Being A Patient!

February 25, 2013

an-ailing-young-patient

“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.


“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