Virtues in Medicine

It was a dark gray day in late summer. No rain. Just cold, northern air that had brushed across my face as I walked from the "L" train stop to the hospital. It was 5 in the morning. This was surgery. You had to come early so you could pre-round, and pre-rounding was something I didn't enjoy. But I did it anyway because talking to patients about frivolous matters was better than getting yelled at for incomplete notes. "Have you been going to the bathroom?" "Are you eating alright?" "Have you been walking?" Waking up anyone else to ask questions like this would be insane. But after you've been operated on, you hand over your rights to interesting conversations and get to be awoken at any time for a barrage of inconsequentiality. My reasoning was simple: the surgeons seem to think these questions matter a lot, so I asked them.

Then we round. I enjoy rounding because I get to cross my arms behind my back and walk around the hospital quickly and quietly with my fellow medical students, a flock of baby ducks following behind residents. It is generally peaceful. Today it wasn't. Today we went to see a patient who has some form of nasty infection in her leg. How nasty? Well, surgery residents are highly sarcastic. But if they weren't flat out lying in the residents' room during sign-out, well then... this patient could possibly die from this infection. The solution? She needed her leg amputated. Late last night, during her admission, she had signed a consent form okay-ing the procedure. Now as we saw her, she was resisting. She wasn't going to lose her leg. A soft-spoken but snarky, sixty-something year old woman--this patient was refusing the operation for some reason. As a human being I could see the resistance in her face. I knew there was more to the story.

But the resident just asked the same old, stupid, inconsequential questions. And the wall separating us, hidden underneath white coats, and the patient, sickly and exposed behind a cheap hospital gown, shot right up. The rounding team left. Notes for the intern: send the patient over to internal medicine. Get them to deal with her.

After rounding, everyone disappears into operating suites. I stayed behind on the floors. And I went back to that old lady's room. I left my white coat at the nursing station, and I went and reintroduced myself to this woman. I broke the silence with some silly, history taking questions: "What brings you in?" "Where does it hurt?" Then I asked the question that nobody had asked because nobody took the time to connect with this patient. "Why don't you want to lose your leg?" Followed shortly by, to get around the wall, "Why don't you want to lose your leg, really?"

And everything spilled out. This patient's history of present illness, but what it really was, not with transformative language but with a story anybody but these surgeons could understand: Recently widowed, fifty pack year smoking history, mismanaged diabetes, shame at being in the hospital again, too embarrassed to call her only living relative, her son, to tell him that she might be dying, because what would he say, "Mom, why didn't you listen to me? You've got to take your medicine. You've got to stop smoking."

It's regrettable nobody took the time to figure out why this woman was refusing treatment. It only took a smile, friendliness, and fifteen minutes of my time.

"You should call your son. Tell him what's going on. And you should get this surgery." I had told her. And she did both of those things. The next time I saw her she was missing a leg. But she smiled when I walked into her room to pre-round on her.

Clerkship

I hate my life.

But first, let's focus on the positives:

• During my last entry, I had decided (although not revealed) that I was going to push my step one test date back 10 days to June 11th. Good news, I passed. 
• I am now almost entirely moved into my downtown apartment. My room is still full of random stuff and I still don't have a well stocked fridge, but I know the area pretty well now and every weekend I go to the beach (within walking distance) with my friends. 

Okay, now on to clerkships.

I started with Surgery. At Lutheran. Widely rumored to be the toughest place to do a surgery rotation. Results are in: I hate it even though I love how much I'm learning and how much I'm doing everyday. In the last two-and-a-half weeks I have cried six times, every single time because of surgery. I am a mess. And I finally know exactly why so I'll tell you:

Being a third year medical student on rotations is like being a middle child: no one likes you and no one pays attention to you so you might as well die. 

If we were to compare the classical hierarchy of teaching hospitals to a nuclear American family circa 1950, the Attendings would be your parents, your older sibling is the residents, medical students are the middle child, and depending on group dynamics, the role of younger sibling is played by either medical students who are great at sucking up and being professional or interns. 

Attendings are the people you want to be like. They are your role models. Sometimes you hate them, but most of the time you love/respect them. They may make you upset because they yell at you and occasionally call you dumb, but eventually you realize they are right about almost everything. 

Residents are your older sibling. But there are a lot of different ways older siblings can act:

-We're in this together: Life is hard. But with any luck, your older sibling likes you and wants you to succeed. This sibling gets extra points if they know how to succeed. Residents can be good role models, just like attendings, but they can also be terrible influences. And as a young med student, you can't really know what's right or what's wrong yet. So you just pray these people are good influences.

-Too cool for you: Okay, you can't really blame someone for this, and to be honest, medical students are dorks. So...

-Constantly antagonistic: For some unknown reason, most likely being they are still bitter about that you took attention away from them (i.e., your birth), they hate you. They would never say that. But if they can, they will make you look bad. For fun. Because, to sum it all up, the world is cruel and if seeing someone else suffers helps you get through your shift, then someone's going to suffer. 

Essentially, residents will determine how you feel about yourself day after day. Your parents may be important to you, but sometimes, they just don't understand. If a resident physician tells you that you did something well, then you feel pretty cool and competent. Otherwise you're just a useless person who know one pays any attention to.

Finally, there are the suck-up med students, the little sibling who really just makes you feel worthless. Everyone is so much nicer to them for reasons you cannot completely elucidate. They are even nice to you--but only some times. At other times they are totally working the angle so they get more assignments. Everyone wants to be around them... nobody wants to be around you. 

Anyway, I'll probably post up something less... emotional, more analytical later. But right now, an hour past my bedtime, I'm genuinely shocked that I haven't quit yet. 

More good news I guess.

Thalassic

Thalassic is defined as "of or relating to the sea." Thalassemias are hematological conditions in which you don't produce adequate amounts of certain proteins that compose your hemoglobin (the stuff that carries oxygen around on your RBCs).

The name for this condition comes from the prevalence of this condition around the Mediterranean Sea, essentially: you live around a sea and your blood is messed up. However, another translation of Thalassemia would be something like.... "Blood full of the sea" or "Sea Blood" which sounds to me like the exact opposite of Land Lubber. I love it.

Unfortunately, there is a wide spectrum of how severe a thalassemia can be: from clinically silent to death in utero. 

13 days, 23 hours

I pushed back my test 10 days. I wasn't hitting what I wanted to get on my practice exams, and it didn't seem realistic that I'd get to that target in five days, no matter how much I studied. Also, I've probably spent over $1000 on books and reviews for this exam and all the courses it supposedly covers. I'd like to at least skim all the materials I have.

Oddly, my stress headache has returned. Which is impairing my ability to study. You can't overdose on Ibuprofen right? Damn it. I should know this.

HOLY .... ! IT'S ACTUALLY A TUESDAY! This update on my progressive is appropriately timed, then. And I'm taking the exam on a Tuesday. That bodes well, doesn't it? 

6 days, 20 hours

Continuing on with how poorly my body handles stress:

I've developed BPPV (benign paroxysmal positional vertigo) and the skin on my outer ear (my auricle) is peeling off and scabbing over and it is thoroughly gross.

I was going to claim that I have trichotillomania (compulsive pulling of hair) or dermatillomania (compulsive picking at skin), but apparently these are serious conditions. And even though I can't sit still and not pull my hair or pick scabs while I study, I feel absolutely fine when I get up to do something else (that's a lie. I never feel fine anymore).

Regardless, my exam is in 6 days and 20 hours. I have a box of Pop-Tarts, a box of Teddy Grahams, Hansen's natural cane soda, Fruity pebbles, and a box of Quaker Chewy bars. I also have about 65 more hours of lectures to watch. So.......