Crossing the First Threshold

An Excerpt from a Work-in-Progress

All the third-year medical students were paired up. Debbi and I were happy to be working together. We had become good friends in the past two years. Debbi had managed to survive the grueling academic schedule despite a 90-minute commute each way, despite caring for a child while pregnant with her second. She delivered her second son during the summer break, then nursed him while sitting through third year classes. Some of our classmates had no appreciation for what she was going through.

Copyright: Ventdusud/123rf Stock Photo

Once during second year, the tape for note service came out inaudible. The person responsible for note service that day tried to get Debbi to give up her personal tape of the lecture. Listening to tapes while driving was how she managed to stay afloat. Our classmate was asking her to give up her life jacket. When she refused, he tried to guilt her into it by saying it was for “the good of the class.”

Today we would do our first History & Physical (H&P) on a real patient. The class climbed on the bus to the hospital. To pass the time, we quizzed each other on the finer points from Bates, the definitive textbook.  We studied our note cards so that we didn’t forget any component of the Review of Systems (ROS). We filled the pockets of our short white coats with otoscopes, ophthalmoscopes, tuning forks, and reflex hammers.

Debbi and I were assigned to a young woman who had been admitted for drug rehab. Though unsmiling, she was quite cooperative with everything we asked her to do. She was young and healthy, so she had no findings on either the ROS or on the physical exam. Even so, we managed to take a full two hours to go through every page of her thin hospital chart, to ask all the questions, and to do the most thorough physical examination she had ever had. Likely neither Debbi nor I has done quite as thorough a job since then, either.

Our preceptor was a kind pulmonologist. He guided the three pairs of students through their presentations. He had the patience necessary to teach the most elemental points, and he was gentle.  He took us to the bedside of some of his patients to show us some classic physical findings. I’ll never forget the first time I heard the characteristic Velcro crackles of pulmonary fibrosis.

In between the H&P and the presentation, we had our first lunch in the hospital cafeteria. I remember pushing my orange plastic tray down the metal rack toward the cashier and feeling sweaty in my brand-new white coat. A tension headache was working its way up my neck, and the noise of chatter and clatter was overwhelming. I wanted to find a place where I could unburden myself from the coat with the heavy pockets, from the stethoscope weighing down my neck.

I feared I would never feel comfortable in any hospital, that I would never know how to go through a hospital chart efficiently. The H&P was easy. Assimilating into hospital culture was the challenge.

Question: How did you feel the first time you entered a new environment with unfamiliar rules and values? You can leave a comment by clicking here.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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5 thoughts on “Crossing the First Threshold

    • I hope that eventually you achieved a sense of mastery. I agree with you that the orientation process doesn’t have to be painful if there is support.

  1. I was proud to land my first job as an RN onto a critical care floor but my welcome was not so welcoming. I was the first new grad to be hired into this ICU and the nurses working there were tight. The team leader came up to me and said that I was put her to spite them and they didn’t want me there. I survived this. Next the team leader had me follow one of the RNs. Our first patient was an elderly man with poor hygiene. The preceptor took my pen from my pocket and proceeded to show me how a babinski reflex was assessed, with my pen, and then placed it back into my pocket. Of course, I reported her and my orientation was discussed. I survived to become the Team leader in 2 years. I will never forget how intimidating it was to enter a new environment and I now work with new nurse orientation and the RN residency program with a goal to introduce new nurses to ARMC and make them feel welcome to our culture.

    • Thanks for showing how you were able to take a negative experience and use it in a positive way with new nurses. Sometimes it’s easier to perpetuate harm that’s done to us. You were strong and self-aware enough to turn it around.

      • It was the first time I knew I had the strength to persevere in an unfavorable situation. We speak to the new nurses about having the moral courage to be an advocate for themselves and others.