Day in the Life: Rural Under-served Family Medicine

The next couple “Day in the Life” posts are gonna be kinda squished together because I lagged so far behind on the last one (Peds Neurosurgery)!

I got off to a really rough start on this rotation, due in part to:

1. Breaking my dominant hand the weekend before
2. Misplacing the housing papers and spending the night sleeping in my car because I couldn’t find the apartment
3. Getting my car towed

After that first week, the only way things could have gone = up. Michelle (one of the other medical students on the rotation) said she felt that if everyone adopted the mentality and positivity I had, the world would be a better place. (She is super super sweet. I was so frustrated by strike 3 [towing of car]. :'(! )

Day in the Life: Rural Under-served Family Medicine

The people here were super, super nice. The medical student coordinator was somewhat distraught when she found out what had happened (this was after “strike 2”).

“You’re low-key defenseless right now and you slept outside in your car in the elements!?!

I like the term “low-key defenseless,” haha. The residency coordinator was completely alarmed, and came by during didactics on Thursday afternoon to make sure that I was okay.

F: Hello! It’s nice to see you here! How has your week been going?
C: I’ve been worrying about you all week. Is everything okay now? Did you get into your apartment yet? How’s your arm? Did you get your car back?

She even got me hooked up with a “special circumstances medical student reimbursement fund” so that I’d get reimbursed for the towing of my car. <3

A Typical Day

Totally valid board question/discussion.

I had my time split between two different rural clinics. On Mondays and Tuesdays, I’d work with a physician and see/write up notes for half her patients. She told me the general expectation for interns was to be able to see 3-4 patients per half day, so that’s what she wanted me to aim for. We’d work from 9 – 12-ish p.m. and break for lunch, then go back to seeing patients from 1 – 5-6 p.m.

Her goal was to get me out the door by 5 p.m., but I’d usually stay til almost 6 to finish seeing patients who’d been double-booked, so she sometimes said she felt like she’d failed me since she kept unintentionally keeping me late. I had a lot of fun working with her, especially after that first week (she jokingly offered to burn some sage and throw some holy water on me). She told me that I did really well, wrote awesome notes, and felt that I was definitely ready for residency! :]

Roughly 50% (if not more) of her patients were Spanish-speaking (I really, really need to learn Spanish…), but thankfully, there were interpreters available and there’s still a lot you can convey even without knowing the language. A 92yo Spanish-speaking granny gave me a huge hug and a kiss on the cheek before she left, and she was apparently one of the patients that my preceptor had described to me as “usually very cranky.” I did a lot of counseling on diabetes and nutrition, and also had to break bad news to one of the patients, which is definitely something I’m going to have to get used to (and improve upon) in the future.

Life advice from one of my patients:

“I’m going to tell you something today that I hope you’ll always remember–don’t let losing trust in one person cause you to lose trust in everyone.”

I spent Wednesdays/Fridays and Thursday mornings at the rural resident clinic splitting patients with the residents there. On the days where there were no residents, I’d take walk-ins and staff with the preceptors there. I had a lottttt of autonomy on this rotation–way more than I was used to. My name would be on the board as one of the providers, and the medical assistants would ask me what orders I wanted to place and whether or not I could sign off on things (no to the latter). My preceptors trusted my decision-making and I got to call the shots on most of my patients (although they’d always be around if I had any questions to ask or things to run by them first).

I really liked working with the faculty and the residents here–everyone was super super friendly, and it was an amazing learning environment. :] One of my preceptors said that I did an amazing job with my oral presentations (“Did your resident coach you beforehand?” [“Nope!”]) and in working with patients! Another gave me a whistle for if I was ever cornered by a patient, and told me that he’d try to get me some vacation days so I could enjoy senioritis.

My favorite resident would say things like, “Yay! Today’s been an awesome day–I got to work with Farrah, and we managed to see all our patients on time and get some teaching in and all our notes done!” He even let me write his residency bio for him! (I may or may not have snuck in an, “as swift as a coursing river, with all the force of a great typhoon, with all the strength of a raging fire…” somewhere in there…

He in turn gave me some lovely advice since he used to live in NB:

“Don’t walk around at 3 a.m. in the street looking like a girl. Baggy sweatshirt, none of your hair showing. Maybe keep a fake beard in your pocket so you can just slap it on when you walk around at night. The minute they see a girl, people tend to assume that they have permission to talk to you. It’s unfortunate, but better to be safe!”

…I was following him til he got to the part about the fake beard. Who wants to send me a crocheted beard hat!? :P

We had didactics on Thursday afternoons, and they were a lot of fun! There were the usual board reviews and lectures, but we also had a talk on Wellness by one of the chief residents who also happened to be the wellness chair (she coordinated puppy therapy for the residents, and I really need to implement this at my future residency program too <3).

A Wilderness Medicine fellow came in to do a talk on MCI’s (Mass Casualty Incidents) and we practiced MacGyver-ing splints/airways/tourniquets and a mock simulation of a plane crash. We also had a casting workshop, which I found semi-hilarious because I was already in a cast and we thought it’d be fun to give me two of the same injury.

A photo posted by Farrah @ fairyburger (@fairyburger) on Apr 16, 2016 at 5:01pm PDT

Meals

Breakfasts and lunches were free at one of the clinics! I had some basics at the apartment, but since I couldn’t really think of anything to cook one-handed, I kinda took to getting a big lunch and eating the rest of it for dinner to save money. There was also a bunch of food for us on Doctors’ Day! :]

Parking

Free! (Yay!) I did do a whole ton of driving though since I was at two different clinics.

Housing

I did this rotation out in rural California and lived in a student apartment in Fresno (or as I like to call it, Fres-yes), which was $450 for the month. I’d paid for a shared bedroom since I didn’t feel like forking over another $200 for extra privacy, but I ended up getting my own room anyway. I didn’t meet my roommate until the evening of day 4, but she was super awesome, and we’d often talk in the evenings when we were both home. :] It was nice to have company, and she was really cool!

This was also the rotation where I found out where I was going for residency!!!

This was my friend’s super helpful message from the night before Match Day.

Check out my other Day In The Life posts!