Saturday, September 29, 2007

Alphabet Soup

I signed my first chart today. Eisha Z, MS 1. What a sight.

With the assistance of a seasoned third year medical student, I composed my first SOAP note in my patient's chart. SOAP (in medical terms) does not represent a hygenic product; it stands for subjective, objective, asssesment, and plan. Essentially, a SOAP note serves as a fancy way to recap the patient's words, our findings, and the next steps in medical care.

Writting the note for one of my first patients was an interesting experience--the equivalent of translating the patient's symptoms, vitals, history, medications, allergies, social history, interview, and treatment plan into a medical language that could probably be only understood by healthcare providers. For goodness sake, it takes three people to make out the handwritting.

Entering medicine as a first year student is like learning a new language that seems to get more and more complicated as you venture further. In addition to all the acronyms--NAD, HPI, CC, HTXN, Hx, NPO-just a few of the new words I learned today--the words get longer and more difficult to pronounce, the anatomical structures get more complicated, and time slips away. And despite all the challenges, I stand here even more excited for the years to come.

* * *

The challenge of medicine is not limited to the alphabet soup contained in a patient's note; it extends into the realm of the patient-physician interaction.

I would consider myself to generally be a articulate and social (and my friends would attest to my ability to talk on and on and on). I don't think I can remember the last time I was short of words. In fact, my problem is that I lead long conversations that linger on and on and on. I admit it; But today, I was unable to keep the conversation going.

I was inhibited by my limited Spanish. In my mind, I knew exactly what I wanted to say. But I had difficulty stringing the words together. For the first time in a long time, I was silent and listening and barely understanding (and being understood).

"Que es tu problema?" My problem is that I should never ask a Spanish-speaking patient that question (it's rude). There are certainly better ways to elicit a chief complaint (CC), but my limited Spanish left me struggling to phrase questions. As my patients reported to the Spanish-speaking medical student I accompanied, I could understand what it feels like to be in a world where you are barely understood because of the language you speak, your view points, your beliefs, etc. I will need to revisit my high school Spanish book before returning, but I am interested in learning so I can understand and so that I can be understood.

In a way, my early clinical exposure has given me a deeper understanding (and a reminder) of why I decided to enter medicine in the first place. My first few weeks have been brimming with endless facts- everything from anatomy to biochemistry to genetics to physical exam techniques. I have begun interviewing and seeing patients; first at the homeless shelter earlier this week and again today (on Saturday).

I am a 22 year old (22 y/o) medical student with four weeks of medical training. And yet, I'm standing face to face with patients and learning about their life, everything from hearing the most intimate details of their social Hx to listening to the "lub dub" of their hearts and the sounds of their lungs with my shiny red stethoscope. In a 30 minute exchange, I enter the life of a stranger and become their healthcare provider. I become responsible for my patient's well-being. What a duty.

With an upcoming exam in less than a week, I am starting to wonder how much can one retain and when the letters of the medical language come together to form words.

Being immersed in medical and biological facts (and I feel like I'm way in over my head most of the time) has been a transformative experience. At times, I feel overwhelmed, exhausted, tired, and worried my brain will expand beyond its capacity. But then I learn more and more and more and continue to worry my brain has reached its capacity and just simply leaks facts to make more space for new fascinating facts. Perhaps, I am just expressing my pre-exam jitters.

Whatever the case, I am determined to make sense of this alphabet soup, so I can continue to sign future charts and tell stories of my patients in a language that makes sense.