Building rapport

First day of Internship

I had spent five years in medical school and somehow felt I wasn't ready for tomorrow. I knew I would be starting my internship from the obstetrics and gynecology department but felt like I had forgotten where babies come from, and so began a sleepless night as I flipped through book after book trying to remember everything that I thought I might have forgotten. A very bad idea in retrospect, I was now tired before I even reported to work. 

I heard my alarm going off at 6:00 am but I was already awake and packing my bag. I wanted to make a good first impression today. My clothes were brand new, ironed and wrinkle free, My hair neatly combed and tied in a ponytail (as I always have), light dab of lip gloss and wore my most expensive perfume. We are always taught in med school that first impressions matter, how you look will influence the rapport you build with the patient. And you need to build a good rapport if you want your patients to open up to you.

I took a picture to remember the day. White coat folded on my arm, stethescope around my neck and a brilliant smile plastered across my face. That was the first day of my actual career and I can't begin to explain the excitement I felt knowing that I had made it this far. I got a lot of well wishes that day. But the best advice unknowingly was given by my younger brother, 'try not to kill anyone'.

In this department, just like in many others, the morning started with a handover meeting. The idea is that the night team brings the day team upto speed and to discuss the occassional mysterious patient. More often than not there is a patient that we don't know what to do with. Handover meetings at my new hospital was a big deal. Everyone from the medical students that were rotating through the department to the consultants, the doctors at the top of the hierarchy, were expected to attend on time.

I realized on my very first handover that the ones under fire were the interns. This is partly due to the fact that we had to present special cases every morning and partly due to the fact that we were the lowest ranking officials on the hierarchy. The interns who had been through a twenty four hour shift were now sitting infront of a big audience and presenting all the cases that got 'complicated' and how it could've been prevented. The senior doctors would often question the decisions that were made in the patient management and the intern was expected to justify his/her reasons and defend their competency on many an occasion. This I was told is a system designed to ensure that the most juniour doctors would learn from each others mistakes and never make the same mistake twice. I was also told that I would learn how to present my 'special cases' without any loopholes and not be under fire. 

My first month was to be spent in labour. I had witnessed the miracle of child birth many times before as a medical student. But being a medical student had meant I could watch from a far not really do anything to help and this too was only if the mother had consented for onlookers. Today I was going to deliver atleast one baby myself, and I did. My excitement about pulling that baby out was short lived as I noticed that the mother had a tear. I've never sutured before, atleast not real skin. I knew how to suture but my lack of experience had meant that in the time it took me to suture, the local anesthetic had worn off and the mother was starting to feel pain. The beauty of child birth though is that after all that she still thanked me for bringing her third child into this world. 

p.s. I work in an underdeveloped country at their central hospital. So all the patients that get referred to our labour ward are complicated deliveries. We do have experienced midwives in the delivery suite but we are most of the time heavily understaffed and even the interns are expected to deliver babies where necessary.