Awake at 06:00 to get ready having a small celebration inside my head for putting on scrubs for the very first time in my life and advancing yet a step closer toward my aspiring career as a health care practitioner, a medical doctor. This was the very first day of Electives after a year of being a GEMP1/MBBCH3 student.
Having written two tests consecutively on the previous Thursday and Friday, my hospital practice day (HPD) partner and I decided that due to circumstances pertaining to the strike it may be wiser to start electives (which takes place over 10 working-day period) immediately on the following week and finish academic work before December starts, provided that we are exempted from the end of year examinations (EYE). I would like to start this report by writing about the activities of our days and then reflect upon what I have learnt and my feelings toward the electives.
We were instructed by the secretary of the department of our choice for electives (Surgery) to be in our scrubs at the office at 08:00 sharp. So at 07:30 I started walking toward Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) via medical school. Recalling that it is not so different compared to walking to medical school for lectures every morning, except this time I’m wearing scrubs and stethoscope and with new found energy that does not really fit with a student that is approaching holiday after a full, hard-working academic year. This had been my goal all year: to know that I have worked hard, to have exempted with no baggage (i.e. the worry of needing to write EYE), enjoying and having a good learning experience during my elective.
Initially, I had chosen to do my elective at the Trauma Unit of CMJAH but was told that there was no more space, as it was many students’ first choice as well. I then opted for Surgery for my interest in the department and considered the activities and learning experience I will be exposed to as a young student.
I, alongside my HPD partner and two other students arrived at the department and was assigned to the ward 394 later discovered the reason for it was that the interns there were more willing to teach and engage with students and the secretary of the department wanted to ensure that we have the best learning opportunity.
Upon arriving at the ward, we were introduced by a consultant who was standing in as an interim head of surgery to the interns and was quickly taught and given the job of taking bloods from patients for their files. Thereafter, throughout the first week, we tried absorbing as much as we can by jotting down notes of what the doctors say and teach, revising what we have been familiar with during our studies. We participated in ward rounds, and various meetings which include thyroid and x-ray meetings, M&Ms and even grand ward rounds.
A comical digression – interns always told us first thing in the morning after ward rounds to take one blood form each and take bloods until the phlebotomists would come and take it themselves. Interns were grateful that we could help, as it free their morning up for other things to do, and we were even more grateful for being given the opportunities to practice what we see interns do so easily, even if there were no veins to be seen or felt. Until today, however, we had not seen a phlebotomist, and have started to think they were as mysterious and mystical as unicorns.
We have, for obvious reasons, gone to theatre and observe procedures such as a parotid tumour excision, right hemi-colectomy, left mastectomy and even scrubbed in to help during a thyroidectomy. During this time, doctors would show us structures and refresh our anatomy and we soon realized the difference between cadavers to a living human being.
Our day would also include going to clinic to observe the clerking and in-taking of patients and were told to practice clerking on breast-clinic patients to further present it to doctors. The difference between what we learnt during clinical skills of GEMP1 and actually doing it in the clinical setting, is that we had to think on our feet about what to ask and how to follow through, covering as much important facts as we can whilst coming up with a list of possible differential diagnosis with the pressure of time constraints, the amount of patients waiting outside, learning to present coherently (as 70% of diagnosis is in the history – we were told), examine patients systematically and to have an awareness of the different cultures, behaviour, lifestyle and especially language barrier of each and every individual patients.
We finish each day at 16:00 but the doctors usually allow us to leave at 14:00 as that’s when we have done everything they asked and we had two call nights which start at 16:00 and end at 20:00 which we would then do PM ward rounds, clerk patients at the ward, taking bloods and do ECGs on patients.
Two incidences that are worthy of note and impact my perception as a student and future medical practitioner is: Everyday there would be at least one or two patients we would struggle to take bloods on and as it is not a pleasant ordeal, patients usually ask us to stop and we do understand. However, on the Tuesday of this week, I asked a patient’s (her Hb was 3 and mildly obese) consent for taking bloods on her and after having putting needles in her for the fifth time on the left arm my confidence was waning but she kept encouraging me, she said, “I am not letting you go until you have taken bloods from me, and you must be the first one to take bloods from me.” I cannot express how bad I felt.
In the end, after wasting two needles and trying three times on the right cubitle fossa, I finally managed to draw blood from the lateral aspect of the right arm of the patient. I will never forget what she said to me after I had apologized profusely, “Stop being a perfectionist, it’s okay to make mistakes and at the very least, you got to take bloods from me, which none of your colleague could do. Besides the reason of you being a student, the other reasons for insisting you try to take bloods from me was because I know you will be a great doctor one day, you have good bedside manners, you talk to patients and not at patients and you feel. Just believe in yourself and keep up what you are doing.” I will forever be grateful for what she had done for me.
A professor of the surgery unit was one of rank and knowledge, and who really took note of us, acknowledged us and taught us as much as our level of understanding allowed despite her position in academia and medicine. On the Monday, during ward rounds, she asked my HPD partner and I to accompany her to a cubicle to examine an open wound and she first introduced herself, then my partner and I.
Every action she took on the patient or everything she would teach us she would first explain to the patient and also use layman terms to help the patient understand his conditions every step of the way. Two things she instilled in us verbally and through action was: Always have good bedside manners, everyone deserves the same respect in their very presence and to be very patient, whether to fellow colleagues, students, staff or patients. I would want to be as good a teacher as I am a doctor to people, just as she and many other people in my studies and life was to me.
I have also noticed that one really notice many, many different kinds of people in hospital, physically and psychologically, be it doctors or patients. This helps create the awareness and practice of having a good eye, perception and understanding of the people one is encountering and interacts with the people around one in the best way possible. For it not only get the job done, saves time and (excuse the cliché) lives, but also helps me as a person to gain insight and people skills that is suited as a health care practitioner and in general as a normal person that would interact with people outside my niche, my comfort zone, my workplace.
In conclusion, I really did enjoy the experience of my electives at Surgery for GEMP1/MBBCH3. I have learnt a lot, and felt too much positive emotions that words cannot adequately express. I thank Wits Medical School and CHSE, as well as my host for the opportunity to broaden my mind and horizon in medicine. To help me see my future clearer as the kind of person and doctor I want to be. Inspiring me to be a better learner and reminding me to improve myself daily. In providing the growth of my knowledge and love for the career even if it gets tiring, tedious, and tough. For it is a challenging degree but can become a rewarding career.
A thank you to my internal supervisor for taking the time to read and mark my report. I hope you have enjoyed it.