Right
on the dot, our consultant for the Wednesday’s Consultation-Liaison (CL) rounds
came into the department office.
Looking
absolutely chic, and totally unruffled, she breezed into the conference room in
a no-nonsense outfit of a blue and black corset-top and pants ensemble with
matching nude pumps and Louis Vuitton bag.
My
co-residents and I were slightly anxious, as certain aspects of the rounds we
had with her from last month didn’t go that well. She had high standards, and
well, that always kept us on our toes, which is always good, I suppose. Anyway,
I had three patients out of the cases that we were going to discuss for the
week, which was why I was on edge. I could present any of them, at any time.
While
taking out my notes from my clear book file, I caught my co-resident, Mer’s eye
and mouthed, “I just want to get through this day…and then after that, I’m
fine.” Mer gave me a quick nod and a
grimace (he was anxious too). I smiled
nervously. “Well, here goes,” I said, and then heaved a sigh. She was my
supervisor, and she had a reputation for having high standards. I, of course,
did not want to disappoint.
-----
As
it turns out, I didn’t get a chance to present any of my 3 cases. Which was just as well…I didn’t want to do it
that day, what with all the interns sitting in with us, my co-residents also
concerned with their own cases.
My
insides were in a terrific coil. I had to leave five patients at the
out-patient department for screening because I wanted to attend these rounds.
Bien, one of my co-residents, who didn’t have any admitted patients at the
time, covered for me so I could sit in with this consultant.
Minutes
later, when it was all done, I gathered up my papers, excused myself, and told
her that I would be back for supervision by 12 noon, when all the activities
were done.
-----
Thirty
minutes past 12…I got a call from one of my co-residents, telling me that my
supervisor was looking for me. In the middle of wrapping up my screening
interview with a patient, I could feel the familiar racing of my heart, knowing
that she was really strict about time and schedules, and therefore, I had to be
there immediately.
----
She
was sitting with the others, eating lunch, with perfect poise and manners…not a
hair out of place. I had to pause for a few moments so I could catch my breath.
(I
suppose the only visible signs of my anxiety during that was the thin sheen of
sweat on my forehead from the exertion of walking and the slight flaring of my
nostrils. :-p)
She
calmly told me to eat lunch first so we could talk longer about my cases.
We
only had 45 minutes (as per schedule, of course), so I requested that we continued
with my self-supervision during the next session and so we could talk about
more pressing problems, i.e. my admitted patients. She obliged, and listened
patiently while I introduced my 3 cases.
What
followed was a careful critiquing of my management and how I handled my
patients so far. From discussing the case with her, I learned a little more
about the intricacies of how to manage my patient. She pointed out details that
I had not really focused on, but were important nonetheless. My management done
and medications given, along with my rationale for doing so were talked about.
“I
did not want to put my diagnosis like that ma’am, because it would look like I
hadn’t made a decision…” I started to say.
She
smiled, and said, “It’s not about you, S., it’s about your patient…it’s always
about your patient.”
----
And
then, before I knew it, we were done with the week’s supervision.
I
smiled contentedly. “Wow, “ I thought myself, “now this is what you call
learning!”
In
the span of just a few minutes, I learned a few techniques from experience, I
learned how to look at certain things from a different perspective, and most
importantly, I had more handles on how to tackle a problem that seemed simple
enough at hand, but was actually a little more complicated.
I
now understood what Dr. ALJ meant when learning was supposed to be done in the
context of having someone “looking over your shoulder” while you dealt with a
patient.
As
with everything in life, it is not all about book-learning. Oftentimes, we
benefit from the experiences of more seasoned teachers, who help us process our
own experiences.
----
Note: Screening is a procedure at the
out-patient department where we first diagnose a patient and then assign them
to a resident-in-charge. Psychotic cases go to the juniors (i.e. first year
residents), and non-psychotic, medical cases go to the seniors (i.e. second
years.) Supervision is the learning process where a consultant is assigned to a
resident, and they meet regularly for discussing cases. Usually, during the
first few sessions, the resident undergoes “self-supervision”, where he/she
gets to discuss his/her own history and process why he or she reacts to certain
ways, and undergoes certain countertransferences.
The “past is prologue”, after all. :-)
Love,
S.
mp)
