Sometimes it seems as though the world's greatest people are dealt the worst hands in life

Happy birthday Dad!!!

The flight paramedic I worked with this week started his job the year I was born. He has seen patients of all sorts, at all stages in life, with all sorts of background stories. Yet, the story of the patient we flew into the big city, and what she did right before we loaded her onto the helicopter, he told me later really moved him.... something that means a lot considering how hardened he is and how much he has seen.

Actually, considering the several shifts I've had with the flight paramedics over the years, I have been surprised at how sensitive they are to their patient's needs while serving in a job that could have the tendency to see them slip into the mindset of a courier transporting inanimate packages. Even in the little things. "You're gonna feel a poke here" is something the lab tech should have said (many times) when she was digging to find a vein; instead, it was the paramedics who were keeping an eye out for the patient in that time. Treatment of a patient like a pincushion is something you never want to see... it is even harder to watch when the patient receiving the bludgeoning had been admitted for treatment of a suicide attempt.

But back to this inspiring patient.

It was a sweltering day in the city, and I had been regretting trying to dress nicely to impress the paramedics beacuse in my pants and long-sleeved shirt I was doing more sweating than shadowing. I wished we could stay in the air-conditioned ambulance station at the airport but instead when the pagers went off. I was hoping for an exciting scene response trauma call, but no, we had to head to the helicopter to answer yet another boring transfer call.

Rachel, a 33-year-old mother of two, was being brought in to the big city to see a specialist for a growth in her throat. It hadn't been biopsied, but it was pretty obvious to everyone that it was the cancer coming back.

You see, ten years ago, after a dental procedure, she started having trouble swallowing some foods. She ignored it for a few days because she assumed it was inflammation left over from her root canal, but it didn't go away, and finally looking in the mirror with a flashlight revealed a growth that made her weak at the knees. Her worst fears were confirmed when she was given the diagnosis of cancer.

The tumour grew incredibly fast, and she soon lost feeling in her face, control of her facial muscles, and had to soon start eating through a tube. That seemed like a minor inconvenience when she had to have a tube put into her throat because the tumour was blocking her airway. Surgery was attempted, followed by chemotherapy and radiation, which took the pressue off her trachea and allowed her to breathe again, but left her bedridden.

Then, miraculously, her strength began to come back, and so did the feeling and control in her face. She soon was talking, sitting up, then standing. Nobody seriously expected the day to come when she would leave the hospital, but she did... walking entirely on her own.

Unfortunately, the road to recovery soon came to an end. Three years after that, shortly after the birth of her second son, the cancer relapsed, this time much worse. It had spread to the bones in Rachel's vertebrae, paralyzing her from the waist down. Again, she had to undergo surgery, chemotherapy, and radiation. And, amazingly, against all odds, she again had a complete recovery, more miraculous than the first - all of the feeling and mobility in her legs returned. She could walk again!

It would have been nice if it could end there, but the story goes on, and not in the direction anybody would want for her. Earlier this week Rachel was having dinner with her family when she got some food stuck in her throat and started choking. She was unconscious for some time before anyone could revive her, and the preliminary tests suggest that not only was the cancer returning, but she had lost some cognitive function while her brain was deprived of oxygen.

Right before we picked her up to take her to the big city for some more tests, a few more results came in. It seemed as though the tumour was growing around some crucial arteries and veins, and that surgery would not be able to reach it. Treatment this time around, if any, would likely be palliative.

Despite all of this, she was one of the most genuinely nice people any of us had ever met. She thanked all of the paramedics profusely, and didn't complain about anything. "Thank you for serving me," she said to the paramedic I was shadowing as we took her into the hospital. He replied, "No, you have been the one serving me."

When it comes to life, it seems that sometimes it's the world's greatest people that end up getting dealt the worst hand. I don't know how I would cope if I had to go through everything she had in the past ten years. She truly put a face to courage and grace, and since then I have found myself remembering her every time I think I have it rough with traffic or something else minor in comparison.

Like I said, though, the paramedic told me he was also really moved by something she did right before we loaded her onto the helicopter. As we pulled her out of the ambulance, and were readying the aircraft's stretcher support, she did something that made me regret cursing the sun the whole day. She was strapped in to her stretcher, but her arms were free, and she spread them out and looked into the sky. "It is such a beautiful day," she said. "I love the sun!" And, knowing full well that she would likely be on a cancer ward for the next several weeks or months, and that this could be the last time she would be at home, she added aloud with the most beautiful smile on her face, "And who knows when I'll see it again."

Read the rest of this entry »

The failed mandate of our family practise course

Our medical school has a strategy to fight the sagging number of doctors choosing family medicine as a profession: expose students to the profession through a mandatory course in family medicine. Unfortunately, if you ask anybody in my class, it's quite apparent this strategy is probably doing more harm than good.

It involves exposing us to family medicine by arranging for us to shadow family physicians for a few hours per week in our first two years, assigning various time-consuming projects, and providing a number of family medicine-related lectures, attendance to which is encouraged (with limited success) more by sending threatening e-mails to the students than by providing interesting topics.

Then, we are given an exam for each of our first four semesters, asking medically relevant minute details from the lectures, such as, "How many people died in Somalia last year?" "Which of the following is an example of grey literature?" and "What does the E stand for in FIFE?" (the latter of which I know quite well after getting yelled at by a patient for using said technique).

I'm not sure who thought making medical students write exams on boring lectures that they've been guilted into attending would develop in us a passion for the field, especially when we're already overwhelmed with the study load for our other courses. It's a good thing we are instead able to develop this passion by spending time with family doctors, right?

Well, it's not that simple. Personally, I lucked out, and ended up with outstanding tutors. I'm among only a few people who had an excellent experience with all my various tutors, getting the chance to regularly see patients on my own and conduct histories and physical exams, and fill out prescriptions, referrals and lab requisition forms.

Unfortunately, for many people in my class, the taste of family medicine they got from this experience is a very bitter one.

First of all, urban family practice is very different from what family medicine used to be. While rural doctors still do a lot of procedures and deliveries, most of the doctors we shadow have cut down on the amount of these extra services, including following patients in the hospital.

Secondly, with the increases in class sizes, only a small number of students are one-on-one with the doctor, and even after grouping students, the faculty is still having a hard time finding
doctors willing to teach.

So, the preceptors they do sign up aren't all doing it out of a love for teaching, and the students suffer for it. Two students that I know spent most of their shifts with one physician sitting at the end of a hallway, called in only once to see patients. Two others I know spent a semester watching the doctor perform alternative medicine such as waving his hands over the patient (all of which he billed the government for), and they even spent a whole shift punching out pieces of aluminum foil, to build up the doctor's supply of tinfoil confetti to tape on to patients' hands as an (undoubtedly ineffective) alternative medicine method.

However, despite the lectures, exams, and poor shadowing experiences, the course is by no means a complete failure. Some students, like myself, have a fantastic experience with the doctors, getting to do and see a lot, including surgeries and infant deliveries. And even if it didn't convince anybody to become a family doctor, the amount of clinical and patient experience we got will give us a step up for when we start our medical student internships in the fall.

Additionally, the course also gave us the chance to practice a few office procedures, such as prescription writing, suturing, biopsies and excisions, which is the fun 'doctor stuff' that everyone looks forward to in med school. Unlike the medical students from some Canadian schools, though, we never got the chance to learn how to place IVs in our first couple years of med school.

As well, everybody in the class was exposed to the huge variety of sub-specialties of family practice that exist when we spent time with two specialized family physicians. Family doctors can tailor their practices with a focus in prenatal care, oncology, surgical assist, inner city medicine, emergency, hosptialist, sports medicine, and many other fields, something I didn't know before med school, and a realization that definitely piqued my interest as I search for a specialty that satisfies my desire for variety.

Finally, the rural exposure component of the course is one that is apparently a lot of fun. After two years of medical school, we get the chance to spend some time in a rural community, an experience I'm looking forward to right before I start my third year. This is evidently one of the redeeming factors for this course, and hopefully when I'm shipped out, I'll have a few interesting stores to share... and not spend the whole time punching out tinfoil confetti.

Read the rest of this entry »

Blinded by the silver lining

As I've mentioned before, some people seem to be much more willing to open up to you about their medical details when they hear you're a medical student. Often this involves unpleasant details, such as elaborate depictions of fungating lesions and uncontrollable bodily functions. Once in a while, though, I get a response I don't expect.

I was at a coffee shop a couple weeks back - to relax, not refuel, unlike during the school year - and was served by a cashier whose competence at baristing I immediately called into question. After she dropped a few things, had difficulty counting out my change, and made something other than what I ordered, I admittedly made some silent judgments about her intelligence too, which I assumed were related to the lack of natural pigment in her hair.

It was a slow day, and so when I went to return my dish before I left, she started making conversation. "You're a student around here you said? What are you studying?" "I'm taking medicine," I replied, and braced myself for the "Oh, let me show you this rash" or something of the sort.

"Oh, neat, do you know much about Alzheimer's disease?" she asked. "My dad has had that for the last seven years or so. It's pretty interesting, isn't it, with the tau protein deposits and the beta amyloid plaques, and all that."

I think my jaw noticeably dropped. She wasn't so blonde after all!

She went on to impress me with the other things she had learned about the disease, and talked about how she had moved in with her dad to take care of him when he got considerably worse, so that he wouldn't have to go to an old age home. She had left her job as an accountant and found the coffee shop gig which didn't require her 9-5; that way, she could spend more time with him.

Alzheimer's is a terrible disease. Many people get upset as it ravages the cognizance of their loved ones, feeling as though they can only stand by helpless as the person they love is taken away from them, a bit at a time, leaving an empty shell of the personality they once knew. Some even choose to not deal with the stress of the disease by moving their parents to an old age home and not bother visiting.

With this in mind, I asked, "that must have been difficult, I imagine, watching him change so much over the years?"

Her response to that question surprised me even more.

"No, no! It's the best thing that could have happened. You see, as he loses more of his memory, he's been becoming more and more like a child. Now we hang out and make jokes and play in the backyard like kids, and have so much fun. If it were a heart attack or a stroke that took him, then it would be instantaneous - I wouldn't have the chance to say goodbye. This way, though, it's been slow... and so I have had many years to accept that he'll no longer be with me soon, and I've been able to say goodbye."

Not only did I learn once again to not judget a book by its cover, but I also got the chance to see someone who embodied the "acceptance" phase of grief more than I had ever seen before. Perhaps it was because I was expecting her experience to be the same as the others I'd heard of, that she was full of anger at the situation because she had to watch this disease degrade her father to the point that he now is fully dependent on support from others. Instead, she embraced it. The amount of positivity she had for a disease so ruthless was truly inspiring.

Read the rest of this entry »

Doctors are better than nurses.

Okay, okay, there is no way I actually believe that doctors are better than nurses. Too many nurses are friends of mine and know where I live and would make me pay dearly if I ever actually held beliefs like that. I just put that in the title to get your attention (and it worked, right?)... and in the past I've made a point of proclaiming my respect for good nurses on many occasions.

But on to the story. Something interesting is happening in the medical blogosphere I thought I'd draw your attention to.

Three days ago, Guitar Girl, RN apologetically admitted to correcting a new intern in front of a patient.

A doctor who replied to that post in the comments section is getting roasted for presenting his opinion on how doctors and nurses have different roles in the care of a patient, for saying things like, "If you believe a nurse would ever have as much medical knowledge as a physician, even after 50 years of clinical experience, I'm sorry to break the bad news of reality to you. It simply will never happen."


Despite the fact that this quote is surrounded by other comments proclaiming his respect for nurses, he's being called "arrogant." Nurses and medics are politely (and not so politely) disagreeing with him, with many of the possible exceptions to his statement being brought up. It's actually turning into really quite the interesting conversation because some other nurses are actually defending him. I recommend you grab a coffee and check out the discussion.

My take? Well, I've already been told to turn up the respect a little (by someone I respect) once on this blog in the past couple weeks, which is enough for me, so I left my comment there instead.

I'm also going to conclude that to me, this appears to be one of those issues that is SO sensitive, that anyone who tries to present their viewpoint runs the risk of getting misinterpreted... even if they're attacked for the tone of what they're saying and not actually the words they're using.

That being said, I enjoy watching people dialogue opposing viewpoints, and hopefully everyone will come away understanding the opposing points a bit better. Respect all around. (Fat chance, though, right?)

Read the rest of this entry »

Oh, you're a medical student?

Now that I'm well into medical school... well, who am I kidding, this happened back in pre-med too... family or friends or even strangers are willing to tell me the most gruesome details of their personal medical lives.

It's partly a testament to the amount of respect doctors have. They know that I should be able to understand that part of their lives a bit differently than some of their other friends. They know that I won't go broadcasting their story to the rest of the family.

It's also partly a testament to apathy. Why book an appointment when Vitum is here and I can just ask him? I'm not mocking them... just saying, there are plenty of things I've not bothered to see a doctor about that maybe I should have (like how it always burns when I use the toilet).

They way I respond to these varies on the situation. Sometimes it's about old aunt Helga who is having trouble getting up off the couch these days, and I smile and nod. Sometimes it's about Jimmy's dad who now has a tumour, and I ask if they have biopsied it yet and how the treatment is coming along. Sometimes its about the fungating, smelly growth on their foot, which they insist on showing me, wafting its visible fumes vigorously towards me ("Does that smell like anything bad?") - for those people, I try to encourage them to see a doctor and explain I haven't had a lecture on that yet so please take it away from my face...politely.

I don't usually provide an opinion as we've been warned to not provide advice to people outside the office setting (or at all, really, right now, since we're still students) - we've been told enough horror stories of lawsuits from such situations - so I usually simply tell them that's something they should discuss with a doctor. I don't want to be telling somebody that a mole is nothing of concern and have it turn out to grow into a massive tumour.

However, a couple times I've grown quite concerned after I asked a few questions and end up being a bit more insistent that they go see their doctor. In fact, for a couple of my friends, I asked them to go the hospital right away. One of those people ended up needing surgery.

I appreciate being the person that people feel they can approach with questions, and being able to apply my interest in science to the answers. That's undoubtedly one of the many things that attracted me to medicine as a career. We'll see if I can put up with it happening more than once or twice every few weeks.

A story on this topic: Blinded by the Silver Lining

Read the rest of this entry »