Changes During Clerkship

Assalamu Alaykum! (Peace be upon you!)

 Today, our Integrated Clinical Clerkship II a.k.a. "The Slave Trade" officially started. I still can't believe it's already begun, my fourth and second-to-the-last year in Med School. *Spine chills* If this is still a dream, I really have to wake up.

We will be rotating first under the Department of Pediatrics, one of the "Big Four" departments in the Med School World. We will be staying with them for 4 weeks: each student must rotate for a week in Pedia ER, another week in NICU (Neonatal ICU/ Baby Catcher in the Labor Room) and two weeks in one of the two Pedia Wards (9 and 11). 

I am with the Pedia ER group. At first it actually thrilled me: "Oh yeah! First day of clerkship and it's already under ER! Things about to get real!". 

And yet my first day as a Clerk was not that eventful as expected. After the release of the ever-changing schedule, I was the fortunate (or the unfortunate) one to be stationed under "Post-Duty" on our first day! It means I won't be doing much today. (will explain why this is so important, later). Anyway, I would have to save all the excitement (and anxiety) for tomorrow on my real pre-duty. I hope it would be as high yield as how I would expect it to be. I have to prepare myself as well for this, yes.

For now, let me just type in and share some observations I had as a newly anointed clerk in PGH.
(see? I had that much time in a day to think about these things while working on my Immersion report, buying medical stuffs I need and paying my overdue bills!)

What Changed now that I am a Clerk?

1. Duty, Pre-Duty, Post-Duty:  
My everyday life now is defined with only three days: Pre-duty, on-duty and Post-duty. What you do during those three days depends on what rotation and in what service you are assigned. For example, if you are under PER, during Pre-Duty you will monitor  vital signs and do necessary lab procedures (aka procs) to all old patients from 7AM to 5PM. Non-Stop. This also applies when you are assigned in the Wards. Pre-duty works for NICU is different: you will only chart 3 neonates and then report one selected cases by the afternoon. You can go home after your presentation.

If you are On-duty on the other hand, you will be the Student-in-charge (SIC) of some patients, you will also be the one receiving new incoming patients, do their proper history and PEs, prepare all papers they need (oh the horrible number of those papers to be filled up!) and endorse them as well to the next SIC by the end of your duty. This only apply on PER and Ward duties. NICU/Catcher duty have an essentially the same role (receiving new patients) with the added bonus of catching newborns and helping in resuscitating them as well. You are supposed to be on your post from 7AM to 7AM the next day for both ward and NICU duty. This is the real 24 hour duty. (But for our group, we were somehow able to divide the PER duty into AM Duty (7AM-7PM) and PM Duty (7PM-7AM) with two different student clerks for each duty. Cool huh?
 
The post-duty does not always mean "rest day" as how it supposed to be. You are still required to attend patient endorsements at 4:30PM the next day of your duty for wards. It is only in NICU duty and PER duty that you can go home an asleep after you've done all your backlog procedures in PER or do charting in NICU.

2. Back to Seven O'
For the past three years, I got used to the 8 o'clock schedule of lectures, conferences and even exams (with the notable exception of OBGYN rotation during ICC year). We even get some rare chances of delaying it for another hour or two... And we still get a number of tardy students coming to class with that? (including me, sorry :p) And now we are back to the conventional "beginning" of the day: 7AM.
 
This won't change much for those waking up at the early wee hours, but this is surely a frightening change for those who wake up 20 minutes before class. No, stop looking at me! I'm a changed man alright!
 
3. The Spaced-out faces
During my first two years in Med School, I noticed one horrible thing that happens to those I met and knew in Med School upon entering the world of clerkship: They never recognize you anymore! I would at times find myself greeting and waving cheerfully at this once-a-funny-guy-now-a-very-grim person and receive nothing but a blank stare. Hello! Are you there?! It just makes me wonder what clerkship can do to a person to change that drastically! So, I made a promise then not to go that horrible path. 
And yet here I am now, barely starting my first day and I found myself on that same situation again but now in a different role: I am now the one not responding to my juniors greetings and friendly waves. I would just smile or nod. As much as I wanted to strike some random conversation, I am just stuck midway, feeling awkward because of a frightening thought that lingers in my mind: "What was his/her name again?" haha! It will just be another awkward moment. So I would rather just pretend to be busy or look far away with a blank face than call a individual with made-up names.
So yeah, to all those LU5 to (future) LU3 students that will receive my blank stare, just understand that I just forgot your name. Was it Ramon? Rogelio? haha. *Space-out*

3. The Big Bombs
The realization of being a clerk is also an atomic bomb as well to your carefree self. You just woke up from all those fretful dreams that you are still a baby ICC student that everyone will treat kindly andd forgive whenever you commit mistake. You realize everything is about to get real dead serious starting this year! That you will be on your own now without your buddies to back you up when you stutter over an answer to a quick question from a consultant! Deym! hat have I done with those 3 years in Med school, you ask yourself everyday... Every. Single. Day.

Day Zero: To prepare us for whatever that is about to come, one of the interns (the guy in black shirt at the back) met with us and gave some invaluable tips on how to survive the first few weeks of clerkship. Talk about being excited eh? 

 
Another big bomb is that fear of doing things you know you are supposed to have learned in the past but now you are just unsure if you really did learn anything at all! After all those horrible trainings and after two months of not doing it, you already feel like a newly hatched duckling: fresh, naive, unskilled. really, you just have to test it and revive those skills you learned in the past. You just have to convince yourself that you can do it hehe.

Of course this one is one of the most painful bombs of all: NO MORE WEEKENDS :( :( :( I really hate this news. Weekends are the only remaining human things we have and they also took them away! huhuhu! Oh well, what's the use of whining here. The clerks in the past survived without it, so we can do it as well right? (Good news: Some rotations have free weekends! Yeay!)

4. The Stash
We also started buying lots of equipments for our procs during duty works. I have to orient myself again and again about which top to use for which lab test. A personal reminder, stashes are not personal items but shared items. DO NOT HOARD! LEARN TO SHARE!
 
We are also now entitled to use our own trodats! Yeay! True that! ahaha. Got my own trodat for P250 with my name, the beloved college and hospital with the PGH logo (see above photo). Will surely be using this for years (hopefully).

5. FREE MEALS!
If there are free perks of being a Clerk, it's the free meals in Mess Dining Hall during on-duty. Be warned though, you have to bring your own utensils and water bottles. They also lock the doors after meal times so you have to go find other entrances just to get your free food (assuming there are still left for you). I found the "secret entrance" today thanks to two of my friends from the other departments hehe.

6. Here comes the Sun!
As the poor network connection in the PGH is still unresolved: the ever mysterious vortex of nothingness that dissipates all mobile networks with the sole exception of one, Sun Cellular Mobile. All students who will start working (or living) in PGH will have to switch to Sun Cell Sim Card unless he or she is ready to risk not receiving important information (and hopes of passing med school) in that vortex as well. Maybe a dual sim phone would be a better choice. Or maybe not.

last note:

Isn't it better to call the 4th year Med Students as JUNIOR MEDICAL INTERNS than CLINICAL CLERKS? Just sayin'.

Signing off!

Now-a-clerk,
Ahmad

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