Thursday, September 22, 2011

Hematology/Oncology... intense but great

Posted by Elizabeth Kelly at Thursday, September 22, 2011

First off, I would like to apologize for not blogging sooner, but if the fact that I haven't gotten to it yet says anything about how busy my month has been I don't think anything else can. I was on the hematology/oncology rotation with Dr. Shawna Kraft at UofM Hospital this past month.

I am going to split up the rotation between the first two weeks and the second two weeks.

First two weeks:
The first day was a little overwhelming, I was with another student in my class and the first thing we did was go on rounds and each get assigned 6 patients to work up and be ready to go over and present to Dr. Kraft. I also discovered all the people who can make up a team: an attending, a fellow, a senior resident, two interns (first year residents), two medical students, a pharmacist, and us the two students. It was also really interesting how their was an attending for hematology with a fellow, and then a completely separate attending for oncology, with no fellow. So the team I was on would go with one or the other and then switch with the other team and go with the other attending. Hematology is leukemia and lymphoma patients. Oncology patients were mostly people coming in because they are having symptoms related to their cancer like neutropenic fever (lots of infectious disease), pain (morphine up the wazoo), nausea/vomiting, etc. Hematology is basically considered to be more complicated and that is why they have fellows and not oncology.
And then also on the first day we were given a quiz. I did terrible. I felt like I knew nothing. We were given the quiz at the beginning of the rotation and then we also took it at the end. I actually got a 12/30 the first time and improved to a 24/30 today when I retook it. Hey, it was hard! Anyways...
So, to basically summarize the first two weeks it was the other student and I trying to figure out what was going on with our patients while also attending "boot camp" which was a series of topic discussions lead by the different cancer pharmacists. For example, neutropenic fever, anemia, tumor lysis syndrome, etc. For me at least I was feeling pretty bogged down and not getting anywhere close to the amount of sleep I needed.

Second two weeks:
Everything changed the third week however. The first two I was nervous about talking to the doctors about potential changes and felt like a lowly student. Then an epiphany hit and I was all over them like white on rice. I was making suggestions all over the place, monitoring my patients therapy much closer, and becoming a true member of the team. It was great, I felt so sad leaving them today on my last day. I think they got really used to the other student and I being there to help them with everything they need.
Some examples of the great interventions I felt I made:
- clarified allergies (note: if someone says they had a red face to Keflex, does not mean they have an allergy to penicillins!!)
- thorough counseling on Lantus Solostar
- pain management dosing
- antibiotic dosing
- called a patient's wife to clarify a home regimen.
- and of course much more.
If you notice some of the things I did, its what you will do on any rotation. To the future P4s: become involved as much as possible. Its sad to say, but even though the MD's are super smart and well meaning, they are just as human as you and I, and will make mistakes/not know everything.
The only thing that truly sucked about this rotation was the patients who passed away, or the ones you knew you were sending home to hospice for them to pass away there. There were some really great patients though and by the end of the rotation they were MY patients. I worried about their pain, how their liver function was, or if their vanco trough was going to be therapeutic. It's truly a great population to work with. Also, Dr. Kraft is a great teacher and even though it felt overwhelming at first, the other student and I both learned a lot and I appreciate everything she did for us. I would definitely do this rotation again if given the chance.

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