The Human Guinea Pig

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After finishing medical school and learning exactly how and by whom a patient is seen in the hospital, sometimes I worried that I would be a human guinea pig. I was afraid that if I were to go to a teaching hospital, meaning a hospital that has residents and medical students, they would practice their “first-timers” on me. Let’s say I need a surgery. Maybe a student who has never sutured in their life gets to practice on my belly. Or if I am hospitalized with a common complaint, e.g. pneumonia, maybe a student will tell the other doctors the wrong story about me and I will receive the wrong medications. As an applicant to medical school, or a newly accepted medical student, knowing the little you do know, maybe you’ve thought these very same thoughts.

The reality is that teaching hospitals are fantastic. The attending physicians (the doctors who oversee both residents and medical students) are well-educated and always on their toes. They must be, otherwise how could they teach? With medical students around who are fresh off the books and residents who are recently trained in different fields of medicine, you’re bound to bring many more ideas to the table. This includes differential diagnoses, appropriate medications to treat the condition, potential rare drug reactions that may come from them, and many more eyes and ears on the patient as they recover.

But that still takes me back to hands-on skills. Maybe you have wondered how doctors become good at techniques. How does a medical student become a surgeon without ruining beautiful skin with horrible amateur scars? My answer to you is pig feet. There are practice boards to suture on, but nothing gets as close to human skin as pig feet. Granted, the skin is tougher than most human skin (hence why they make leather out of pig skin), but the tensile strength and elasticity of the dermal and epidermal skin layers is out of this world compared to synthetic practice boards or cloth.

Although I consider myself a pescetarian, for the sake of all my patients to come, I’ll keep practicing on these little piggies.

Match Day 2015

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No, this isn’t a day celebrating those perfect little wooden sticks that make fire. Match Day is the day every medical student finds out what kind of physician they will be for the rest of their lives, and where they will train for residency. It’s official; I matched into a general surgery program, and I could not be happier!

As of now in the United States, there are actually two Match Days, one for DO students in February, and one for MD students in March. There is talk of merging these momentous days into one, but it likely won’t occur until around 2020. In case you did not know, the American Osteopathic Association (AOA), the governing body of DO education across America, has recently agreed to come under the governing power of the Accreditation Council for Graduate Medical Education (ACGME), the governing body of MD graduate medical education. This is a huge step for physicians-to-be. Beginning this year, and hopefully being completed by 2020, all DO and MD students will be able to apply for any residency program they want to, whether that program is an AOA or ACGME program. Previously they were largely segregated. The details of this “merger” are still playing out, but hopefully there will be a single, unified Match Day in the near future. More info about the merger can be found here.

Matching into my top choice general surgery residency program was the best news I have received since my acceptance into medical school. It was not easy to choose which speciality to apply to, since I did not have any bias towards any field of medicine prior to starting medical school. I decided to pursue the field of general surgery after my 3rd year rotations in surgery. Although I enjoyed my surgery rotations so much, it scared me to think of the strenuous, long hours that residents work in general surgery. However, every rotation I tried after surgery had me wishing I was downed in the operating room. I look forward to the five years of residency, not as strenuous, but as exciting opportunities to grow.

I hope you will also figure out which field of medicine to go into by experiencing your medical school rotations with an open mind. Surgery is certainly not for everyone, and you will find that within medicine, prestige and respect come in many fields of medicine. Fear is the worst motivation one can have. Use logic when planning your life, but always follow your passion.

Becoming The Patient

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On December 17th, I underwent a tonsillectomy for recurrent tonsillitis. This was my first surgery under general anesthesia, and I was incredibly nervous. I have learned all the possible reactions and complications that come with general anesthesia, and I thought maybe I would be the 1 in 100,000 who get malignant hyperthermia or something wild like that. (Medical student syndrome or hypochondriasis at its finest.) Thankfully, my husband was by my side in the pre-op and post-op areas, and my mom was eager to hear how things went and how I was feeling. I had the support I needed for a “routine” surgery, and I had been forewarned about the pain and difficulty of getting tonsils removed as an adult. I was ready. “Are you the husband? It’s time to give any hugs or kisses; she’s going back.”

My surgeon was calmly waiting for me as they wheeled my bed into the operating theater. He made some jokes about how he felt ready to operate since he watched the video once again, to which I replied, “I watched it too.” Everyone laughed, and I lied back and began breathing in cold, chemical air from a mask as the anesthesiologist instructed me to do. I felt a stinging sensation through my IV in my hand as the propofol was pushed; the burning climbed up my arm, and I was out.

When I woke, my throat felt the way it does when you get strep throat. I was coughing from the endotracheal tube being placed, and I happily accepted an offer of pain medications from my kind nurse who told me that I was “ok”. My husband arrived, and we filled my prescription for liquid tylenol with codeine and continued on our tired way back home.

The next 4 days were relatively uneventful as I struggled to stay hydrated with ice pops and water as my sole diet. On the afternoon of day 4, I was feeling a little better, when I tasted the same metal flavor in my mouth that I get when I get bloody noses. My surgical site was bleeding. I looked in the mirror, and it was pulsating out of my left throat, into the sink, filling the sink quickly. My husband rushed me to the emergency room of a hospital which we discovered didn’t have ENT surgeons in-house. We waited for an ENT surgeon to come in from the city as I gushed blood into extra-large sized styrofoam cups and attempted gargling with ice water. As I looked at my heart rate monitor, I thought, “Her heart rate is in the 140s and blood pressure is in the 150s systolic. This is clearly an emergency, and she needs treatment now. No time to talk with her, I need to tell the attending about this patient. Wait, this is me. And I’m helpless…” After about 45 minutes of bleeding and vomiting clots that collected in my esophagus, the supplies and surgeon were brought in, and I was wheeled back, once again. This time the pushed the propofol while I was sitting up, nauseated and vomiting into a cup. They must have caught my head from falling. I’m thankful.

I started from scratch again, with the pain, the difficulty staying hydrated, on top of being very anemic. I lost about 1.5L of blood. Within 5 days I lost 10 pounds. Despite all of this, I’m thankful that my tonsils are no longer a part of me, and I’m thankful for the support I received. I wasn’t sick very often as a child, so this was the first time I felt the patient’s experience. It was my first time knowing how it feels to be dependent on a medical team for my well-being, for my survival. It was the first time I felt like my body was doing me an injustice. I was so thankful for how the nurses cared for me, how the anesthesiologist walked me through what would happen step-by-step, and for the surgeon who fixed the part of my body that was doing the injustice. It is truly a humbling experience to be so helpless and dependent on others for my life, literally, and I know that as I treat my patients, I will not forget this. I promise I will one day be the physician who will work with a great team to fix injustices.

Death in the ICU

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I just finished a rotation in the intensive care unit (ICU). This particular unit was surgical and neurology, mostly. Dispersed amongst the large number of my patients who had brain bleeds was the esophageal variceal bleed, the diabetic ketoacidotic patient, and the handful of motorcycle trauma patients who were often only in their 30s or 40s. Most of the brain bleeds left the patient severely disabled, often requiring mechanical ventilation to breathe and many medications to increase blood pressure and decrease brain swelling.

Admittedly, I find it exciting to help with a code, a.k.a. cardiac arrest, which happens frequently in the ICU. I enjoy the rush that comes with potentially stabilizing and saving a patient’s life in minutes. Considering about 1% of true cardiac arrests are revivable, of course I would never wish it upon a patient. I chose to do this rotation so that I would be involved with a number of codes and help guide very ill patients either to recovery or to a peaceful goodbye. Many of the patients had the latter.

Death and dying can be scary things. For families who are watching their loved ones deteriorate, they struggle to make decisions about what to do next. The hardest part is to have the family decide what the patient would want – to possibly survive only to be paralyzed on one side and in a nursing home at age 40, or to leave memories of his or her time alive as a well, fun, successful, loving, etc., person. Many families seem find it difficult to let go, but often the patient would not have wanted to live so disabled.

As a physician, the role is to help families differentiate between their own desires and the patient’s wishes. It can be difficult not to cry, but explaining things from a medical standpoint is a mature coping mechanism that works nearly every time. I have had to console parents as they cried over their deteriorating son or daughter and told me, “this is not how it’s supposed to be.” They already buried their parents, and they always assumed that their child would bury them, not the other way around.

At the end of the day, the right answer is always, “what would the patient have wanted before he or she was in this state today?” Answering that question accurately is true love, even if that means stopping any further interventions and letting that patient give his or her peaceful goodbye.

Surviving Medical School: Finding the Right Balance

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It’s application season yet again! As you are submitting your applications for medical school, I just submitted my application for residency. With all the personal statement and deadlines we have to meet, it can be hard to balance your home life with your work life.

As a medical student, each month I do a rotation in a different hospital. This constant uprooting can be stressful or exciting, depending how you process it. I am married and have a dog who we treat like a firstborn child, so it can get frustrating to be on away rotations and only be home on the weekends. When I am home, I often still have assignments and presentations to complete. I think you all can relate in many ways, but if not, then consider this a forewarning.

Another way to look at things is that when I am busy all week long on away rotations, doing rounds and making treatment plans during the day, and reading up on my patients’ diseases at night, it makes coming home on the weekends something to look forward to. The spare time I spend with my spouse is usually spent doing fun things – eating out, going to the park, exercising, cooking together. It’s almost like dating again. Work hard, play hard, right?

The movement of being a rotating medical student isn’t always easy, but it is also exciting. Being at a new location each month, getting to know new people and learn the styles each physician has, makes me more versatile. I can pick and choose what I like about the physicians I work with, so when the time comes, I will reject the bad aspects and keep the good ones in my own practicing skills.

Throughout your medical school career, you will constantly have to battle the clock as you balance your work and home life. Time management is going to be your key to success, so start practicing now. Block out times for work, and make sure to schedule times for play, family, and alone time. However you set up your schedule, do your very best to stick to it. If you go over or under, don’t beat yourself up. Get up and keep going. This is the secret to success in medicine.