Medical Odyssey

adventures, monsters, battles, and maybe a moral here and there

A Sad, Random Realization


Day #66: Standing in the kitchen, listening to the news about some poor athlete who was partially paralyzed from a brain aneurism, I randomly thought about how sad it is to not have any family or friends to regularly check up on you.

The reason my brain took a seemingly meandering path to that realization is actually quite logical: the people on the news were saying that this athlete is fortunate to have had someone with her when she suffered that debilitating aneurism because if she hadn’t been rushed to the hospital immediately, she would most certainly have died. And that made me think about how if a homeless person had passed out on the street from a devastating aneurism, no one would stop and check on them. Likewise, an elderly person who is not regularly checked up on by family, friends, or healthcare professionals could suffer the same unfortunate fate: dying alone, from something that could have been stopped or prevented.

if a homeless person had passed out on the street from a devastating aneurism, no one would stop and check on them.

It deeply saddened me that there are countless people out there that have passed away in that unfortunate way and countless more that are living in the conditions to die in that way. If you just stop and imagine yourself just randomly collapsing as your brain is rapidly hemorrhaging with blood and dying from something (albeit devastating either way) that physicians could potentially have saved you from.

Yeah, this post is a depressing one. You probably shouldn’t really imagine what I just explained.

But let’s end it on a positive note. Take a moment and be thankful for the support you have around you. Appreciate those who are there for you and make sure you return the favor. Being busy (as a medical student, nurse, physician, etc) should NEVER keep you from the ones you love.

Call your mom/dad. Call your grandma/grandpa. Call your loved ones. We’re all in this together.

Taking Care of Yourself Goes Much Further Than You Think: A Hard Lesson Learned


Day #65: If you’re tired, unfit, unhealthy, or just generally not doing well, you’re not only harming yourself, your education, and your experience, but you’re also harming those future patients who will be depending on you.

Immediately upon setting my alarm clock, I regretted my decision. Last night, I finally went to bed around 1:30am. Now, this might not be a crazy time to most in the medical field, but considering I’m up around 6am every morning, going to bed at that time is setting myself up for failure. So why did I stay up? That’s a question I’ve been beating myself up with all day. Simply put, it’s just because I was studying all day and decided to spend the last 45-60 minutes before bed just surfing the web. That little study break turned into almost 2 hours of random youtube videos and funny picture websites–an all too common occurrence with many people.

Let’s just say this morning was pretty rough. But what I find is that, even when sleep deprived, I can still function for the first few hours in the morning without a problem. It’s just when the 11am-2pm block rolls around, I begin to drift. And just like I had feared, lectures did not go well today. Right off the bat I was nodding off in a Histology Lab review we had at 9-10am (earlier than usual meaning I was pretty damn tired). Now let me just stop right there. If you have ever had that feeling of “OMG I’m so freaking tired! But I HAVE to stay up and concentrate,” then you know exactly how I feel. It’s that brain-melting, eye-burning, deep infuriating frustration of being so exhausted that your body is simply shutting down while mentally trying to keep yourself awake and focused. It was so bad that I wouldn’t even notice I was nodding off until my proprioceptors (receptors that monotor your body, essentially) kicked in when my head was bobbing down or slipping out of my hands.

 It’s that brain-melting, eye-burning, deep infuriating frustration of being so exhausted that your body is simply shutting down while mentally trying to keep yourself awake and focused.

Thankfully, I am fairly comfortable with the information that was being lectured and I caught enough to connect the dots. The same can’t be said for the Radiology Clinical Correlation lecture after lunch.

Trying to preempt any nodding off in the afternoon, I bought a small black coffee and brought it with me to lecture. All was going well until about 20 minutes into the lecture. I thought sipping on the coffee throughout the lecture would provide a steady flow of caffeine to keep me awake–I was sorely mistaken. Reflecting on the lecture now, I unfortunately don’t remember much, if anything, that was taught and will have to completely go through the lecture again. Thankfully, the lecture wasn’t a difficult one. The remaining Gross Anatomy lecture after that went fairly well: my infuriation with myself and bathroom break to splash water on my face woke me up enough to maintain consciousness for the next hour. Though the ride home was difficult, to say the least.

 I thought sipping on the coffee throughout the lecture would provide a steady flow of caffeine to keep me awake–I was sorely mistaken.

Lesson Learned: Reflecting on my day, a passage from our Declaration of Commitment (an oath we recited at our White Coat Ceremony) came to mind. On that day, among other things, we pledged “The health of my patients and myself will be my first considerations;” and I now fully understand the importance of that declaration. Although I was lucky I didn’t miss anything too important, if I don’t change my ways, I will undoubtedly sleep through vital information in the future. Thanks to digital streaming, I’m lucky enough to be able to revisit hazy lectures, but that’s time wasted because I should have paid attention in the beginning. Furthermore, streaming won’t be an option forever, and if I don’t change my ways now, I will become a subpar resident and physician. Not to mention that getting about 4 hours of sleep isn’t doing too much positively in terms of my health. Although running 3-4 times a week is a good start to maintaining a healthy study life, I’ve definitely learned my lesson that sleep is much more important (duh, right?).

Bright Eye’d and Bushy Tailed: Listening to the Underclassmen


Day #64: What does listening to those who have yet to experience what you have already experienced make you feel?

More and more these days I have found that my view of healthcare and what it means to be a doctor have been evolving from what I imagined it would be. But is my perception changing because of genuine change or from listening to those with more wisdom than me? I can’t count how many times I’ve been talking about something with an upperclassman only to have them chuckle at one of my statements and say something to the effect of “oh that’ll soon change, you’ll see.” Now, I know that I have a great deal left to learn in terms of what it means to be a physician, not from an academic point of view, but from a social and professional perspective. But is my perception changing because I’m genuinely experiencing something that is changing my outlook or is just hearing an upperclassman’s opinion plant a seed in my head that elicits the change?

In some cases, listening to upperclassman has its advantages. But I’m discovering a growing trend that it’s only useful in objective circumstances. For example, getting the inside scoop of what topics are high yield on exams, what information was stressed or tested previously, where to go for the best [insert thing]. But when it comes to subjective cases like how “hard” or “interesting” something is, what they think about an instructor, or what they deem as most important, is typically not how I experienced it. Now I know you might be thinking “well ya, everyone experiences things in a unique way.” Although that is undoubtedly true, my point is that it seems like upperclassmen opinions seem to be swaying us idealistic and inexperienced underclassmen and what I’m worried is that these upperclassmen opinions build us up to becoming the stereotypical doctor.

As new generations enter and pass through medical school (or ANY establishment) the ideals and beliefs should be evolving with them and not being passed down.

I’m not naive, though, I know that we don’t have the wisdom on many things medical/ healthcare related so we can be very naive to how the world really is. And this brings up something that happened last night. It’s saturday night and I’m spending a wonderful evening with my girlfriend, eating dinner on a patio of a restaurant in beautiful (and uncommonly warm) October weather. We’re about done with dinner when I overhear two guys sitting behind us discussing their applications to medical school and sharing “facts” they’ve heard about schools, things to help their admission process, and how to properly write a secondary. The first thing that came to mind was my own experience in the application process and the fond nostalgia of those stressful yet exciting times. However, as the guys kept talking and sharing stories (and as I kept periodically eavesdropping) I realized that these guys had a lot to learn. And just then, at that exact moment when I said to my girlfriend, “wow those guys have a lot to learn,” I immediately thought “holy crap, I’m turning into one of those guys.” I’m slowly becoming wise and getting a better grasp on things that they have no personal experience with. And although many of the “advice” they were sharing was, in deed, factually incorrect or misrepresented, other things seemed more subjective, and I still found myself shaking my head and smiling as I thought “well I can’t wait to see your face when you see that’s not how things really are.”

As I reflect on that, it really does interest me how much of what we become as doctors and healthcare workers is influenced by those older or more experienced than us. Is it possible that passed down knowledge is what’s keeping our evolution and progression behind? My answer is that I truly don’t know. However, what I do know is that you must always forego judgement until you have personally experienced something and reflected on it personally. It’s vital to bring in new, fresh perspectives into institutions and belief systems, but when you give into the shared opinion, you just might be doing a disservice to yourself, your profession, and those who will one day depend on you.

Stay bright eye’d and bushy tailed, but don’t make a fool of yourself. There’s always an upperclassman waiting to put you in your place.

Interesting Occupy Wall Street Poster: “Shoot Sperm Not Bullets”


A Divide in Caring for Health


Day #63: There is a vastly growing divide between the healthcare we advocate and the healthcare that’s sought by lower-income minorities. Is it cultural, economic, or social? An enlightening observation while volunteering at an innercity clinic.

What, you think I can’t make my own appointment? You don’t trust me?

No, no. I’m just doing that to make it easier for you!

It was after a short exchange between a patient and me at a Student Run Free Clinic that really made me think, “why aren’t you more concerned about your condition?!”

Today from 8:30am to 12:30pm I volunteered at a local Student Run Free Clinic established and run by students from my school. As a training co-chair of referrals, my job was to absorb as much information as I can about how to properly fulfill patient referrals that our care teams deem necessary. Now, these particular (and unfortunately limited) referrals are all sent out to partnering organizations that provide free or low cost services that we at the free clinic in turn provide to our patients at no cost. Referrals stem from annual mammograms to biopsies of potential cancers; however, we’re limited in scope because of the difficulty to find free or affordable health care establishments that are willing to work with us (that’s a blog topic in and of itself).

The day was running smoothly until a returning patient decided to show up for a general visit. Now this patient, let’s call her Mrs. Doe, has been to the clinic several times before and has been told that she needs to go have her menorrhagia looked at by specialists. Luckily for us Michiganders, this is done easily through the BCCCP program. The problem, however, is that she refuses to go through with making and appointment and actually showing up–always presenting to us with a new excuse as to why she hasn’t been to see a specialist. So, following the same routine they have before, the student care team diagnosed her with menorrhagia and irregular cycle along with recommending she gets a pap smear, mammogram, and a biopsy on a worrisome tissue–knowing full well that she most likely won’t get any of those things done.

Enter me and my co-chair.

The reason we were selected for this new position of Referral Co-Chairs is simply because many patients the clinic sees–all low income, uninsured minorities–simply do not follow through on their appointments to the clinic or to their referrals. Now, this is a multifaceted problem: they may not have had transportation, they may be afraid of going, they may have been too under the influence to remember to go, etc etc. However, it’s become evident that these patients time and time again do not follow through on their health plans. Therefore, my co-chair and I were tasked with setting up referral appointments for them, hoping that if we do all the work for them, they will show up to their appointments.

That’s when I had my encounter with Mrs. Doe. After receiving her medical chart from the care team, I decided to go see her in the waiting room to tell her I’ll be calling BCCCP to make an appointment for her and that I would like to know which days work best for her. My decision to go see her was simply to make sure she doesn’t leave the clinic before getting a copy of her referral but also so that she can see that we’re all working hard to make sure she actually goes to her appointments; a little bit of cognitive dissonance never hurt anybody, right?

So I approach her in the waiting room, introduce myself, shake her hand, and tell her I’ll be making an appointment for her and ask which days and times work best. Her response was a sly smile before quipping back: “What, you think I can’t make my own appointment? You don’t trust me?” Then she broke out into laughter while shaking her head. Knowing that she is notorious for not showing up for her appointments, it’s clear that, yes, that’s precisely why I’m here. But could I simply say that? Of course not (at least I don’t think that’s the right approach).

But reflecting on it on my drive home, it really struck me that “why is it that, even though these services are free, the patients are failing to follow through on their medical conditions?”

As I mentioned before, there’s probably no easy answer to this, but it seems like there’s a big disconnect between these poor minorities and any real interest in their health. When you think of your generic suburbanite, they see their family physician quite frequently and most of the time have done a little bit of research before their appointment in order to ask educated questions about their symptoms or medical conditions. If that suburbanite is told they may have some disorder and should get it checked by a specialist, they are usually on top of it. Not something you see from the patients at the free clinic. Is it possible that it’s a cultural or social issue like the fact that they weren’t raised in a household that could afford (financially or temporally) to stay on top of their health? Could these minorities feel ashamed or uncomfortable to visit these places? Or is it simply just a lack of basic education the severity of turning a blind eye to their health?

This is an issue that is developing and evolving in urban centers like Detroit and, with the current political and economic climate, this is an issue that seems to unfortunately be one that will only get worse.

Lesson learned: The baseline cognitive ability or educational foundation should never be assumed in patients. Every patient should be treated like a toddler who needs to be talked to slowly and clearly in order to really understand their current condition and what needs to be done in order to palliate or prevent certain conditions. This shouldn’t be done from a paternalistic position of “I know what’s good for you and you don’t, so shut up and listen” but from a “I have the education that can save/prolong/enhance your life, so tell me where you’re coming from and we’ll work together to make sure you get what you need and what’s best for you.” We are here for the patients and we should make sure there are no disparities between races, ethnicities, cultural background, beliefs, or income levels.

Heartbreaker


Day #62: What better inaugural topic is there to write about besides the human heart? The human brain? Quiet down.

As instructors, physicians, and every upperclassman will agree, being a medical student (and especially a first year at that) your life is again filled with milestones as if you are back to your baby/toddler days. First day of classes. First time seeing your cadaver and dissecting. First time taking exams. Etc, etc. As someone who is fascinated by the cardiovascular system and surgery, today’s gross anatomy lab was chock full of milestones: dissecting out the heart and holding this amazing organ in your hands.

Now what’s more romanticized than the heart? Nothing! So imagine holding a human heart in your hands, feeling that personal trusty motor of a generous body donor, imagining that this time last year it was steadfastly beating away, pumping oxygenated blood throughout the body and deoxygenated blood to the lungs — working furiously and unfalteringly. After completing a few minute lab instructions, I was able to free the heart from the thorax and hold it in my two hands and just simply gaze down at it. It would be an understatement to say I was thrilled. I simply stood there for a few moments holding the heart, rotating it around and just appreciating it for what it is physically, practically, and metaphorically. Snapping out of my amazement I reflected on what I just experienced and again realized how lucky I am to be where I am today and how I can check off another box on the old milestone checklist.

Hold human heart in hands? Check.

This milestone reaffirmed my strong desire in pursuing a medical degree and a career as a surgeon. Moreover, this experience reaffirmed my amazement in the technological and educational advancements we’ve made in the field of medicine. Although most things in medicine are amazing (at least to me), take a second and appreciate what it really means to do a surgery like heart surgery. There’s no room for error in an area that beckons accidents: a few centimeters in any direction and you’re on top of something that, if damaged, will bring a swift death to your patient. But just because we can get into these places isn’t the real amazing part, the fact that we can actually get in there, repair structures, and get out while doing so little damage that patients can make a full and healthy recovery is the real miracle of the technological advances. It truly baffles my mind just how amazing surgeries on vital organs like the heart can be.

So what’s the moral for today? Studying might suck especially when it’s late and you’re tired. But everyday brings a new fascinating experience and everything gets better and better because you’re building your knowledge foundation and working toward something you’ve wanted your whole life. Keep working hard. Stay humble. Love every minute.

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