Saturday, November 7, 2015

Rotation 5: “Cause, baby, now we got bad blood”

Posted by Stephanie Burke at Saturday, November 07, 2015

I was on the inpatient hematology/oncology service this past rotation block. The experience was more than I anticipated! As my first intensive patient care rotation, I was slightly (i.e. terribly) intimidated by the thought of enduring five weeks on such a demanding and challenging service. Fast-forward a bit: I survived! It took quite a bit of adjusting to the therapeutics of the rotation, but by the end, I felt fairly comfortable managing my patients on the floor. I arrived at the hospital early each morning and some days stretched pretty long. My daily routine involved working up patients for the day, rounding with the hematology and oncology teams, following up on patient needs or physician questions, and finally topic discussions with my preceptor and PGY1/2 residents in the afternoon. Overall, it was a well-rounded learning experience.

My favorite part of the rotation was working with hematology patients. I learned the guidelines for managing acute myeloid leukemia patients, lymphoma patients, and patients with neutropenic fever relatively quickly. I always felt on top of the needs of my patients; monitoring their renal function, need for continuation/discontinuation of anticoagulation, antibiotics or antifungal agents, drug levels, etc. I had an impact on the health of my patients, and even if they only had a week or a month more to live, I was going to do everything I could to ensure their last days were comfortable. This was the hard part of heme/onc – many patients did not have much longer to live. I remember my first week on service standing with the medical team in a patient’s room. The patient was dying, completely incoherent and unable to communicate effectively with us. As the attending began the conversation about home hospice care with the patient’s spouse, the spouse appeared okay, taking in this difficult news. Then, he was not doing okay and began to cry. As we all stood in silence with our heads down, the attending comforted the spouse. It was my first dose of reality in the world of the sick and dying. This aspect of the rotation also took some adjustment. Many of our patients were sick and dying. But, as my preceptor reminded me, the patients we saw in the hospital were only a subset of all the hematology and oncology patients outside of the hospital who were doing fine.

This rotation challenged me in many ways. Professionally, it challenged my knowledge and understanding of therapeutics and pathophysiology. Personally, it challenged me to remember that each day is a gift, and even in the toughest of circumstances, one can still find joy and hope. It takes a special person to work on the hematology/oncology service. Some days it was a lot to handle, but if nothing else, remember your patients. Some are fighting for their lives, and you need to do your best to help them in that fight. 

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