The best part of spending two weeks with medevac? Not what you might think.

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

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Studying Scared

What does it take to get Vitum off his butt and into study mode?

Good intention? A desire to do well?

Try fear. Plain, simple fear of failure. That's all it takes.

Unlike last year, when around this time I was enjoying how slack I thought medical school was, this year is different. Not just for me - I've noticed that a lot of people who took it easy early in the semester for the last two terms are turning up at the hospital & university study rooms on the weekends / evenings. And I've got three things that are giving me enough fear to get me studying scared this early into the semester.

1. Life around finals time sucks.

First of all, now that I've been through a year of medical school, I'm more aware of what it involves. I know how hard I had to work when last year's finals were approaching. I spent entire days and entire weeks studying with few breaks. Seeing few friends outside of med - and even friends in med - was not an option, and how the only thing that kept me going was the thought that "if I don't work my butt off, I'm gonna fail." I don't want to be going through that again come finals at the end of this term, so I'm studying now. Hopefully, as a result, around finals I'll feel a bit more prepared and the stress level will be a bit lower.

2. Finals are gonna be brutally hard.

While that should be reason enough to get my nose in the books, there's another reason. If there's any truth to what the third-year students say, my finals this year are going to be tough... much harder than last year.

That could be because for some of our units, the course directors have decided that providing us with lecture notes and lectures that cover all the topics that will be on the final are ineffective strategies for teaching physicians, and so we're expected to do a lot of reading from a variety of sources outside our lecture material. That's intimidating... as is generally the case with medicine, there's not enough time to learn everything, which means I can only hope that which I've learned is enough to get me through.

3. I don't want to fail and have to repeat second year!

In addition to those first two reasons, there's something else. There are a few people in my class this year who are repeating second year. Their reasons for doing this span a wide range - personal reasons, lots of stuff going on in their lives, MD/PhD students who are doing bits of the program at different times as their classmates, and not doing well enough academically last year.

Despite the fact that I don't know the individual reasons that these people are in my class, every time I see them around I think of the last reason. Yeah, it's hard to fail out of med school, and if I do fail a few courses I'll be able to repeat the year, but the third reason I'm getting my study on is because the last thing I want to be doing next year is repeating second year. Med school is a long time and I'm excited for the clinical part of medicine, which doesn't happen until next year. I would hate to be stuck in another year of PBL and our physician and society course.


The funny thing is, I'm sure this year will be a lot like last year in that it seems 90% of the class is scared of failing, but 99% of the class ends up passing. I think it's because we former pre-meds are used to undergrad exams, which we would routinely go into feeling like we knew all the material. Med school exams are scary because there's no way you will know all the material... and getting your 60% for a pass is much harder and requires much more knowledge and understanding than getting a 95% in undergrad.

There's a few people I've talked to that are afraid of third year. Rightly so - from all accounts 80-hour work weeks, being on call all the time, and having the stress of working with attending physicians, seeing patients, and trying to figure out where all the equipment is - let alone knowing how to use it - will be stressful enough. But I'm not even thinking about that yet. I just want to get through second year.

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By the way, Happy Thanksgiving, y'all. That's right, it's Thanksgiving weekend in Canada. (early holiday, our soaring currency, our pristine health care system...bet you want to move here now!) Seems like everybody is doing family stuff this weekend, but since school is so far from the family - and since the 'rents are coming out here in two weeks - I'll be going to a friend's house for the festive meal. He's a master in the kitchen and I'm looking forward to it.

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What doctors REALLY think... and preliminary thoughts on interdisciplinary health

"Research is a real problem. Doctors just make up the data. They don’t report negative side effects, no question about it."

Someone at New York magazine had a brilliant idea a few weeks ago.

"If I ask a bunch of doctors a bunch of questions," they pondered, "but promise them anonymity, just think all the great dirt I'll be able to print! They'll be so straightforward and honest, I'll be one of the few people on earth to know what doctors really think."

Someone at New York magazine seems to have forgotten about the medical blogosphere.

Every day, countless doctors rant anonymously about the dirt that goes on in hospitals. They just happen to do so in the form of blogging.

But someone at New York Magazine ended up doing the interview, writing the article, and hey, it got published. How Comrade found this article in the New York magazine online four full days ahead of print, I'll never know, but thank him, since you'll probably find it quite interesting.

Selected highights, my smartass comments in italics:

• Why you have to wait so long in a doctor's waiting room.
  It's because you are not the doctor's only patient.

• Doctors make up research data.
  Did you know that 86% of statistics you hear are made up on the spot?

• The way we train doctors now is worse than it used to be, because the residents who do surgery on patients are now allowed to do surgeries after they have had time to sleep.
  Yeah, you'll have trouble convincing me of that one. Say it with me: "Old-Boy's-Club."

• Patients have to wait for 45 minutes after they press the call button, not because nurses are standing around chatting, but because there's a nursing shortage.
  Hmm, so it's not just in Canada, eh?

• Doctors think that "By virtue of our training and knowledge, we can get away with... treating patients like shit."
  Strange, it took me only one year's worth of med school finals to get that feeling. At this point, I call it self-respect. Three more years of this and you'll probably call it me being an asshole.

• A doctor admitted to dropping a baby once.
  You think that's a big deal? Read the next one.

• Doctors feel powerful when they've killed somebody.
  I told you you need to read this article. Here's the link again.

After reading that article, I'm surprised that even at my early stage in the game, a lot of it I could have told you. A good chunk of it is, in fact, common sense. Think about it. Doctors like seeing patients that don't yell at them. Surprise. You have to wait in the waiting room for a long time because, well, doctors are seeing other patients. Surprise again.

But there's one thing that I'm surprised they didn't mention. It's...wait a minute, what? you want my opinion?

Sorry, but apparently in training for making a living by, well, mostly giving my professional opinion, it's been made abundantly clear that I am not to provide medical opinions of any sort. Not even to a friend who asks about their cold. Or growth. Or whatever.

Of course, I'll give you my opinion anyways. That's what this blog is all about. But here, I'm protected by my fancy disclaimer at the bottom of this page. Yeah, it probably provides little more protection than did those fancy flying-squirrel-like jumpsuits that early would-be aviators donned before jumping to their deaths, but at least it's something.

So here's what I think. I'm surprised the article didn't ask any of the doctors their take on the "interdisciplinary health team" that everybody is talking about.

I was talking about this interdisciplinary health thing with a nurse friend of mine the other day. I was going with that old joke that I find so funny (that no nurses see any humour in at all), telling her, "I can't wait until I've graduated med school so I can boss around nurses." (That is NOT how I will approach nurses on the wards...trust me, I know better.) But after we got back on speaking terms, we got into this talk about interdisciplinary health care - a concept that is very interesting, considering how little of it I've heard in my med school curriculum.

Medicine these days is supposed to involve all "health professionals" on an "equal playing field" - doctors, nurse practicioners, nurses, licenced professional nurses slash registered practical nurses (depending on your geographical location), respiratory therapists, physiotherapists, occupational therapists, chiropractors, naturopaths, quack cure-all syrup salesmen... (uh, in no, particular order...I swear...), all working together in perfect harmony like oompa-loompas churning out everlasting gobstoppers. If that's the case, though, and if it's the new wave, how come I haven't been taught that yet in medical school?

But that's another story for another day - I have a rant on that waiting in the wings...to be continued.

Click here to read the continuation of this post.

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