It Is Finished!

October 2, 2014

“I have finished the work, which You have given Me to do.” —John 17:4

Medical Doctor or Nurse Theme Graduation Cake Stethoscope _amp_ Syringe

Greetings future healthcare professionals!

After a very long hiatus, I am very happy to share with you the update on my journey as a medical student.

To those who have been following my journey, thank you for your support and kind words, spoken and unspoken. One of the many things I learned during my matriculation through professional school is that support is paramount. No man is an island, and if one tries to be, one area of your life will suffer for it. In short, ask for help when you need it. Seek a mentor, a therapist, a friend, a pastor, a financial advsior, and certainly seek God.

I have seen firsthand how not seeking help can be detrimental because I went through it myself. One reason for my silence in posting during my fourth year of medical school is due to an incident that occurred at the end of my third year.

After completing my third year clinical rotations in London, U.K, I realized I had some time left over to partake in a voluntary international elective. I am interested in global health and plan to volunteer as a medical missionary for at least a few weeks a year. For the first time, I was also in a prime location geographically to travel to Africa cost-effectively. As with all my major decisions, I wasted no time to research and sign-up for an amazing opportunity to rotate thru an inner-city hospital in Dar es Salaam, Tanzania with Work The World. I chose two weeks in Pediatrics, two weeks in OBGYN and one week in a faraway village. Those five weeks would take place in December/January, meaning I would be spending Christmas, New Years and my birthday in unfamiliar territory. How exciting!

Sub-Sahara Africa was definitely an eye-opener in more ways than one. I was emotionally taxed by the preventable deaths I witnessed due to the shortcomings of a 3rd-world healthcare system; however, I was increasing my medical acumen by being more hands-on with cases that are far more advanced in presentation than I would ever witness in the West. These cases included malaria, typhoid, tuberculosis, HIV, gastroenteritis, viral illnesses, very premature infants, etc.

Then, the unthinkable happened. On December 26, 2012, I was preparing for a presentation that I volunteered to do for the residents. Unfortunately, my program’s accommodation did not have WIFI access so I went across the street to conduct my research. Only steps away from my home on my return, I rounded a corner and immediately saw the man who would attack me.

Let me preface by saying that only seconds before, a voice in my head told me to cross my cloth-bag, which contained my valuables, over my shoulders. I refused to listen because home was seconds away, but the voice was relentless. Therefore, I crossed my bag over my shoulder, and seconds later, the eyes of the man that would attack me is now burned into my memory. He reached out and grabbed my bag and my first reaction was to instinctively resist and scream. He pulled at my bag and I clutched it harder and screamed louder.

It was dusk, and the streets were filled with a large post-holiday crowd, marching down the street. I screamed in desperation for someone to help. Finally, I noticed a group of young men walking towards me. “Praise God,” I thought. They would help me.

To my utter shock and disappointment, instead of pushing my attacker away, they were also attacking me to try and get my purse. This brought attention to me, as a crowd of young men pushed, punched, and kicked me. Unfortunately, the extra attention brought on more vagabonds that were now removing my clothes in the middle of the street. In the end, there were about 20 men attacking me. I was numb and hovering above myself. I thought I would die that night. I just kept screaming, crying, resisting, and watching the gate of my home that was literally steps away, wondering why no one would help. Finally, out the corner of my eyes, I saw an old man yell something from afar in Swahili, waving them off, and just like that, all the men surrounding me dispersed, walking away as if nothing had happened. I never saw that old man again.

I limped home, crying, angry, disheveled, clothes tattered, clutching at my ripped handbag, which they were never able to take from me. That very night, I wanted to leave the country. I made plans to leave early after the necessary police/hospital/embassy runs, but changed my mind hours before my flight. I wouldn’t let those criminals win! I will finish what I came here to do! And I did.

The next three weeks in Tanzania resulted in my delivering 11 babies, saving a baby’s life that was born in distress, vaccinating a whole village, going on an amazing safari, swimming with dolphins and celebrating an unforgettable birthday. It was an extraordinary journey. However, the lingering post-traumatic stress was very evident when I commenced my fourth year in New York. Any man that walked towards me on the streets of NY were possible attackers. In such a crowded city, this was every day, and it affected my mood. I thought thru sheer willpower I could get through it. Unfortunately, it led to isolation and a depressed mood, which negatively affected my studies.   After much introspection, I decided I needed to take a step back, take some time off, recuperate, and seek help. This help came from my amazing church family in New York and although things were bleak on the outside, my renewed faith in God led to a calmer spirit.

I was worried about not graduating with my class, however, what kind of physician would I be if I didn’t take care of myself first. Studies show that a good number of medical students and doctors face depression or other mental health issues but keep it to themselves for fear of being an outcast and considered unstable. The results range from compromised healthcare delivery, troubled relationships, substance abuse and even suicide. The stigma has to end!

If you have read my previous posts on what it took for me to get here, you would soon understand that this journey was never meant to be simple for me. I was faced with major setbacks for years. It is not superhuman strength that allowed me to finish. It is a relentless tenacity and a remembrance of where God has brought me from in the past.

The song says: “I just can’t give up now. I’ve come too far from where I started from. Nobody told me the road would be easy, but I don’t believe He’s brought me this far to leave me.”

He hasn’t left me yet, even when the enemy tries to whisper in my ear that God has. You are your worse enemy. Only you can extinguish your goals and desires. The moment you stop, it stops. I hope to encourage you that you may pause, but don’t ever stop. I was almost done with medical school when things went haywire. I was very discouraged and wanted to go into an eternal abyss and never come out. I plastered on a smile but inside I was shattered. My first semester thoughts of being an impostor came back full-throttle. But I was so close!

Therefore, like the last leg of a marathon on a hot, humid day, I focused on putting one foot in front of the other.

Step, step…pause…step, step…pause…step, sip some water…pause…step, step, final step…finish line!!!

I can proudly say that I am now Natacha Pierre, M.D, as of August 2014.

My journey is a living example of the old adage: “If I can make it, so can you!”

Godspeed!

~Tasha

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When Plans Don’t Pan Out

April 7, 2013

“For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future.” Jeremiah 29:11safari.elephants.africa

I am very fortunate as to how my whole medical school journey panned out, although there was a time when I didn’t consider it as such .  Offshore medical school wasn’t what I originally planned while a Biology major at Oakwood. In fact, when I first heard of such medical schools, I told myself I would never allow myself to go there.  My plan was to go to Oakwood, get my B.S in Biology (which I did), then go to Loma Linda, get my M.D (which I didn’t), then get a residency at Florida Hospital in Orlando (which is still in the air).

Long story short, after my graduation from Oakwood, I went to Miami to pursue my Masters in Biomedical Science for two years.  Then, I went to South Korea to teach English for 26 months.  And then, I ended up at the American University of the Caribbean School of Medicine in St. Maarten.  WOW! This allowed me to literally complete medical school in 4 different continents: 2 years in St. Maarten, 1 year in England, five weeks in Africa, and my final year in the States.  I don’t regret a second of it.  God knows me so well, that He knew my passion for traveling, learning, and new cultures can only be fulfilled by the route I have taken.  I started medical school 5 years after my original plan, and yet, I know I am a better medical student for it.  I’m not afraid to push the limit and delve into unknown territory.   My adventures during my travels (close to 30 countries in 6 years) has given me so much courage, that I became a much more confident student in every way, allowing me to be in the top 12% of my class, and having the honor to address the new medical students during my Honor Society Induction ceremony.

This is not a boast, in the least.  It is a testament that God’s purpose in our lives will be fulfilled for our own good.  I say this is not a boast, because the years that I wasn’t in medical school, I screamed in anguish as to how my Lord can take away the dream that he placed in my heart!  I was angry, sad, and bitter.  That is until I stepped into my own “newfoundland.”  For once, I allowed myself to not think of medicine and just enjoy life. I am in my 20s, and this is the time to enjoy my life and cultivate my other interests and talents.  In that, I was able to discover other talents that I’d never known I had.  I was able to see myself as completely well-rounded.  I was able to live a life of no regrets.  I am still flabbergasted as to all the jaw-dropping, heart-wrenching moments I’ve experienced in the different corners of this world.  And that, no one can take away from me.  In fact, taking time off before pursuing one’s career is customary in Australia and England.  This is called Gap Year.  In many of my travels, I met many Aussies who’d been traveling for months! I was very envious of them.  They take the time out to enjoy life, discover their talents, take a break in the best decade of their lives, while their responsibilities are low to nil.  Once you start working and starting a family, taking a year off is near impossible.

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So, fortunately for me, I started medical school in January 2010.  This meant that I would have lots of time off before my fourth year, and I will have lots of time off before residency.  I took advantage of that and did a 5 week elective in Tanzania, East Africa.  My dream of being in Africa finally came true.  I spent Christmas, New Years and my birthday in this foreign land.

I will say this.  In those five weeks, for the first time in all my travels, I wanted to go home during my second week.  In fact, my plane ticket was bought.  But why? Something major must have happened!  Thankfully, I didn’t go home early, and the weeks that followed more than made up for the reason I wanted to get out of Africa.

In my next post, I shall discuss my adventure as a medical student in Africa!

But do remember,  when plans don’t pan out as you would hope, it is not the end of the world.  Don’t lose sight of your original goals.  Keep pushing, but use the time “off” to cultivate your other talents.  We are all more than just medical students or future doctors.  What else do you love to do?  It helps to take time out to do something completely non-medical.  When you do come back to medicine, you will be refreshed.  You may even be a better medical student!  My fear that I have been out of school for too long when I started medical school catapulted me to study THAT much harder and more effectively, and it definitely paid off!

Good Luck!

~Natacha


Being A Patient!

February 25, 2013

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“Humble yourselves, therefore, under God’s mighty hand, and he may lift you up in due time.  Cast all your anxiety on him because He cares for you.” 1 Peter 5: 6-7

Today, the roles of my everyday life was reversed for the first time.  On this day, I became a patient.

To make matters more interesting, I was a patient in the exact same hospital in which I’m a medical student.
I was scheduled to have both upper and lower molar wisdom teeth extracted under general anesthesia, due to recurrent infections (occupational hazard of a healthcare professional). I waited three months for this moment, and the time has finally arrived.
What i didn’t know, however, was that I would be admitted into the day surgery unit, and be dressed in hospital gown. I thought I would be in and out as an outpatient.
As I sat in my hospital bed, being consulted by the dentist,doctor, nurse and anesthetist, I couldn’t help feeling vulnerable and thinking, “this is what it’s like to be a patient.”
Ironically enough, just the day before, whilst in my usual role as medical student, I visited the same ward I was in, to check up on gynecological patients,who’ve recently had surgery. The irony goes even further than that, as the day lolls along.
Most of the staff who looked after me somehow knew that I was a medical student…some of them referring to me as doctor. Everything they explained was followed by:  “but you know that already.”  They were very kind and extremely thorough. I was amazed, as this was my first time ever as an inpatient in a hospital.
One caveat of being a patient who is also a medical professional, is that you know too much. As I’ve never before been under general  anesthesia in my life, I was rightfully very nervous. I have control issues, and for the life of me, it disturbed me to think that I would  medically be induced to sleep, where whatever happened during that time, I would never know.  Such a violation, I kept thinking. But more worrisome for me were the rare complications of general anesthesia that I remembered studying in Pharmacology. These complications include Malignant Hyperthermia, Locked-in Syndrome, Mendelson Syndrome, allergies to the anesthetic drugs,  just to name a few.
Sure, I knew that without known family history of the Autosomal Dominant gene that predisposes to Malignant Hyperthermia ( pyrexia, convulsions, myoglobinuria, arrhythmias, tachycardia, etc),there is a very slim chance I would be affected. Also, all the other complications were rare as well. Still, I asked for an anti- anxiety medication to calm my nerves.
When I was finally rolled into the operating theater, the second coincidence was that my anesthetist for the day was also the anesthetist who I worked with just the day before, for a patient due to have a Dilation & Suction for retained products of conception.  That patient hardly spoke English, so all the information had to be relaid in elementary, laymen words and very slowly.

However, for me, they hardly explained much at all.  I am a medical student after all, and I just observed the exact same procedure the day before, I’m sure they thought.  We used the time right before I was induced to sleep to joke around.
The irony of it all was not lost on me.

They were very gentle, and once the mask came over me, I was gone within a few seconds.
My dream was so sweet, but for the first time in my life, I couldn’t remember it. It was a very deep sleep that I most certainly needed due to my lack of sleep the night before.
All of a sudden, I felt a nurse shaking me awake, ” Your surgery is done. You can wake up now.”
I was so confused. What’s going on, I thought. Where am I?
Why am I in a hospital bed?
Then, the pain in my mouth hit me at the same time as the sensation that I couldn’t feel the left side of my lips. A huge gauze was imbedded in my mouth, and I reoriented myself. I’ll never forget those first few moments.
I can’t believe that I didn’t feel or recall a thing in that OR. I never even met the dentist who did the surgery (being a replacement for my original).
I continued spitting blood, which was hard to do due to my numb mouth.
I had to stay in hospital to monitor my blood pressure and heart, due to the proneness of hypotension after general anesthesia.
All the staff continued to be very kind and during recovery, I got on with the other patients in my bay, actually giving them medical advice and opinion about their various day surgeries.
It was a very pleasant experience, overall…one I shall never forget.
To boot, the pain in my mouth was very minimal and I was out and about in no time.
I truly believe having a pleasant experience in hospital encourages faster recovery due to the endorphins doing its work.
It should be mandatory for all up and coming medical professionals to be a patient for a day, in order that they may empathize more with the patients they will one day care for.
I know I will.


Nearing The End…

September 27, 2012

“I press on toward the goal to win the prize for which God has called me heavenward in Christ.” Philippians 3:14

Tis bittersweet, to say the least, to be less than 9 weeks away from the end of my third year of medical school.  Of course, seeing the light at the end of the tunnel is the sweet part.  But when that tunnel is housed in such an amazing experience as living in Europe, it is bitter to realize that all good things must come to an end.

I am now in the middle of my second to last rotation, OBGYN, affectionately called “Obs & Gynae” in England.  This rotation is closely related to my favorite rotation thus far, Pediatrics.  In fact, I regularly see some of the Peds registrars if anything goes wrong with the baby as soon as they’re born.  This makes me excited! Why?

Because I actually also love OBGYN.  I get slightly emotional every time I see a new life springing forth from the womb. I also get emotional in a different way when I get to deliver the actual womb.  I have yet to deliver a baby. I came close, but there was shoulder dystocia (anterior shoulder stuck behind the pelvic bone) requiring the OBGYN doctors to intervene.  I shall persevere in trying, however many nights I must sacrifice.

However, I am really happy that, God willing, as a future Pediatrician, I start care of the child as soon as they’re born.  I actually enjoy looking after the babies and doing baby checks.  I couldn’t imagine a career that didn’t involve regularly looking after babies.  They bring me so much joy!  I’m actually dissatisfied with the fact that OBGYN only involves bringing babies into the world, and even one minute after, if anything goes wrong they’re handed over to the Pediatricians.  Hence, why I’m convinced that Peds is my calling.  Yesterday, a poor mother who had been pushing for over an hour was not progressing.  The obstetricians decided they would use a vaccuum (ventouse) to get the baby out.  Even anticipating using an instrument requires calling the Pediatrician, in case the baby comes out in respiratory distress due to the difficult labor.  Unfortunately for mother and child, even the vacuum didn’t work.  To the chagrin of the mother’s relatives, they had to go for the last option that would allow her a natural childbirth: forceps.  Forceps usually lead to more trauma for the mother (episiotomy), while vacuum can lead to more trauma for the neonate (“chignon,” cephalohematoma, etc). If that didn’t work, she would need an emergency c-section.  Fortunately, it did work.  Baby came out in mild respiratory distress.  I noticed some recession, increased respiratory effort, and some atony (floppy baby), and she didn’t cry right away.  The pediatrician was not worried because the baby had good perfusion.  She gave some oxygen and intermittent PEEP (positive end expiratory pressure) to assist the lungs in removing fluid.  The Pediatrician was great at teaching me signs to look for in a distressed baby and what one must do.  I was fortunate to receive teaching from the Obstetrics side and the Peds side.  It was a wonderful experience.

Of course, I still have one more rotation to go through.  This rotation is something I considered as a career for a while also.  However, I’ve never been more discouraged by others (family, friends, strangers) about a career choice as I have with PSYCHIATRY!  I considered it seriously, because my personality and character screams: “Listener. Attentive listener.”  I have always been keen on understanding people’s psyche and the reasons behind their behavior.  I always want to know how something makes someone feel, more than anyone I know.  So, it seems natural that I should consider this field.  Unfortunately, the pure hatred of this field by others have done more than discourage me from considering it.  It’s a shame that there exist so many stereotypes about Psychiatry, as it is truly needed for a functioning society.

The only downside to Psychiatry in my opinion, is the concept of managing instead of curing. I’m someone who needs the satisfaction that something has been resolved.  With matters of the psyche, this is rarely so.  It’s a lifelong battle that is at best managed.  Is that enough for me?

In the next post, I shall let you know.
~Tash


“My Calling Is Clear!”

August 30, 2012

 “For I know the plans I have for you,” declares the Lord, ” plans to prosper you and not to harm you, plans to give you hope and a future.”  Jeremiah 29:11

As I stepped out of the elevators and entered the double doors, I heard the familiar sounds of crying, objects clashing, and running feet. I looked around and saw the bright and colorful surroundings that felt like a reprieve from the rest of world. It was then that I knew I was “home.”

This “home” I refer to is the Pediatrics ward.  I have found my calling.  My interest in Pediatrics goes as far back as middle school.  I always knew this is what I wanted.  Furthermore, to confirm my desires, I interned in Florida Hospital’s Pediatrics and NICU ward for a semester during my senior year of high school.  I never stopped smiling!

However, when I started my eventual career in medicine and started learning about all the “cool” and interesting cases medicine has to offer, I started rethinking my path.  Maybe I should be an Internist, so that I would witness and diagnose these “cool” cases that mostly affect adults.  Suddenly, Pediatrics seemed a bit boring.  Aren’t most children relatively healthy?  Would I be bored with checkups, immunizations, school physicals, and the other mundane tasks of a pediatrician?  What about the paranoid, know-it-all, helicopter parents?  I would have to deal with them as well.  And babies?? They can’t tell you what’s wrong with them.  Will their incessant crying and irritability reduce me to a pile of frustration, as their parents look to me to tell them what’s wrong with their child? And let’s not forget the dark side of Pediatrics, which includes child abuse, depression, and other mental illnesses.  How will I keep my composure when I witness these unfairly treated adolescents and the consequences it brings?

I rotated in Internal Medicine from January to April.  I was sure that I would probably seek a residency in IM, due to the vast number of sub-specialties I could go into afterwards.  However, I couldn’t shake the boredom I felt most days of the week.  Surely it is interesting, however, it wasn’t for me.  My surgical rotation was quite interesting, and I will always be fascinated when one opens the body while the patient is asleep, repairs something inside, closes it up and the patient is better.  However, my interest in surgery is from afar.  But as soon as I started Pediatrics, the familiar smile that never left my lips in high school during my internship returned, even on my first day of rotations.  It was evident: I love kids!  And I can’t imagine a career without them.

As it turned out, Pediatrics ISN’T boring after all.  Children are so dynamic as they grow older, that many things change, including differential diagnoses and drug dosage, even with children only months apart.  Also, most attractive to me in Peds, is the fast turnover of the kids, with new kids on the ward everyday, unlike the adult ward, where a patient can be in there for months. Kids tend to get better faster, which increases a sense of accomplishment (important factor for me) and decreases boredom (also important)!

I found myself staying on the ward for longer hours, coming back to interview patients in the evenings (long after I settled in at home and had dinner) and just hanging out with the kids and their parents.  I realized that I could never do so willingly in Internal Medicine or Surgery.  Sure, I did a few overnight and weekend calls in Internal Medicine, but I was always aware of the hours passing by.

The most proud moment for me in Pediatrics, was when I spent some time with a mother and her 11 year old son who has Type 1 Diabetes that was poorly controlled.  It was common knowledge among the doctors and nurses, that due to a slight language and culture barrier, the mother seemed to not understand the importance of supporting her son in his tight blood glucose control to prevent the sequelae of a chronically high blood glucose, and would undermine the efforts of the doctors by feeding her son way too much sending his blood glucose spiraling upwards.  I spent the morning educating, in laymen terms, about diabetes to the mother.  The light seemed to emerge in her eyes, as she finally seemed to understand the pathophysiology of what was happening to her son.  She became tearful and was very grateful.

I presented the 11-year old patient to Grand Rounds, and later, during morning rounds, the patient’s mother kept saying to her doctor: “Natacha told me…”  I was a bit embarrassed that she kept mentioning my name, afraid that I may have said the wrong thing. I held my breath after each declaration.

The doctor followed with: “Natacha? The medical student, Natacha? You know she’s only a medical student. There is a difference.”

To which the mother replied, “I know, but I figured she studied about diabetes and knows something about it.”

Fortunately for both the both of us, the information I gave was correct, and the doctor subsequently praised my efforts.  It was at that moment that I, paradoxically, felt like a real physician.

“I can do this,” I thought.  “I CAN be a Pediatrician.”

~Tacha


Difficult Doctors!!

June 28, 2012

For if you love those who love you, what reward do you have? Do not even the tax collectors do the same?

Matthew 5:46

Hi everyone.  Again, it has been awhile since my last post in April.  As usual, things have been moving pretty swiftly.

I am currently rotating in surgery, which is quite interesting.  Sadly, my time in England is more than halfway done.   After surgery, I have only three more rotations left: Pediatrics, OBGYN and lastly, Psychiatry.

On another note, I am happy to learn today that the Supreme Court approved Obama’s health care bill.  I’m excited and anxious (as is the rest of America) to see how this will shape health care in the future, something we as health care professionals are intimately involved in.

The next series of posts will consist of three topics that I’ve already encountered in my five months on the ward, and which I am pretty confident that you all will encounter as well.

I do not have all the answers in how to deal with them.  In fact, an excellent discussion on the subject could certainly shed light for us all.

The three topics I want to discuss in the series are:

Difficult doctors. Difficult colleagues. Difficult patients.

All of these three are inevitable.  As a student, difficult doctors and colleagues (other students) are separate entities, however, as a doc, they are one and the same.

To begin, we all know that every profession in the world has their share of negative and adverse people that are undesirable to work with. Medicine is no exception.  In fact, due to the high level of stress doctors are under, medicine is especially doomed to have a few doctors whose company leaves a lot to be desired.  Fortunately, in my experience, they are the exception.

Unfortunately, I have personally encountered such company.  This was in none other than surgery, a specialty well known to have its share of grouches.

I scrubbed in for a circumcision of an older man.  Unlike in the United States, circumcision of infants is not common practice, unless for religious reasons, in Europe.  Therefore, you’ll frequently see older males that come to their urologist uncircumcised.  There has been a ton of research documenting the pros and cons of circumcision verses keeping the foreskin.  It is a matter of personal choice, at this point.

However, one sequelae of being uncircumcised is the higher rate of infection under the foreskin due to poor hygiene (it’s more difficult to clean around the extra skin) that can harden it and make it very difficult to pull back the foreskin over the glans penis.  This condition is called phimosis.  It can be very painful.  The best solution: circumcision.

I scrubbed in on the second circumcision that day, after the consultant was called in because his registrar couldn’t sedate the patient enough to start surgery.  The consultant also didn’t like the way the registrar started the surgery, preferring his own method.  Therefore, the consultant was already irritated before beginning.

I scrubbed in because my colleague almost fainted at the sight of the registrar cutting the foreskin with scissors instead of using a scalpel.  She had to leave.

During the circumcision, which went well, the consultant asked me to cut the thread of a suture.  As I begin to cut, he suddenly asked me to stop.  However, it was too late.  I had already cut the suture.

He was furious and asked me to leave. I was shocked and embarrassed (it was a full room).  I didn’t understand what just happened.  I just did what I was told.

I tore off my surgical gowns and left the surgery table.  To be fair, the surgeon apologized after the surgery,  mentioning something about protecting the patient.  I still don’t understand where I went wrong, but I nodded to be polite.

Again, I have no magic solution in how to deal with difficult doctors, but to be polite, and fight off the urge to cry.  It will happen!

Therefore, always be able to explain and justify your actions.  There will always be differences of opinions, but try to justify your reasoning as best as you can.  Also, if the difficult doctor raises his voice or uses swear words, obviously do NOT conform to the same level.  If in public, it is him/her who will appear the idiot, not you.  Also, never be afraid to report to your superiors if you feel that you are verbally abused.  Just because we all know that difficult doctors exist, doesn’t mean we should accept abuse in the workplace.  You do have rights.

How about you? Have you had any similar experiences with superiors? How did you deal with it?  Any advice will help.

~Tacha


Fake It Till You Make It…

April 20, 2012

“Now this is the confidence that we have in Him,
that if we ask anything according to His will, He hears us.” 1 John 5:14 (NKJV)

Hello again! Today I want to talk to you about something that may seem in complete contradiction to what I wrote about last month. Last month, I talked about not being afraid to ask questions in the clinical setting, because not asking, in the worse case scenario, can be fatal. I also spoke about being aware of how much we don’t actually know once we start actually seeing patients.
However, there is an intimate balance between not knowing and asking questions and appearing as if you do know and being confident. The balance is extremely intimate in fact.
Just today, on my last day in my Internal Medicine rotation, I was with the “on call” team for the day and we were called in to see a 25-year old lady who came into Accident & Emergencies (A&E aka ER) hypotensive, tachycardic, and having passed out. On her bloods, it was shown that she was neutrophilic (high neutrophils on her white cell count) and acidotic (increased lactic acid). Basically, she had an infection. On further examination, it was determined to be a urinary tract infection/pyelonephritis.
Because she was acidotic, it was important for us to monitor her acid levels by taking some blood from her arteries, as venous blood can’t accurately tell us what’s going on with someone’s oxygen, carbon dioxide and bicarbonate levels. This is called an Arterial Blood Gas (ABG). Taking blood from an artery is more painful, as it requires us to go deeper into the skin. We usually do an ABG on the radial artery of the arm. Therefore, you must palpate the artery first to feel for a pulse. There are various techniques, and I have found one that has worked for me.
The registrar doctor I was with asked me to take the ABG. As soon as I walked in to take it, the patient was agitated. She didn’t like needles and kept asking if this was absolutely necessary. This wasn’t helped by the fact that her boyfriend was with her and kept asking why I couldn’t take venous blood (he’s a dentist, and had more medical knowledge then the average populace), and wanting the registrar to do it instead.
What do you do in this situation? First, let me tell you that I was seeing out of one eye, as I woke up that morning with a painful, pus-filled right eye, which was later diagnosed to be bacterial conjunctivitis, so contact lens were out. I had a headache as well. And I was hungry. So, what do I do at this point?
I carried on. I reassured the patient and her boyfriend that this was absolutely necessary. I warned her that it will be painful but hopefully it will be quick.
But guess what? I’ve attempted more than several ABG’s and only succeeded in one! At this point, I had to appear confident.
I prepared the ABG kit, cleaned the area, felt for a pulse, inserted the needle…and a loud YELP followed. No flash! Crap! That means I have to go fishing for the artery. I could feel the pulse underneath my finger, but I wasn’t in. I adjusted my needle and a greater YELP followed. At this point, disappointed, I removed my needle, and replaced it with a cotton ball. SIGH! I was not happy. Although I appeared confident, it didn’t work. The boyfriend beseeched me to let the registrar do it instead. I shamefully let the reg know that I couldn’t get it, and she should give it a go, because the patient was in pain.
Well, what do you know? The registrar gave it a go, and the SCREAM that followed was heard throughout the whole A&E. She couldn’t get it either. It’s terrible for me to say this, but I felt a slight twinge of satisfaction that it wasn’t just me. The patient’s fear of needles and low pain threshold combined with her overbearing dentist boyfriend made it impossible to get the ABG.
To the patient’s dismay, this meant that she had to stay in the hospital overnight, whilst getting I.V antibiotics and monitor her acidotic state.
This situation was a stark contrast to my last ABG, in which the older woman was also afraid of needles, and at that point, I hadn’t gotten a successful ABG yet. However, I appeared confident, and proceeded with the same steps. I was rewarded with a flash of beautiful bright red arterial blood – I WAS IN!!!
Moral of the story? Appearing confident is key. I have been called upon to perform several competencies that we are expected to know as physicians. It is very nerve wracking, especially for a shy girl such as myself. One must decide at this point should I carry on or ask for help. I believe asking for help is always the answer if there is a risk of patient injury. However, how can one learn if one doesn’t practice? As you get to the clinical setting, you will run into these scenarios time and time again, and you have to decide what the intimate balance is for appearing confident and asking for help. You may have to do both!
Today, I’m glad I attempted one more ABG in Internal Medicine. Now, on to Surgery!

~Tacha