As my third year was winding down last month, I had the opportunity to do a two-week elective in anything I wanted. Supposedly it had to be medically-related, but given that some of my classmates were approved for two weeks of wakeboarding or a 3-hour first aid course*, spending two weeks in paramedicine made me look like an overachiever.
The elective was pretty incredible from a medical point of view. Among the dozens of calls we attended, we picked up a young lady whose ATV had gotten away from her, crushing her leg to the point where she might never walk again. We also treated a few patients who had fallen off ladders or nearly drowned, and a nailgun injury. As well, there was a variety of medical patients too complex for the rural hospitals who needed to be brought to the big city for super-specialized care.
There were things that I didn't anticipate. There were heart-wrenching moments, like talking to one of our patients, a young lady who had been poisioned by carbon monoxide...intentionally. Sadly, she was not the only suicide survivor that we saw during my two weeks. As well, we went to a few car accident scenes and I saw some things, tragic things, that I wish I hadn't.
One thing about the elective really surprised me. Those of you who have read this blog for a while might remember that I have shadowed flight paramedics in the past. Back then, it was fascinating for me to see what the paramedics did...treat and transport the sickest patients in the province. What surprised me is that this year, my time with the paramedics served as a stunning eye-opener, revealing to me how little I knew about not only paramedicine, but medicine in general back then.
In other words, until I had completed my third year of medical school, I had no comprehension of just how sick the patients were that we were transporting. Not only that, but I had no idea the elite level of training of the flight paramedics. Back then, I did not understand the skill demanded when handling ventilator settings for patients with severe lung disease, or the implications and specialization required in order to keep alive a patient with bacterial infection coursing through their entire body. I only now realized just how sick these patients were, having been involved in identifying and treating sick patients myself, and also that some of the drugs that the paramedics were trained to prescribe are typically only used by intensive care specialists.
It was exciting to be able to understand at a deeper level the diseases affecting our patients, and to be able to have a new level of conversation with the flight paramedics, actually discussing treatment options with them. To put it another way, before I had completed three years of medical school, I didn't even know what questions to ask.
Needless to say, my understanding of the complexity of the patients and the difficulty of their management gave me a new level of respect for the critical care flight paramedics.
Retrospect, for me, is a valuable, meaningful experience. In fact, one of the reasons I started this blog was so I could look back and see how far I've come; in a program that is years in length and where you rarely realize how much you have learned from day to day, sometimes looking back is the only time you'll realize how much you are learning. It was a huge privilege to be invited back to spend time with these highly-trained paramedics, and it was a great surprise to discover that without realizing it, I had signed up for two weeks of seeing how much I have learned. Glad the $45,000 I've spent so far on tuition seems to be paying for something!
*In defense of my classmates, they did have to write a 500-word essay relating their elective to medicine
Wednesday, August 19, 2009
The best part of spending two weeks with medevac? Not what you might think.
Sunday, September 30, 2007
Getting used to palliative patients might take some time.
For our clinical skills classes, we spend most of our time on actors / standardized patients, who come into our clinical skills training rooms at the hospital and we learn how to do basic exams on them.
However, the odd time we'll go onto an actual hospital ward and get the opportunity to examine symptomatic patients.
Last semester we were at the hospital practicing our cardiac exams on a couple of hospitalized patients. My group was assigned a patient who was really friendly, and such a great sport - she didn't complain once about the four medical students percussing and auscultating her chest, tapping for a lung here, listening for a murmur there, asking her to sit up and lie down, even though it was obvious that due to her bad back the ordeal wasn't entirely pain-free for her.
Over the twenty or so minutes we spent at her bedside, she told us more and more about her condition, but she also talked her life - her job, her family, and the things she enjoyed doing before she ended up in the hospital. She wasn't too old, and she was pretty coherent. She seemed like a really nice lady, and I really enjoyed the chance to get to know her.
After our exam, we went to the nurse's station with our physician tutor, who called up the patient's lab tests and CT scans on the computer. We talked a bit more about the patient - she had a few other conditions that weren't related to our cardiac exam which we briefly talked over - and then were ready to move on to the next one, when the doctor said something that hit me like a truck.
"So that's Mrs. Walters. With all of that going on in her body, she doesn't have much longer to live."
I was shocked. I had just spent twenty minutes with this patient. She seemed to be functioning cognitively pretty well, and I figured she was in the hospital getting fixed! Never in a million years would I have thought she was about to die.
The seriousness of her situation started to set in, and from a medical perspective I realized that yeah, if I had been given this patient as a narrative case, I probably would have figured out that the prognosis was dismal. But because I met the patient as a person first, and didn't know all the details of her condition while I was talking to her, I hadn't really thought about what her prognosis was. Even while our tutor was going through the patient's chart, listing her conditions, the impending outcome of the sum of her conditions never hit me until the doctor put it into those words.
I suppose that now that I think of it, I might as well get ready for my clerkship year next year, when I will be meeting dozens of patients on a regular basis - some of them who don't have much longer to live. I've never really been in that situation before, and I think it's going to take some getting used to.
Thursday, March 15, 2007
Everything had been routine...until Judith's phone rang.
Judith* made a living out of being even-keeled. As a counsellor, she was used to being in control, and not acting surprised when even the most shocking things were said. Nothing ever fazed her.
She took care of herself, too. She was always prim and proper, well dressed, and looked great – she was turning sixty in a month, and looked ten years younger. Looks mattered to her, and to her clients. She always looked in control, and she always was in control.
But right now, she was losing control.
Everything about last week’s appointment had been routine. The doctor’s visit before, the casual mention that ‘you know, we might as well get a mammogram,’ not putting on deodorant that morning, the trip to the cancer centre, the damned squeezing of her breasts as if the technician was making some sort of compressed breast sandwich using plastic bread, and the expectation of a letter about a week later saying that everything was fine. Judith had been through it a dozen times.
Everything had been routine, except the letter never came. She got a phone call, instead. Confusion, instead.
“You need to schedule an appointment with your family doctor.”
She pushed away the feeling of fear that began coming out of nowhere. “It’s nothing,” she said out loud to herself. But she was having trouble convincing herself.
After three days of a million thoughts, all ending in ‘Cancer?’ here she was in the doctor’s office, listening to him describing the results in medicalese.
“Calcifications… anomaly… zone one…. abnormal…” More confusion.
Her heartbeat was pounding in her head. She realized that she had started fidgeting with her watch, her fingertips were getting sweaty, and now she was swinging her legs over the end of the bed.
She looked like a scared little girl.
She never showed any sign of losing composure, and yet now, she was losing it. Even worse, she was showing it.
The doctor stopped talking for a moment. Then, he placed a hand on her knee.
“Judith, you always have a heart for everybody.
“But right now, you need to have a heart for yourself.”
He was right, and she knew it. She had suppressed her emotions for years, out of necessity. In her work, she had distanced herself from her feelings for the benefit of her clients. Now she couldn’t even tell what her own feelings were.
When he said that, though, she started to feel again, just a little bit.
She began to cry. She cried for the first time in years, right there in the doctor’s office, right in front of the doctor.
As the doctor finished his paperwork, she tried to understand what would happen next. There was nothing conclusive from the results, so she would have to go for more tests. Something about a focused scan, higher resolution, more radiographs.
As she wiped her tears away, the question marks in her mind didn’t go away. She still didn’t know if things would be okay. She wouldn’t know for a while if she even had anything to feel worried about.
But she was feeling again.
Saturday, September 30, 2006
"She was dying, and he didn't even look at her."
"I was watching my wife die over the course of those nine months. Our family doctor sent us to see a specialist. Without even doing a physical to see the her ribs jutting out of her back, he told me that 'women typically lose weight during their menstural period.' I was shocked. She was dying, she was as skinny as a corpse, her brain wasn't functioning properly, and he tried to tell me it was her menstrual period. He didn't even look at her."
That happened almost thirty years ago, and still, my patient's husband talks as if this happened last week. Today I had to go to the home of a patient who had volunteered to discuss their chronic condition, part of a rather interesting assignment meant to get me thinking about the impact of a chronic condition on a patient's life and family.
Unfortunately, the husband is still convinced that the only reason his wife was eventually diagnosed or received treatment is because he reamed out the doctor.
Not every story like that has a happy ending. But this one did. Once they diagnosed the disease, although that was a nine-month process, they gave her one injection and other than the low body weight, she was completely normal the next day. Today, one pill per day is all she needs to live a completely normal life, and if she didn't tell you about her disorder, you wouldn't even know it existed.
If only all diseases had outcomes like that...
