I arrived early. After all, it was my first day at my new job. I had worked in another doctor’s office, for about a year, so I was familiar with the setting. However, switching from Sports Medicine to Internal Medicine is like comparing apples to a porcupine and I had no idea what to expect.
“Hi. I’m Shannon and I will be training you today.” I was surprised to hear a booming voice explode from someone with such a small stature. “Welcome to the practice. You can place your bag over here.” Her bright green eyes seemed electric peering above her surgical mask. “Come with me.”
“Sure!”
I followed her into the first exam room and she got right down to business. “Doctor C’s patients are seen in rooms 1, 2, and 3. I will teach you how to triage. It is imperative that you go over the medication list with each patient at every appointment, even if they were here last week, because dosages and allergies change often.” I nodded with some level of confidence as this was standard protocol at my last doctor’s office.
“You need to find out if, when, and where a patient was Covid Vaccinated and it needs to go into their chart by clicking here.” She pointed at the computer screen and started speaking very quickly. “You also need to get a complete patient history including: recent surgeries or hospitalizations by clicking here, then get their social history if they drink, smoke, exercise, by clicking here, and then you need to complete this form, and that form, and this other form, within the chart.”
Twirling my auburn hair tightly around my finger, anxiety crept in. Even though Dr. C’s office uses the same Electronic Medical Record system as my last doctor’s office – we didn’t ask half of these questions, we never had to include any of these forms, and we certainly didn’t have nearly as many clicks.
“If this is a Medicare Patient and it’s an Annual Visit,” Shannon continued without even giving me a chance to process the previous information, “you have to grab a depression screening form from the breakroom for the patient to fill out and you need to order another PDF form in their chart by clicking here and here, then select Depression JC, then click here and click here, and then close the form by clicking here.”
My inner monologue turned on.
What. The. Hell. Click, where? Click, what? Oh, my. That’s a whole lot of clicks. That’s even more clicks, in addition to the other clicks, I have to remember from the other questions! Any forms at my other doctor’s office got filled out by hand, by the patient, and scanned into their chart – easy breezy. This seems like a lot. How the heck am I going to remember all of this?
My dark brown eyes glazed over with fear as Shannon continued to give me instructions. “Speaking of Annual Visits, for any patient of any age, you will need to click here to add the assessment code: z00.01. After you finish updating their chart you can go ahead and take their Vital Signs. You will enter those values by clicking here.”
Assessment codes? Isn’t that for billing or the Doctor’s responsibility to input? Now I have to remember assessment codes too? YIKES.
I had only been there for twenty minutes and I already began to doubt my decision to make such a drastic career change. Not only was I inundated with an overwhelming amount of information within a matter of seconds, but I hadn’t taken Vital Signs since I was in Medical Assistant school – nearly two years ago. And I certainly never took Vital Signs with a blood pressure cuff attached to the wall.
And, OH MY GOD, what am I going to do?
“C’mon,” Shannon smiled, “it’s time to take the first patient.” With a lump in my throat I nodded because I couldn’t reply with words.
Luckily, the first few patients we took into the back Shannon did all of the work. She asked the questions, she input the information, and she took the vitals. I was impressed with the way she was able to command the room and redirect the patient back to ‘what brings you here today’ when they went off on tangents.
Meanwhile – I hovered over her shoulder, like a fly buzzing around her head. Desperately trying to memorize where all of the ‘clicks’ were located and jotting down notes on my yellow legal pad. With foggy reading glasses and sweat beads forming on my upper lip, I slipped a mint into my mouth so my breath wouldn’t stink.
Things were moving at lightning speed, my brain was on overload, and my bladder was about to burst from way too much caffeine. “Um, hey…” I muttered, “Where is the restroom?”
Shannon pulled down her mask revealing shiny, white, buck-teeth, “There’s one in the building lobby, you need a key to open it.”
“Thanks,” I grabbed the key, “I’ll be back soon.”
Darting through the waiting room I saw a sea of multicolored face-masks sitting six feet apart waiting to be called by the receptionist sitting behind glass. I couldn’t believe how many patients were waiting. I raced across the hallway, unlocked the door, and ran into the first stall.
As soon as I sat down I almost started to cry. This was all too overwhelming. Within the first half-hour Shannon triaged at least 6 patients and we had 25 more on the schedule. At my old office we were lucky if we had 6-10 patients in one day. I told myself there was nothing to worry about. I told myself I was only here for training and I wouldn’t be expected work at Shannon’s level. I took a few deep breaths and went to grab some toilet paper.
Sadly, and much to my dismay there wasn’t any. GODDAMNIT! I would have to start a new roll. After sliding the plastic lever, it became painfully obvious this wasn’t going to be an easy task. The edge of the roll had been seemingly super-glued together and the paper holder was located at an awkward angle making it even more complicated. Now what the hell am I supposed to do?
Sweating, panicking, and cursing under my breath – I began clawing at the extremely thin toilet paper, like a cat on a scratching post, creating confetti on the floor and narrow streamers in my hand.
Suddenly, I really missed my old office. I thought about all of the bathroom breaks I used to take with my former co-worker and how much we used to laugh together. I missed her. I missed the small, intimate, laid back office, and feeling like a rock-star-champion at my job. Now I just felt lost, like a pathetic newbie. Fighting back tears, I pulled myself together, gathered flakes of toilet paper, finished my business, and got ready to leave the stall.
And that’s precisely when all hell broke loose.
The heavy, grey, metal, door, speckled with rust stains, would NOT open.
I pushed the latch back and forth as hard as I could, but it refused to budge.
WTF! WTF! WTF!
I screamed inside my head.
How am I going to get out of here? This can’t be happening. It’s my first day! This can’t be happening! Okay, okay. Stop and think. Should I yell for help? Would anyone even hear me? No. No. This is way too embarrassing. Think, dammit. Think. Maybe I should call someone from my cellphone?
I shoved my hand into the pocket of my navy-blue scrubs only to realize I left my cellphone in my car – on purpose – so nothing would distract me from training.
SH*T! I don’t have my damn phone! Well, that doesn’t really matter anyway because even if I had my phone I don’t have any of my co-worker’s numbers BECAUSE I DON’T KNOW ANYONE YET…I DON’T EVEN KNOW WHERE WE KEEP THE GAUZE!
I looked at the bottom of the stall door assessing the distance to the floor. Is there enough room for me to shimmy out from underneath? For a moment, I contemplated lying on my stomach and army crawling my way toward freedom, but then I immediately dismissed that idea because bathroom floors? Ewwww. Gross. And I can’t very well treat patients covered in germ infested scrubs.
Dammit, dammit, dammit! How am I going to get out of here? AND HOW LONG HAVE I BEEN IN HERE? I HAVE TO GET BACK! THERE ARE SO MANY PATIENTS WAITING! Please, Lord, help me!
Finally, I positioned myself like a ninja. I summoned my inner strength and karate kicked as hard as I could until the door flung open, slamming into the wall, sending the loudest echo throughout the entire bathroom. Once free – I washed my hands, splashed cold water on my face and neck, and hightailed it back to the office, hoping no one overheard the commotion. I vowed never to use that restroom again.
The next two hours flew by like a whirlwind.
Shannon allowed me to sit at the computer to learn how to do ‘all. of. the. clicks.’ and typed the patient note while she asked the patients questions and took their vitals. I was beginning to feel a little more comfortable when she asked, “Are you comfortable giving an EKG?”
I gasped.
“Well…I know how to give an EKG, technically. I mean sort of…I mean I haven’t done that since I was in school, either. We didn’t do those at my last doctor’s office,” I rambled on, “we were a small, specialized office, for PRP and Stem Cell treatments, Hormone Replacement Therapy, and ultrasound guided injections for people with injuries. I drew a lot of blood as a phlebotomist, so I can do that no problem, but, I…”
Shannon interrupted, “We have one phlebotomist, from Quest Labs, that comes to our office three times a week to draw our patients’ blood, so you won’t be doing that here. But you will have to perform several EKG’s, daily.”
Oh that’s just friggen dandy!
My confidence plummeted.
One of the skills I was hoping would prove my worth didn’t even matter at this office.
And if that wasn’t bad enough?
That’s when Shannon dropped a bomb onto my lap. “I have to leave today at 12pm.”
“Wait…what?” I looked at my Apple watch. It was 11:25am. “Ok, then…um, is someone else going to train me this afternoon? We’ve only spent 2 and a half hours together. I’m not even sure where supplies are located.”
Please God, let someone else train me. I didn’t sign up for this. WTF?
Shannon shook her head, “Unfortunately, no.”
Incessantly twirling my hair, I asked, “Sooooooo….. I am really going to be on my own from 12pm-5pm?”
“Pretty much.”
M*ther-F*cker!
My heart sunk down to my toes. The palms of my hands were saturated in sweat. My eyes welled with tears and I turned so Shannon couldn’t see my face. I wanted to run away. I wanted to go home and call my old office and beg for my old job back. Racing thoughts trampled through my mind.
OMG. What made me think I was going to be able to do this job? How am I supposed to learn so much, so quickly, and without anyone training me? Did I make a terrible mistake? Should I just walk out, right now? OMG.
“Hey!” Shannon snapped me out of my mental spiral, “Let me show you where we keep the extra table-paper, gauze, band-aids, alcohol wipes and stuff you’re going to need for the rest of the day.”
We hustled around the office on a medical supply tour and before I knew it? It was 12 o’clock.
Shannon grabbed her pocketbook and punched out, “I’m really sorry to throw you to the wolves, but you’re a smart girl, I think you’ll be fine. I spoke with Dr. C and he told me to tell you just do what you can. Whatever you can’t handle the doctor will take over and finish himself.”
“Ok.” I said. “See you tomorrow?”
Shannon laughed, tossing another grenade in my direction, “No. I am off on Friday’s.”
I went into full-blow-panic-attack mode and I wanted to scream, “ARE YOU F*CKING KIDDING ME? But I didn’t. Instead I calmly said, “Um… When Dr. C hired me, I was under the impression I would be trained for the first few days before triaging on my own. Why did they schedule me for training this Thursday and Friday if you’re not even going to be here?”
Shannon shrugged, “I don’t know.”
“Great.”
And then she left.
My heart was beating so fast I thought for sure I was going to have a stroke or a brain aneurysm. I needed to catch my breath. I needed a minute to clear my head and calm down. Thankfully it was time for my lunch break. I went outside, got into my car, and hid.
You can totally do this. I tried to convince myself. I thought about all of the other times in my life when I was faced with the choice to either ‘Sink Or Swim’ and I never sank; I always figured out how to swim. You’ll be fine. I thought.
But I was wrong.
I am not going to lie. The rest of the day was an absolute shit-show.
I nervously asked patient questions, barely speaking above a whisper, with my shoulders so tightly clenched they practically touched my ears.
I deeply struggled to pronounce medications when reviewing a patients’ list such as: amiloride hydrochloride, hydrochlorothiazide, metoprolol succinate, Irbesartan, Atorvastatin, Rosuvastatin calcium, and Colesevelam. While frantically Googling the drugs intended usage. Why? Because if any of those medication are used to treat blood pressure I had to remember to add a special BP form into their chart. And I had to remember which form. And I had to remember were to ‘click’ to get the damn forms.
AND SWEET BABY JESUS HOW AM I EVER GOING TO LEARN ALL OF THIS?? I AM STARTING COLLEGE FOR THE FIRST TIME, AT 46 YEARS OLD, IN JUST TWO WEEKS! THAT IS NOT GOING TO BE ENOUGH TIME FOR ME TO ADJUST! THIS WAS REALLY BAD TIMING FOR ME TO DECIDE TO SWITCH JOBS. GOOD GOING, MORON! FML!!!!
I didn’t dare attempt to take blood pressure when getting Vital Signs. Mostly because I still had no clue how to use the cuff attached to the wall, or even how to change the cuff sizes for large arms vs thin arms. And, because I am hearing impaired, I need to use a special cardiac stethoscope in conjunction with my hearing-aids to be able to detect the systolic and diastolic sounds of a heartbeat – which my mother ordered for me but hadn’t arrived yet! So, I lied. I told the doctor I left my stethoscope at home because I thought I would just be training.
“Can anyone here do an EKG or inject a B-12 shot?” Someone shouted in the hallway. A curly-red-headed woman, with freckles on her face, sporting black scrubs and white lab coat, appeared out of nowhere. “Seriously? Anyone?”
Holy shit, people. You knew when you hired me I needed to be re-trained. Why do y’all keep asking me to perform a procedure you damn well know I can’t do?
“Um… It’s just me and the other new girl today.” I announced. “But the other new girl has eight years of experience including working at Urgent Care. I think she can do it…” my voice trailed off. I felt like a wounded deer, paralyzed on the side of the road, just waiting to be mowed down by the next speeding car.
On my next break, I relentlessly studied the notes I had taken earlier. I started looking up medications and taught myself some shortcuts. I noticed if the name had the letters “statin” at the end, that usually meant it’s a cholesterol medication. If it had the letters “olol” at the end, that usually meant it’s a beta-blocker used for high blood pressure medication. And then I rehearsed pronouncing them in my head.
When I brought back the next patient, I felt a little less anxious, but when I discovered they were at the office wanting treatment for a bum knee? I thought EUREKA! Hooray! An injured person! That’s my wheelhouse! I know EXACTLY what questions to ask and I know EXACTLY what to do!
I fired off questions without any hesitation, my shoulders relaxed and dropped four inches, while feverishly typing the ‘HPI’ also known as the patient note.
“What brings you here today, sir?”
“My knee.”
“Which knee, right or left?”
“Right.”
“When did the pain begin?”
“A few weeks ago.”
“Was this the result of an injury? A slip or fall? A car accident?
“No.”
“And how would you describe the pain… is it sharp and stabbing, or dull and achy? Is it constant or does it come and go?”
“It comes and goes, depending on how I move it, sometimes it’s sharp and stabbing other times it’s dull and achy.”
“Does the pain radiate up or down your leg, or go behind the knee?”
“No.”
“Do you have any numbness or tingling?”
“No.”
“Are you having any difficulty walking, standing, or getting up from a seated position?”
“Yes.”
“Do you feel like you knee is going to give out on you?”
“Yes.”
“On a scale of 1-10 how would you rate the pain?”
“8.”
“Have you tried using ice/heat or over the counter medications?”
“Yes.”
“Do they help?”
“Not, really.
“Have you had any recent X-rays or an MRI?”
“No.”
“Have you had any recent injections like cortisone or gel shots?”
“No.”
“Are you currently in physical therapy?”
“Yes.”
“How many times per week?”
“3.”
“Is that helping?”
“A little.”
“Okay, sir. I will let the doctor know you’re ready and he will be in shortly. Have a great day, it was nice to meet you, I hope your knee feels better soon!”
And just like that, I created the most perfect patient note.
HPI:
58 y/o male presents in office with right knee pain, which began a few weeks ago. No known injury. Patient describes the pain as intermittent, sharp and stabbing, and dull and achy -depending on how he moves. Patient reports no radiating pain, numbness, or tingling. Patient is experiencing DROM: difficulty walking, standing, and getting up from a seated position with buckling sensations. Pain scale 8/10. Patient has tried using ice/heat and OTC medications with no relief. Patient is currently attending physical therapy 3x’s per week with minimal relief. No recent radiology imaging or injections for this problem. Patient would like to discuss treatment options today.
Finally. FINALLY. Finally, something went right.
Finally. FINALLY. Finally, I wasn’t dying from crippling anxiety or fear.
And, finally. FINALLY. Finally, I started to believe in myself, just a little bit.
Needless to say, I did NOT start off my new job like a shiny gold star.
I am not ashamed to admit that I was a HOT MESS.
And it definitely took me at least a full two-weeks to adjust to my new surroundings, the patients, my co-workers, and the procedures, ect.
I am proud to announce, now that I have been there for over a month, I am 100% acclimated. I am more than capable of providing accurate and proper EKG’s. I distribute B-12 injections and the Influenza vaccines, LIKE A BOSS. I do all of the clicks like a motherfucking Rockstar. Those godforsaken forms are now my friends. Blood pressure is my bitch. And all is right again in my little world.
And that’s a wrap.
Stay tuned.
Love,
M
