Paging 612-818-8067… Paging 612-818-8067…
“We’re sorry. We are unable to complete your call as dialed. Please check the number and dial again, or call your operator to help you.”
Maybe I need to dial 8 for an outside line?
“We’re sorry. We are unable to complete your—”
Shoot, 8 was my last hospital. Ummm, 9. I think it’s just 9.
“We’re sorry. We are unable—”
But it’s definitely 9.
I have literally hundreds of thousands of dollars worth of education. I should not be bested by a telephone.
“Hello. Lauren? It’s Dr. Serposs. I thought you were gonna call into my first appointment?”
“Yeah, yes. My apologies. I was having some difficulties with the phone—”
“Did you try dialling 9 for an outside line?”
That was the first, though most innocuous, time today that I was faced with an overwhelming urge to thunk my head against the desk in defeat. But I was saved from the headache by a mysterious beeping noise! My…pager? Someone was actually paging ME? I didn’t know why anyone would page me, but I did know that to answer a page at the VA you needed to call the number displayed on the screen. Which meant I was going to have to go toe to toe with the telephone again.
I did not anticipate that telephone operation would be the most pressing and challenging skill that I would learn during my first week of VALUE. I knew that I would be developing my “advanced clinical skills,” but I was thinking more along the lines of point of care ultrasound, EKG interpretation, and electrolyte replacement – certainly not operating a telephone. And yet, as I reflect on my tangles with the telephone, I can acknowledge it as a vitally important learning moment, beyond the obvious necessity of utilizing it as a means of communication. Asking for help requires humility, and I most definitely needed to ask for help. The battle to subdue my shame at failing to perform such a basic task so that I could humbly ask someone for help was exceedingly difficult.
As a medical student, our full time job is to learn massive amounts of information. Subsequently, we get really good at knowing things. There is an endless parade of exams testing how much we know and threatening failure if we don’t know enough. Then we enter our third year clerkships, and we don’t know anything – how to find the bathroom, how to enter orders, how to tell CPRS I am not now, nor have I ever been, in the 4th floor pharmacy. Despite all this mental conditioning, we must learn to accept how much we don’t know and learn to humbly ask for help. That is the true “advanced clinical skill” I developed.
But it was time to put introspection aside and put that shiny new clinical skill to use – I had a page to answer! I wrangled my pride and sheepishly poked my head into Dr. Serposs’s office to ask for help. Armed with his advice, my second attempt at the telephone had minimal misdials, and I was able to reach the emergency department. One of the patients I follow longitudinally presented to the ED with cellulitis. The staff physician readily agreed to allow me to be involved with the patient’s care.
I made my way down to the ED, mentally reviewing what I knew about cellulitis. The staff physician took me back to interview and examine the patient. When we got back to the work station, the questions started flowing: “Are they septic? By SIRS or by SOFA? NEWS2? Are you going to send them up or out? To what level of care? Obs? Tele?” The unfamiliar acronyms and nicknames were overwhelming. While the recent Becoming a Doctor Week I session on Jargon recommended that we put ourselves in the patient’s shoes, I did not plan on taking that advice quite so literally. I must confess I found it quite uncomfortable. I stumbled over questions that I should have known the answer to: “Obs? I don’t, I don’t know, What’s that?…Oh…” At least I had a fundamental understanding of what those things were, even if I didn’t recognize the jargon. But our patients do not have that medical knowledge to fall back on. When healthcare providers start going on about lactate levels, bicarb, and their sulfonylurea, patients feel every bit of the confusion I felt, and then some. Just as I needed my staff physician to fill in my knowledge gaps, so too do my patients need me to take care to slow down, be deliberate in my word choice, and check in about how much they understand.
I accompanied the patient up to the medicine unit, where I performed the patient’s admission history and physical – my first ever admission. I will follow and round on the patient throughout their hospital course, making sure to take the time to use patient centered language and answer their questions as we go. They’ve taught me a great deal in just one day. I can only imagine what they’ll teach me tomorrow and how much help I’ll need along the way. But for right now, I’ve got another phone call to make.