Wednesday, August 30, 2006

Top 10 list: Things I learned in med school orientation

Fortunately, I learned a lot about med school through my recently-acquired hobby of reading med blogs. However, believe it or not, I did actually learn some things in orientation, though they were somewhat spread out, and not all of them were in the orientation sessions (see #8).

10 Statistics show that the people who are unprofessional in med school are the ones most likely to get sued later in their career.

9 Apparently the people who are training me to become a doctor are dumbfounded by a simple technical device known to many as the "wireless microphone." I was hoping their technological incompetence would end with their nearly unusable online admissions form - I was hoping for far too much.

8 If you're on a bus, and the back door closes before you have the chance to get out, yell "Back Door!" at the top of your lungs. The back door will then magically open. (Don't laugh, I haven't lived downtown since I was young. And I've already taught this pearl to someone else.)

7 I'm expected to buy about $2,000 of textbooks. Some second-year students have advised me to only buy 2, as there are many textbooks online.

6 I will spend the next four years and beyond in class from 8-5 and studying thereafter. Unfortunately, sleep, along with blog updates, will be rare, if existent.

5 I should be ready for some crazy bitch who could try to con me into doing something that she wants.

4 My parents are probably more excited about me being here than I am.

3 There are doctors who will develop illegal drug addictions. There are resources designed especially for them.

2 I will learn 18,000 new words over the next four years.

1 It's true. Med students work hard, and party hard. My class is full of amazing people and they LOVE to party. Even the 2nd years come to the 1st year events. Apparently there just isn't enough fun to be had.

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"If you don't go out with me, I'll just report that you touched me during my clinic appointment."

She was absolutely gorgeous, and she dressed in a way that complimented her body incredibly well. She put her hand on my knee and looked me right in the eyes.

"I can't stop thinking about you," she said to me. "I have never really done this before, but I need to tell you that I think you and I are right for each other. I can't sleep at night thinking about you, and I know deep inside that we are meant to be together."

"Uh, okay, but actually, Esther, I don't...." I stammered.

She apparently only heard one word in my attemped objection.

"Okay? Wonderful! I'm so excited. We can go for coffee -"

I tried to interrupt. "Coffee? No, that won't work, I can't..."

"That's fine, you can come over tonight - I make a mean chicken pie!" She was unstoppable. I should never have agreed to meet with her - even in a public place like this.

"Chicken? I don't...I mean, I can't..."

"Then I'll make something else! I'm so excited to see you tonight!" I couldn't get a word in edgewise. I took a deep breath, tried to collect my thoughts, and said, "Well, no, I can't actually, I mean - okay, hold on for a second. Look, you and I, it's not going to happen. I can't date patients."

I couldn't believe I was saying this to someone during the first week of med school.

She did not take well to this statement. "Oh. Well. Okay then, I think you are completely wrong, and we just need to spend some time together before you can see," she told me. "If you don't agree to, I'll just report that you touched me during my clinic appointment."

She got up and left.

"Okay, let's recap," said the faculty member in charge of our group. "What are some things Vitum could've done better, or possibly done to avoid such an outcome?"

That was one of three simulated scenarios that we came across in our anti-harassment workshop, a part of my med school orientation week. Esther was an actor, one of several hired by my med school to involve us in such situations in order to train us how to react. We had actors sketch out two other situations - one who played a racist, sexist preceptor who felt it necessary to make frequent and insensitive comments about immigrants and women - and one who played a student in our group who thought that one of our classmates with a non-science background was so dumb that anytime now she was going to start killing patients left and right. It was a memorable way to learn, interacting with these actors and situations and discussing our responses. What I went through in that workshop was an outstanding way to structure our 90 minutes of anti-harrassment training, much better than just lecturing at us for the whole time.

promised that I'd tell you about my first day of med school. It was pretty much the same as this whole week, filled with workshops, lectures, social events, and not much time for anything else. Right now is pretty much my first break. We didn't see patients the first day and probably won't for a week or two, but our first anatomy class is tomorrow, where we'll be dissecting cadavers. I'm not sure if there's any significance of us working on dead people before living ones.

Throughout the week, we've had a number of lectures, with titles ranging from "Library and Computer Orientation" to "Life as a Med Student" to Intro to Office Visits," some of which have been excellent and some of which have been somewhat dull. We heard a doctor and a dentist speak about the cocaine and steroid addictions they were recovering from, and learned about the crisis resources designed especially for physicians and med students. Our social activities thus far have included a scavenger hunt, BBQ, wine & cheese reception, and we've got some more parties lined up in the days to come.

It's slowly sinking in that I'm really here in this place which has been on a pedestal so high in my mind for so long. It's still exciting, but we'll see how long that lasts once the homework hits.

Six weeks till our first exam.

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Tuesday, August 22, 2006

Saturday, August 19, 2006

What happens on the first day of med school?

Coming soon!

I've always wanted to know. I've heard a few things (ie. Patient interaction from day 1) but it varies from school to school. So I'll let you know when I find out.

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My First Patient: Mr. Box. Mr. Cardboard Box.

I felt like a nerd being excited to finish up my rotation with a 10:30 pm to 7:00 am shift in the ER.

So, just think how excited I must've been when the doc told me, "If there are any drunks that come in who need to get stitched up, we'll get you suturing tonight."

If there are any words which will guarantee that no more patients will come into the ER, that must be the magic spell. Between 2:00 am and 6:00 am when I went home, we saw two patients. Somewhat unusual for a Friday night.

It's probably a good thing. The rest of the time the doc and I and the nurses all sat around and chatted. Then, I did end up suturing - on a cardboard box - following one-on-one lessons with a physician. It was good to start on something that won't leave a lifelong scar. And I quickly learned that suturing is another one of those things that isn't as easy as a doctor makes it look - it's easy after a bit but you feel like all thumbs for the first few minutes. He also showed me how to hand-tie sutures

I did finally get a view of a patient's
fundus using an opthalmascope, though! Well I was excited because I had tried a number of times, unsucessfully. All the more reason to buy an otoscope/opthalmascope set - so far in our registration package we've been told that only about half the class buys one; the other half thinks you can get by without one.

So that's it for me. Back to relaxing for the rest of the summer, until classes start.

I can't wait.

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Thursday, August 17, 2006

Learn from someone else's mistake #1: Humour and patients

It feels good to sit down after an 11-hour shift. And, I get to sleep in tomorrow (that's the good news; the bad news is it's because I'm doing a night shift tomorrow starting at 10:30 pm.)

Story time.

As we left the patient, the doctor pointed to a dressing cart and said, "How about you put some gauze and tape on her cut so her dad doesn't have to hold that tissue paper on it."

"Oooh," I thought, "I get to talk to a patient! No doctor in the room! Awesome!"

I collected myself and grabbed a roll of tape and some gauze, and carefully put it on the ninth-grader's wound in a very amateur and untrained fashion that is probably contraindicated in every way and will cause the nurses to shake their heads and mock me under their breath as soon as they seen it. But as I left, I said the fatal line:

"That should keep your dad from having to have his arm up for the next few hours!" Ha, ha, ha, I thought. A few hours. I'm so kind-hearted, cracking a witty joke and keeping these patients smiling.

The reaction was not what I expected.

The girl's eyes went big in horror and shock.

"A few hours?!"

They had been there for hours already and had seen us walk by their room several times to see other patients - likely including patients who arrived after they did. I quickly learned a lesson from the poor girl's reaction to my offhand comment: When it comes to joking around with ER patients, they don't find it funny if you make a joke along the lines that they have a long time left to wait. Most of them have been there long enough just to see a doctor. Unfortunately, they will likely be waiting there for a while longer as they wait for labs and xrays to come back. But don't remind them. Especially in joke form.

I figure that this could be the first of many mistakes that I post here, mine and others (med school classmates beware). Yes, I have come to terms with the fact that I may do two or three things wrong over the course of my medical education. So I'll try to immortalize them as they come along in what could be a great new VM miniseries. And hey, why not just talk about my mistakes? Here's another one. One that I didn't make.

This I learned from the doc I was following: Never give a patient any definite indication of how much longer they'll have to wait. Not that you should avoid the question or lie to them. It's just that things can get crazy. A patient we were seeing was getting antsy to go home, and he asked how long he'd be. The doc explained, "We're going to refer you to a specialist, Dr. Frist. We've paged Dr. Frist, and she always responds to her pages right away, so you shouldn't be here longer than ten or fifteen minutes." On top of all hell breaking loose in the ER, this also marked pretty much the first time that Dr. Frist didn't return a page. I felt really bad when I noticed him still in his bed an hour later and went over to explain what had happened.

Shadowing doctors is great now that I'm a medical student and not just a pre-med. Maybe it's just the docs I'm working with, but I've noticed a difference. Even though what I'm allowed to do is still very limited, the doctors have that much more respect for me. I've had deep conversations with six or eight doctors where they've gone into detail on questions I've asked about about their experiences in med school, lifestyles of various residencies, pros and cons of specialties. One gave me good advice about going the military route to pay for med school. And I've been so surprised by how much they care about my future.

All the stuff they're letting me do is part of that respect. Even though it's just been little stuff like going to a patient on my own and explaining that we'll need to run some more tests, or reducing a dislocated shoulder, or putting on a cast (the last two under close supervision), it's a good feeling when the patient asks why more tests are needed and I can explain, or feeling the shoulder pop back into place, or hearing the patient say "that cast makes my arm feel better already."

It's also a good feeling that I'm no longer just doing the pre-med thing - watching. Instead, I'm practicing. For when I get to do this for real. For a living. It feels good.
If I can choose to walk around an ER for "fun" for 11 hours, and still be willing to go back for another helping tomorrow (during a night shift, no less), I think this might be an indication that I've picked the right career.

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Wednesday, August 16, 2006

Solemn Questions

Q: What's one way to make a macho, healthy young man cry and wail like a baby?

A: Tell him that the semi truck he crossed the centerline with killed an entire family in the minivan.

I don't recommend doing this. Trust me - it's not fun even just being around when something like this happens.

Talk about dropping a bomb. Just think of the stinging questions that this poor patient must have had swirling around in his head while his body shook with his sobs. "Will I go to jail?" "Are those cops here to arrest me?" "Am I a murderer?" "Will I ever be able to sit behind the wheel of a car again?" "What were their names?" "Where were they going today?" "How old were the kids?"

Who knows - maybe even he wondered,"Will I go to hell?" I'm not trying to be funny. Maybe that does go through the mind of someone who's just been told that it's not just their own blood on their hands. What would you think if you learned you've just snuffed out several other lives in the blink of an eye? That somewhere, sisters and grandparents and aunts and cousins are devestated; they'll be planning a group funeral for a young family? None of them were even sick, none of them should've died today or anytime soon, but they're gone now, all because of you.

Can you imagine having to deal with those questions? And after having to deal with so many other intense questions. "Why am I strapped to a back board?" "Why am I wearing a neck brace?" "Will I ever walk again?" "I make my living driving - will I ever drive again?"

"Are the other passengers hurt?"

That's the one question he asked out loud. Maybe he shouldn't have. Maybe the cop should've waited before he told the patient. Maybe there is no 'ideal' time to tell someone something like that. Here's a question - What's worse, anyways? Dying in a car accident, or living knowing that you killed someone? a bunch of people? And then later trying to get behind the wheel of a car again - to use again something you once turned into a weapon of mass murder?

I've already come to accept the fact that someday soon when I'm finally a doctor I'll be telling family members that their loved ones have passed, or don't have much time left on God's good earth. Not that accepting this fact will make it a walk in the park when that day comes. However, what happened today is one variation of such an event that I didn't foresee. I'm glad I came upon it as an observer, rather than being the informer.

I hope I never have to deal with it again.

Maybe now you can understand a bit that being in the ER for just a couple days has already made me ask more questions about myself.

"Should I really be eating this?" "Do I need to add this much salt?" "Should I choose a safer way to separate these frozen burgers?" "Do I really need to be driving this fast?"

Being in the ER has made me much more careful.

Because I've seen what could happen to me - or what I could do to someone else - if I'm not.

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Monday, August 14, 2006

What's the antonym for consent?

The 17-year-old looked at the doctor with a face that showed everything up to but not including sheer horror.

"Prostate exam... so does that mean you're gonna have to stick a finger up my bum?"

His girlfriend, sitting on the chair by his bed in the exam room, burst into laughter.

Let me put it this way: He wasn't a big fan of the doctor's answer.

In fact, he refused. In a sense, we gave him an option: if it is a urinary infection, the antibiotics we give him will knock it out in a week. If he still is having, ahem, trouble, in a week, he'll need the finger.

Today was my first shift in the ER of the hospital where I used to volunteer. It was great to go back. I signed up for a rotation, hoping for OR, but they're a bit busy and the doc is swamped this summer, so I took ER instead just as happily. In fact, I spent all day thinking about a nagging question - if I want to do ER over OR. I spent a ton of time in the OR in Nigeria, and that gave OR a lot of points in my mental checklist. But now, I'm starting to think some more about the option. I've got tons of time, though.

Being a rural location, they're trying to lure docs. They gave me - courtesy of the physician search committee - a goodie bag with a bunch of stuff including a tshirt, notepad, mug, tea, etc. etc. I also get all my meals free, and a parking pass.

I promised you stories. I don't have much time, but I'll tell you a few.

Watched the ER doc suture up a thumb laceration of a well-known brain surgeon from a world-famous hospital in the city - the doc doing the procedure was only a little nervous. ("I've been using power tools all summer doing renovations on my new cottage, and how do I cut my thumb? using a knife to separate frozen hamburgers).

Later I did my first procedure: reduced a dislocated shoulder. The guy was very grateful, and announced that (and everything else that crossed his mind, including his opinion of the cute nurse) to the ER. Might've been the alcohol. Later I followed a patient to the OR to get a battery pulled from his stomach. We also had to tell an 88-year-old woman that she'll be dead in a few weeks. Other than that, a few casts, a few sutures, and one incredibly average night in the ER. I had a blast.

It's 12:30 am now, and I need to get some sleep. My next shift start at 7:30 am. My first short night of many, thanks to the whole me choosing a life of medicine thing. We'll see if I'm excited to get up when my alarm rings. If I am, then that's another point for ER.

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Tuesday, August 08, 2006

Grand Rounds

Grand Rounds is now up at Mexico Med Student's blog! This guy really put some time into this - it's complete with musical interludes and everything! I encourage the survey portion thereof.

And, it's also special because it's my Grand Rounds debut (even though I may have had to formulate a post on the requested theme to get noticed!).

In other news, looks like I'll have some ER experience - and therefore stories to post - before my classes even start. Stay tuned.

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Thursday, August 03, 2006

Once upon a time in Nigeria...

Fever, nausea, vomiting, diarrhea, shaking, chills, sweating...

It’s a bit embarrassing to leave a blood donor clinic after meeting with the nurse, without giving blood. I assume that people are thinking about me, “Why can’t he give blood? Does he have AIDS? Did he say ‘yes’ to the screening question, ‘I had sex with a man for money or drugs since 1979?’”

I’ve had to leave without donating twice, for none of those reasons, and both were only temporary deferrals. The first time was because I had been to Turkey, which is a malaria-risk country, and yesterday was because I had just gotten my measles/mumps/rubella vaccine updated last week. Should’ve looked up the guidelines before I went.

The funniest part about me not being allowed to give blood after going to a malaria-risk country is that every time I give blood, I already tell them that I have had malaria...possibly.

Back when I was a first-year pre-med, I had the chance to chat with the dean of a med school, since he used to be a neighbour of ours. He told me something that ended up changing my life. “If you want to apply for medicine, you should spend time finding out what it’s like. Talk to doctors. Read books about medicine, such as William Osler or Hardy Cushing’s biography. And get experience doing it – the best way to do this is to go to a third world country and work with a doctor.”

I had never pictured myself somewhere in the slums of an African city giving out medications to lepers, but because of that conversation, that’s where I found myself a year and a half later. Going to Evangel Hospital in Jos, Nigeria (link flickr) was an incredible, life-changing experience. I was able to see and do so much.

One of the themes I picked up on was that people would generally wait for a while to go to the hospital, for a variety of reasons; they were scared or didn’t trust the white man’s medicine, lack of financial means, or transportation issues such as living in the bush. Because of this, I watched a woman with a softball-sized goiter removed, a man with a football-sized tumour on his arm removed (it had grown back after being removed 5 years earlier), a 9-year-old girl with osteomyelitis that had been oozing foul-smelling pus from her arm for 9 months, and a 5-year old boy get a circumcision, to name a few cases. (I felt bad that the best thing that I had on me that I could offer him in empathy was a balloon. I’m no medical expert, but I think he’d rather have his foreskin).

In the lab, they had some modern equipment, but every week you’d have to check the memos to find out what labs they couldn’t run because they had no reagents for them. Blood cell counts were done by staining blood and…you guessed it…counting. And malaria tests were done the same way, as I found out first-hand.

I took my prophylactic pills every day, but slept one night without a mosquito net on a church floor in a village outreach. The DEET dropped the ball on this one. A couple weeks later, I had all the symptoms. I’m not 100% sure I had it because never got a conclusive test, but there were good reasons why the tests wouldn’t have worked, and malaria pills knocked it out four days later. So I tell the blood people that I have had malaria... possibly... and they just don’t use part of my blood.

Back when it wasn’t too volatile and they were still sending pre-meds to Nigeria, supposedly it usually worked out that one decides that there are professions other than medicine that are good for them, and the other decides s/he really wants to do medicine. I was definitely the latter.

I’m about to start medical school where things are going to be very different. CTs and MRIs will be there when we need them, there won’t be open windows in the OR, and we can expect the lights to stay on more than 50% of the time.

To be honest, I don’t know if I could practice medicine full-time in a third world country. Don’t get me wrong, I can’t wait to go back for a few weeks at a time, but it would take a lot for me to do that permanently. I’m pretty sure that over time it would frustrate me not being able to do everything possible for the patient, knowing that if I was in Canada I’d be able to offer so much more.

And I don’t want to get malaria.


... possibly.

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