Tag Archives: Medical Students

“Stayin’ Alive”

12 Tuesday Dec 2017

Posted by in Education, Emergency Medicine, Medicine, Philosophy

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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.

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The Things They Carried: An MS3 Story

24 Thursday Apr 2014

Posted by in Medicine

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Having just finished my third year here are the things that made my life easier.

1. Comfy shoes: Try walking around the hospital on rounds for >4 hours a day and standing in one place in a pair of uncomfortable dress shoes. I dare you. I can’t even imagine how it would be in heels. Buy yourself some comfy shoes for work. I use rockports when I need to be dressed nice and a good pair of sneakers for when I’m in scrubs. Invest in them- your feet will thank you.

2. UpToDate Mobile: You can signup for an uptodate username and password at any hospital computer and download the mobile app. If you’re not familiar with uptodate it’s the best way to quickly educate yourself about relatively recent guidelines, pathophys, treatment etc. Keep it on your cellphone so you can read whenever you get a second.

3. A stethoscope belt: Stethoscopes can be heavy. Wrapped around my neck it started making me stick my neck out like a turkey. Around Thanksgiving that’s a dangerous thing to look like. A stethoscope holder may not be the most fashionable thing around, but a few days in the hospital will make a sartorial slob out of any fashionista.

4. Snacks: Keep your white coat well stocked with snacks. You may prevent a hypoglycemic coma on Surgery, OB-GYN, and Medicine.

5. A gym membership: You need to stay sane in MS3- it’s busy and you’re going to need things out of medical school you can focus on. For me that was the gym. It was my endorphin rush, my cleanser and my calmer. Do what makes you happy dude.

6. Books: Walk around with the books you might need on your rotation. They’re specific so expect a post to follow later, but a good one year round especially around Step 2 time is USMLE Step 2 Secrets.

7. Reference Guides: Everyone suggests you buy the “Green Book” (used to be Red, now is purple). It’s the Pocket Medicine series and was questionably useful on medicine. Buy it if you’re really keen.

8. A credit card in your ID holder: Your stomach will thank you when you’re in the cafeteria with 10 minutes to eat between OR cases.

9. Pens: Black for the hospital- no blue. And keep your nicer pens on the inside. An attending or resident can snag a pen and “forget” to return it…

10. Fresh socks/Undies/Toothbrush: This one should be self explanatory- but post call- these are amazing.

11. Gum: If like me you’re prone to the sleepies especially after 4-5 back to back OR cases while sitting through a fascinating lecture on the biochemistry of transplant rejection- have gum in your pocket. Or your attending WILL make fun of you.

12. Someone to complain to: We complain. That’s what we do. We complain about our lives, the slights both real and imagined that we endure and the futility of our positions. You need someone to complain to- or lots of someones. So keep friends, significant others, classmates, parents, everyone handy. You’ll need them.

This will be one of the best and worst moments of your lives. My two months on IM was the most educational experience in all of medical school. The year will transform you from a bumbling and eager to please second year into a slightly jaded, somewhat educated, rather arrogant semi-physician.

In fact I’d postulate that the bulk of your learning pre-residency happens in this year. Buckle up. It’s going to be a fun (if slightly bumpy ride!)

 

Third Year: A Survival Guide: In memes

15 Tuesday Apr 2014

Posted by in Bioethics, Medicine, Philosophy

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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

 

 

 

 

Bleeding by a Firehydrant

14 Friday Sep 2012

Posted by in Medicine

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Firstly, my apologies for the long silence. Microbiology as a block is quite high volume -capable of leaving one with little time for other things.

Now, a funny thing happened some days ago. As my roommate (also a second year medical student) and I left the house to go to the gym we saw someone lying on the side of the road next to a firehydrant. There were two women near him talking excitedly. My roommate, smart man that he is, asked “Was he shot?” Why does asking that question make a difference you ask? Because the first thing they teach you to do in an emergency situation is to make sure your scene is safe. If it isn’t, you leave and wait till it is- since your being in an unsafe scene increases the likelihood of there being two

The women respond that he wasn’t shot, that he had simply fallen over. So we started following our training- which took a few moments to recall. He was breathing, had a pulse and was non responsive. Thankfully by this time the ambulance had arrived. We helped the medics get him on the backboard, and as they’re putting him on the stretcher my roommate and I spitball ideas. Was it some kind of a stroke? Did he have a hemmorhage? Low blood sugar? Brain tumor? (Now you know we were grasping at straws…)
As the paramedics finish putting him on the stretcher and start collecting his items, one of them grabbed a slipper that had fallen. Then, they grab a paper bag none of us had noticed. He glances inside, chuckles derisively and holds it up for us to see. A almost empty bottle of vodka, which suddenly explained why he passed out and fell over.

“When you hear hoofs, think horses not zebras” a doctor once told me. Case in point.

Limits

19 Sunday Aug 2012

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A few weeks ago, as I rotated through neuro in India I was working with this really nice resident. Excited or at least tolerant of having me there he bombarded me with questions- quizzing me on trivia about neurology. I was asked to recall through the fog of months of other material the tests for cranial nerves, how to determine mental function, and where the lesion was if a person couldn’t move his eyes together…

As the quizzing progressed and I did decently (much to my surprise, since I was convinced I’d forgotten most of my neuro) he seemed to grow more confident of my abilities. He then looks me in the eye, says I need to go talk to the attending about how to disposition some patients. Take the histories and physicals of the next few patients, will you?

I said yes, and sat down, secure in the knowledge that I’d been fairly well trained during doctoring and in the ED in how to ask a patient questions. Interpreting the answers- not quite yet.

Secure in my little knowledge I sat and started talking to patients. One of the first, was an elderly gentleman who’d developed a neuropathy in one eye losing sight completely. He seemed to be in excruciating pain, rocking back and forth in his chair with moans of agony. Now, he and his relatives were freaked out- totally terrified since they had been told by the person who referred them to this hospital that the eye in question was lost and the other could go too. The resident, was looking at over 12 patients waiting who needed full neuro exams and histories- an arduous task at least. He had been a little short with them before.

As I started seeing them, they answered all my questions and showed me the MRI’s. To my semi-trained eye, there was a lesion. However I’d at times been convinced something was a lesion only to be told later that it was an “artifact”.

I had a rough idea in my mind that I knew what the lesion was. And I thought I saw it on the scan. I anticipated answering the residents questions, but I hadn’t anticipated the patients. He and his family started questioning me. For them, I was the “doctor”. A term that showed the promise of understanding what was happening and a way to fix or treat it.

They started asking me what was wrong with him. I started trying to answer their questions with a simple I don’t know. They couldn’t accept it, even when I explained that I was a “junior doctor” green to the ways of medicine. They kept saying, we understand that, but what do you see? Unsure of what to say, I stayed quiet, waiting for when the resident would return. I sat there, realizing my not answering their questions was prolonging their agony. At the same time I realized if I answered their questions I’d add to their agony if I was wrong.

All the arrogance and pride I felt in my taking an excellent history had faded, and all I felt was the realization that I was doing a disservice to this patient. So I left and left the rest of the exam to the resident.