Psych, out!

Today I completed my 6 weeks of psych-ation, and boy was it sweet! While I will probably not miss the subject matter or the patients, I will definitely miss the schedule that allowed me to go to yoga 4-6 times per week, eat 3 meals a day,  and spend some quality time with my friends. In tradition of how I close every chapter of medical school – here is a few things I have learned over the last 6 weeks:

  • People crashing off Methamphetamine and PCP are NOT very pleasant to be around.
  • 80% (by my approximation) of patients hospitalized in psych hospitals have Borderline Personality Disorder.
  • Nothing intimidates you like having a patient with antisocial personality disorder posturing in the window of the resident room during rounds.
  • I have seen more fist fights on psych than all my other rotations combined
  • If you don’t have a relative with schizophrenia – you don’t have schizophrenia.
  • Don’t put your cat in the freezer.
  • Most psychiatrists operate on a scale between biological vs psychoanalysis in  terms of treatment. When a psychoanalyst heavy attending covers for a biological heavy attending over the weekend – it’s not pretty on Monday morning.
  • I don’t want to be the “bad guy” when it comes to patient care.

Probably the most impactful thing that I learned has to do with the concept of “dissociation”. Dissociation of something that well all do. It’s that thing that we do whenever we zone out while reading a book, going for a run, playing video games (for those that do that), or browsing social media. It’s something that we need, because it allows us those moments where we feel outside of our current situation. In moderation, it’s an essential thing and a healthy coping skill. When it starts to take over our lives and impede our social functioning – it becomes an addiction (and a really unhealthy coping skill because now you’re legit coping with nothing).

The point of this, is that I have been desperately in need of dissociation for the last few months. The overwhelming thing about medical school is that it tends to have the ability to consume all parts of my life, making distancing myself from it really challenging. Even my free weekends and evenings are shadowed by an overhanging cloud of anxiety.

So now that I am officially 1/2 done with my 3rd year of medical school(WHAT?! thats crazy! Let me just freak out for a second) it’s time for  me to embark on 2 weeks of “dissociation” from this medical school life. For the next 2 weeks I am not going to worry about picking a specialty, getting letters of recommendation, or deciding where to go after next year (these are the things all 3rd year medical students are currently having aneurysms over).

Goodbye Student Doctor Tessa – Hello Tessa, 24 year old girl traveling in Australia =)

Peace out, reality.

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From Such Great Heights

We all have that Thing.

You know what I’m talking about – that one Thing about ourselves that we just can’t get over. That one Thing that more than anything else we would want to change if we could.

The Thing that our nasty little inside voice whispers to us about. If only you weren’t __________ then you would have that job. If only you didn’t have _________ then you wouldn’t be alone.

Maybe if I just changed ___________ then he would love me.

We all have that Thing.

Mine is my height.

At 6’1″ tall, I’d be considered a tall guy, but for a girl? It’s ginormous. And the thing about this Thing of mine is that it may be one of the few things about me that I absolutely, under no circumstances, can ever change.

No matter how much I wish, pray, hope, and dream – I will never be any shorter than I am.

But here’s the other thing about this Thing of mine – while I hate it, I also LOVE being tall (find that confusing? It’s cause I’m a girl, don’t worry about it).

I love that I can always see the stage at a concert. I love the fact that I draw attention when I enter a room. I like that I am an incredibly difficult person to intimidate (a VERY valuable trait as a female medical student), because it’s nearly impossible to look down on me. I love the fact that I feel comfortable traveling alone because I would be a super inconvenient person to kidnap!

Isn’t this so often true about our “things?” Even though there are a thousand reasons for why we want to change them, I bet you we can also come up with a thousand and a one reasons for why they are an important part of what makes us so incredibly unique and beautiful.

Of course, I do get tired of hearing “Wow you’re tall” from random people on the street, having to always wear flats (because people complain when I wear heels), and getting asked if I play volleyball. I get jealous of all the “girl squad” photos where are the girls are the same height. And yes, there is a part of me that full heartedly believes that I will end up alone because I am tall.

However, in the spirit of Thanksgiving this week – I am choosing to be thankful for this Thing of mine. And perhaps by not perseverating on all the things I hate, maybe I won’t have the energy to hate them anymore. What if we did that more? How much happier would we be if we stopped hating unchangeable things about ourselves?

So while I do get exasperated by the aforementioned items, today I am just thankful that I am tall enough to reach the top shelf where they store all the jeans in the extra, extra long sizes 😉

 

 

Internal Conflict

My first full 10 week rotation is finally complete – and man does it feel good! Internal medicine: it’s a physician’s “bread and butter,” where we as medical students learn how to manage both chronic and acute illness.

Or, thats what we’re supposed to be doing.

For me, internal medicine felt a lot more like a combination of speech and acting class, where we learn how to give a perfect presentation and act completely enthralled on rounds. However, as much as I struggled with certain aspects of this block, I did learn a few more interesting things:

  • Medical School is hard – it’s even harder when you go through your day feeling as if  all your effort is completely useless.
  • Patients can be both at risk for clotting and massive hemorrhage at the same time – good luck deciding whether or not they should be on anti platelet therapy
  • Ohio is not for me.
  • I dislike shadowing just as much now as I did when I was in undergrad.
  • You can be good at something and still hate every second of it.
  • No matter how good the circumstances of life, you can always find something to complain about (and vice versa), your experience of a situation has much more to do with your outlook than the situation itself.
  • I have a “great” personality.
  • I LOVE cardiology.
  • For many patients, the social work part of their case is often the most complicated
  • I have the capacity to be jealous of a catatonic schizophrenic.
  • Don’t try to put SCD’s on a bilateral above the knee amputee – the nurses will get VERY confused.
  • Rheumatology is a specialty for BOTH joints and autoimmune disease.
  • The best way to motivate people is to believe in them, its far more effective than threats. We’re much more scared by the prospect of disappointing you than angering you.

All in all, I am thrilled to be done with Internal Medicine, and totally psyched to be headed to psych-ation next!

15 minutes 

For his last seven days I was the first face he and his wife saw in the morning.

He was admitted for uncontrolled atrial fibrillation with rapid ventricular response. At 69 he was a man riddled with cancer. Stage IV pancreatic cancer that had metastasized by the time of diagnosis.

His case was complicated. He was fluid overloaded but intravascularly depleted. His Afib combined with his diastolic heart failure caused his heart to be unable to fill, resulting in hypotension. At the same time our meds to control his rhythm and rate tanked his BP. When we tried to get off some of the extra fluid from his lungs and legs he developed worsening AKI from volume depletion. We switched him to digoxin, but his kidney failure resulted in rapid development of supratheraputic levels and hyperkalemia. We started midodrine and sotalol, finally controlling his heart rate but throwing it the other direction with rates in the 30’s.

Every morning would start out the same way.

“How are you feeling today sir?”

“Fine ma’am, just tired.”

His severe back pain from the bony metastasis combined with orthopnea caused him to only be able to sleep sitting up in a chair with his head leaned forward over a table.

“Any chest pain, shortness of breath, nausea or vomiting?”

“No ma’am.”

Then I would listen to his heart (in its textbook irregular irregular rhythm) and lungs (diffuse wheezes bilaterally and crackles throughout) and examine his impressive 4+ bilateral pitting edema.

All in all, this took about 10 minutes. He wasn’t a very talkative man – probably due to his inability to breath – and his physical exam rarely varied.

On day 4 his right hand became edematous. That was the day my attending gave me a “gold star” for teasing out that he has a history of gout. Back on the prednisone he went – just when we had finished his taper from his last COPD exacerbation.

Next I would turn to his wife and spend the next 5 minutes having an identical conversation every day. I would inform her of the changes we made and what we were hoping they would accomplish. I stressed the complexity of his situation. Heart rate vs blood pressure, lungs vs kidneys.

“We’re stuck between a rock and a hard place” I found myself saying day after day.

We had run out of options. He had failed amiodarone when he was first admitted due to prolonged sinus pauses during conversion to sinus rhythm. Our last resort was to give him a pacemaker, then we could then load him up on amidarone and he could pause away all he liked.

The only catch was that in order to get the pacemaker, cardiology required he have a life expectancy of at least 6 months. So we talked to the oncologist, who is unable to give a prognosis without the patient completing the full round of chemotherapy. Only as long as the patient remained in uncontrolled atrial fibrillation he is not stable enough to get the chemotherapy.

It was a circular argument – the man could not live without the pacemaker, but he could only get the pacemaker if he was expected to live.

Finally, an agreement was made and he was sent down to get the pacemaker.

I come in the next morning excited that he will finally be turning the corner. I take a look at his morning labs and vitals and I’m shocked – they were horrible.

I look for the op note from cardiology, and I find that he never received the pacemaker. He was unable to lay flat as they were prepping him for the procedure, so it was aborted and he was transported to the ICU in acute respiratory distress.

I take a look at his chest x-ray: it’s catastrophic.

I read the notes from the ICU doc, the nephrologist, the cardiologist. I see a note from a palliative care consult.

Over the last week I had often wondered to myself when it would finally be the time to call palliative care and talk about hospice. Something about this family was shrouded in such optimistic denial that it never seemed like a good time to bring it up. This man fully believed that he would be able to get well enough to go back to work. I think we all wanted to believe that too.

I take a deep breath, and head to the ICU.

When I enter his room, I see him laying on his back for the first time. He’s on high flow oxygen through the nasal cannula, but his breathing sounds like he’s on the ventilator. He’s unresponsive and gurgling sounds escape as he struggles for air, using his accessory muscles of respiration.

I turn to his wife:

“A lot happened yesterday.”

“Yes, it did.”

We stand in silence for a moment, watching him gasping for air.

“I was really hoping he would be able to get the pacemaker.”

She nods “me too.”

We’re silent again.

“I saw that you met with the palliative care doctor yesterday, I’m sure that was difficult.”

She turns to look at me now “I’m going to tell the doctor today that we’re ready for comfort care.”

She’s crying, and I feel the tears welling up in my own eyes.

“I am so sorry, I was really pulling for him.”

She walks towards me with arms outstretched and wraps herself around my waist.

“You woke me up every morning. Thank you for being so kind.”

This man passed away later that afternoon.

There are a lot of emotions revolving around me when I think about this experience. He was my first patient to die. I have been present at codes before and have seen patients die, but this was the first one who was mine. It’s a unique and conflicting situation, mourning for and with people you barely know.

But it’s the words of this mans wife that continue to stick with me: “Thank you for being so kind.”

I’ve never consider myself to  necessarily be a “kind person.” When I say that the first thing that comes to mind is one of those girls who is all smiles and brakes for squirrels and refuses to kill spiders but transplants them outside their house instead. That’s really not me.

So what was this woman talking about?

Looking back, I can’t think of anything in particular I did that was all that kind. I didn’t bring them flowers or offer back massages. The only interaction I had with them was that 15 minutes  every morning. It wasn’t anything out of the ordinary, it’s part of my job as a medical student.

But maybe the true beauty of kindness is that it doesn’t have to be anything extraordinary. It doesn’t have to take hardly anything from us. Maybe it’s not all about big sacrifices or superficial statements. What if the kindness that counts is the type that you don’t even know you are giving, but that flows from compassion and genuine concern?

And what if this kindness is really the most important thing we can give as a healthcare provider?

In the end, it wasn’t our valiant efforts, medical knowledge, grand medications or extraordinary measures that she thanked me for. It wasn’t my flawless explanations of the pathophysiology of the disease process nor my ability to diagnose gout. It wasn’t my thorough progress notes.
It was my kindness.

So if kindness is so important, why is it that while I feel confident that my clinical knowledge, reasoning and skills will fully develop over my training – I feel a terrifying ache that I may lose this kindness by the end?

So for now, I just fight to remember those words. To remind myself that no matter how poor the outcome or how helpless we are medically – we can always be kind. And perhaps, that can make the greatest difference.

**Patient identifying information and diagnoses have been changed to protect patient identity**

Elephants

“We need to address the elephant in the room – which is your size.”

I gasp.

Surely I just heard incorrectly and the physician did not actually just say that to my patient.

I witnessed this encounter back during my first week of rotations as a third year medical student in an outpatient family medicine clinic. The office was almost completely empty that afternoon as most of the residents were in a meeting, and I was assigned to work with the one remaining resident and a covering attending (who shall remain nameless).

As I introduced myself to this attending, he informed me that he was a self-proclaimed nutrition expert and that he had recently written a book on that subject. Being the daughter of a dietician, I was excited. I liked being able to speak to patients about making positive lifestyle changes and I figured he would be a good example of how to implement such change.

Boy was I wrong.

The first patient that afternoon was an 85 year old women coming to establish care at this clinic. I go in to get a full history and talk with her about her long list of medical problems. She had all the usual stuff – diabetes, hypertension, chronic pain and a BMI of 33 (actually not all that impressive these days). I ask her about diet and exercise and she tells me that she has been unable to exercise for the last 10 years due to a car accident followed by chronic back and leg pain combined with severe osteoarthritis of her knees.

She was a very sweet lady who seemed genuinely interested in improving her health and quality of life as much as she could. She told me about how she used to be a runner and that she never had any of these problems before her accident.

So when I go out and give a brief story to the resident and attending before they head in to come up with the final plan for her, I am looking forward  to seeing how this attending can help such an eager patient to make some realistic, practical changes to improve her quality of life.

But as you can tell by what was basically the opening statement by this attending – that did not happen.

I understand that some physicians endorse a “tough love” approach with their patients, and I have seen it work really well when that physician has a good relationship with their patient. However this encounter had no resemblance of relationship building. This was no “come to Jesus” conversation. All that happened was three people of authority walking into a room and telling a woman everything that she is doing wrong – which believe me, she already knew.

When we forget to add the “love” part to the tough love conversation, all that ends up happening is shaming – and no one has ever been promoted to change by being shamed or made fun of by their physician.

I have no answers for how to make sure we maintain the love. For now, when I am tempted (which is several times daily) to forget to have compassion for my patients I remember the look on this poor woman’s face, take a deep breath, and try again.

Continuing to care

“I can’t find the fetal heart tones.” The nurse states with a tone of underlying panic as she exits the patient room.

It’s around 7 am, and those of us working the night shift are getting ready for morning sign out before we can head home and get some much needed sleep after a crazy 14 hours shift.

“Tessa, go scan her” the resident nods towards the ultrasound machine and I cheerfully follow his command, rolling the ultrasound into the room of my patient.

She’s a young woman admitted the night before for preterm premature rupture of membranes (PPROM) at 21 weeks gestation. I’d seen her once before, a few weeks before in the L&D triage area right after she had found out she was pregnant. When I saw she was back in triage the night before I recognized her name immediately. I remembered really liking her and feeling an easy connection.

That night I was there  when we explained to her the options with a PPROM at 21 weeks – either we induce labor now to terminate the pregnancy (as a 21 week old is not medically viable), or we wait and hope to keep her pregnant and infection free until 23w5d when we can give steroids to try and mature baby’s lungs. We scanned her and saw cardiac activity but minimal fluid, and she made the decision to try and make it to 24 weeks (when the fetus is considered medically viable).

Throughout the night, whenever I had a spare moment I would stop by her room. I chatted with her and her mother about medical school. They asked me about the details on any of the cute residents and if it really was as much like grey’s anatomy as they imagined (I told them it totally is, except for the fact that everyone else is married and I still go home to my cat everyday. But other than that it’s basically the same 😉 ).

So as I haul the ultrasound into the room, waiting for it to turn on, I try and make cheerful smalltalk, seeing the terror in her eyes. I scanned, and I scanned, and I scanned. Again, trying to maintain a poker face as I didn’t want to be that medical student who told the patient their baby was dead when in reality I just don’t know how to use an US machine. But as I continued to scan, I found no cardiac activity.

I kept scanning.

I knew that I couldn’t tell her this, because while I was nearly 100% positive on the outcome, I am a medical student and I needed a resident to confirm the results. So I stood there, continuing to scan, planning how to strategically exit the room and grab a resident without alarming her. Thankfully, at that moment one of the day shift residents  came into the room. We looked at each other and she saw on my face that it wasn’t good.

“Are you having some trouble?” she asked carefully.

“Yea I am, would you mind  taking a look for me?”

She did, and found the same thing I had.

I remember as they told her the news, how her and her mother both looked repeatedly back to me. As if somehow the way I responded to this would dictate what came next.

I left that morning with a heavy heart. Just an hour before I had scrubbed into a cesarean section where the attending physician had complimented how good my subcuticular suturing looked (although it literally took me like 6 years to do it) and I had felt on top of the world.

That night as I arrived back at the hospital for another night shift, my patient was ready to deliver (they had induced her that morning after I left). I walked into the room before the rest of the doctors came in, wanting to know if it would be alright with them for me to be present in such a delicate situation.

As I walked in, my patient’s mother came and gave me a hug saying “I am so glad to see you.” I was moved at the importance of a familiar face in this devastating situation.

Continuity of care – it’s an aspect of medicine that we like to talk about, especially in the setting of primary care specialties. Basically, what it means is that you get to see the same patients for a long period of time. It literally translates (from medicine talk to english) as continuing to care (both physically and emotionally) for a patient.

As medical students, continuity of care is a phrase that we throw around when discussing why or why not we want to pick a certain specialty. People who require continuity and really enjoy having long relationships with their patients pick fields where this is possible – family medicine, OB/GYN, Pediatrics.

I struggle with continuity of care. Obviously I believe that having stability in your primary care is a good thing for patients – you won’t find a doctor or prospective doctor who disagrees with that. But I struggle  with whether having continuity of care is a good thing for me.

By continuing to care you patients, you are not just taking care of them – you are actually getting emotionally invested in their outcome. How wonderful that is when things go awesome! It’s great when you have helped a patient along from conception to birth. But when things go wrong, how do we deal with that?

I think one of my strengths (and my weaknesses) as a medical student is that I have the ability to throw myself 100% into what I do. When I am in the hospital, I am 100% there, all the time. This allows me to be involved and empathetic to my patients, and they feel that they are my whole focus – because in that moment, they are. The problem I face with this is that it requires that I have a career where when I go home, I can 100% go home. I don’t think I have the ability to compartmentalize my life if the specialty I go into doesn’t do it for me.

I am afraid that for the rest of my life I will constantly be “taking patients home with me”.

The story of the patient above is a perfect example of this. I became emotionally invested in her story, and I am glad that I did. I think that becoming connected to your patients is something that makes you more than a doctor – it makes you a human being.

My fear is that if I allow myself to continuously becoming connected, invested, and heart broken when things go wrong – that eventually I will lose my ability to connect and care at all.

OB/G-Whine

These last 6 weeks I’ve been in the wilderness (of the 3rd floor of the Loma Linda Med Center) being tempted by OB/GYN – and it’s kind of working for me!

This is  super surprising, as coming into medical school I always said “I don’t know what I want, but I know I DON’T  want OB/GYN”… In fact, I complained a lot about starting my OB rotation (hence the title OB/G-Whine, instead of OB/GYN – get it? I know. I’m hilarious, you can thank me later) but somehow, in the midst of some things I didn’t enjoy doing, I also found myself doing things that I LOVED and that made 14 hour shifts something I looked forward to doing and reluctant to leave.

I don’t know if I will end up doing OB/GYN, it’s entirely possible that the things I hate about it will beat out the things that I love. However, it is back on the table, making my future life decisions even more challenging than before.

The good news is that again I have learned some fun facts to share with you:

  • Babies are a lot like God in the fact that they really don’t care to follow any of your plans.
  • If you can see through, it you can cut through it.
  • “Out of all the risks a woman can take in her life, getting pregnant in the biggest one.” – Dr. Patton
  • Breast is best.
  • Hormonal pregnant women do surprisingly less yelling than I expected them to (referring to my fears mentioned in A Family Affair).
  • My back rubs can cure hyperemesis.
  • It’s pretty awkward when an attending physician stops operating in the middle of surgery to inform the entire OR team that you look just like Jennifer Lawrence.
  • Hummingbirds hibernate every night and have to warm-up in the morning before they can fly.
  • For those pro-life friends of mine: the best way to decrease the number of abortions is not by making abortion illegal, but by increasing the use of long acting reversible contraceptives (LARCs) such as IUDs.
  • Benign Gyn has the power to kick Cardiothoracic surgery out of the OR.
  • On L&D, some nights everything that can possibly go wrong will and you will have 13 people waiting to be seen by triage, and the next night there will be one delivery and no triage patients and you will spend the entire time watching videos of polar bears, Russian and Korean rappers, and cats getting shot out of trees with a fire hose.
  • If you meet resistance while pulling out the foley – don’t keep pulling.
  • When you tell a surgeon you’re ambidextrous and then tell them you probably aren’t going into a surgical specialty, they get pretty upset.

And while all of these facts are super duper fun to know, probably the most important thing I learned and that I particularly want people who are not in the medical field to understand, is this:

The process of pregnancy and child birth can go wrong so incredibly fast. Yes, women have been giving birth centuries before hospitals and physicians. But childbirth was also the #1 cause of death in women during that time. So to my friends out there that are pregnant or planning to get pregnant, please go see your OB. Get consistent prenatal care and have the discussions about the birth process with a physician. Let them help guide you in the decisions you make about how to bring your child into this world in the safest possible way for both you and your baby. 

I’ll get off my soap box now. But for reals, OB/GYN has been a blast. I’ll be missing these times as I walk around in endless circles on internal medicine.

FullSizeRender

Shout out to these fool’s for putting up with me for the last 6 weeks!

If you’re looking for some midnight entertainment – here are a few of my personal favorites for your viewing pleasure, compliments of a few slow shifts on night float:

Life hack: if you type in “Russian _______” (insert literally any noun or verb) on youtube, you will find some great entertainment!

 

Demolition

There’s a George Ezra lyric that goes: “you may think that he’s a demolition expert when he’s finished with your self-esteem.”

I can’t think of a single better way to describe the process of medical school. You get  accepted and you feel AMAZING. I mean, medical school is very competitive to get into, and this means that you are pretty much a part of the top percent of people as far as intelligence goes (don’t mind me tooting my own horn over here).

Then you get here and you are reminded that even the top 5% has to have someone on the bottom. Nothing makes a smart kid feel stupid like being surrounded by a boat load of  smarter kids.

No matter how many exams you pass or OSCE’s you sail through, the next hurdle never fails to have you leaving feeling like the dumbest person on the face of the planet. Entering 3rd year of medical school steps up this game to a whole new level.

There’s this process known as “pimping” that is hard to explain in any other way than that it is the feeling of shear terror when an Attending physician turns to you and says something like “What is the mechanism of action of human placental lactogen in the context of gestational diabetes?” or when you’re in a surgery and the surgeon points to a small string like structure and asks “What vessel is this?” Usually followed by frozen silence, an attempted answer, and then a deep sigh of disappointment or if you’re really lucky, a verbal beatdown about how you should know this.

It’s horrifying. I’ve definitely had nightmares about some of these episodes after they happened.

However, I will forever remember everything about human placental lactogen because of the moment when I didn’t.

An attending physician friend of mine once said to me: We’re not cooking breakfast here.

How true is that. When we screw up – be it medical students, nurses, residents, or even the big bad attendings themselves – it doesn’t just result in burnt eggs or funny tasting pancakes. These are real lives we’re dealing with. People with families, stories, hobbies, hopes, fears, and dreams who entrust all these things on us.

So yes, if I don’t know the relationship of the uterine artery and the ureter, someone can die. If I show up in surgery without knowing the past medical and surgical history of a patient, someone can die. If I don’t understand that a diabetic experiencing hypoglycemic episodes in the late stages of pregnancy can be caused by uteroplacental insufficiency (resulting in decreased HPL production and decreased insulin resistance), someone can die.

Sometimes we medical students require reminders that despite everything we have learned, we don’t know nearly enough for this responsibility. There are moments when being yelled at for being unprepared is the correct outcome, because someday when we are the ones holding the scalpel there will be no one there to be prepared for us.

So maybe a little loss of self esteem isn’t the worst thing – at least not when the alternative is someone losing their life.

Can’t touch this

What is it about our fragility that makes us feel so invincible?

I had a patient a few weeks ago that got me thinking about this. He was a HIV negative man currently having unprotected sex with his HIV positive husband. Before I went into see him I read in his chart that he had been counseled on the importance of using barrier protection and had refused. I was curious as to why. When I got to talking with him he explained to me that he made it through the 80’s – seeing many of his friends and lovers die – without contracting HIV. He stated that he should have gotten it, and since it didn’t happen then he felt that it wouldn’t happen now.

He felt invincible.

There was another patient I spent an absurd about of time with trying to convince him to adhere to his statin therapy. He was post-MI and had several other risk factors that according to our guidelines placed him in the group requiring him to take high intensity statin therapy. When I ran his work through the ASCVD risk calculator it came back with a result of 35% chance he would have a cardiac event in the next 10 years. I showed this to him and he exclaimed “That’s great!”…. It really wasn’t. But to him, a man who had survived a heart attack with very little impact on his daily life, this 2/3 chance of not having an event meant that nothing could touch him.

He felt invincible.

It’s not just patients that have this problem. I see it in myself and my friends.

In medical school, there is a mantra that we follow: “see one, do one, teach one.”

This means that when we are learning procedures we (maybe) get to watch one done and then we are thrown into doing them ourselves. This part of the culture of medical school makes it hard for those who are more cautious to thrive. In my first weeks of clinicals an attending offered for me to give an intra-articular cortisone injection and I jumped right in, and was commended for it. Another time when I hesitated before excising a squamous cell carcinoma from a patients arm, and was chastised for my hesitance. We are encouraged to jump into situations we are in no way confident about or totally prepared for, and those that love trying new things and are comfortable with not being comfortable, do really well.

Now this isn’t supposed to make you not trust your doctors or think that any time a medical student comes at you they are completely unprepared. During all the procedures I have done I always had a resident or attending right next to me with years of clinical experience under their belt ready to step in if I were to fail. Your primary care or specialist has probably been practicing so long that there is very little left in medicine that they are not prepared for (so don’t freak out, they do actually know what they’re doing).

These personality traits that are acquired or maybe (as in my case) are accentuated in medical school spill into all other parts of our lives. While I can think of many times in my life where this applies, one recent experience stands out above them all.

A month ago I did a solo climb of Mt. San Jacinto. To give some background – I am not a mountain climber. Before this I had never even attempted climbing a mountain (although to be fair, this is about the least technical mountain you can climb). When doing the minimal research that I did on hiking in the San Jacinto wilderness, I saw all the warnings about not hiking alone and to have all the proper gear. Did I listen? Absolutely not.

The night before my hike I received a phone call from my parents informing me that one of my friends, Brian, had gone missing. He had gone out on a solo hike the day before and had never returned. He was an experienced hiker who had climbed the mountain he was hiking on several times previously. Yet something had happened. And if an experienced hiker who knew the trail could completely disappear, what business did I have hiking up a mountain that I had never been on without anyone and with very little actual gear?

How little gear you ask? Well here is a list of some of the things I should have had with me, that I didn’t:IMG_7027

-Hiking boots (I wore my trail runners)
-First aid kit

-Enough water (towards the end of my hike I thought I was going to pass out)
-Albuterol inhaler (I have exercise induced asthma)

Somehow in spite of all my unpreparedness and this blatant example right before me of how dangerous the wilderness can be, I still set out bright and early that next morning for my climb. And you know what, it all went perfectly fine.

It all went fine until I came down off the mountain to a text message telling me that they had found my friends body and he hadn’t survived.

I was faced with the absurdity of my arrogance and the realization that this isn’t the first time I’ve knowingly put myself in a ridiculous situation, thinking that it couldn’t possibly happen to me. Is it a result of my youth or is it narcissistic carelessness? Could it be possible that the traits that allow me to thrive in medicine also tempt me to compromise my own health and safety?

Maybe this is why they say doctors make the worst pilots or why I am chronically putting myself in dangerous situations. Do we become too comfortable jumping into the unknown, confident that our general skills and knowledge will save us?

We feel invincible.

Until we don’t. Because we aren’t.

 

 

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Brian and I playing in the BLYC golf tournament a few years ago. RIP my friend.

 

A Family Affair

A few fun facts I learned during my month in the desert for my family medicine rotation:

  • “Hip pain” very rarely actually involves the hip joint.
  • 126 degrees is HOT.
  • “If in doubt, take it out.”
  • Very few people actually know what “urinary or fecal incontinence” means, and I have not figured out another professional way of asking if they’ve peed themselves.
  • Don’t clean out your ears with Q-tips.
  • Reading on the toilet will give you hemorrhoids.
  • Patients who come for med refill appointments are rarely in a good mood.
  • Theres almost nothing you can’t inject with cortisone and hope it will go away.
  • The words we speak to our patients and the words we put in our SOAP note are not the same language.
    • i.e. when I write “PE displayed purulent discharge draining from the posterior aspect of the tympanic membrane with a positive air/fluid level and splaying of the cone of light”, what I actually said to the patient was: “I see some pus in your ear.”
  • Apparently I’m the type of person who looks like they don’t know how to spell “raccoon.”
  • Pelvic exams come in threes – as do cases of gout and narcotic seeking minors.
  • Jokingly recommending to your patient that they can cut down their caffeine use by substituting cocaine may not be the greatest idea, as they may take you seriously and report this to your attending (who thankfully has a better sense of humor than the patient).

DCIM100GOPROGOPR0990.

Cheers family med – I liked you surprisingly more than I expected to.

Next stop: OB/GYN.

So if you happen to see me in the corner crying, its because I’m spending my days being yelled at by hormonal pregnant women (Dreams DO come true haha).