Friday, September 7, 2007

Ear day -- a.k.a. Kill-Linda's-self-esteem-day

Today started out as a normal day in clinic. I had a well-baby visit, which went smoothly. I was actually ON TIME for once, so I was feeling pretty good about myself. Then the ear visits started. First it was a little boy with fever and congestion - sounded like a viral respiratory infection to me. I strolled off to my preceptor's office feeling confident, presented the case, and said "He looks great. Tympanic membranes are clear, so I don't think there's an ear infection causing his fever. This is probably viral - we'll treat him symptomatically". My preceptor walks with me to the office, takes one look in the baby's ears and says, "He's got an ear infection." Great. Moving on. Next patient has similar complaints: fever, congestion, cough, loose stools... so again I'm thinking viral infection. But this time I wanted to be sure, so I attempted to get a good look at the kid's ears. FULL of wax. I tried cleaning it out with my little ear pick, and I guess I was too aggressive because the kid started screaming and I noticed blood coming out. CRAP. I ran to my preceptor's office in a panic, thinking I perforated this patient's eardrum... but he assured me that it's not uncommon for ears to sometimes bleed when being probed. So I sent the baby to get his ears flushed (I figured I had tortured him enough with my little instrument of death). When I was finally able to see his ears, they were bright red - as expected, since he had been screaming his head off. So I couldn't figure out if he had an ear infection or not. Turns out he didn't. (Again, my preceptor took one look and said, "No ear infection. Just red from crying." Of course, his ears didn't look any different to me than the previous kid's ears, but apparently it was obvious).

And then there was the finale of ear drama. My last kid of the day, chief complaint of hearing loss. Mom seemed friendly enough; she didn't even seem to mind that I was an hour behind. We chatted for a little while, I got the medical history, and then it was time for the exam. I looked in his ears and whadya know... full of wax. Perfect. It's the end of the day, I just want to go home. So I decided to try to get the wax out so I can see his eardrums. After my previous experience just hours earlier, making a kid's ear bleed, I decided to be extra gentle. So I got my little probe, pulled my patient's ear slightly to open up the canal, and started moving the wax out of the way. He seemed to be doing really well. Then all of a sudden I heard a sniffle. I looked at his face and he looked like he was ready to burst into tears. And a second later he did. Of course that made his mom get all upset, and so whatever rapport I had established with her went out the window. She went off on me. Big time. She said, "I want someone to look in his ears to see if you damaged anything. He never cries, and you stuck that thing in his ear and made him cry." I said, "I apologize, ma'am, but sometimes kids do cry when we try to get wax out." "NO, my son never cries. I want a REAL doctor to look at him. I'm just not comfortable with some intern sticking stuff in his ears." "Again, ma'am, I'm sorry. I AM a real doctor, but if you'd like to see my staff, that's fine." I maintained my composure long enough to leave the room and go to my preceptor's office. Then I lost it. I don't know why, but I started crying. And when my preceptor asked what was wrong, it was like when you're little and you've hurt yourself and you're totally fine until you hear your mom's voice, then you break down. I just felt so frustrated and incompetent. It's so hard being an intern. You've worked four hard years in medical school and you have an M.D. after your name, but you still feel so inexperienced. The nurses seem to know more, even the techs seem more capable. I've tried so many procedures and failed... I can't seem to remember any of the basic skills I should've learned as a med student... I'm tired and defenseless... and now a patient's mother has questioned my competency. It was enough to send me over the edge. But just for today. I won't let her shake my confidence for good. Tomorrow is another day. Fresh, with no mistakes in it yet. :)

And now I'm gonna go take my frustration out on my weeds. Later!

1 comment:

g9ine said...

I'm coming to Austin in December. I won't clean my ears between now and then, and I'll let you build up your self-esteem by helping me hear again.