Pagers, Jean Shorts, and Beyonce: my first three weeks at the clinic

With an iPhone 4s in my shirt pocket, my iPad 3 (aka “the new iPad”) in my white coat, and my 13 inch Macbook Air in my hipster murse (aka man purse), I came fully tech-loaded for my third year rotations. I started with ambulatory medicine, which is the equivalent to shadowing a local doctor in the community.  I remember getting everything ready the night before my first day; I fully charged all of my i-Devices, I laid out all of my freshly pressed clothes one-by-one, I replaced all of the lapels in my white coat, I even cleaned the sides of my dress shoes with soap and water. Incredibly excited to see real patients, I was up before my alarm, getting dressed and feeling fresh. To be honest, this type of preparation is not typical of me. After putting on my fancy wardrobe, and properly placing my iPad in my left white coat pocket and my iPhone in my right shirt pocket (so that both devices were quickly accessible by either hand at any moment), I saved what I was most excited about for last. It was my pager.

Its actually hard to describe a newly minted MS3′s (third year medical student’s) fascination with this archaic (old and lame), and simultaneously retro (old and cool) device. Its strangely beyond the appeal of things that were cool in the 80′s and have come back to be in style like jean shorts, or Beyonce’s leotard in the Single Ladies music video.   As I clipped my pager to the right side of my belt, I felt a little special, I felt a little more important. It might be one of those things that only a 3rd year med student, who has spent the last 6000 hours studying books for this day, would understand. It didn’t matter that deep down I knew I was at the bottom of the medical totem pole. It didn’t matter that nobody would be paging me for a code blue patient needing my expansive expertise of unusable facts related to anatomy, physiology, pharmacology, and pathology.    Regardless, I felt cooler than an MS2 and nobody was going to take that away from me.

On my walk to the clinic, I was pretending a patient was “coding” just to practice the process of pulling out my pager  and putting it back in its holster on my belt as fast as possible. Imagine a gun slinger from the wild wild west. I didn’t bother reading my pager’s manual, because that’s not what a cool doctor would do. It only has a few buttons anyway. Even though my pager didn’t go off on my first day, my experience at the clinic was fantastic. I was lucky enough to get paired up with a superb clinician who loves teaching. In the clinic, I have  2 duties: (1) Watch the clinician and learn everything she does, (2) Interview patients, get a full history, do a focused physical exam and present my findings to the clinician. On day one, my clinician wanted me to present.

Presenting is intimidating to a new student. There is a strict format: Subjective info (chief compliant, past medical history, etc), Objective info (vitals, physical exam finding, etc), and then the Assessment and Plan. What you write down is called the “SOAP note” and it is a cornerstone of medicine.  Every teaching clinician wants it done in a different way, making preparation difficult. I’ve done it in the past, but never for realsies. But what actually scared me a little was that the clinician wanted me to present my findings in front of the patient. A real patient. As I prepared my first presentation I was overly thorough, and I prayed that she wouldn’t “pimp me” while my first patient watched. (“pimping” is lingo sometimes used by medical professionals where they grill a student with rapid-fire questions, its origin is unknown, but its mentioned in this NY Times commentary). While I don’t mind being pimped in front of my friends, getting pimped in front of my first patient wasn’t something I was looking forward to. Luckily, she threw me softballs and I got to keep my dignity. At the end of the day, I went home and practiced my presentation like I never had before, because I knew I had to step up my game.

On day 2, I again practiced being a gun slinger with my pager all the way from the parking lot to the clinic. It wasn’t until halfway through my second patient that my pager finally went off.  The only reason I knew it was me was because I was one of two people in the room.  I pulled it out, reacting quickly, just like I had practiced. Unfortunately, I never got to practice turning it off.  To stop the loud obnoxious beeping, I pressed every button simultaneously, pretended to read the page quickly, and put it back the holster. I played it cool,  like nothing had happened and I just continued my exam.  But, every minute or so, my pager would give off a single loud beep in front of my patient. Each time, I pulled it out pressed a button and hoped it wouldn’t return. After finishing the interview, I walked into the hallway and finally figured out how to read past the first line of the page. To my dismay,  there was no code blue needing my attention. Actually, the hospital was just letting everybody  know, via loud beep, that there wouldn’t be any translators available for the next few hours. It wasn’t what I had imagined, but it would suffice. I still couldn’t figure out how to keep the damn pager from beeping every minute. So I took out the battery for the rest of the day after making sure nobody was looking.

I still felt cool even though I hadn’t received a paged directed toward me, but to keep that feeling of cool going, I had to swallow my pride and ask one of my classmates (Kimberley), how to delete pages to get them to stop beeping. The funny thing is, I’m considered one of the “tech” guys. I grew up around computers because my dad was a computer teacher. I put together my first computer at 14. I own just about every Apple product out there, and consider myself a power user. But when it came to something as simple as deleting messages on my pager, I was clueless.

Fast-forward a little, my first real page didn’t come until a week later, and the timing couldn’t have been worse. I was on my geriatrics rotations. As part of the rotation, they want you to spend a half day at the forensic center for a experiential learning opportunity to take calls with social service employees responding to elderly abuse. The end of the half day experience consists of sitting in on a high level, confidential, 15 person meeting. At this one hour meeting, the senior staff at the forensic center discussed strategy in dealing with abuse cases. There was a big table where all the big shots sit, and then the walls are lined by chairs for the little people like me. The big shots consist of police officers, doctors, psychologists, and the top-level staff.

The meeting itself was fascinating, never have I seen so many people collectively putting their heads together to help individuals in the community. But 10 minutes before the end of the meeting, a loud beeping sound emerged in the room. Trying to localize the sound, I looked to my left and I saw the person to my left doing the same thing.  I look to the right and the guy next to me is checking his phone to see if it went off. Then I look in front of me, and everybody is looking in my direction. At that point, I realized…ohh  $#!+   it’s me! A wave of panic tore through my body, like being struck with a lightening bolt in the kiddy pool. All my practice taking out my pager from my holster became worthless, as I fumbled to get it out and turn it off. I am rarely one to be embarrassed. But in this case,  I was somebody in the little chairs who just disturbed everybody sitting at the big chairs. Add this to the bolus of endogenous adrenaline rushing through my body, and you’ll understand why my fight or flight responses kicked in. In panic mode, I bailed to make everyone think my page was something important. Yes, I bailed, I know. I left the meeting 9 min early to avoid a slightly unfounded fear of humiliation.

On the plus side, it was a real page, it was from a real doctor, and it was directed specifically to me.  It stated, “Are we still meeting for lunch?”