Clerkship Update: Palliative Care

I had an incredible experience on my palliative care rotation. Going into it, I wasn’t sure what to expect. Whenever I informed people what rotation I was in, many wrinkled up their faces and said, “Ooh, it’s got to be depressing being around so many dying people”.

I have to say that my experience was quite the opposite. It is a different way of practicing medicine. Rather than focusing on curing a patient, one is focused on making them as comfortable as possible as they navigate the last months, weeks, days, hours and seconds of their lives. I found it a true privilege to accompany people on this journey.

I very much enjoyed how much time I got to spend with each patient and their families on a daily basis. It was certainly never easy discussing a short prognosis but in some ways, families found relief in having an idea of their loved one’s trajectory and in knowing they would be kept as comfortable as possible. The main things that impact heavily on dying patients, particularly in the context of terminal cancer, are pain, nausea, lack of appetite and a progressive sense of loss as they decline in function. Although it can be  difficult to do much about the loss of function, it is staggering to see how much better a patient feels when their pain and nausea can be controlled.

On this rotation, I worked with an excellent interdisciplinary team of doctors, nurses, social workers, PABs and art therapists.  I was truly inspired by their dedication and compassion for our patients.  I certainly struggled with my emotions when I lost a patient (which was almost on a daily basis) especially seeing the profound impact on the family members left behind. I truly treasure the meaningful connections I had with patients and their families on this rotation.

I also had the opportunity to participate in home visits. There was something especially touching about being able to go into a patient’s home and deliver care to them in an environment where they feel most at home.

Overall, my palliative care rotation was one of my best experiences in medical school. I encourage medical students out there wondering what electives to take to strongly consider taking it. It will change your perspective on life.

As my fourth year of medical school continues, I feel my confidence as a doctor-in-training progressively growing. There is still so much to learn of course. One of the great things about medicine, is the challenge of constantly growing and learning new things. As I ponder the current stage in my training, I am so grateful to be on this path to becoming a doctor, as difficult and challenging as it can be.

Featured image courtesy of https://www.medstarfranklinsquare.org

Clerkship Update: Pathology

I just completed my 2-week rotation in Pathology and I really enjoyed it. My days consisted of a variety of activities such as grossing specimens in the lab (that is, examining and cutting them in preparation for creating microscopy slides), looking at slides under the light microscope and electron microscope, plenty of studying as well as attending autopsies, tumor boards and rounds. I also had the opportunity to observe intraoperative consultations which is when a surgeon excises a sample during a surgery and asks the pathologist to make a quick slide (better know as a “frozen” section) in order to have a preliminary diagnosis, usually in the context of cancer.

What I enjoyed most: 

First of all, I think microscopes are just so cool! Secondly, I had a fantastic team to work with! I also liked the flexibility and variability of the day with a lot of autonomy and self-directed learning.  For example, my main interests for this rotation were renal and gynecology pathology so I was able to tag along with the residents and staff physicians specializing in these areas.  I particularly enjoyed “sign-outs” when the staff, resident and I would sit at the teaching scopes (several microscopes connected to a main one so that you are all viewing the same slide) as this is where you get a lot of useful teaching on how to identify various structures. I also really appreciated that I got to brush up on my anatomy! The schedule was fairly light and I got to see my kids more often than in other rotations which was great!

What I struggled with most:

I missed patient contact and also sometimes felt helpless in cases where we diagnosed cancer since the clinical management is not done by the pathologist.

My take home message: 

I think Pathology is a great rotation for  medical students to consider regardless of your interests because it exposes you to a different side of medicine and will increase your understanding of various disease processes which is very useful to know in the clinical world. For example, I now have a much better understanding of glomerulonephritis, nephrotic syndromes and gynecology-related cancers. I also have a much better idea of how to interpret pathology reports and the amount of work that goes into creating one! I would currently rank Pathology as a “medium” as a future potential specialty for me because I still have to reconcile the fact that there is not much in the way of patient contact. However, it really resonated with me in terms of the intellectual aspects and I loved the detective work behind it.

My next rotation is an elective in Medical Genetics which sounds fascinating! Stay tuned!

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My assigned desk…reading up on some renal!
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My little monkeys climbing trees in the backyard. Love them to bits!

Featured image: lookfordiagnosis.com