During my first week of my rotation with the Northern New Mexico Family Medicine Residency Program at St. Vincent’s Regional Medical Center in Santa Fe, I had the privilege of being the first-assist on a couple of C-sections. My very first day on the inpatient service brought me into the operation suite within the first hour. It was such a treat to work with Dr. Manske and Dr. Bacon as they did a great job teaching me during the surgery. For the first time, I had the chance to place my hand inside the uterus and separate the placenta from the inner wall with the guidance of the doctors there – a moment that will live in my memory for the rest of my career.
Dr. Rigales gave me the opportunity to work with him in the newly created family medicine center. I received training in the EMR used in the clinics and saw a wide range of patients from sick children to senior citizens with chronic pain. His style of quizzing and teaching never put me on edge, and it was a pleasure to work alongside him. He really embodied the ideal family practice physician and I hope to model myself by his example.
Dealing with difficult cases
Dr. Chyorny helped me improve my communication skills by permitting me to see the more difficult patients in clinic. One patient had suffered a traumatic brain injury many years ago. The patients’ ability to communicate clearly had obviously been undermined with the injuries sustained. Not only was communication hindered, but also the general mood and affect had undergone major changes leading to a diagnosis of depression with occasional outbursts of anger. I found it extremely difficult to communicate with the patient due to their consistent perseverating – another manifestation of the brain injury. It turned out to be an excellent experience by which I was able to practice my patience, direct patient conversation, and tweeze out pertinent information. I found myself in good standing when Dr. Chyorny came in and had about the same difficulty as I did and retrieved not much more information than I had.
Sleep deprivation and being prepared to move quickly
In my last week, a 24-hour call provided me with a glimpse into how challenging residency, and medicine, can be. Dealing with sleep deprivation through the night after an already-long day proved quite a struggle. A major lesson reinforced by the experience was how intolerable snippets of sleep can be. Rather than getting three hours of sleep from six 30-minute naps, I think having no sleep at all might be best. I felt like I was operating with a flat tire in the morning and now I know how to avoid it.
On one occasion on labor and delivery with Dr. Rigales, a multiparous woman struggled through a fairly long labor. We had started her on Pitocin to speed up the process but it seemed not to produce the kind of acceleration we were hoping for as she had stalled at 6 cm. We left the room momentarily to write orders on the patient, taking only minutes. To our surprise, upon our return, the baby’s head started to crown. We scrambled calling for additional supportive nursing staff, bringing out the sterile equipment, and getting into position for the delivery. The baby came out completely with only two pushes. The experience served as a prime example of how things can accelerate to extreme speeds in multiparous woman in labor.
Outside of the work in the hospital and clinics, I also had to deal with the difficulties of still being based back in Albuquerque. Though I had a room in the home of family friends in Santa Fe during my rotation, I had to handle the problems that arose from moving out of my house and back in with my father in Albuquerque. In addition, unplanned trips back to Albuquerque were too common a problem (2-3 times per week) due to family health emergencies including cholecystitis, labor, and surgeries.
Overall, I believe I received a well-rounded taste of medicine in Santa Fe in the clinical setting as well as a hefty load of life experiences that have contributed a lot to my growth in medicine and life in general.