It's that time of year again.
When you see people wearing socks and sandals, you're either in a hospital or in Finland. (No judgement! The practicality of wearing one pair of shoes through three seasons is unsurpassable.)
This summer, I'm working in the Internal Medicine department again, but this time with the title of 'substitute doctor'. In Finland, medical students can work as doctors with limited rights after their fourth year of studies. Upon completing your eighth academic semester, you can apply for a student doctor license from Valvira (the National Supervisory Authority for Welfare and Health).
If there is only a short amount of time between your last exam and your first day of work, you can work as an intern until the glorious moment your license arrives.
The difference between being an intern (or 'amanuenssi' in Finnish) and being a student doctor was bigger than I expected. (You can read about my experience last summer as an intern here!) Along with a heftier pay-check comes responsibility. I can sugarcoat the 'great learning experience' but everyone gets enough superficial fabrication in a day so I'll just go straight to the truth.
TRUTH: It's exhausting.
The responsibility takes a toll. My very first day after getting my license I was working in the emergency room and sent a bradycardic (slow heart rate) patient to the CCU (Cardiac Care Unit). I wasn't aware that I had to modify his drug list before sending him to another department filled with resident doctors and cardiologists. In other words, I sent a patient with bradycardia to another department without stopping his heart rate lowering drugs. If you have a slow heart rate and take take drugs to lower it, you don't have to have a medical degree to realize these drugs need to be paused. I wasn't at work for an hour before my boss (the department head) comes from the CCU with and ECG and drug list in her hand an announces to the ER "Katrina is going to tell everyone what she should have done differently."
Lesson learned. Check the damn drug list. (Duh.)
But what makes this job exhausting is constantly being on point. Being on top of everything, reconsidering your every order, drug administration, lab test. Monitoring things on your patient you didn't even know could be monitored. Being on top of everything, all the time, as an amateur, is exhausting.
TRUTH: It's terrifying.
The self-doubt is real. Continuing the aforementioned experience, you can kill someone. If you're irresponsible or don't ask when you're unsure, you can make a big mistake with life-threatening ramifications. Understanding that is not only imperative in your decision making, but also how you treat yourself and others. Keeping calm while you're confused, unsure, anxious and exhausted is a skill only the best doctors master.
TRUTH: You'll want to blow a fuse.
But don't. There was one afternoon in the ER where I nearly flipped a sh*t. I had three patients waiting to be seen, hadn't eaten in six hours, I was incredibly stressed and had an urgent patient who needed an arterial blood gas sample. Both her wrists were taped up so I knew I needed to take the sample from her brachial artery (as opposed to the usual radial) = an added challenge to the already stressful day. We have a wonderful young intern in the department now who is very eager to learn, so he tagged along as I attempted to take the sample. I gathered what I needed in a very un-ideal setting with a vomiting man behind the curtain in the neighboring bed, but proceeded to talk my way through the procedure. As I started to prepare the sample, I felt myself get very warm. The intern started to ask questions. The vomiting continued. My work phone started to ring. A nurse came to ask me a question.
As I felt my body start to approach 600° I knew I could either yell some four letter profanity and tell everyone to calm the f**k down, or, I could calm the f**k down. I excused myself from the setting, went into the doctor's room, answered the phone call and then went into the bathroom to hyperventilate. I stood over the sink for a solid 10 minutes before I gathered myself up and took myself back to work.
I got the sample. Answered the phone call. Answered the nurse. And no one died. Win-win-win-win. Gather yourself when you need to. Everyone wins. We're all losing our sh*t, some just hide it better than others 🙂
TRUTH: Nice people are nicer to work with.
There's a noble thought, right? 🙂
There's a great rule in Mikkeli hospital where you always answer your phone. No matter what. I'm pretty sure I've consulted an anesthesiologist while he was resuscitating a patient. No matter how busy you are, if everyone answers their phone when it rings, work just progresses and it's beneficial for everyone. If you had to wait for a consult as long as a lab test result, work would go at a glacial pace. There are times when you want to forget that rule because anything and everything you're doing at that moment feels far more important than answering your phone, but don't be a stubborn bitch and just answer your phone."I have 9 patients I don't know how to treat, haven't eaten in 7 hours, don't know why my patient is foaming at the mouth, haven't gone to the bathroom in hm, lets see, 13 hours, but SURE! Go ahead!"
Teamwork friends 😉
Be nice to the people you work with. I found that trying to learn all the nurses first names made cooperating with them so much more enjoyable. Saying "Thanks Sanna" as opposed to a simple "Thanks" goes a long way. (Ps. in case you're blissfully unaware: nurses run the show, best be good to them 😉 )
There's nothing better than a good work environment. A healthy work setting is supportive, encouraging, fearless, inspiring and educational. You can never work at your full potential if you're not surrounded by colleagues who strengthen and empower you, so why not be one of those people? 🙂
If there's one important lesson I've learned this summer, it's the insignificance of my previous attitude that exam grades correlate with the kind of physician you will become. You can have a 4.9 GPA and memorize every textbook in the library but that still determines nothing. Anyone can read books. Becoming a great doctor involves more than sitting in the library until 11p.m. The truth about transitioning from a student in the library, with the sole responsibility of needing to pass an exam, to a doctor in the ER where people actually depend on you for their well-being, is daunting. Sure I work as a doctor now, but I've merely dipped my toe in the water. What I can take away from this summer is understanding I still have a long road ahead. But being surrounded by colleagues that teach you the essentials, and make you laugh to tears after tackling a 14 hour work day makes a grueling jacket-sprayed-with-pee, patient-vomit-everywhere, endless academic journey that much better 🙂