The first week of work, I noticed that many of the patients were named Mast. At first I thought it was the same patient who kept coming in – other doctors were seeing Mast, but he kept popping into my schedule too. Maybe he was a sick child, or had a nervous mother who kept bringing him back in for a multitude of complaints. Then I realized that the various Masts had different last names, so there must have been more than one of them. I wondered briefly if it was a popular name here in Darfield.
It took me a little while to notice that the slips of paper they printed, which had my patients’ names on them, never said Mast. Did the various Masts always cancel their appointments? Or because it was such a popular name, the kids went by their middle names, and the middle names were printed on my slips of paper? It would say Mast Zach in the computer, but then for some reason my paper would just say “Zach”. It was making less and less sense. Who were these mystery Masts?
It took an embarrassingly long time before I noticed that the little girls all had Miss before their names, and the adults generally had Mr or Mrs. Then I was able to piece it all together. But these are the little things that you learn, quietly, without mentioning them to your colleagues.
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The nurses are very friendly to me at work, and they claim that they really like me, which puzzles me. I am always polite to them, of course, but I spend half of my time hovering over the nurses’ station asking them how to do things. They have to spend a lot of their time patiently educating and re-educating me. They claim that they don’t mind but one of these days I am sure they will get tired of me. In the meantime I am learning everything I can from them.
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Overall I’m not sure exactly what they think of me at work. The other day I wore a necklace that Annie had made for me. It had brightly colored plastic beads, and some plastic animals – hot pink giraffe, bright green seal, etc. It didn’t look exactly like the sort of necklace you would expect your doctor to wear. But Annie asked me to wear it all day, so I wore it all day. I was puzzled that no one commented on it. Not my patients, not the nurses, receptionists, or other doctors. Were they just being polite, or did it seem routine for a doctor to be wearing a necklace that had clearly been made by a 3-year-old? Or was it because I am an American, so they expect me to be wacky and unpredictable?
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One of the ladies at reception told me that patients have started to request to see me particularly. I told her I was skeptical of this. “It’s true,” she said. “They ask for the skinny doctor with the high-pitched voice.”
“They do not!” I said.
She assured me that she had had patients (plural) ask for me this way. Not the American doctor – the skinny doctor with the high-pitched voice.
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Overall, I believe I see more sick patients than I did back home. One of the most fundamental skills taught to every medical student and resident is the ability to differentiate Sick from Not Sick. But this is tricky when all the patients coming to your office are Not Sick – because in the USA, a Sick child is generally brought to the emergency room rather than to his family doctor’s office. You can see sick adults and children on your hospital rotations, but someone else has already designated them as Sick, so this does not help a student to hone their Sick/Not Sick skill set. At an urgent care, you might see a sick adult, but sick children are much rarer – someone has usually already told them that they should just go straight to the ER. In New Zealand, at least where I am working, patients come to their doctor’s office when they are sick, even if they are very sick.
“She’s breathing very quickly. She’s been doing it since last night. I’m worried about her,” a mother told me recently, as she rocked her glassy-eyed child in her arms. The child, who was almost 3, had a heart rate of 184 and was breathing 50 breaths per minute – meaning her heart was beating about twice as fast as it should have been beating, and she was breathing about twice as fast as she should have been breathing. She had a fever too. Sick. I was able to admit her to the hospital from my office room. I suppose this could have happened to me back in Connecticut, but it certainly didn’t happen often.
Later that day, a father carried his child into the office. The child was grey and also breathing very quickly. There wasn’t room in any of the doctor’s schedules so a nurse took the child back. I happened to be hovering around the nurse’s station trying to get an answer to an unimportant question when the nurse came out. She was looking flustered, trying to find the head doctor, who was in with another patient; I went in to see the child instead. An asthmatic child, grey, lying in his father’s arms, not talking because he was using all his energy to breathe. Sick. It’s actually pretty obvious when it comes down to it. I looked at the child and was grateful for my training so I could help him. And I was grateful for my team of competent nurses, who could get him his breathing treatment and his steroid and start the oxygen because his oxygen was so low, while we waited for the ambulance to come.
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Sometimes at home Annie pretends to be a Mommy. I get a lot of insight into myself as a Doctor Mom by watching and listening to her at these times. Once she lay on the floor next to Cora and pretended to weep, saying “Please go to sleep, Cora! Please sleep!” Another time, she pretended to walk in the door – using a blanket as her fancy work clothes – and announced “I just comed home from work and I’m very tired.” She proceeded to strip off her blanket and the clothes she had underneath, informing us all that she had to take off the sick clothes before she could touch anyone, because she is a doctor.