Look for me or my classmates asking Governor Schwarzenegger the tough questions tomorrow on
Hardball with Chris Matthews
, on MSNBC. I’ll obviously be asking about
plot inconsistencies in Terminator 2
health care reform in California.
Comments Off on I’m On Hardball Tomorrow
I’ve managed to completely forget that medicine is about people.
I came to realize this over the past couple weeks, especially at a ceremony to remember those that donated their bodies for the anatomy course. The first-years were reading poems, talking about their experiences in anatomy, and I found it all very drab and boring. And then I realized that I was finding it drab and boring, and realized that these were people. Mothers, fathers, brothers, sisters. Friends, co-workers.
And about a month ago, while we were studying analgesics (pain relievers), our pharmacology professor reminded us that one of our roles as physicians was to relieve human suffering. “Suffering?” I thought. “Oh. Yeah. These diseases cause suffering . I almost forgot.”
In medical school you want so bad to learn that you dive right in, without looking where you’re going. At first, you get confused by terms like “dyspnea” and “syncope.” You learn the language. Then you go deeper. You learn the organs, the body, and how it can go wrong. You learn about infections, and pathology, and disease. You learn buzzwords, associate diseases with stereotypes, all in hopes that when someone says “night sweats, weight loss, and hemoptysis,” you can be the first one to shout out “tuberculosis!” and ramble off the drugs of choice and their side effects.
And while you’re in the library memorizing diseases associated with symptoms or organs, or at a cafe going over tropical infections and how you get them, you gather this big list of words in your head. You try to organize these words and tuck them away, so you can recall them later. All the while, you haven’t seen a single patient with this disease, or that infection. You know how to describe a certain type of rash, or how it’s supposed to look, based on a Google Image search , but you’ve never seen one in person.
I completely understand how physicians can view patients as only their diseases; there’s enough to know about any one disease that it’s just less mind-exhausting to try to reduce someone down to a few lines or bullet points. But then you think about someone you know with a disease, and it sickens you that anyone would ever reduce them down to a list of symptoms or a pathophysiology. They’re too good for that, they’re too three-dimensional. Too funny when they’re drunk, or too insanely brilliant, or even too annoying to just be a disease.
We had a written clinical case today that discussed a woman with “multiple spontaneous abortions,” and I instantly thought, “ antiphospholipid antibodies! ” and figured I was done with the case. I successfully matched the buzzword to the disease.
But then I read the words again: a woman with multiple spontaneous abortions . How absolutely dreadful, emotionally awful, and mentally scarring.
I’m at a stage in my medical training where my goal is just to get the diagnosis right, but that’s nowhere near my goal as a doctor. If you don’t see the patient as a person, we might as well just replace physicians with computer programs-they can probably make diagnoses faster than doctors. Click here for your diagnosis.
Fever of Unknown Origin (FUO) is when a patient has a fever (that’s >99.7F oral, or >101 rectal) on three occasions or three days in the hospital, and nobody can figure out why the heck he or she has it. It’s usually due to an infection, cancer, or autoimmune disease, but I’ve recently recalled from my childhood one major cause that no one at Smartypants Stanford thought of:
Child faking a fever.
I was no expert at this, and having a nurse and physician as parents didn’t help, but on at least one occasion I took the thermometer my mom gave me and stuck it up next to the lightbulb of the lamp next to my bed. Voila, temperature of 106. Unfortunately, lacking the knowledge that I’d probably be dead, or at least look close to it, at 106 degrees, I was forced to go to school.
Also fun to say in the “Eff You” category: 5-FU , a chemotherapy / cancer drug.
It was a dark and stormy night.
So I’m walking to Borders with fellow anatomy TA Ronnie, we’re just leaving the parking garage, and an elderly woman carrying an umbrella mis-steps and crashes to the ground. She doesn’t even get a chance to FOOSH it (fall on out-stretched hand). It’s like it’s out of a bad medical student training video or something. She kind of lands on her side, or so I think, and we hustle over to see if she’s okay; I instantly think broken hip.
She’s partially picked herself up, and she’s about to stand up, and I notice a little blood on her hand. I say, “Oh, you know what, you’re bleeding a bit, just sit down, let me grab some Kleenex from my car.” That is, until I see that the blood isn’t coming from her hand. Oh no, that blood is just some of the fresh red that’s gushing from her left temple. My eyes kind of do a zoom-out / once-over look at her, and there’s blood all over her coat, down her shirt, on the ground. I give my phone to Ronnie and tell him to call the paramedics, and run into California Pizza Kitchen to get some napkins or something.
My heart’s pumping. I grab the napkins, come back out, and she’s pressing some tissues onto her head, and the bleeding’s pretty much stopped. We wait for the paramedics, and I joke with her that she lucked out, falling right in front of two medical students. She rips back with “First-years or second-years?” and I get the feeling that she’s still with it. This Is Good. The paramedics arrive, check her neck and examine the laceration on her head, and the hematoma (big blood clot/bump under the skin) is bigger than a golf ball. I couldn’t believe how quickly the thing grew.
We eventually go off on our way; it feels kind of weird to just leave, but she’s in better hands with the paramedics anyway (let’s just be honest here). Ronnie and I start discussing all the possible complications-I’m focused on the hip, then he starts wondering about an epidural versus subdural hematoma. I just couldn’t help but think about how thin and delicate elderly people’s skin is, and how easily it can tear and rupture.
It was an exciting moment, and I of course use it as Clear Evidence from God Almighty that I should go into Emergency Medicine (my latest specialty of the month). Then again, after almost 2 years of medical training, I don’t know that my knowledge really helped me all that much; “apply pressure to wound” is kind of common sense by the time you get your second nosebleed in life.