• About
  • Academic Publications
  • Bioethics
  • Blog!
  • Columnist: In-Training
  • Narrative Medicine: Why I Write

Sarab Sodhi

~ My Life in Medicine

Sarab Sodhi

Category Archives: Philosophy

Three Patients

19 Tuesday Dec 2017

Posted by Sarab Sodhi in Education, Emergency Medicine, Medicine, Philosophy

≈ 1 Comment

Tags

Emergency Medicine, medicine, Residency


Another publication from way back when, detailing the insanity of intern year.

 

At 0622, I walked into the resident room. I pulled on my scrubs and clipped my stethoscope, cellphone and trauma shears to my waist. A patient had joked I looked like a gunslinger from an old western. I felt more like Don Quixote, with my makeshift strapped on armor, trying to do good against all odds.

 

I walked into my shift at 0645, into the busy urban Emergency Department I called home. The night intern signed out to me. The sign out included the usual scattering of the very sick, and the very intoxicated, everyone else had gone home before dawn broke.

 

I walked up to see a new patient that EMS had just rolled in, an elderly Vietnam vet who’d fallen and couldn’t get up. He was terrified he’d broken his back. I reassured him and his wife as best I could without lying to him. Leaving, I got a call from the nurse of one of my patients. “The woman in 19 wanted to leave, is at triage.”

 

Stale alcohol wafted through the air. As I tried to make sure she was sober, she grew irate. When I asked her to walk, she huffed and took two steps to me with her middle finger raised, stopping right before she slammed into me. I went to print her discharge to a commentary telling me where I could put it.

 

I’ve been a resident in Emergency Medicine for two months now, but I’ve already begun to find those encounters blasé. As I bade her good health and walked back, the veteran called me over. He and his wife seemed terrified so I reassured them and explained what to expect as the day went on.

 

I walked over to go see my new patient and I got a call “Bed 14 wants to talk to you”. As I approached, I saw the half-naked, well built, angry looking fellow I’d been signed out and had a sinking feeling. He cursed at me with a fluency I’ve grown to expect, with his sweet, old mother sitting next to him holding his dirty shoes and clothes on her lap. “Let me go!” he spat, as I kept my distance, a muscular technician at my side. As I tried to examine him, his anger grew. He ripped off his C-collar in one mighty swipe and his blood pressure cuff in another. As he was rising from bed, security officers materialized, as if beamed down from Star Trek. Under their gentle, watchful gaze, I finished examining him and finding him sober, discharged him.

 

As my day progressed, I saw a handful more patients, dispositioning them with the eagerness and ineptitude of an August intern.

 

The veteran ended up having a compression fracture, and as I helped put him in his back brace, he thanked me effusively. As I said goodbye, he looked me in the eye and said, “I don’t know how you do it. I heard that woman curse at you, and I saw how badly that kid wanted to rip your head off. How do you do it? All this pain and suffering day in and day out would destroy me…” I smiled, shrugged my shoulders and said “It comes with the job.”

 

As I walked away I was forced to confront my flippant answer. I’m an intern, two months into residency and already I’ve lost a handful of patients. I see terrible violence every day and as I dip into and out of people’s lives I feel a faint echo of their misery. To survive as I tilt my lance at windmills, I wear a coat of emotional armor that allows me to take the hits and keep working. My armor is adaptive: titanium when I see angry, intoxicated patients and cotton when I see scared sick people.

 

Then I sign out, walk out of the Emergency Department’s bright neon lights and try to leave it all behind me. As I get home, to a loving significant other and puppy, I take a deep breath as I walk in the front door, take off the armor, piling it carefully by the door. After all, I work again tomorrow.

“Stayin’ Alive”

12 Tuesday Dec 2017

Posted by Sarab Sodhi in Education, Emergency Medicine, Medicine, Philosophy

≈ Leave a comment

Tags

CPR, Education, Emergency Medicine, Medical School, Medical Students


A variation of this was published in a peer reviewed medical journal. Another walk down memory lane. My first emergency medicine journal publication, and my last publication of the end of medical school.

The paramedic’s bullet was short and to the point. “40 something year old woman. Found down, possibly after a fall. Unresponsive in the field. Bradycardic to the 40s. Protecting her airway initially, but now desating to the 80s. Barely got an IV.”

As a fourth year med student who had seen a bunch of codes, I still felt a frisson of excitement when codes came through the door. After all codes for me represented Emergency Medicine- no information, a deathly sick patient, lots of adrenalin and a healthy dose of fear.

I stood by my resident’s side as she induced and intubated the patient. As the pearly whites of her vocal cords came into view and I saw the tube go through it, we all released the breath we had subconsciously been holding. A dose of Atropine raised her heart rate and she seemed to stabilize. I walked to the door of her room pulling off my gloves as I went- I had patients to see after all.

As I pulled off the gloves, alarms began to sound. Her heart rate was beginning to drop again. My resident met my eyes, and said just one word- “Compressions.” Within seconds of her having given the order, I was at it. I had done compressions on dozens of people- and each time I did, I recalled my BLS instructor teaching us to compress to the beat of Stayin’ Alive, since the song had a beat of 100 a minute. He said it also worked with Another One Bites the Dust- a connection that was too morbid for me at the time.

So as Stayin’ Alive played in my brain, I pushed down on her breastbone, hard and fast, and I felt something pop beneath my crossed hands. I was breaking her ribs as I compressed her chest in a violent, last ditch attempt to beat her heart for her. Each time I broke ribs I found myself pausing for a moment- pausing to apologize and acknowledge the violence I was inflicting. Then, I remembered that if I didn’t do it my patient would never hear any apologies again. So I fell into my terrible cadence, in my own little world with Stayin’ Alive for a soundtrack curiously disconnected from my humanity and the sadness of the situation.

Around me there was a blur of motion. The nurses were drawing up and giving med after med. My resident was splashing betadine on the woman’s chest right next to my hands and blindly trying for a subclavian line. I momentarily felt a stab of fear as she stabbed the patient in her chest millimeters from my crossed hands, but I made sure my compresisons never faltered. The patient’s one tenuous IV blew, and suddenly there were people all around me with needles stabbing away. And through it all I was humming “Staying Alive” under my breath. Each time I lifted and dropped my shoulders, about 100 times a minute, I saw her chest lift off and drop back onto the bed, her breasts, exposed to the world, flop up and down, her head jerk up and down, and her arms lift and fall just a little. For a second her movements gave her the illusion of life- an illusion I was creating. I knew the statistics, knew that more than likely she wouldn’t survive- but as I compressed I hoped. Sweat was running down my arms as I worked, landing on her chest and mixing with her blood as I kept to my terrible cadence.

Around me the needles were ineffective. Nothing was working. The nurses, who almost never miss, were cursing in frustration as they got a line only to have it blow a second later. My resident and two attending physicians were trying to get central lines, and from their lips too came soft curses.

As my arms began to tire, one of the nurses switched with me. Her light svelte frame was perched precariously on her toes as she began the same cadence trying to beat this woman’s heart for her. It seemed like seconds later that I was switching back with the nurse. As she did her final compressions and switched with me I heard the strains of “Stayin’ Alive” fading away softly under her breath.

We worked for what seemed an eternity. My arms pushed of their own accord. Thirty minutes after we began, my attending called it. “Time of death, 1040”. I walked out of the room yet again pulling off gloves- this time slick with blood. Having gotten sufficiently desensitized after dozens of unsuccessful codes, I walked out with a sigh and a stab of sadness at the life lost. In a few months I would be an intern, and a year or two after that I’d be expected to run a code. But for the here and now I was just a medical student, and my only job was to learn. So I learned from my patient, the woman who had died. I learned yet again that I couldn’t always save my patients.

There was a chart on the rack to be seen, and I walked to the room. As I walked into the room, trying to leave my previous patient and the violence I had inflicted upon her behind me, I smiled at the next patient with Stayin’ Alive still playing in my mind. All I could hope was that perhaps this patient would.

“You Set the Tone”

05 Tuesday Dec 2017

Posted by Sarab Sodhi in Education, Medicine, Philosophy

≈ Leave a comment

Tags

Emergency Medicine, Empathy, Medical School, medicine, Residency


Another walk down memory lane, as I finished my ED months and did my medicine sub-internship. A good reminder, that when all is said and done, you do set the tone and you choose the job. I still vacillate between the emotional teflon being extra thick and it being porus enough that the insanity of work spills into my personal life. And I probably will keep doing that forever.

 

“Don’t ever say you’re sorry. See, there’s two kinds of doctors… there’s the kind that gets rid of their feelings, and the kind that keeps them. If you’re gonna keep your feelings, you’re gonna get sick from time to time – that’s just how it works. People come in here and they’re sick and dying and bleeding, and they need our help. Helping them is more important than how we feel.  But it’s still a pain the ass sometimes. Sometimes, I just want to quit and do somethin’ else.”

-Mark Greene, ER

 

I’ve realized recently that there are a few things medical school teaches you nothing about. There’s the fabled four year curriculum that all neophytes believe will make you into an educated, caring, considerate and capable physician. And then there’s the reality that most of what it is to really be a physician is learned in the “unwritten curriculum”, the curriculum you learn from watching the residents, attending’s and nurses. Handling death, seeing suffering and being unable to do anything about it, and how to handle the abuse that a day in the hospital sometimes throws at you- all of these are things you figure out on your own, and hope you’re doing right.

Today, the Match list opened. I’m going to put in my list of programs I want to go to and in March, I find out where I go. And then on July 1st, I become an Emergency Physician- terrified, marginally capable and hopefully guided as I try to take care of people. I’ve spent a lot of time recently watching season after season of ER, and I’ve come to realize something terrifying.

Three and a half years of medical school have hardened me. They’ve acted like a forge, providing tremendous heat and a constant pounding to beat out the ‘imperfections’ and to expose me to the wonders and terrors of clinical medicine. They’ve taken a humanistic person who read Wordsworth, Sarte, and Dostovesky and replaced him with someone deeply familiar with the PERC rule and the CHADS2. I’ve become capable of taking care of patients to some degree, I walk with the strut of someone comfortable with much of daily patient care. My training has helped me save a couple of lives already, and will likely be responsible for saving many more over my career. But I can’t help but wonder what I’ve lost along the way.

The last patient I did CPR on died. I had my hands poised over her sternum when time of death was called. I realized later, that when I left I walked out without a second thought as to the life that had just ended, moving on efficiently to the next task.

More than anything else that terrifies me. I’ve never been overtly or overly emotional, but recently in the hospital it’s as though I’ve developed this protective Teflon coating that blunts both the great saves and the terrible losses. I can’t imagine functioning in a busy Emergency Department without it- the fear would probably render me catatonic, but the existence of it makes me wonder if I’ve become the soulless automaton I swore I would never become- the soulless automaton so far from the physicians identified by Mark Greene and John Carter.

As my mind wanders down this tangent, I’m reminded of another patient I’d seen that same day. He was an elderly gentleman, a veteran of World War II and Vietnam. A patrician gentleman with a regal bearing, I was admitting him to the hospital for pulmonary edema. When I told him, this man who’d survived the landing on Normandy and pushed on despite seeing scores of his friends die, broke down in tears. He was terrified he was losing his independence to a disease that crept on insidiously with age. My heart broke a little inside, because he reminded me of my own grandfather, a 85 year old general who hated the hospital. So I sat with him for ten minutes just talking, and holding back tears.

I do set the tone, I do decide how I’m going to see and manage and handle the emotional onslaught contained in the walls of an Emergency Department every day. And despite how useful my emotional armor is, I think I need to continue to live in fear of it. The day I grow to like it too much, is I think the day that I should hang up my stethoscope.

May that day be far, far away.

 

Exceptional

14 Tuesday Nov 2017

Posted by Sarab Sodhi in Education, Medicine, Philosophy

≈ Leave a comment


Continuing the theme of posts I’ve written in years past, this one talks about the weirdness of having a self admitted mediocre student being called exceptional. I remain, quite honestly, mediocre at many things, but somehow clinical medicine clicked with me, and allowed me to become better than mediocre. 

This post was written halfway through medical school! Enjoy!

 

It’s a lovely word, exceptional. Makes you feel all warm and fuzzy inside, gives you this idea that you’re something more, something above and beyond, raising your self image to dizzying heights.

 

It’s something I’d never heard till I got to college. Through my middle school, my report cards would read, “Can do so much better if he’d apply himself” or “Capable of so much more.” In college, I started hearing the word smart, or even gifted applied to my name. I convinced myself that I was actually just gifted, and the fact that I’d done two years of college level Biology, Physics, General and Organic Chemistry in high school had little to do with the apparent ease with which I achieved academic success. So, I coasted through college on autopilot, passed out in nearly every class with my legs sprawled out on the seat ahead of me, working through experiments, projects and exams in fractions of the time of the rest of my class, never seeing the frustration on their faces as I did these tough tasks with obvious ease. I tried to explain that I’d done it before, but I didn’t try very hard. I enjyoed the mystique the achievements gave me, enjoyed the feeling of being seen as gifted and smart, and I loved hearing from the people around me, professors, peers, and the people I taught that I was exceptional- sometimes in words, or sometimes in just the way I thought they saw me. So, I remained oblivous to the trial and the tribulation that is hard labor of the mental kind. I graduated mangna cum laude, with college and departmental honors and sundry pats on the back from the world.

 

I then moved onto medical school convinced in my little mind that it’d be the same thing as college, that I’d be able to sleep through my classes and still outshine everyone else. The first day of medical school, as they explained that we’d be dissecting on one day and studying the other, my small group was told we had a study day first. So, I floated around the library in this vast new building unsure of what the heck to do with myself. I opened my Netters, and promptly passed out with my face in it, drool leaking from my open softly snoring mouth onto those glossy perfectly drawn images of the anatomy we were to learn. The next day, during cross teach, when the other half of our group who had dissected taught us, I experienced what it’s like to feel like an idiot for the first time in my life. There were terms flying around I’d never heard of, gray structures that looked identical to my naive eye being distinguished from one another all the while I tried desperately not to throw up my breakfast. I was like a fish lost in the desert, totally out of my element. Slowly, I got the hang of it, but that first two months I learnt to feel like a fool and began to downgrade my estimate of my own intelligence. I still didn’t study, since I’d never learnt how to; hoping instead that somehow magically I’d survive. I did survive anatomy, and felt much more comfortable during Biochemistry (since that was my major in college) but my self esteem was about the lowest it’s ever been in the first two years of medical school. I’d gone from an honors student in college to an average or slightly above average medical student. The swagger and arrogance of my college years remained as a thin veneer to hide the fear and insufficiency I felt on most days, with my peers the equivalent of linebackers to my metaphorical ninety pound weakling being kicked in the face with the sand of anatomy, phyisiolgy and pathology. The sense of meaning, purpose and power I’d felt in college, the heady sense of strenght, and the knowledege of where my path was leading was replaced by a never ending gnawing self doubt that nibbled at the foundations of all of my choices, questioning why I came to medical school, what it was that I hoped to accomplish and fear that the Siphysian task of learning all this material would never end.  Nearly every day I experienced at least moments of dread, fear and anxiety, feelings that I wasn’t cut out for medicine, that I was in the wrong field. I’d heard that it would get better, but the future was so far off, with such daunting obstacles between me and it that there were days I nearly despiared of my goals.

 

Somehow, I managed. I passed my Boards, and did fairly well. I began my rotations, jumping into psychiatry where I had always done well in my boards and my classes. I found my strengths again, talking to people- a skill that had nearly atrophied in my two years of social isolation, finessing out the details of their conditions and trying to match their symptoms with this whole set of diseases I’d had stuffed into my brain over the last two years. I guess some of it stuck, because I was doing quite well by the end. The soft skills I had discounted in favor of my so called intelligence in college, of conversation skills, charm, courtesy, politeness, and reading people began to show their worth as I searched to find them under the haze of biochemistry formulae and physiology concepts. So, I started hearing the voices again (not the schizophrenic kind), those of my attending physicians and my residents, telling me that I had skills, that I could be of value in medicine and I could be a good doctor. I spoke to a resident yesterday, a self described hard ass who ‘didn’t kiss medical student’s asses’ who said the magic word to me- exceptional. She called me an exceptional medical student, not so much for my fund of knowledge, but for my abilities with people, for the confidence to ask questions and try things, and most importantly the confidence to give it a shot and be totally wrong- something I have in abundance.

 

The Evolution of a Medical Student

12 Tuesday Aug 2014

Posted by Sarab Sodhi in Medicine, Philosophy, Writnig

≈ Leave a comment


At this moment, I’m on the top of medical student evolutionary tree. I’m a fourth year, strutting my stuff in the hospital and casually describing intubating, sticking and poking people. A few days ago, I got to run a book discussion for the new first year medical students.

As I walked into the medical school I walked down memory lane a little. I relived the boring hours of my first years orientation and how little it oriented me to medical school. I relived the shock of my first day of anatomy, and how I was told to “go read” since my group didn’t dissect that day- but I had no idea what to read… I remember how I felt, going from a cocky, confident, relaxed college student who was big fish in his little pond to a medical student who was surrounded by people who were smarter and studied harder. I remember the feelings of inadequacy when I didn’t get an honors grade on an exam, or it seemed that my peers were so much more clued into a concept than I. I remembered feeling like I didn’t belong- that somehow I’d crept into medical school and would be discovered and laughed out.

I recalled how magically in my third year of medical school, when I was seeing actual patients my strengths came out. I could talk to people, get a good history, make a solid differential and decide how to work them up. I could explain in non-medicalese why I thought they needed something and work with them when they didn’t want it. I remember beginning to enjoy going to the hospital, feeling like I was where I could do good work, where my actions and my words meant something. I remember the first time I was called “Doctor” in the hospital and how I meekly responded, I’m just a medical student.

I remembered how in my recent Emergency Medicine rotations, I was being given great autonomy and freedom. I could confidently walk into a room of someone who was sick and make decisions to make them better. I had acquired the skills to take care of people- diagnosis, treatment and decision making. I remembered most recently when I was leaving the room of a woman who had come in with abdominal pain how she had said in parting to me, “Thank you doctor” and I had smiled in return as I walked out not correcting her.

If you told my first year self that I was going to be who I am now in a few short years I’d have reacted in disbelief. At this moment I can scarcely believe that I was once that timid, that new or that scared.

I told the new first years some of this. I doubt they believed me. But maybe in a few years when they’re looking back at their beginnings they will.

Oh, and in terms of advice for you first years, here it is. Watch “Dead Poets Society”. Then you go and carpe the hell out of that diem.

A Labor of Love

07 Wednesday May 2014

Posted by Sarab Sodhi in Bioethics, Medicine, Philosophy, Writnig

≈ Leave a comment

Tags

Baby, Doctor, Hospital, Medical School, medical student, medicine, Obstetrics


I stood in the room, gowned and gloved, waiting for the woman to push. There was a thin trickle of sweat running down my back where the bright lights of the delivery room were trained. The baby was just short of the pubic bone, nearly ready to be born.

The mother-to-be had been pushing for hours and was exhausted. We watched the strips that recorded her and her baby’s heartbeats—each time that she pushed, her heart rate spiked to more than 170 beats/min and she closed her eyes and blew the air out of her lungs as we urged her on. “Push. Push. Push.” “Breathe. Breathe. Breathe.” We continued, our implacable rhythm timed to the clockwork contractions of her uterus.

Her exhaustion had caught up with her; I could read the defeat in her eyes as she whispered to her husband, “I can’t do it.” He smiled into her eyes and whispered back quietly, “Yes, you can.” My eyes were transfixed by this private moment between husband and wife, for all intents and purposes alone in a crowded delivery room, oblivious to the five other people standing around.

My hands moved on autopilot, assessing the baby’s position, a job my eyes should have done, as well. I stood there, doing what I was supposed to by habit—this was the fourth delivery that I’d done, after all, and I was a 5-week OB veteran. I stood there watching this moment, this beautiful, private moment, and some of life’s mysteries became clearer.

It was suddenly apparent to me how much I’d given up to be the one bringing this couple’s baby into the world. The fact that I could be welcomed into this intensely intimate moment and thanked after I’d done my job attested to the value of the profession I was joining. But in this moment, I wondered, at what cost?

This couple was a few years older than I. They had been married since they were my age and were having their first child now. They were madly in love, had jobs that fulfilled them, and were bringing their first child into the world.

At that moment, I had one purpose, one raison d’être, one thing I was searching for—that obsession, that passion, was medicine. In pursuit of it, I’d given up my hours, my sleep, my financial future, my social life, and my relationships.

My family was thousands of miles away, rarely seen and always missed. My friends were languishing, with unreturned phone calls and text messages on my phone, forgotten among 14-hour shifts and minutiae that needed to be memorized for each rotation. My love life was challenged by my constant lack of time and impossibly high standards—not to mention my jealous, unforgiving mistress named medicine.

She pushed again, and I snapped back to the here and now. Her son was crowning, and my hands moved automatically. I checked for a cord around his neck, pulling him out of his mother’s womb, one arm at a time. He was born from a warm and safe womb into the cold and lonely world he would now inhabit.

I swaddled him in blankets and placed him on his mother’s chest as his parents stared at him with love, drinking in the sight of his fingers, his toes, his perfect little features. I finished my work quietly. They thanked me warmly as I left the room and ripped off my gown and gloves as I went, their eyes never having left their beautiful baby boy.

I smiled as I left their delivery room, lost in my bittersweet thoughts. I kept walking because my shift had been done 20 minutes ago. I walked to a house filled with books about medicine and the tools necessary for its practice—stethoscope and white coat among them. I walked to an empty house and an empty bed. I was on again in 9 hours.

Ann Intern Med. 2014;160(9):653. doi:10.7326/M13-2673

Third Year: A Survival Guide: In memes

15 Tuesday Apr 2014

Posted by Sarab Sodhi in Bioethics, Medicine, Philosophy

≈ 5 Comments

Tags

Clerkships, Clinical, Clinical Rotations, Doctor, Medical School, medical student, Medical Students, medicine, Physician, Rotations, Third year med school


Third year of medical school is a different beast from anything you’ve had before. You’re going from studying the basic sciences in a laboratory to functioning as a part of a healthcare team. You’re expected to truly learn to begin to be a doctor- and by the end of it you’ll be expected to manage patients to some degree autonomously. It’s a lot of work, a lot of fun, a lot of misery and just a lot- all at once. So with that in mind here is what to expect- #whatshouldwecallmedschool style.

Third Year

(http://whatshouldwecallmedschool.tumblr.com/post/80871300029/medical-school-in-a-nutshell)

This is going to be you much of third year- sprinting around the place, going nuts and basically losing your mind. Live with it and own it.

That said, the biggest thing that worked for me in third year was confidence and trying to get comfortable. Some people and some places have this idea that medical students just sort of stand around like part of the furniture. And there are those who do that!

I’ve found that the people you work with and work for- attendings, residents, interns, nurses and above all the patients appreciate you trying to do things. So when you’re asked a question, answer it with confidence (not a question). Surgeons especially hate that. If you’re not sure, start talking about what you think is going on- typically someone will cut you off if you’re rambling. But if you see someone starting to fall over asleep you should probably stop.

Don’t be afraid to get your hands dirty and do things. In my third year, I’ve delivered babies, opened incisions, stapled heads, done ABGs and placed more Foleys than I would ever want to. The reason I got to do those while some of my colleagues didn’t is that I asked if I could!

Even when you’re on a rotation you’d NEVER ever want to go into- try to learn something.

On a psych interview

What I tried to do (most rotations) was pick one thing or one skill set I’d like to learn that I found interesting, was cool, or could help in me in my future field of choice. And then go out and try to get good at it.

So on OB, I learnt to deliver babies, and do cervical exams. The only way I got to do those is by letting my residents know that I wanted to learn and do those things, and them being nice enough to let me. But still- try!

 

Also, some residents may in general be not the most interested in teaching- that’s the luck of the draw. And that’s okay.

 

 

 

The other thing is prepare to do a good impression of a piece of furniture in some situations.

“This is my medical student”

My favorite is when you’re rounding on a team of 10 people, you all squeeze into a patient’s room and then you’re introduced in an offhand fashion as you have to half sit on the patient’s grandmothers lap.

Though seriously, people don’t really hate medical students. They know we’re learning, that in a year or two, or three we’ll have an MD or a DO after our names and need to take care of them. And most are okay with us learning on them.

It helps if you are comfortable, a little charming, and not totally creepy- a high bar I know.

It’s okay being the wall, but if you’re comfortable introducing yourself do so.

And with that we’re back to confidence. If you want third year to go well, be confident. If you’re not, fake it- till you feel confident and comfortable. The hospital is an alien environment for everyone initially, but if you want to be seen as a better medical student (and one of the most important things for anyone evaluating you is how you interact with those around you)- for two med students with the same thoughts, grades and physical appearances- confidence can make one seem a far better physician to be than the other.

 

As I round off the remainder of my surgery rotation and consequently the last rotation of third year, expect some more gems like the ones above. And if you’re interested in medicine/ in med school/reminiscing about the torture that is med school dive into #whatshouldwecallmedschool. I’ll leave you with a link to one of my favorites.

http://whatshouldwecallmedschool.tumblr.com/post/81984496130/welcome-to-third-year

 

 

 

 

The Goldilocks Conundrum

05 Friday Jul 2013

Posted by Sarab Sodhi in Bioethics, Medicine, Philosophy

≈ Leave a comment


This was initially meant as a submission to the Gold Foundation. I submitted it to their essay contest on what it means to be a good doctor, on time, but with a blank entry sheet so it was never considered. Clearly, I’m a genius. The title is inspired partially at least by my obsession with the Big Bang Theory. Enjoy!

The Goldilocks Conundrum

When I told people I was going to med school, the first thing I’d hear was “oh, you’ll be a good doctor”. As an idealistic and energetic first year I was flattered every time a standardized patient said that I came across as a good doctor-to-be. Of course, I wasn’t a good doctor- primarily because I wasn’t a doctor. My exposure was to esoteric subjects like biochemistry and physiology- I wasn’t much good to any person in distress. Like my classmates I believed I was going to be a great doctor- all that was missing was clinical knowledge, clinical acumen, and experience.

Now, as a second year med student with almost all of my classroom experiences behind me, I’ve developed a degree of clinical acumen and clinical knowledge. I’m still lacking in detail, and I often mistake horses for zebras- like the time I made a diagnosis of possible Ebola virus in a patient with bloody diarrhea. It turned out to be Salmonella from bad chicken. But, I figure, once I’ve studied up my First Aid and learnt the theory of medicine, I’ll be a good physician. The question remains, who or what is a good physician?

As a naïve newcomer to medicine, I believed a good doctor was someone who not only knew the medicine and the art of diagnosis, but also deeply cared for and was invested in each patient’s prognosis and care. A good physician would put his or her all into a patient, and if the patient didn’t make it, would feel sadness at their loss, yet that physician would get up and do it all over again, a dozen times a day. And at the end of the day, they’d go home and see their loving, caring family and be well adjusted parents and spouses.

Now, I’ve come to believe that image of a good doctor in my mind is flawed. If I’m too invested in my patients, chances are, I’ll become an impaired physician. If that happens, I’ll probably be an alcoholic, or start abusing drugs misbegotten from my own prescription pad in order to forget the people I couldn’t save, the mistakes I made. If I spiral down that path, I’ll likely cause damage the whole way down- to family, friends, and perhaps even patients.

The other path, the one which many doctors take, is detachment. I can choose to look at my patients like bags of organs, with a dysfunction that I can repair or replace. If something fails, if they don’t make it, I can insulate myself enough to not be truly hurt. In this case, I’ll protect myself from self-destructing and perhaps even accrue wealth, prestige and power. The downside is, I won’t be practicing medicine for the reason I went into it. Instead, I’d be functioning as an automaton and a machine- which should be anathema to a physician.

If I were to truly be a good doctor, I’d have to be like Goldilocks. Just right. I can’t be a callous, uncaring person who sees patients as bags of enzymes and organs. Nor can I be completely invested in and care about every patient who sits in my exam room, or haunted by my failures. I need to be able to care about my work, and care for the people who need me, but also be able to let go. I need to be able to separate home from work, and to keep my family safe from my professional demons. I need to be able to go home at night, and let go of the day’s travails and sleep without being haunted. Yet my failures need to inform me, to teach me as a physician, and as a human being.

That’s a nearly impossible standard, especially since we don’t talk about it as a profession. We don’t discuss how to let go- we don’t discuss how in Rudyard Kipling’s words to allow “all men count with you, but none too much”. We are taught everything about medicine, except to express and deal with our feelings. We keep them bottled up inside, unexamined somewhere deep in our psyche. Expressing our doubts, our feelings, our weaknesses is frowned upon, or seen as touchy-feely and weak. So, we repress our feelings and our demons, exorcising them if we must with alcohol and drugs.

A good physician? I’ve seen some of those. I’ve seen physicians who can stand in front of a crowd of medical students and talk about what gives them strength, what keeps them going, their challenges and the pain they’ve felt, and how they got over them. One, a doctor who works in the trenches in the Emergency Room spoke about how every day, he sees people who are terrified, afraid and often having the worst day of their lives. And that his job is to make their worst day a little bit better, a little bit more bearable. He spoke about the cost, about the difficulty of separating work from home, about the losses and failures that haunted him but how every day when he walked into his house and saw his daughter’s eyes, his demons were banished.

The practice of medicine is a truly human profession- flawed, challenging, inspiring and infused with the sadness of mortality and the fear of futility. To practice that art well, may be one of the toughest things in the world. But, if my mentor’s words are true that challenge may also end up being the most fulfilling thing in my life. I’m not a good physician yet, and not just because I’ve not received my MD. I’m still learning, still finding my humanity. That’s a process, a long road I may walk every day of my professional career. So I start my search for the perfect temperature porridge, warm enough to be compassionate, cool enough to remain objective.

Bon appétit.

It Gets Better

04 Thursday Jul 2013

Posted by Sarab Sodhi in Bioethics, Medicine, Philosophy

≈ 2 Comments

Tags

Dropping Out, First two years, Medical School, Misery, MS1, MS2


I was sitting in the coffee shop today, and I must have looked a little miserable as I kept running my hands through my hair surrounded by papers trying desperately to get work done. I guess I did, because two guys sitting a few spots away called out to me and asked if I was a third year medical student. Surprised, I looked back at them and they smiled and said, “it gets better.” They had seen the OB-GYN textbook I had lying buried under a pile of papers I was reading and working on, and figured that was the source of my apparent angst.

Funnily enough, it wasn’t. I was knee deep in a long paper on end of life ethics that was challenging to write, and hadn’t yet cracked the textbook that day.  I did, later, and it wasn’t quite as much joy as a tub of ice cream or a nice long run, but it wasn’t agony. Their conversation did give me pause though.

The first two years of medical school aren’t pleasant, no matter what school you go to. The process takes the top 5% or so of students based off their scores and grades, all typically Type A personalities and pushes them into a room together where they’re then tested and graded.

We go from being the valedictorians or the smartest people around, to being that dreadful word- average. Our psyches and our selves can hardly adjust to the change from achieving a routine 93 and being vaguely pleased to the pressing fear that this test may be the one that pushes you below 70. If it doesn’t, you then start looking for a yardstick convinced the exam must have been easy then. You go from being the person people look at and think, wow they’re smart, to feeling like an impostor who got into medical school as an elaborate cosmic joke. Sometime in the first two years, you’ll think about quitting. Maybe even every day. You’ll look at the books and the piles of lectures, and think “how can I ever learn this stuff?” You’ll go and learn to see patients and consider it totally a waste of time when you could be studying for the important stuff like enzymes that catalyze reactions. You’ll likely live your first two years in fear, dread and a caffeinated high that when you crash will lead to weekends ‘wasted’ in sleep.

It’s not a pretty picture, and to put it bluntly, the first two years of medical school are horribly rough- for some people. There are some in my class who excelled in the first two years, loved the minute details and the never ending reams of paper to read. They did very well in the first two years and likely loved it. I wasn’t one of them. I didn’t like the never ending memorization with what seemed like minimal to no usage of what we learned. In college, I’d thought I was book smart, believed it with all my being. In med school, I learnt how very wrong I was. The first two years of medical school weren’t fun for me, but they weren’t pure agony either. Like anything else, they were marked with periods of good and bad- but I will say that they make you feel like a fool often, grasping for details you missed. There were days I considered quitting, but it died pretty quickly once I remembered the debt I was in!

That said, I’m one and a third rotations into third year, and I’m rediscovering my passion for medicine and what brought me in here. I’ve been seeing people, actual human beings, not just anatomical drawings of them and the hard oak of a library desk with a blank wall beyond. I’ve even been helping them sometimes. I’ve been doing things like listening to hearts, taking histories, making diagnoses. On this rotation I may even get to deliver a baby. Some of the nurses took to calling me “Doc”, a word I’m not at all used to. When they’d ask me what to do with a patient, I’d actually feel as though my toils and my labors weren’t in vain. So, I still spend a fair amount of time with my nose in my books, I don’t have as much of a social life as I’d like, and most of my meals are spent in the company of my favorite TV show. But, it’s much better because my reading, my work, my toils are all towards a readily apparent goal. What I learn today in my readings may well help my patients tomorrow, the next week or the week after that.

So, for those of you still in the depths of the tunnel with only a faint light trickling in at the end of the tunnel, know that it does end, and you will survive. Your misery, your minimal social life, and your never ending time with the books will have purpose and meaning. Till then, I’ll leave you with this story from one of my favorite books (Blue Collar, Blue Scrubs, which I highly recommend  by the way).

There was a person (who’d later become a Mayo Clinic trained Orthopedic Surgeon) working throwing rocks. That means that someone would go through and use a jackhammer to break down huge segments of concrete and this future surgeon would go behind him lifting 100s of pounds of concrete- ass outstretched in correct lifting posture, and bending his elbows he’d throw them into a truck. His boss, when he would begin each day would call out, “I don’t want to see anything in the next twelve hours but asses and elbows!” So, for the first two years focus on keeping those asses and elbows moving. It does get better after.

Night and Day

31 Friday May 2013

Posted by Sarab Sodhi in Medicine, Philosophy

≈ Leave a comment

Tags

medicine, Step 1


One month ago, I was an antisocial, overworked bleary eyed machine. I was inhaling facts as fast as I can, trying desperately to keep them down. I was listening to a dozen lectures a day, reading a couple of hundred pages of books forcing esoteric facts into my struggling memory. I didn’t know how to talk to people anymore. My social skills were non existent. All I talked about was the horrendous 8 hour exam I was to take. I was pretty miserable. I was constantly stressed, worried and afraid. I had nightmares that I’d failed Step 1. One of them featured my kindly white haired Dean who pushed an ornately carved scalpel across to me and told me to do the ‘honorable thing’… It wasn’t a nice time.

Today, I’ve been working in a hospital for 3 weeks. I’ve grown somewhat accustomed to being called ‘doc’, to asking patients matter of factly if they want to kill themselves, how and how they’ve tried. I’ve heard heart wrenching stories of agony and pain, learning to clamp down on my emotions so I can feel empathy, but can stay ‘objective’. I actually feel like I’m of some use to people. I’m required to wear my white coat to work and since I travel by subway I’ve grown accustomed to being looked at a little differently as I wear the uniform of my profession. It’s a nice feeling.

The only thing is, I don’t deserve it yet. Each time I get called doc or someone looks at me with a hint of respect for the white coat, I realize how much more I have to do to actually deserve it. I’m a 3rd year med student. At this moment my ability to help people is minimal. My clinical acumen remains nascent, my skill as a diagnostician unformed and untested.

Frost said it best, miles to go before I sleep…

Oh, and fyi, I did end up passing Step 1. And I saw my Dean today. No ornate scalpel in the office. I checked…

← Older posts

Match Day

Match Day 2015March 20, 2015
The day my future is revealed

Create a free website or blog at WordPress.com.

Privacy & Cookies: This site uses cookies. By continuing to use this website, you agree to their use.
To find out more, including how to control cookies, see here: Cookie Policy
  • Follow Following
    • Sarab Sodhi
    • Join 51 other followers
    • Already have a WordPress.com account? Log in now.
    • Sarab Sodhi
    • Customize
    • Follow Following
    • Sign up
    • Log in
    • Report this content
    • View site in Reader
    • Manage subscriptions
    • Collapse this bar