Friday, November 30, 2007

Can we save the patient?

Any student can use the services of ASP at my law school.  During the semester, I keep a steady flow of appointments on my calendar.  However, my regular load of appointments started to dwindle a few days before the Thanksgiving Break.  The final week of classes has followed immediately on the heels of that holiday break. 

Do not fear that I might be sitting quietly in my office with nothing to do.  At the same time that my usual student load began to drop off, my walk-in traffic sharply increased.  A whole new crop of students arrived to fill the gap.  Many, but not all, have been 1L students.

With roughly two weeks of classes left when the first walk-ins began to appear, I found myself dealing mainly with students who had been merely surviving the semester.  Some were in worse shape than others.  My questions to evaluate the severity of the symptoms tended to elicit responses such as:

  • Yes, I have kept up with the reading. 
  • No, I have no outlines of my own. 
  • No, I have not done practice questions. 
  • No, I do not go to the group tutoring sessions. 
  • No, I did not go to any of the ASP workshops. 
  • Yes, I did all right on the practice exams that my professors gave; I was just below (or at) the median grades. 
  • No, I did not go to see my professors about the practice exam or anything else this semester.

I consider these types of cases to be the equivalent of ER triage.  Stop the bleeding.  Use stitches or staples to put them back together.  Provide oxygen if necessary.  Prescribe some pain-killers and other appropriate medications.  And, request a follow-up visit in five weeks. 

Depending on the severity of the academic trauma, I must make a judgment call on whether quick action and minor procedures will suffice or if we are into academic CPR mode.  (Occasionally, resuscitation is not possible, and the Academic Associate Dean is brought in on a consultation about possible WD or LOA procedures if circumstances warrant.)   

First, I keep a calm voice as I probe with questions to evaluate what steps must be taken immediately.  Is the pulse racing or non-existent?  The student is usually at least pale, worried, near tears, or breathless.  No need to arouse total panic.  Good bedside manner is important.  My heart may sink to the bottom of my toes as I analyze the situation, but I listen to the story and nod to encourage dialogue.

Second, I try very hard to ignore the "ounce of prevention - what were you thinking" speech in the back of my mind.  Instead, I suggest to the student that there are additional steps we can take in the future, but that for now we need to take quick action.  I make mental notes regarding next semester - possibly a rehab period of 4 - 6 weeks once classes start in January. 

Third, I decide what can be realistically accomplished in the short time frame.  How can we use time to advantage by being very efficient?  A bit easier for 1L's who have nicely spaced exams than for my 2L's and 3L's who often seem to be the very ones with multiple sets of back-to-back exams plus a paper.  What are the most effective study techniques for this student?  The options will vary depending on the particular student, professors, courses, study deficiencies, and number of days left.

Fourth, I decide whether there is time for multiple sessions or if one intensive session will have to suffice.  Although I know that my repertoire includes some powerful medicines for academic woes, I also know that there are no miracle drugs in ASP.  I can provide the triage, but the student needs to have the will to live and fight another day.  And, an extra strong dose of assistance may not stand up to a massive infection of poor academic planning and inadequate study habits.

Fifth, I help the student lay out a treatment plan to minimize the damage and salvage the semester.  I offer follow-up visits if desired.  I make referrals if appropriate.  I often say silent prayers for the most traumatized.   

Sixth, I remind myself that I have done the best that I can in an emergency situation.  I hang up my stethoscope for the day.  I close the door to go home.  I am relieved that I do not wear a beeper.  However, I know that tomorrow there will be a new batch of triage cases outside my office.

And after exam period ends, I wait for January when I can re-assess the prognosis after test results and schedule the major surgery needed.  Hopefully, it will not be too late.  (Amy Jarmon)

               

 

 

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