Over the winter holiday break, Jackie, a fellow MS2 on the Terre Haute campus, suggested that students from the Terre Haute campus sign up en mass to volunteer at the IUSM Student Outreach Center.
The SOC is a very unique, student-run wellness center where the uninsured or otherwise financially challenged can come to receive evaluation and potentially treatment, medications as available, or referral for whatever might be bothering them.
Not only do students from the med school participate, but students in pharmacology, social work and law do as well, and Dr. Frick volunteers as the final word on each patient (and educational resource for the students).
I liked Jackie’s idea, but had some trepidation about what to expect when we actually arrived.
On a frigid bright morning-yesterday, January 14th, 2012, in fact-I drove Jackie and Tyler to join Anna and Derek at the Center at 9:30am. With light Saturday morning traffic on I-70, we had a rambling conversation on the way over and the day felt like it was off to a good start.
We didn’t know exactly where to go in, but as soon as we did enter, we were greeted with a warm environment of fellow students and potential patients. I was surprised to find one of the student board members was non-other than Charles Goodwin, a fellow blogger, and remarkable MD/PhD student (gratuitous compliment, but he was great to work with).
See his blog here:
We were quickly oriented to the format of the day, after a few minutes of social interaction and kidding with the students (who ranged from a single, remarkably capable first-year, through several MS3s and MS4s), and when 10am rolled around I was lucky enough to be the second student to be handed a chart and triage my first patient.
The independance was exhilarating, and I found myself for the first time feeling like, hey, I am responsible for this patient’s well-being; I better get this right.
I can’t think of a better way to instill clarity into the soup of learning med school can become.
My initial role, however, wasn’t a brain transplant. I took vitals by trying to juggle a clipboard on my lap and fish my BP cuff from various scrub pockets and assemble it. My first patient was great; from his chart, I could tell this was his first visit, yet he dealt with my various contortions and apologies for ineptness with dignified patience and good humor.
I should mention that while dressing that morning, I made the wise decision, after consultation with my wife, to wear long underwear under my crisp blue scrubs. I am so happy for that.
The Center is a wonderful example of what I would guess is early 20th century parochial school architecture, designed for maximal use of natural light and most likely steam heat via a boiler, though I suspect that system had been updated to modern forced-air heating.
In an era before modern insulation, the thermal mass of the bricks was expected to suffice in maintaining a reasonably stable temperature, which means that when people arrive in the morning and turn the thermostat up, it can take awhile for the room air to adjust, and even though the windows were modern updates with good seals, the heat loss through the glass further delayed that warming feeling we all needed-especially the patients, who I repeatedly apologized to when palpating their abdomen or searching for a pulse with my icy cold fingers.
(After all that blah blah, I could have just said it was 11 degrees outside and a bit chilly inside, so my hands were both cold and a little clumsy. I dropped things, repeatedly, and my pen didn’t work so well, which began this particular narrative.)
Back to me trying to record my patient vitals and chief complaint before corralling a 3rd or 4th year student for further evaluation; my apparently chilled pen is recording a sad, patchy script that even a pharmacist couldn’t likely read (Ever helpful, one of my patients, later in the day, explained how they sometimes would use a lighter to warm up the pen).
Thank goodness for pharmacy students, who always have extra pens, and allowed me to borrow one, knowing they might never see it again (it later fell apart on the floor and I had to hold my thumb over the back end to continue using it because one part disappeared under a cabinet-I don’t know what I did to it).
It seemed that everyone involved in this ‘doctor incubator’ understood the uncertainty that can occur, and it was set up so that you understood you were never alone in any decision.
You are free to perform a focused H&P (history and physical) if you are comfortable doing so, but you are also encouraged to grab a 3rd or 4th year student after the initial brief vitals/chief complaint interview and proceed with someone with more experience guiding the process.
At every point we were gently cheered on to take the initiative and practice our art, to evaluate, consult, consider differentials and drug interactions in a way that really can’t be done in a typical classroom because there is no sense of the immediacy of your actions.
A human being in need is a compelling motivator to learn, and in some way the experience paralleled that scene in Forrest Gump when Forrest is clanking along with his leg braces, chased by the bullies, and the plaintive call of “run, Forrest, run!” pushes him to break free of the braces and discover his ability not only to run, but make running one of his defining strengths. I gained some confidence yesterday is what I think I am trying to say.
My classmates are going to laugh at this, but I play my cards close to the chest sometimes.
By this I mean I prefer to listen to both patient and those further along in their education before I comment. At times this means I don’t say much-a revelation that will cause some snorting in the peanut gallery.
At the Center yesterday, I found myself actually involved in the conversation, presenting part of the patient case to Dr. Frick, discussing drug interactions, side effects, etc. with the 4th years I grabbed for consult. Discussing what was best for the patient because it finally mattered-wasn’t a theoretical construct with a “model patient”, with a single, expected “best answer”.
What we decided, upon approval by the Doctor, was what would happen. So we needed to get it right.
Aside from Christmas with my wife and family, yesterday was the best day I’ve had in the last six months.
If you are a medical student, especially if you are interested in patient-centered care and interaction, and you have not yet volunteered for the SOC, then you are simply missing out.
Search for IUSM SOC, and just do it. Especially you first years, or anyone who is struggling with where they are in school. It can be a reality check-in with with the fact that you have actually learned something while here in school, if you are feeling uncertain. And it is great practice for your future practice.
Thank you Jackie for suggesting it, and thank you Charles and the whole crew at SOC. See you in February! (I mean you guys at SOC, not you guys reading this blog).
Normally that would be a simple way to finish a blog-it seemed final when I wrote it, at least.
But there is an after-story of sorts. Anna recommended we try a mexican restaurant, El Sol de tala ( http://elsoldetala.com/ ), on Washington, a few blocks from the Center, where she had been going with her family for years. The restaurant had recently expanded into the newly renovated posterior portion of the building they’ve occupied for years, and when we dropped in, we were greeted, by the two managers on duty, with a broad,warm welcome and much verve.
We hadn’t eaten while at the clinic so it was a great way to wind down, and I have no problem giving them a shameless plug for the great atmosphere and great variety on the menu. I was disappointed they didn’t have the Mahi-mahi the day we were there (in the interest of full disclosure though, until I saw it on the menu, I had no idea it was something to be find in a mexican restaurant). But then I never claimed to be that sophisticated.
The End, part II.