Jacob Lentz attended the David Geffen School of Medicine at UCLA. He is in his first year at UCLA Emergency Medicine Residency Class of 2019. Prior to medical school, Jake worked as a comedy writer for the Jimmy Kimmel Live Show for 8 and a half years. Here at Pondering EM, Jake blogs about his journey through EM residency.
While a good number of my failings can be ascribed to laziness, in the instance of the preceding paucity of writings for the good Robbie’s blog, it can be ascribed to an awareness that for the months of September, October, and November, I had little to share that might not be a complete waste of your time to read. Robbie and I had discussed the possibility of me writing about my time on the trauma surgery and plastic surgery services and relating anatomy to clinical practice, but I didn’t learn anything that most readers don’t likely already know. Most of what I thought seemed exciting I strongly suspected would, if I shared it with others, be met with some amount of “Yes, I know that already.”
Not only was I not learning anything that might be of value to readers, I was also not learning. In October I realized that I was on autopilot (and a poor autopilot at that), trying to keep treading water while I rotated through the trauma surgery service, plastic surgery, and the cardiac ICU. Refilling electrolytes, ordering enemas, trying to order wheelchairs for people so they could leave the hospital, coming within spitting range of killing a few people here and there. I was firmly in the moat of the first-year doctor’s conviction that all is hopeless and that it is impossible to learn how to be a doctor. So, like a Brit, I muddled along.
But for what it’s worth:
- The most commonly injured organ in an abdominal gun-shot is bowel.
- In a stab wound, it’s the liver.
- The value in reducing severe fractures that will require surgery is in pain control, maintaining vascular integrity, and preventing swelling that could make surgery more difficult (I finally drummed up the courage to ask someone that).
- A flail chest requires positive pressure ventilation because the negative pressure ventilation produced by the diaphragm and rib cage is lost.
- A large avulsion of tissue from, say, the finger pad, that is otherwise unremarkable can be sewn back on after the underlying tissue is debulked of subcutaneous fat, which is relatively nonvascular, and the reattached piece of tissue will rely on diffusion mostly for its blood supply.
- Any trauma victim who is using their phone on arrival in the Emergency Department is going to have a good outcome.
See, not much worth anyone’s time.
Though that’s just off the top of my head. I will say that, having hit the wall of utter failure and possessed of the knowledge that everyone knew I was a fraud, I gave up on my shame and began asking questions. I became even more unafraid of looking dumb, as my stupidity was at this point well-documented. It turns out that most people are very happy to teach you about the thing they have dedicated their life to. So on the trauma and plastics services and the cardiac ICU, I asked a lot of questions and gained much in return.
I’m still very much in the woods of intern year, but I have seen only recently that I may be learning. It was only in the past few months that I realized that intern year has a lot of experiential learning, something that is very hard to appreciate during the process of failing and falling.
But there seems to be movement. I found myself weighing in on an ECG a few weeks ago. Afterwards I realized that I wasn’t sure where I had gained any ability to have any opinion about an ECG.
Truly, no idea whence it came.
The main thing I’ve come to see is that even as I feel the real doctoring knowledge taking hold, I know how much I have ahead of me. If experience is the true teacher of humankind (hat tip to the Irish-Englishman Edmund Burke), then my six months of experience are very little learning indeed. When an attending tells me that she wouldn’t be completely shocked if a very, very low-risk woman with pleuritic chest pain did in fact have a PE, it gives me pause, because she is speaking from decades of experience, and what I have is a few dozen patients with pleuritic chest pain, a grand total of two PEs, and a lot of books and guidelines.
Whenever I find myself disagreeing with what someone with a lot more experience than I have wants to do for a patient, I remember that.
I will endeavor sincerely to be a bit more fecund for Robbie’s fine blog in the coming months.