As Simple as Tootsie Pops

The medical profession is all about stereotypes. Pediatricians tend to be the overly peppy, optimistic types. OB/Gyns are all angry women or gay men. Surgeons are the bros and jocks. While these stereotypes are largely true, I have learned not to judge a book by its cover. 

We have a particularly difficult patient on our vascular surgery service who is a frequent flyer at the VA. He is a poorly compliant patient with some psych issues, in addition to be morbidly obese with very poor hygiene and even worse bowel/bladder control. None of the nurses or doctors like to take care of him and they don't do the best job of hiding that fact. He frequently becomes agitated with the staff for "not treating him like a vet." Last week he threatened to leave AMA (against medical advice) because he wasn't allowed to ride his motorized scooter to the canteen to buy tootsie pops. While most of the staff scoffed at his seemingly ridiculous request and were ready to get him out of their site, my surgery intern had a different approach. He bought our patient the tootsie pops and got him his scooter back, which lead to an immediate improvement in our patient's behavior. He saw that we were on his side and were not conspiring against him.  

Although some of the staff members yelled at my intern for convincing this "terrible" patient to stay, my intern explained that he knew if the patient left, the infection in his foot would undoubtedly spread and he would likely need an amputation.  He said that as a doctor you have to have enough perspective to look past the actions of your patients. That was one of the most sensitive things I have seen any resident do. I guess I was expecting the resident to have the same dismissive attitude as the rest of the staff, especially because he was supposed to be a typical surgeon who only really cares about cutting and suturing up the patient. His simple act reminded me that whatever field you go into, you can always avoid the negative stereotypes. You don't have to let the preconceived notions dictate your actions. You just have to stay true to your convictions and let them dictate the type of doctor you become.  

First Cut is the Deepest

Whenever people ask me what field of medicine I want to go into, I usually say, "I'm not sure yet, but I'm pretty sure I don't want to do surgery." That statement was mostly based on stereotypes of what I have heard about surgery...long hours, minimal patient interaction, harsh residents and attendings, etc. etc. etc. Previously the only experiences I had in the operating room consisted of me trying desperately not to contaminate the sterile field while trying to catch a glimpse of what exactly they were cutting or suturing. If I was really "lucky" I got to cut some sutures or staple up an incision, which were both surprisingly terrifying the first time. Among the more glamorous jobs are suctioning up the crazy amount of fluid that pours freely from the body or better yet retracting the bladder. 

My perceptions slowly changed when I got to scrub in on some surgeries with this incredibly awesome urogynecologist. I was ready to feign my enthusiasm for getting to do the menial tasks of a med student when she handed me a scalpel and told me I was going to make the incision. I'm glad that I had a mask on so she couldn't see how far my jaw dropped and reconsider. I probably took about ten times longer to cut because I was pressing so gently and trying really hard not to let my hand shake. With that scalpel in my hand, I realized why surgery is so appealing to so many. You feel pretty powerful slicing through skin, then fascia, then subcutaneous fat, as blood slowly trickles out. After they finished the surgery, the attending told me to close up the incision. I found myself praying that my hours of practicing suturing on sponges and banana peels at home would help me to not look completely inept. With the kind guidance of the fellow, I sewed up the incredibly straight incision that I made. There was something so satisfying about the experience. The resilience of the human body is truly amazing. Now that I have had a positive experience with surgery I can go into that rotation with some excitement rather than complete dread. I still highly doubt that I will go into surgery, but I know now to keep an open mind about everything.

Rest in Peace

A few weeks ago I experienced the death of my first patient. It came suddenly and unexpectedly during a routine prenatal care visit. My patient was a healthy young lady, 12 weeks pregnant, who came in complaining of some vaginal bleeding. I knew that vaginal bleeding early in pregnancy could either be nothing, or a sign of trouble. My patient calmly explained her symptoms to me and didn't seem alarmed at all, which made me worry less. Her examination also seemed normal for that stage of pregnancy. The intern and senior resident thought it was probably nothing too, but we had to do an ultrasound to make sure. The ultrasound showed a lifeless fetus measuring at 8 weeks, with significant intrathoracic calcifications. Since my Spanish was the best, I had to explain to our patient that her baby had died inside of her. I had to make her understand that this wasn't her fault and that she had three possible treatment options. She nodded her head through a constant stream of tears, but I knew her grief prevented her from fully comprehending my words. The experience made me realize just how quickly things changed in medicine.

One of the reasons I was initially really interested in OB/GYN was that overall the outcomes are very positive. You get to help bring new life into the world much more that you see your patients pass on to the afterlife. I've realized that you can never truly escape death's dark cloud in medicine. The best thing you can learn to do is find a way to prepare yourself for the unpredictable.
 

Roller Coaster Ride

The first few weeks of clinical rotations have been such a roller coaster ride of emotions. I start each day feeling chipper and energetic even if its painfully early in the morning. Throughout the day, my emotions change with each patient I see, from elation and joy to fright and despair. I have been lucky enough to share the miracle of life with new parents this week on OB. Its absolutely amazing to witness 20 hours of painful labor finally result in a tiny little bundle of joy. After congratulating the proud parents and helping them take some pictures with their baby, I have to move on to the next patient. If I'm lucky the next patient will just be a normal pregnancy or postpartum check, but other times I have had to comfort tearful patients who are most likely going to lose their pregnancy. I've been having trouble finding the balance between empathy and internalizing their sadness.

To top it all off, its been pretty difficult trying to find my place within this world of white coats, adjusting to the hierarchy of interns, residents, and attendings. I find myself constantly inserting myself into everyone's business, while simultaneously trying to stay out of the way. Its difficult to not feel invisible, to not disappear completely sometimes. When you bust your butt to help your team for little or no thanks or recognition, you have to actively fight off the feelings of frustration and anger. One thing that our clerkship director said really resonated with me and helps me in these situations. She talked about the true nature of altruism and about how being a doctor is a job; we get paid for it. You have to do more, by volunteering in the community, without expecting anything in return, for your actions to fit the definition of altruism. That really put things in perspective for me. I got in to this field to help people, especially those who can't necessarily help themselves. As long as I try my hardest to help my patients, I will be a successful doctor. Honors, awards, and competitive compensation are so much less important.

Its a tough world out there and I'm quickly realizing that I have to find ways to hold on to what is important to me. I hope that sharing my reflections in this blog will help me to make sense of this roller coaster ride of emotions and help me to find the path to my chosen field of medicine.