If They Came To Hear Me Beg They Shall Be Disappointed
I suppose this is as good a time as any to start to get into the experience that has been my rotations thus far. I'm sure you're wondering why I'm doing this so early in the morning and on a weekday. As luck would have it, this day is a day off for my current one. So I've decided to take advantage of it to the fullest.
The first two rotations were ones that made me wish to God I could go back to November of 2009 and rethink my decisions. Particularly the first one but the second one was not much better. I must say it was a shock to my expectations. And I don't think very highly of people that were making the decisions in placing me in the two most challenging positions right at the outset of the experience.
The first one was acute care with Dr. Elsasser. Acute care, for those who are as unfamiliar with the term as I admittedly was at the outset, is people who are going to the hospital for basic emergencies. Broken bones and pneumonia that requires hospitalization are good examples of what the experience entails. Needless to say there's a lot going on with a lot of the patients and Elsasser expected us to know it all, regardless of whether it was relevant to the reasoning behind the person's hospitalization. Also he wasn't the most forthcoming in the explanations at times. He had this example of what an A patient review was but neglected to explain the mechanics of why it was an A paper.
To his defense, he was a very knowledgeable person about the profession, I'd say it would be a challenge to find someone who knew more. Going along with that fact, I think he had gotten to a position similar to that of an MD in prestige and the accompanying ego. The conundrum that came from all of this was that I liked him when he did the lectures for therapeutics. But the sterile environment of having someone lecture a few times in class is a very different environment than actual practice entails.
I'm trying to remember some of the particulars, one of my first cases and the first one I presented on had a rare side effect that was oft discussed in class but seeing it in the flesh crystallizes the knowledge much more than time in a classroom does, that and knowing that actions and decisions you make actually affect a real person. That, of course, is the whole point of the experience. And we had a significant number of sessions in the afternoon where much was learned over various topics many related to select articles from literature that were mandated reading material.
I will confess, I learned much at a very rapid rate on this rotation. I must also say the victory gained by that rate of knowledge gain would have to be a Pyrrhic victory because if I had to continue in that environment it would have ground me down to nothing in short order. Elsasser's methodology of castigation and intimidation when things were not to his pleasure made me liken the experience to going to my execution on a daily basis. Even knowing what I gained, I would be hard pressed to call the experience worthwhile.
My time was made doubly difficult by a disturbing development on the home front. On the eve of my final day, with a combination of both a presentation and my final paper to do, my dad called and casually informed me that he had "taken a mental health day". That's one of his many euphemisms for getting drunk. I knew it was disturbing right from the beginning for the simple reason he never calls unless he's stuck in an airport terminal with nothing better to do. I blame myself for feeling bad about this. For the first time that I can remember I had begun to hope that the awful days of the past might finally be done and the rifts between us might have a chance to heal. Part of this is that there had been a minor scare that I note that I failed to mention in my earlier writings. Back in March he'd undergone surgery to get rid of some polyps. A further examination of the offending polyp revealed something far more vexing: carcinoid cancer. All the preliminary scans following that had shown that things seemed alright. The option was being tossed around the table about doing a second surgery that was more along the lines of what they say they would have done had they known the polyp was a tumor. But at the time it seemed he had dodged a major bullet. The slipping back into drinking which is ALWAYS accompanied by smoking which is not good news when it comes to cancer. Let's just leave it his little moment could not have come at a worse time. Mom was furious that he had called me like that and frankly so was I. This wasn't him coming to me hat in hand legitimately feeling sorry for what he did; he was looking for absolution just to make himself feel better.
In any case, at the significant cost of sleep, I was able to pull through and get the job done. While the moments up to the deadline were a frenzy of activity, mostly putting in details that were probably unnecessary, but I did it to be as thorough as possible since Elsasser had done nothing in the way of trying to ease the burden in that regard. The moment I hit submit on that email was the moment of release. For the first time in five weeks, I was a free man, no obligations or deadlines. It felt good to an extreme that is hard to put in words. I went and established a tradition that has been followed with all of the subsequent rotations and got dinner out at Olive Garden. Whatever the results may be of this hellish experience, it was out of my hands at that point. One trait of mine that is a saving grace in this profession is the ability to disconnect from the tasks at hand, particularly once they are done. To be blunt, it is a necessary tool of survival. After I ate, I think I slept pretty much from the early evening right on through to the morning wake up for my shift at Wal-Mart.
A confounding difficulty in this time came on multiple fronts. One major one was the fact that my schedule of work at Wally world did not decrease in the slightest. Rather, I was told, things were going to increase. I had expressed some doubts about my abilities to keep up the pressure, but Diane pooh-poohed those in short order, she said rotations were easy. This was before I had the empirical evidence to the contrary and even then I was aware that this was one of the more difficult rotations before I found out that psychological torture was an integral part of the experience. More on that later. And even on the weekends that were not dedicated to the jungles of Wal-Mart were spent at home and in manners that were decidedly less than relaxing. My first weekend home we went out to the farm and worked cattle and the second was the 4th of July weekend. Never has the isolation from even the slightest hint of internet connection been such a vexing factor. Without it, my ability to work on anything was severely curtailed. But I'll say no more about the experience, I survived it and was ready to move on.
Unfortunately my next item on the itinerary was not that much better. Infectious disease with Dr. Destache, the first of my elective rotations. It has been a topic of interest for some time now and once again I learned a lot. And thankfully Destache was not inclined to try and play bully with me. It was still a stressful time and for all intents and purposes acute care part 2. I had a lot of things come through my hands and it was a very interesting time where we saw a lot. We would meet in the labs before going on rounds and saw a lot of cool stuff. One of the techs showed us a plate with MRSA on it. I have oft said in retrospect I was not entirely comfortable with how close they had held the opened plate of the stuff to my body when they showed it to us. On this one we did not have nearly the patient volume as the last one, which helped considerably, but the level of detail was cranked up a notch when I didn't even think that was possible. Most vexing about the experience was during the midway review, I got the impressions I was doing a fine job just to open the review on the website and basically be blindsided. I have no problems with places I need to improve, I'm here to learn and, more importantly, I'm PAYING for that service. I can understand not giving constant correction, but at least tell it to my face in the review. The rotation began to reacquire the sense of misery that the last one had when I had admittedly started to feel at least a little better about things prior to that. And, to my dismay, Elsasser showed up for my presentation, a most unwanted development. I think his being there had a lot to do with me doing something I have never done on an oral presentation before, completely flubbing and loosing my sense of what I'm talking about. It didn't end well. My review of the rotation was considerably harsher than my first one had. I had been a little more favorable in an effort to extend the olive branch and also because I was not aware that my grade was determined before they got to see the review. In retrospect, I wish I could rewrite the review at times. But I don't too badly for several reasons. First of all, I've never put much stock in those reviews anyway. I don't see any point in putting any effort into those things when my time in the experience has already passed. I also think the opinions I make are of dubious value, doubly so in this case. I think Elsasser would be the same person regardless of what I said, so why even bother? Finally, and most importantly, there is the chance that the action might have consequences. He may not be able to lower my grade based on my review of him, but I'm sure other ways could be found to add to my discomfort. A general rule in life is if you don't want to get shot at, not shooting first is an excellent approach. I may have been a little harsher with Destache than I should have been in retrospect, in some senses I was doing the passive aggressive thing since I hadn't with Elsasser and the two of them were good buddies. And he's also a decent guy all-in-all, just the classic example of a researcher whom I'm sure would be much happier devoting his full energy towards that endeavor.
Turning in my CUMC ID badge was a task I took a lot of pleasure in. If I didn't have to set foot in that building ever again in my life or see most of the principles in the previous weeks, I would be perfectly fine with that. Some of my colleagues were not exactly supportive. In the first one, there was one whose treatment of me bordered on out and out sabotage. The second one there was one whose whiny nature became more than a little grating. I remember one comment she made about excusing it as being an only child. My immediate thoughts were "so am I, the difference is I was raised right." My discretion in my commentary has undoubtedly saved me a lot of trouble, let's hope I can keep that up for the future, pharmacy is a profession where you'll bite your tongue in two with the things some people put you through. And my trips home did not improve much either. I got to relax at home the first time back and the second time we had some minor basement flooding when a massive deluge passed through the area. So I was quite busied with helping with that in addition to my duties associated with my rotation. On top of that, Dad came down with the flu Friday night. I knew that did not bode well and sure enough, Sunday night when I was back, the same stomach flu hit me too. Somewhat fitting I guess, seeing as how it was an infectious disease rotation, still, I would have rather not been a living example of our studies.
Well that's a summary of the experience that took me down more than a few pegs. Its hard to think that its already been half a year since then. I survived my journey into the howling dark and came out my confidence shaken, for the first time doubting my decision to go this route, but still alive. And things were set to get better.
The first two rotations were ones that made me wish to God I could go back to November of 2009 and rethink my decisions. Particularly the first one but the second one was not much better. I must say it was a shock to my expectations. And I don't think very highly of people that were making the decisions in placing me in the two most challenging positions right at the outset of the experience.
The first one was acute care with Dr. Elsasser. Acute care, for those who are as unfamiliar with the term as I admittedly was at the outset, is people who are going to the hospital for basic emergencies. Broken bones and pneumonia that requires hospitalization are good examples of what the experience entails. Needless to say there's a lot going on with a lot of the patients and Elsasser expected us to know it all, regardless of whether it was relevant to the reasoning behind the person's hospitalization. Also he wasn't the most forthcoming in the explanations at times. He had this example of what an A patient review was but neglected to explain the mechanics of why it was an A paper.
To his defense, he was a very knowledgeable person about the profession, I'd say it would be a challenge to find someone who knew more. Going along with that fact, I think he had gotten to a position similar to that of an MD in prestige and the accompanying ego. The conundrum that came from all of this was that I liked him when he did the lectures for therapeutics. But the sterile environment of having someone lecture a few times in class is a very different environment than actual practice entails.
I'm trying to remember some of the particulars, one of my first cases and the first one I presented on had a rare side effect that was oft discussed in class but seeing it in the flesh crystallizes the knowledge much more than time in a classroom does, that and knowing that actions and decisions you make actually affect a real person. That, of course, is the whole point of the experience. And we had a significant number of sessions in the afternoon where much was learned over various topics many related to select articles from literature that were mandated reading material.
I will confess, I learned much at a very rapid rate on this rotation. I must also say the victory gained by that rate of knowledge gain would have to be a Pyrrhic victory because if I had to continue in that environment it would have ground me down to nothing in short order. Elsasser's methodology of castigation and intimidation when things were not to his pleasure made me liken the experience to going to my execution on a daily basis. Even knowing what I gained, I would be hard pressed to call the experience worthwhile.
My time was made doubly difficult by a disturbing development on the home front. On the eve of my final day, with a combination of both a presentation and my final paper to do, my dad called and casually informed me that he had "taken a mental health day". That's one of his many euphemisms for getting drunk. I knew it was disturbing right from the beginning for the simple reason he never calls unless he's stuck in an airport terminal with nothing better to do. I blame myself for feeling bad about this. For the first time that I can remember I had begun to hope that the awful days of the past might finally be done and the rifts between us might have a chance to heal. Part of this is that there had been a minor scare that I note that I failed to mention in my earlier writings. Back in March he'd undergone surgery to get rid of some polyps. A further examination of the offending polyp revealed something far more vexing: carcinoid cancer. All the preliminary scans following that had shown that things seemed alright. The option was being tossed around the table about doing a second surgery that was more along the lines of what they say they would have done had they known the polyp was a tumor. But at the time it seemed he had dodged a major bullet. The slipping back into drinking which is ALWAYS accompanied by smoking which is not good news when it comes to cancer. Let's just leave it his little moment could not have come at a worse time. Mom was furious that he had called me like that and frankly so was I. This wasn't him coming to me hat in hand legitimately feeling sorry for what he did; he was looking for absolution just to make himself feel better.
In any case, at the significant cost of sleep, I was able to pull through and get the job done. While the moments up to the deadline were a frenzy of activity, mostly putting in details that were probably unnecessary, but I did it to be as thorough as possible since Elsasser had done nothing in the way of trying to ease the burden in that regard. The moment I hit submit on that email was the moment of release. For the first time in five weeks, I was a free man, no obligations or deadlines. It felt good to an extreme that is hard to put in words. I went and established a tradition that has been followed with all of the subsequent rotations and got dinner out at Olive Garden. Whatever the results may be of this hellish experience, it was out of my hands at that point. One trait of mine that is a saving grace in this profession is the ability to disconnect from the tasks at hand, particularly once they are done. To be blunt, it is a necessary tool of survival. After I ate, I think I slept pretty much from the early evening right on through to the morning wake up for my shift at Wal-Mart.
A confounding difficulty in this time came on multiple fronts. One major one was the fact that my schedule of work at Wally world did not decrease in the slightest. Rather, I was told, things were going to increase. I had expressed some doubts about my abilities to keep up the pressure, but Diane pooh-poohed those in short order, she said rotations were easy. This was before I had the empirical evidence to the contrary and even then I was aware that this was one of the more difficult rotations before I found out that psychological torture was an integral part of the experience. More on that later. And even on the weekends that were not dedicated to the jungles of Wal-Mart were spent at home and in manners that were decidedly less than relaxing. My first weekend home we went out to the farm and worked cattle and the second was the 4th of July weekend. Never has the isolation from even the slightest hint of internet connection been such a vexing factor. Without it, my ability to work on anything was severely curtailed. But I'll say no more about the experience, I survived it and was ready to move on.
Unfortunately my next item on the itinerary was not that much better. Infectious disease with Dr. Destache, the first of my elective rotations. It has been a topic of interest for some time now and once again I learned a lot. And thankfully Destache was not inclined to try and play bully with me. It was still a stressful time and for all intents and purposes acute care part 2. I had a lot of things come through my hands and it was a very interesting time where we saw a lot. We would meet in the labs before going on rounds and saw a lot of cool stuff. One of the techs showed us a plate with MRSA on it. I have oft said in retrospect I was not entirely comfortable with how close they had held the opened plate of the stuff to my body when they showed it to us. On this one we did not have nearly the patient volume as the last one, which helped considerably, but the level of detail was cranked up a notch when I didn't even think that was possible. Most vexing about the experience was during the midway review, I got the impressions I was doing a fine job just to open the review on the website and basically be blindsided. I have no problems with places I need to improve, I'm here to learn and, more importantly, I'm PAYING for that service. I can understand not giving constant correction, but at least tell it to my face in the review. The rotation began to reacquire the sense of misery that the last one had when I had admittedly started to feel at least a little better about things prior to that. And, to my dismay, Elsasser showed up for my presentation, a most unwanted development. I think his being there had a lot to do with me doing something I have never done on an oral presentation before, completely flubbing and loosing my sense of what I'm talking about. It didn't end well. My review of the rotation was considerably harsher than my first one had. I had been a little more favorable in an effort to extend the olive branch and also because I was not aware that my grade was determined before they got to see the review. In retrospect, I wish I could rewrite the review at times. But I don't too badly for several reasons. First of all, I've never put much stock in those reviews anyway. I don't see any point in putting any effort into those things when my time in the experience has already passed. I also think the opinions I make are of dubious value, doubly so in this case. I think Elsasser would be the same person regardless of what I said, so why even bother? Finally, and most importantly, there is the chance that the action might have consequences. He may not be able to lower my grade based on my review of him, but I'm sure other ways could be found to add to my discomfort. A general rule in life is if you don't want to get shot at, not shooting first is an excellent approach. I may have been a little harsher with Destache than I should have been in retrospect, in some senses I was doing the passive aggressive thing since I hadn't with Elsasser and the two of them were good buddies. And he's also a decent guy all-in-all, just the classic example of a researcher whom I'm sure would be much happier devoting his full energy towards that endeavor.
Turning in my CUMC ID badge was a task I took a lot of pleasure in. If I didn't have to set foot in that building ever again in my life or see most of the principles in the previous weeks, I would be perfectly fine with that. Some of my colleagues were not exactly supportive. In the first one, there was one whose treatment of me bordered on out and out sabotage. The second one there was one whose whiny nature became more than a little grating. I remember one comment she made about excusing it as being an only child. My immediate thoughts were "so am I, the difference is I was raised right." My discretion in my commentary has undoubtedly saved me a lot of trouble, let's hope I can keep that up for the future, pharmacy is a profession where you'll bite your tongue in two with the things some people put you through. And my trips home did not improve much either. I got to relax at home the first time back and the second time we had some minor basement flooding when a massive deluge passed through the area. So I was quite busied with helping with that in addition to my duties associated with my rotation. On top of that, Dad came down with the flu Friday night. I knew that did not bode well and sure enough, Sunday night when I was back, the same stomach flu hit me too. Somewhat fitting I guess, seeing as how it was an infectious disease rotation, still, I would have rather not been a living example of our studies.
Well that's a summary of the experience that took me down more than a few pegs. Its hard to think that its already been half a year since then. I survived my journey into the howling dark and came out my confidence shaken, for the first time doubting my decision to go this route, but still alive. And things were set to get better.