety. To the Project Prepare patient-educators: Thank you so much for sharing your time, your knowledge, and most of all, your bodies, with us, as we take this journey from classroom to clinic. Our medical school experience feels more complete because of you.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Previously: Reality Check: When it stopped feeling like just another day in medical school

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