Clerk's Notes 3

> Subjective

      Umm... What the hell just happened.
 
       My two months in Internal Medicine is up and I hardly got to document it. Heck, my last post was about the one day off I got. Looking back on everything that's happened between now and my last entry, I have so many regrets for not writing sooner.

       I'm sorry.

       I've been saying that word a lot lately, more often in these past two months than I've ever said my whole life.

      I say it to almost every doctor I work with, right before saying something I shouldn't even be sorry about. Sorry doc, may I just ask a question? Sorry doc, may I get an initial read? Sorry doc, our patient in 4A still has difficulty breathing even after nebulizing. These are the "light" sorry's; I throw them out indiscriminately and they carry no weight. They are a mere concretization of my place in the hospital hierarchy: Doctor, I am sorry that I, a lowly clerk, have the audacity to even speak to you. I've spent many years of my life apologizing for just being myself. These are the easiest sorry's to say.

Rare peaceful moment at [private hospital].

      The harder ones are the ones I say to my patients, especially those I have to hurt. Sorry po ma'am, konting tusok lang po. During my two weeks rotating in a public hospital, it was as if my sole job was to inflict pain on people through this method - inserting needles in their veins, catheters into their urethras, tubes in their throats. I really hate this part of medicine - having to "practice" on poor patients who cannot afford to go to a hospital where unskilled clerks aren't allowed to touch patients. When I say "sorry" to them, I'm not just saying sorry for the pain. I'm saying sorry that you have no choice but to come to this hospital and receive less-than-ideal health care. I'm sorry we're stuck with a health system that doesn't work.

5 PM at [public hospital] - when my watch begins.

      The heaviest sorry I've said was to a patient I handled in the Emergency Room of [private hospital], just three days ago. She was coming in seeking pain relief for back pain, a pain that was, for her, already 10 out of 10. Physically she seemed fine, she could breathe normally, talk normally, walk normally. But as soon as I started our interview I could tell she was not going to be an easy patient.

     For starters, she called me "miss" when I introduced myself as "doctor." Then she would snap at me whenever I asked questions to clarify what she had previously said . She questioned me at every step of my physical examination. Deep down I was enraged by how condescending she was being, and it took much concentration to maintain the smile on my face and the calm in my voice. When the initial interview was over and the orders were carried out by the nurse, I breathed a sigh of relief, thinking the terror was over.

     But as I attended to other patients and did the necessary paperwork, her partner would periodically come up to me to follow up on certain things - if she could get a stronger painkiller, if she could be discharged already when her pain scale was 0, if she could get an explanation for her laboratory results. These were all important things to follow up on. Each time that it happened, I would feel horribly guilty for not having had the initiative to carry out all these things without having been told to (by the patient's kin, no less). My lapses in care further agitated the patient and added to her distress. Finally, she demanded to be discharged and I could do nothing but say sorry.

     Ever since then I haven't been able to stop agonizing over how I failed at caring for this patient. I've made a promise to myself to never let that happen again, even though at the back of my mind I know that would be unrealistic.

     I've long ago grown tired of my own apologies.

Having dinner at 8 AM coming out of my ER night shift.

> Objective

Blood Presure 110/80 mmHg     Heart Rate 70 bpm     Respiratory Rate 18 bpm     Temp 36.5 C
- Awake, alert, not in cardiorespiratory distress
- Beginning 1x1 cm nodular acne on left aspect of chin
- Clear breath sounds, frequent sighs
- Cardiomegaly (heart notably heavy)
- Soft, flabby abdomen with visible trails of shawarma sauce
- Normal-smelling feet, s/p deodorant

> Assessment
to consider severe burnout
status post Internal Medicine

> Plan
Moving on

> Orders
Self-esteem booster stat
Occasional breaks prescribed
Advise proper diet rich in fruits and vegetables
Continue Radiology rotation
Continue clerkship in general
Encourage not to give up