Medical School

10 Things Vol. 6

Back to our regularly scheduled program, here is number 6 in the 10 Things series. Now that I have a whole, whopping 1 rotation under my belt I thought I’d share my top ten things I love about seeing patients. Sa far…

  1. Hearing and seeing the abnormal- in school we were taught to know what “mom” is. “Mom” is normal. You know everything about “mom”. “Mom” is the way the human body is supposed to be. When something is different with “mom” you immediately know something is wrong. Every exam I practiced on a classmate has been normal and not pathological, but seeing real patients means there is real pathology. I am actually hearing real atrial fibrillation and seeing enlarged adenoids, instead of just reading about it.
  2. Their stories- each patient has a complicated story of what got them to that point. Some visits are more simple than others, but no two cases of strep or heartburn are the same. You learn to listen for key words and subtle nuances that lead you to a diagnosis but it isn’t always cut and dry and though its frustrating, its much better than class 8-5.
  3. Kids- Pediatrics is still an option for me, but I don’t know if I could see kids all day everyday for the rest of my life. Still, whenever there’s a kid I get to go see, especially for a sick visit, I get really excited because they are so sad and vulnerable. They only want one thing- to feel better and its very gratifying that I get to have a small part in doing just that. They aren’t faking or lying or trying to get drugs, they just feel crappy and I can see it right on their face. If I can send them home with a medicine and a sucker to get them there, then I’m a happy girl.
  4. Reading articles- call me crazy but I much prefer a couple relevant 5 page articles every night as homework vs. listening to 17-20 hours of lecture a week ANY DAY!
  5. Families- I like when patients bring their spouse or kids or siblings into the room with them. Sometimes they have very different and helpful perspectives as to what is happening with the patient.
  6. Coming home- I love in the evenings when my roommates and I are all home and we swap stories about the day- in compliance with HIPAA of course! We talk about the cases we saw that day and what we learned and pimp each other on which antibiotics to use and what tests to order.
  7. Procedures- I have a lot easier time understanding when its time to remove a mole, when I actually see multiple kinds of which ones get removed. Medical education in the first two years a lot of times says “You’ll understand later when you need to be concerned.” And we are just kind of left looking at one picture example of a concerning mole. Same goes for a lot of different things, not just moles. Its a lot easier to know when vaginal discharge is concerning when you see (ahem, smell) concerning discharge.
  8. Talking- In the first two years of med school, we see standardized (acting) patients in front of an attending. If that wasn’t intimidating enough, you are also being graded by said patient and said attending. For me anyway, this is not conducive to a nice, easy, free-flowing conversation between a competent future doctor and their patient. For fear of saying something wrong, fumbling with the blood pressure cuff, or being awkward, I often ended up saying things wrong and awkwardly and dropping things in those scary exam rooms. Now, that I am with real patients, sometimes in the room by myself, I see that I have their attention. They are looking to me for the right questions and answers and guidance and I feel like I can rise up to that and say useful things sometimes.
  9. Being accidentally called doctor- Seriously who doesn’t love this pleasant mistake, that will soon be true.
  10. Learning- It won’t be much longer that I can fall back on “Hold on, let me ask my attending.” It is my entire job- in this season of life- to learn. To soak up every last thing. To watch every thing that every physician around me does and to determine what they are doing right and what could be improved. I ask the same questions of myself constantly- what am I doing right and what needs fixing. It is such a rare thing to only be asked that you learn. So I will learn every possible thing from every possible patient on every possible day. I’m trying to do just that, and to enjoy it too, because it won’t be too long from now that I will be called upon to just “know”.
Family Health Life Medicine

Empathy vs. Sympathy

I saw this video a long time ago and I remember showing it to my roommate and we just sat silently after watching it. I’m glad I was able to find it again. Its quick and easy to understand but she covers some deep things in it that I mull over in my head quite often.
I always get chills when she says “I know what its like down here and you’re not alone.” If only I was just able to convey that to people that I want to help. Its harder than it sounds.
My relevant story for today isn’t really any thing compared to the pain and suffering some people go through, but I’m going to tell it anyway because it is what has got me to some realizations about helping people pain- both physically as a future physician, and emotionally with family and friends.
I had a bad sunburn recently. Mostly on my back. It was about two days old and I went running enough to soak my back and my shirt in sweat. It started itching in spots on my way home. Then it started burning. Then I took a warm shower. Then I got out and put some moisturizer on it. Through each of these steps it started burning worse, getting itchy all over. I’m not sure if I was done for from the moment I sweated salty chemicals onto raw skin or if I just kept making it worse, but by this time I was in a fit of excruciating pain and compulsive itching. Rolling on the floor, crying for my mom, rubbing it with my knuckles so that it wouldn’t sting worse from scratching. The only thing that took a little edge off was running the bathtub on cold over my back constantly. My parents were trying to talk me down gently and had to resort to holding back my arms, yelling “CALM DOWN” and watching me twitch and sob and cry.
It was awful. Truly I didn’t think I wanted to live much longer if I had not known it was just a temporary skin irritation. I thought of fibromyalgia and other chronic pain conditions. I thought of how scary it was to not know how much longer I was going to feel like that. To not know when or if I could sleep or eat or enjoy anything. I was begging to go to the ER to get a sedative.
The video popped in my head
“I know what its like down here and you’re not alone.”
I thought of how anyone was ever going to help me get rid of the pain. I was going through everything I knew to make it just a little better or tolerable so that I could sleep or distract myself from the itching til it went away. My mom was just as scared and helpless as I was. My dad was yelling unhelpful things like “SHH” and “Don’t touch it!”
After we thought of cool water and I was sitting with my back under the faucet, my mom just sat there with me as I calmed down and the burning got manageable. I don’t know if the house catching on fire could have gotten me out of the tub. I was scared to move for fear that the flood of relief would leave my body. My mom just sat there.  And for a bit, I was fine. My pain was not gone but I was comforted by the temporary relief I found and the fact that someone else was there, as if saying
“I don’t even know what to say; I can’t do anything to help you, but I’ll stay here with you and just be together.”
That’s what I hope to bring my patients if nothing else: Relief through connection.