Thursday, November 27, 2008

Med Student Syndrome: I have ADHD.

Med Student Syndrome: A disorder, commonly seen among medical students, in which the student feels they suffer from every medical condition known to mankind.

It's hard not to feel this way when you are learning about attention-deficit hyperactivity disorder, with which I have diagnosed myself (along with depression and many other conditions).

A selected portion of the diagnostic criteria. Let's see how many of them I fall under:

  • Often has difficulty sustaining attention. Check.
  • Often avoids tasks that require sustained attention. Check.
  • Often is forgetful. Check.
  • Often loses things necessary for activities. Check.
  • Often fails to give close attention to details and make careless mistakes. Chk.

  • Often does not seem to listen. Pardon me?
  • Often is forgetful. Check.
  • Often does not seem to follow through.
  • CHECK - organizing tasks: often has difficulty.
  • Often is forgetful. Check.

  • Often is easily distrac - hey, it's nice outside...

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Saturday, November 22, 2008

Make sure you know what you are getting into... [part two]

When I give that advice to pre-med students, I say it knowing full well that they'll respond to that advice the same way I did - by spending a bit of time learning about medicine, being fascinated by the great parts, and pretty much completely whitewashing any challenges that come up without ever experiencing what they are like:

"Being on call and getting to sleep at the hospital after a full office day sounds exciting!"

"Having a patient stop breathing and everyone looking to me for a decision sounds like it would be a thrilling challenge!"

"Not seeing my wife and family because I am spending 16 hours a day studying sounds like an honourable sacrifice!"

And some of them last well into med school: "I can't wait to have a pager!"

It's not necessarily Mr. Eager McPremed's fault. A large part of it has to do with the fact that it is so hard (especially in North America) to get experience shadowing physicians one-on-one, let alone living the life of a physician day in and day out with full office days and on call nights.

Another reason pre-meds tend to brush off the difficult parts is because the pull towards the pursuit of medicine is so strong, especially when the pre-med student has the capability to succeed in it. It is so hard to be honest with yourself and walk away from a career path that impresses everybody you tell about it.

When you tell someone you're thinking of applying to medical school, the look on their faces, the eyebrows going up, the subtle gasp, and the inevitable story of their friend's nephew with an A+ average who now works for a drug company because he didn't get in after four times applying to med school gives you a feeling as addictive as some drugs. ..and coming to the point where one realizes that a life of medicine is not for them would mean having to give up the dream and everything that comes with it... including the look on peoples faces when you tell them.

I had this in mind the other day when I read a Starbucks cup quote, only the second one to ever make an impact on me (the first one that ever impacted me I read the day of my med school interview, ask me about that one some other time):

The Way I See It #26
"Failure's hard, but success is far more dangerous. If you're successful at the wrong thing, the mix of praise and money and opportunity can lock you in forever." - Po Bronson, Author of "What Should I Do With My Life"

That's why I have frequently recommended reading medical blogs, which have a great way of showing all sides of medicine if direct experience can't be obtained. I have also often recommended Ifinding's series of blog posts, the Don't Become a Doctor Series.

Hopefully reading those will encourage medical school hopefuls to realize that getting into medicine is an extremely serious decision that should be fully investigated before it is pursued.

It might sound like I'm regretting going into this. I'm not - I've just come to a challenging part of the journey that makes me stop and be thankful for what is driving me and giving me the motivation it takes to get through this. It also makes me feel really, really sorry for those people who are going into medical school for superficial reasons, like the money, their parents' wishes, or that look on peoples faces... beacuse when they get to the rough patches, I really don't know how they'll keep putting one foot in front of the other if that's all that is driving them. If those are the driving reasons, and not something deeper, spare yourself... dragging yourself through this gauntlet just isn't worth it.

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Saturday, November 08, 2008

Make sure you know what you are getting into... [part one]

One of the pieces of advice I was given as a pre-med, and that I frequently give to pre-med students (it's #7 on my Top 10 list of advice for pre-med students) is,

"Make sure you know what medicine is like before you sign up for it."

That was ringing quite loudly in my mind when I started my call shift the other night. I had had a busy week in surgery. There were some really long days of showing up on the ward at 7am then a full day of office then going straight to the hospital at 5pm and seeing emergency patients and eventually taking them to the operating room and getting home well into the wee hours of the morning... with a full day in the office after that.

Most of the surgeries were routine, but some came with the emotional stress of having to tell a patient and their family they had a 50% chance of dying on the operating table, and a 50% chance of us opening them up, finding that we could do nothing, and closing them up to face their death within the next few days. (One patient's response to that speech? "Bloody hell." Yeah, no kidding.)

I also had a long academic half-day full of lectures on things that I need to know but had no energy to learn, that also went late into what was going to be my evening relaxation time.

I had to try and fit in studying for my two upcoming exams in between all that, and then on top of that I tried hard to make time to get some exercise and spend some quality time, either on the phone, online or in person, with the people in my life who mean a lot to me. And no, there was no time for going to my buddy's poker game, watching the Leafs get their butts kicked (I haven't watched one game this season!), an afternoon round of golf, or any of the other things I would have enjoyed doing that resemble this "having a life" thing I've heard so much about.

As soon as I finished work in the surgeon's office for the last day of this tough week, I headed to the hospital to get my pager and start call - and within five minutes of my call shift starting, my resident and I had five patients to see, all of whom were pretty sick. Just as we were trying to figure out who to see first, the pager went off two more times. We didn't get a break longer than ten minutes until 2am, when I got a bit of sleep before the pager started going off again (getting a bit of sleep means it was a lucky call night).

I'll admit when all those pages were coming in right at the start of the shift, I was feeling the stress of the whole week on top of having a lot on my plate all at once, and I fell into a rut I find myself in once every year or so when all the negative thoughts come rushing to me. I find myself seriously asking if I am in the right place, if I made the right career decision, if I will ever be able to treat patients on my own, if I really knew that medicine was like this before I invested all that effort and money into pursuing it.

Fortunately, the five minutes the resident gave me before I had to meet up with him on the ward was just enough time to break down, almost re neg on my no-crying policy, and beg for some strength from heaven.

Fortunately, God was listening and obliged. And all in all it ended up being a really good call shift. For me, that means a night with some varied, useful cases that are important for me to learn how to manage, and with some good opportunities for me to see patients on my own, evaluate their situations, and develop a plan and present it to the resident for their approval and questioning. We triaged those first cases well, and got through them and all the other calls throughout the night, and put off studying for just a few more hours in order to do those therapeutic things like write this post and sleep in late for the first time in a while.

::: part two to come... :::

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Monday, November 03, 2008

Poking a screaming child? That'll put hair on your...

"Bet you feel the testosterone surging through your veins now, eh?" the ER doc supervising me said. "That'll put hair on your chest."

Then again, I'm sure everyone else in the ED (and all the other wards on that floor) also had a snappy comment for me, seeing as how each and every one of them could hear the screams of my patient.

A young girl had gotten a huge gash in her arm after falling through a plate-glass window, and the emerg doc took one look at her chart and handed it to the resident, who handed it straight to me. At that point I was still unsuspecting, super keen to sew up yet another wound. Boy, was I naive.

After looking at the wound I flattered her quite nicely about being such a trooper, such a large gash and all and so little crying.

Turns out that all my buttering up was for nothing, which I found out as soon as she asked if she would be needing a needle.

That's where I went wrong.

She sensed my instant of hesitation before my answer, and took that as her cue to start screaming at the top of her lungs.

The screaming didn't stop. We tried everything from distraction, to warm blankets, to massaging her temples, to topical anesthetic and intranasal fentanyl, all of which seemed to only fuel the screaming, which lasted well into the procedure, despite the gallon or so of lidocaine I used to freeze the wound.

Even though I have sewed many a wound with very little fanfare, this whole experience actually stressed me out a lot -- much more than I expected it to.

You see, I still have enough compassion left that it makes me feel REALLY bad when I know I'm hurting a patient, especially a child, and I get uncomfortable when I see a pouty look, let alone screams of bloody murder and "PLEASE STOP! NO MORE NEEDLES! OH FOR THE LOVE OF...' Yeah, I didn't know 11-year-olds knew that many swear words. Kids these days.

It was made even better with the parents shooting me the look of death the entire time for causing harm to their little angel. Fortunately, the father's claim that he wouldn't be bothered by the blood soon proved to be quite false, and the emerg doc saw him starting to reel and whisked him away, saying "OK, come with me, you are sitting down over here. Put your head between your legs."

As well, with all the the flying fists and limbs I was pretty scared of buring the syringe or suture needle in my own hand.

In fact, I was even more stressed that I'd be poking the care aide holding the child down. Keeping this saint happy had risen to a very high priority ever since she set aside one of the leftover hospital meals for me (which, despite being hospital food and looking like it had already been digested once, was still food).

The procedure finally ended, and she finally went home, and a strange calm fell over the emerg. In fact, with the young girl gone I could only really hear monitors beeping, ambulance sirens, nurses shouting, and other patients yelling, which was so much more quiet than when that girl was there.

Later on, one of the doctors told me that he used to feel bad poking children because they would cry so much. "Then," he said, "I had my own kids, and realized they cry all the time... even if you are not doing anything to hurt them."

That did make me feel a bit better. But I was still so worked up when it was all over that I considered going to the homeless gentleman and ask if he was gonna finish that bottle of rubbing alcohol he was using to get drunk (tuition is due soon, so I am trying to get all the free hospital food and free alcohol - of any form - I can get). I figured if dealing with the screaming child didn't put my hair on my chest, perhaps some isopropyl alcohol will.

Either way, any more shifts like this and I think I'll start losing hair rather than growing any more.

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