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Becoming The Patient

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.”

Tonsillectomy by CoblationMy 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

6a00e552e3404e88330133f0d2ee1c970b 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

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.

Approaching Medical and Shadowing Experience

I’ve received a number questions asking about how to approach gaining volunteer, shadowing, and general medical experience before medical school, so I decided to post my most recent answer to R.W.

“Hi R.W.! I recommend just calling offices you’re interested in and asking if they take pre-medical students for shadowing. Most places will ask the physician and get back to you, and it is likely they’ll be willing. If you want to volunteer in a hospital you should search for that hospital’s clinical education coordinator and contact him or her. Hospitals have special requirements and sometimes online modules you need to complete. Private offices usually do not.

As far as who to approach, that is up to you! It depends if you already have an interest in something or not. When I was in undergrad I shadowed an orthopedic surgeon for a while since that is what I thought I wanted to do. I’m no longer interested in doing that, and that shadowing experience actually really helped me to decide. I also volunteered in the ER for a summer and gained a lot of valuable experience about emergency medicine and the way hospital teams function. I was able to help with some procedures and even assist in chest compressions during CPR too!

My advice is to get a broad shadowing experience from various physicians and medical fields, and keep record of everything you do so you can use it for your medical school application.

Good luck!”

Thanks again R.W. for your interest in our site!

18 Months Until I’m a Doctor

I am grateful I am still in school, because I get 2 weeks of holiday break and that certainly won’t be there once I’m working as a physician. Most rookie residents get to choose which day they want off: New Years Day, or Christmas Day. In the mean time, I am spending quality time with my family while I still can. I am in NY with my two adorable little nephews, aged 1 and 3, and my first and only child, my 84-pound dog.

I have been doing clinical rotations for 7 months now. Each month my school puts me at a new place, and I have to relearn the rules, conduct, expectations, and temperament of the physicians I work beneath. It forces me to stay on my toes, and I love it. Under my belt is 4 weeks in each of the following: internal medicine, cardiology, infectious disease, family medicine, geriatrics/palliative care, pediatrics, and obstetrics/gynecology. As a third-year medical student I am expected to begin choosing which career path I am headed. I have truthfully enjoyed each of these rotations; it’s difficult to decide which path I want to take. I spent my spare time during internal medicine in the intensive care unit (ICU) and love the variety of cases and care one has to handle there the most so far.

What can you expect to have accomplished with a half year of clinical rotations completed? I have been able to draw blood about 50 times, scrub, suture, and tie knots in surgery, place a nasogastric (NG) tube and laryngeal mask airway (LMA), cardioverted 3 patients in a-fib, gave injections, used a few different doppler ultrasounds for pulses, did 2 dilation & curettages (D&Cs), and debrided burn wounds. I cannot say that my classmates have done equally as much, because I actively try my best to offer help and ask to be taught new procedures on each rotation. I recommend that whether you are shadowing now or plan on performing your best on clinical rotations, you ask if you can perform techniques like these.

My advice for you today is to keep working hard and do not stop educating yourself! The more you read and the more you practice, the more well-versed you will become. Auf Wiedersehen for now, and happy holidays!Feliz Navidad!