What You Don’t Know…

James 1:5
“If any of you lacks wisdom, he should ask God, who gives generously to all without finding fault, and it will be given to him.”NIV

It has been a while since I’ve posted a blog.  My apologies for the absence.  Since my last post, a ton has been going on.

It has been both overwhelming, exciting, and of course, a blessing.

An update is due:

I have taken and passed STEP 1, by God’s grace, around the holidays.   At the end of January, I moved across the pond to the U.K to commence my 3^rd year clinical rotations.  I will be completing all my cores in England, and then heading to America for my 4^th year electives.  Well, most of them anyway.  Plans are underway to do up to 8 weeks of electives in Africa (more on that in another post).

So, as I sit here today, I have nearly completed two months of my first rotation, Internal Medicine, in England.  It seems surreal that time can actually go by so fast.

Almost everyday in the clinical setting has given me ideas for blog posts, so that you may get a glimpse of what clinical rotation is like, compared to basic sciences.  It has been a wild ride, thus far.  I will definitely post memorable anecdotes during this clinical year.

However, as in introduction to my future clinically-oriented posts, I would like to briefly give you an overview of what clinical rotations has been like!

This is the third time in the last five years that I’ve moved to another country to start a new adventure.  This always combines certain emotions together.  Starting anything new is stressful.  Starting something new in a new country brings its own unique stressors.  Compound that with the major time difference, and well, you get the picture.

Coming to England to “study abroad” has always been a dream of mine.  Unfortunately, majoring in Biology at Oakwood didn’t leave much room to study abroad.  I am fortunate that being a foreign medical student afforded me the opportunity to follow this dream at last.  Choosing to come to the U.K was an absolute NO BRAINER!

And I don’t regret it for one second.

Upon my arrival, I got oriented and comfortable in my accommodation a few steps from the hospital.  The weather in England was a stark contrast to the weather I left in West Palm Beach.  This didn’t help the jet-lag situation, but since sleep is my best friend, I didn’t mind the extra zzz’s.

Internal Medicine (IM) is housed under “General Medicine” because you “know a little about a lot” in regards to adult medicine.  However, within Internal Medicine, there are many subspecialties.  These include: Infectious Diseases, Allergy & Immunology, Cardiology, Endocrinology, Pulmonary, Rheumatology, Hematology, Gastroenterology, Neurology, and Nephrology.  If you are interested in any of these specific fields, IM is an excellent specialty to go into, so that you may sub-specialize later in your career.

Before I continue, I would like to mention some brief differences between the titles of doctors in the U.S and U.K.  In the U.S, new doctors in their first year of residency are called “Interns.”  In the U.K, they are called “F1” for Foundation Year 1.  Thereafter, residents in the U.S are just called residents, and then they can become Chief Residents.  After that, they are Attendings.  In the UK, the second year is F2.  After further training, they are considered Registrars.  It takes many years of training to become a Consultant in the U.K (which is synonymous to Attending).  Also, doctors are called by their first names in the U.K and they don’t wear a white coat, for sanitary reasons.  Only Consultants are called doctors, and surgeons are called Mr./Mrs.

I started my IM rotation with Infectious Diseases.  Starting with Infectious Diseases (ID) left my heart with a gleam and wide open to the possibility of specializing in this unique field, due to my interest in Global Health.  My hospital is located in a very diverse populace of immigrants from India, the Middle East and Africa.  With this, comes the introduction of many diseases not seen frequently in the West, but studied while in Basic Sciences.  For example, I am well versed in Tuberculosis in its many forms due to the astounding cases of TB at my hospital.  This would not have been the case had I been in the U.S.  This is true of several other illnesses and interesting infections I’ve seen during my 3 weeks with ID.

So far in my training, I have been given lots of opportunity for hands on learning.  You just have to ask!!  I have learned how to draw blood, do Arterial Blood Gases (ABGs), take blood cultures, put in IV cannulas, assisted in Lumbar Puncture, take several patient histories and physical examination (“clerking” a patient).  I even assisted in a cardiac arrest by doing chest compressions during my voluntary weekend call.  I attended and witnessed Catherization Labs (“cath lab”), Colonoscopy labs (and I will get to do a colonscopy soon).  I even get to do the not so glamorous necessities, such as rectal exams (called PR in the UK).   There are several other “skills” I want to make sure I attempt or at least observe before I finish IM in 4 weeks: urinary catheter, central line, LP, ascites drain, etc.   Phew!

However, one theme that constantly bombards me while in the wards is how much I don’t know or have forgotten since Basic Sciences.  I look in awe at all the physicians and their apparent ease in navigating this art that is medicine.  It’s only when a humble enough junior doctor assures me that they felt the exact same way that I breathe a sigh of relief.  Therefore, feeling inadequate in medical acumen in the wards is far from a unique feeling, even amongst practicing physicians!  And it is this awareness of gaps in knowledge that keeps us on our toes to continue to research, study, and keep up to date with medicine.

Unfortunately, the medical field has a way of making us feel that inadequacy is unacceptable, and therefore, at times many of us have faked understanding.  This can be deadly for the patient!

So, my theme in the wards has been to ask questions! Asking a question may make me seem/feel inadequate for a few moments, but not asking will certainly make me feel inadequate for a lifetime.  I am a student; therefore I am here to learn.  If I knew it all, I wouldn’t need to pay thousands of dollars in tuition fees.

This feeling of “not knowing” will follow me into residency, as is evidenced by friends’ and colleagues’ testimonies of how they feel in their first year of training.  In my opinion, not knowing is NOT the crime.  Not asking is!

I am very fortunate to be here, a student of medicine.  I love every second of it, and I wouldn’t change this path that I’m on for anything else.  This year is turning out to be one of the best years of my life.  On top of which, I’m in Europe!

This means, I also get to indulge my other passion: traveling!

I just came from Spain and in a few days I’m headed to Switzerland.  Several other trips are under way, as well.

I am excited to chronicle what medical school is like when my head isn’t buried in the books!  Please join me on this amazing journey.

Are there any specific topics you’d like to see discussed in regards to clinical rotations? Let me know in the comments and I’ll be sure to include them in future postings.

~Tacha