Dilesha Kumanayaka -  A Day In The Life

After cramming medical information from books and exams for almost two years, we finally get to make it to the hospital wards during hospital visits this term. Understanding the vocabulary with which physicians speak is one thing; translating the concerns and complaints of a live, in-the-flesh patient into those terms is an entirely different task, and using that information to arrive at a cogent treatment plan is still another. The hospital is a world in itself, with many moving pieces and emotional overload. And then there is me, the second year medical student, trying to navigate it: sometimes playing an active role, sometimes being a shadow, sometimes making mistakes, and sometimes doing well.

On my third day at Grenada General Hospital, I walked down the hall to my first pediatric patient's room with my group. As the patient and her father entered our discussion room, we calmly greeted them and obtained a history of presenting illness. Following our patient encounter, we met our preceptor, Dr. D. The hospital was a fast-paced environment and was warm and sticky; there was no air-conditioning and the temperature was stifling at 27o C. By my observation, the pediatric ward was clean and each little cot kept pediatric patients separated with thin curtains around them. The ward contained several ceiling fans and the ventilation was adequate for the patients' comfort. We crossed the room to where our little patient, X was resting, to perform a physical exam. She was in apparent distress and was lying down on her belly. It was a life-changing experience to hear wheezing sounds so prominently on a real patient, compared to learning about how it would sound in lectures, but at the same time, it saddened me since this patient was only a year old and was in respiratory distress.

Many diagnostic techniques cannot be utilized effectively in the context of a baby. A lot of patience is required when dealing with a very young patient like this. Little patients cannot chat with me and cannot explain their problems, unless their parents notice something wrong. As we tried to diagnose this patient, we struggled to come to a conclusion because she only had two symptoms/signs without at least fever or congestion. We were taught that an infection would have these symptoms and she fit into two of our differentials, but we came to a conclusion based on her age and the blood test results that were done previously.

I came to realize how important it is for us to be plunged into the world of actual clinical medicine, after one and a half years of the predictable life of lectures, textbooks, and exams, where patients and their illnesses rarely go by the book. My greatest hope was that when working one-to-one with a patient, I'd be able to make them feel safe, not scare them, and communicate with them with empathy.

It actually happened like that while I was taking a patient history from X's father. My group members complimented me but I was still nervous to perform the physical exam on this little patient because I was concerned that pressing too hard on her chest or abdomen would hurt her. My preceptor kindly pointed out to me how to perform percussion and palpation while making the baby stay a bit more calm by giving her a toy to play with. I started feeling comfortable holding and moving this little patient after awhile. I came to realize that I had to take time and be confident in what I was doing. Practice was what I needed.

In retrospect, I can only thank my peers and the attending physician for a worthwhile and valuable learning experience. I saw these hospital visits as an opportunity to follow excellent clinicians and really focus on the art of medicine rather than the content of it. My learning is far from over, and has truly just begun in time for my clinical rotations to set in. I approach each day the same: as an avenue to learn from my mistakes in efforts to better treat my patients, and I will take with me a plethora of valuable knowledge from working with this little girl. Aside from the routine management of respiratory/ cardiovascular care and other essentials of the history-taking and physical exam pertaining to the patient's symptoms, I will also take away the thought that compassion is key to dealing with and understanding patient care. Moreover, I will also take away that in the medical world, there need not be a declaration to always be formal in the lifestyle setting; simply guiding individuals on proper hygiene, lifestyle risks  and health hazards may go a long way in determining that very same patient's end point of care in the clinical setting.

Now, as I come to the end of my second year of medical school, my goals have become more humble, from wanting to learn everything possible to the one goal riding above it all: to do right by my patients. There is so much you can pour into patient care. At times, there will be puzzles, but I will try to make sense of them. There will be inevitably be countless moments where I will not know the best course of action, tiny decisions peppering the day with each having potentially dire consequences. I will make mistakes, but I will learn from them. I will work hard. I will do right.