Posts Tagged ‘medical school’

Just a really quick thought as we are ending this clerkship year with a bang.

“Don’t go Grey’s Anatomy on me now” is what I often tell myself when I find myself in situations that could be worthy of a scene in that infamous medical TV drama that has dominated television for quite some time now.  Although I love that TV series and have been watching it for the past six years or so, no way in heck would I ever wish to be one of the cast members in real life because, really, if ever I go through what any of them has gone through in the past nine seasons or so, I’d probably have to check myself into a mental institution out of necessity.

Over the course of the past year, there had been many circumstances when emotions would become so uncontrollable that we are thrust into situations that we would later wish we could forget.  See, drama in medical school and in the hospitals cannot be avoided.  It seems as if we become so fed up with the medicine that we desire to feel just to affirm our own humanity.  Is that too philosophical?  Yeah, I’m profound.  Medical training forces people to interact on such an intimate and constant basis.  That is enough to drive anybody crazy.  It often drives me crazy.  However, for me, it takes constant self-reminder of what it is I came here for.  I came here for the medicine, something that genuinely makes me happy, for some weird reason.  The time I spend here could have been precious time with a family I will not have forever.  With what I gain with this training, I lose a whole lot more where people I love are concerned.

Often, I wish I were the Tin Man.  No heart, no emotion, drama like that.  Or, no drama like that, if you get my drift.  I really do believe that, in this profession, emotions do get in the way of good judgment calls.  This year is testament to that.  But, of course, we are human.  We had been created to feel a significant and diverse amount of emotions, which unfortunately puts many of us into unbelievable positions – positions I would never wish on anybody.  I like medicine because it is very objective – there is a definite practice guideline for a particular condition and such.  But with the human heart, there’s no such thing.  We feel and we work with people who feel and sometimes our feelings… they go haywire and that is when working with each other become so damn difficult, which is inevitable and inconvenient.

This is why I honestly believe that, in this profession, we have to endeavor to place our personal lives as far away from our professional lives as possible.  It is not a requirement but, hot damn, it tends to absolutely decrease the level of stress in one’s life.  Well, that is what they tell me.  Who am I to say stuff like this anyway?

Well, that wasn’t so quick a thought but a thought it truly had been.

I first met Edwin (not his real name) one Saturday in September 2011.  He was around 5 feet 4 inches tall but was all skin and bones that his slight mother could actually carry him with very little effort in her arms.  Bedridden, unable to talk, and with a nasogastric tube stuck into his nose, he did not present a very comfortable sight.  Edwin has SSPE, or subacute sclerosing pancephalitis, actually been living with it for the past two years.  He was then only 11 years old.  SSPE usually occurs at around the age of 9-11 in children who have had measles before the age of 2 or before they had been vaccinated against the disease.  It is a rare sequelae of untreated measles but it happened to Edwin.  His family lives in a single-room house in one of the most impoverished and least sanitary areas in urban Metro Manila – Payatas.

The medstudent organization of which I’ve been part of for the past three years is socially- and health-oriented.  As such, it is typical for the health coordinator to impart with us some of the community’s health-related troubles from time to time.  More often than not, the problem is usually public health in nature.  However, when the health coordinator quietly asked me to go with her that particular Saturday to meet a family with a special health problem, the first thought that popped into my mind was that I was going to meet a family with a bedridden elderly patient, most probably diabetic, hypertensive, or stroked out.

According to one doctor who wanted to volunteer his services by alleviating Edwin’s pain through acupuncture, Edwin was facing a <20% chance of survival.  Despite the helpful tone of his text message, the underlying question was, “Why are you wasting your time on that?” In all honesty, I do not know but, having met Edwin, having spoken to his mother who had been crying the whole time she was talking about the difficulties that came with Edwin’s condition, it is difficult not to “waste” some time on this.

Every time my orgmates and I would return to the community once or twice every month since then, visiting Edwin and his family became a routine.  He may not know any of us, not really.  I certainly was not a lot of help since I do not have money, connections, influence, or even the adequate knowledge to truly help.  But, for families struggling with a chronic disease, emotional support means a whole lot and can go a long way in lifting morale.

How did I get to know Edwin?  I never really did.  Maybe I never will.

Yes, I want you to cry at this point.  That is exactly my intention when I started writing this piece.

Most doctors tend to remember specific diseases by the signs and symptoms presented by their patients.  These patients eventually lose their faces and individualities in these doctors’ minds by the time these doctors’ have mastered those said diseases.  Of course, it is imperative for doctors to master diseases to be able to conquer them with effective treatment plans in the future.  However, perhaps we do a disservice to ourselves and to the faces that embodied those diseases by forgetting the patients who have taught us not just to be competent doctors but how to be human as well.  Those patients were not, are not, and will never be a waste of time.

 

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A few days ago, my batch wrapped up our first three years in medical school with a week-long “celebration” marked with a series of written, oral, and skills exams. Now, we are officially done with classroom-based learning and are (supposedly) ready to embark on a journey of gaining knowledge from the hospitals full-time.

On the last day after our final exams, the batch partied in a way only medical students knew how – wildly. Prior to that however, the lower year level and the school administration threw us a send-off party, where a couple of people who’d gone before us gave us tips on how to survive clerkship. One of our favorite doctor-teachers, who specializes in obstetrics-gynecology, also wrote each one of us a few tips on how to survive not only clerkship but also internship and residency as well. I’m collating all of their tips here and philosophizing on each one because, despite being medical clerks, we are still extremely philosophical beings.

  1. Remain humble; in short, don’t be a primadonna since you are the “lowest animal in the food chain.” How can we not respect the hospital peking order? Learning from the experience of other people is a privilege. Why be a primadonna over that?
  2. Always show professionalism; don’t answer back. I used to think that being professional meant doing your job and, as much as possible, doing it well. It sucks that it actually also means doing it with a smile on your face, which transparent faces could sometimes be unable to do when faced with lack of sleep, food, and camaraderie. How do you hold your tongue when you can’t even hear yourself thinking?
  3. Always smile; kill them with kindness. We have to admit that, when faced with an extremely disagreeable person, killing him/her with kindness instead of with violence is quite hard, if not humanly impossible, to do.
  4. Take the initiative; always go the extra mile. I was telling a friend the other day that one of the advantages of living away from family during medical school is the absence of familial obligations. It’s a sad but somewhat valuable fact at this point in our training.
  5. Look forward to a “toxic” duty.  I cannot remember a lot of things from the lectures but I am hoping sincerely that I learn from doing.  So yes, bring all the toxics!  I just hope I don’t unwittingly kill a lot of people in the process.
  6. Be assertive without being aggressive. Middle children, which I am, are particularly flexible and good compromisers but, having been surrounded with testosterone growing up, being aggressive in the face of apparent attack is what I know how to do. How do you fix that part of yourself in a little over a month?
  7. Be confident without being cocky. In all honesty, I have no idea how one can be cocky when one is at the bottom of the food chain. It’s like trying to be the alpha male when one is apparently a puppy. Furthermore, if one has no idea what one is doing, I am not sure the line “confidence is key” applies.
  8. Pray. Human limitation is the most common reason why our actions, our knowledge, our ability to be kind and understanding, and our endurance can only go so far.

Perhaps the most important thing medstudents can learn from shadowing their seniors is this rare virtue called humility.  The medical field is rife with people with egos the size of Jupiter, which in some way could be understandable given the vast amount of knowledge they have had access to over the years and given that they literally hold other people’s lives in their hands.  Maybe they have a right to those egos?  Gee, I don’t know but, before they were doctors with big egos, they had been medstudents with even bigger egos… and the medical training system had found a way to ensure that those ego could be brought down a peg or two… or a thousand.

moi

Rarely do I particularly write about the people I deal with on a daily basis because I have found a long time ago that it tends to get one in a lot of trouble if one is found out.  However, I am going to make a rare exception simply because I find it so fascinating that she is the only person I know so far who has ever had the cojones to admit to wanting to pursue a career in, wait for it, Geriatrics.

Geriatrics… the very word itself sounds so unappetizing that one could just wonder why she had ever considered it as a specialty.  Pediatrics is unappetizing to me as well but, in itself, it already is hardcore simply because kids as patients are so damn difficult to deal with.  It takes a certain amount of talent and skill to engage kids and make them cooperate.  Internal medicine is hardcore as well because it takes a bad ass to have complete confidence in one’s self to be able to diagnose something without directly seeing it, which sounds frustrating to me.  Surgery is the most hardcore of them all because one gets to open up another human being and directly see what one is doing with one’s hands – lesser probability of screwing up that way.

Geriatrics, on the other hand, sounds so staid, boring and, I have to admit, a little bit depressing.  One classmate actually verbalized it in a way I probably could never have:  “Geriatrics is the safest specialty ever.  If your patient dies, nobody’d care anyway.” Witty, so witty.  People did laugh out loud but, after much philosophizing over the matter (because I have so much time in my hands, you know), I have realized that it had got to be one of the more insensitive things we could ever say about the people who’ve seen more than we’ve ever had, who’ve lived through pain more than we’ve ever had, and who’d survived through all of it and have the scars to prove it.

In one lecture on Geriatrics, it was mentioned that a person reaches the point of being completely comfortable with himself when he is already at his fifth or sixth decade of life.  That actually surprised me and brought me down a bit.  See, the day I hit my twenties, I had sent a silent prayer of thanksgiving to the Lord, rejoicing that my awkward pre-twenties phase was finally ending.  Now, although I believe myself to be quite happy and content with the person that I have become, I realize that I am so far from that point where the old and the wise now stand.  When you’re in your twenties, you haven’t exactly lived yet and, in a way, it’s another phase of life you just have to understand yet again.  While those who are already in their fifties and sixties?  Those are people who’ve already lived and seen it all.  Those are people who are comfortable in their own skin because they’ve been through so much already as themselves.  How could one not respect experience?

Now, this girl who wanted Geriatrics as a specialty?  She wanted it because she grew up with old people around the house.  She wanted to learn how to take care of them specifically.  Although I’m sure there are more and deeper reasons behind this desire of hers, this simply reinforced what I have long ago believed to be the truth.  A medical doctor’s specialization says a lot about that doctor – what matters to him, what drives him, and what he was brought up with.  One cannot simply go into something and live with it happily without a motivation driving the need and the desire, be it money or something else.

Geriatrics is a noble medical specialty.  To have the desire to take care of those who’d painstakingly paved the way for us to become who we are now is just plain amazing.  Why do old people matter?  Because we’re all going to become them someday.

When I was a kid, my parents enrolled me and my brothers into a lot of classes.  For learning and improvement, they said.  My mom tells me now it was their way of making sure that their kids would be able to achieve all of their potentials in life.  Thus, from my childhood to my teenage years, I had taken classes in piano, ballet, karate, taekwondo, landscape sketching, portraiture, acrylic painting, guitar, typewriting, computer technology, swimming and First Aid, declamation, theater, and journalism.  My older brother got enrolled into a summer course on automechanics once.  He was ten.

As a result, there are a lot of things that I know how to do.  The problem is that I’m not sure if I’m that good in all of them.  As such, each one of them is a hobby that I don’t share with a lot of other people, simply because I don’t think they’re at that level of share-ability.  This desire to know or maybe to learn was probably the one thing that my parents had painfully but successfully instilled in me because of the constant barrage of diverse information during my formative years.

Speaking of the constant barrage of diverse information, which sounds suspiciously like medical school, perhaps the downside to being enrolled in an MD-MBA program is that it can be a bit confusing sometimes.  Sure, we know we are here to become clinical doctors but how can you focus on becoming that doctor when you also have to put aside what little time you have to become a public health practitioner, a quick-witted businessman and a social catalyst all at the same time?  Excuse the whining but I’m simply wondering, in earnest, how can you compete, clinically speaking, with other medical students from other medical schools whose only concern is to become the best clinical doctors ever?

It makes me think sometimes that, to have an MD-MBA attached to your name, you have to become sort of like a jack-of-all-trades –you have to know how to do a lot of things but you can’t be so sure if you’re that good in all of them.  Not unless you get the balls to try them all out, all at the same time – now that’s some serious balls.  However, these days, whenever I feel the urge to complain about the work load, I think about Daddy and Mummy and how they used to (irrationally) bombard me with diverse information that are so unrelated, I sometimes thought they were torturing me.  Yeah, my parents were very loving people.

The point though was that I learned how to do many different things and, in a way, I was able to achieve the potential to achieve.  I don’t care that I cannot readily define Ashermann’s syndrome or that I do not know what to call lub-dub-click-whoosh when I auscultate a cardiac patient or that I still cannot pinpoint the parts of the basal ganglia.  I mean, I am doing a lot of things here, okay, I am trying to be a lot of things here so chill, okay?

That is the reason why I am still slaving away right now, not for the MD-MBA titles (although, of course, they are still a major reason why I’m doing the shiz nits I’m doing right now, haha), but because I want to learn something new everyday and, these learnings may not be totally related to each other but they will help me achieve all of my potential – as a doctor, as a social catalyst, as a businessman, as a person.

Boom, we just had a pseudo-mature monologue right there.

When I started medschool around two years ago, I tried to be the quintessential student.  I bought a huge-ass notebook and, for the first couple of months, actually listened to the lecturers so that I could take down notes in shorthand.  We do shorthand because, of course, there’s just too much stuff to take down, you know.  However, the worst handwriting apparently belonged – BELONGS – to me.  Why?  Because I often could not even decipher the characters that supposedly made up my notes.  I couldn’t even remember what certain character shortcuts stood for and, heller, I wrote them myself.  Ridiculous.  It’s worse than having a chicken write its name on the sand.

Hen-scratching during lectures proved to be too much of a hassle, an inconvenience and a waste of time all rolled into one.  So, I spent the last half of my first year in medschool in a state of limbo – half unconscious, half awake.  That was when I first learned how to sleep with my eyes wide open.

My second year in medschool, I learned how to be more technologically savvy.  Hell, yeah, we roll with the times, baby.  I began to religiously bring my laptop to school that year.  While waiting for the lecturer to set up, I would turn on my laptop, open OneNote 2007 and have my fingers poised over the keyboard, ready to type away.  But, inevitably, something would come up.  Like an emergency call that would take the lecturer out of the classroom.  Like a sudden wave of sleepiness that would be extremely difficult to ward off with my amazing powers of will and determination.  Surrendering to sleep was not an option because I sat in the first row within spitting distance of the lecturer.  So what I would do to ward off sleep in class?  I would click on the Firefox icon on my Desktop and check my Facebook account.  And my Twitter account.  And my Plurk timeline.  And, before I knew it, the lecture would be over.  Up.  Done. Kaput.  Go home because you’ve learned nothing today, girl, good job.

This year, my note-taking battle plan involves this:  asking my contacts in the upper years or anyone in class for the lecture presentations of the past few years.  I have found that, apparently, these lecturers rarely update their lectures and, if they do, they add very little.  I’m better off going on a date with Harrison, Nelson and Williams.  But I’m not exactly the dating type so I guess I should just stick to my initial note-taking battle plan of laziness.

I love medschool.  It sure brings out the best in a person, doesn’t it.

There are people who suck at teaching and I happen to be one of them.  Thus, my college degree in Biology, which usually leads its disciples over to the academe, is useless , making it especially hard to pursue any other career path except medicine.  Thus, ever since college and just like any other medical student, I have been constantly going over and over in my brain on what medical specialty I should pursue – the specialty that will get me hooked, lined and sinkered.  I realize that the specialty a medical student chooses says a lot about who he/she is, what he/she can put up with and what he/she feels strongly about.  Hence, the idea of choosing the wrong specialty makes me want to barf… violently, as if I have the worst kind of flu virus nature ever had the vindictiveness to, uh, evolve.

Choosing and eventually deciding on something involve a lot of factors, namely what you like, what you want, what you are good at and what you need to do.  But you know what’s unfortunate?  When you have one specialty for each of those factors.  Makes life all the more interesting, doesn’t it.

  • LIKE: Neonatology.  I am of the belief that most people in the medical field have a Messianic complex – the need to take care of individuals they consider weaker than themselves.  Babies, for me, are the ultimate weak individuals (either that or my biological clock is ticking, augh).  When I am in the hospital, I would stand outside the NICU for hours just staring at babies through the viewing glass.  It makes me happy, watching them sleep or try to turn from side to side or make goo-goo noises in their cribs.  But, when I turn around, the nurses at the station would be eyeing me, probably thinking who the crazy girl was and what she’s meaning to do with the babies she’d been looking at for the past hour or so.  This specialty shows exactly how soft a person can be.
  • WANT: Nephrology and Transplant Surgery.  I grew up watching a disease related to this specialty manifest itself in its worst possible form in a loved one.  Chronic renal obstruction secondary to staghorn calculi, bilateral.  It is a very debilitating disease – physically, emotionally and financially.  Perhaps there is this want to “fix” the person that means a lot to you as well as every other person who reminds you of her.  Nephrology is the specialty I am truly most familiar with.  However, some people learn through theory but, there are some, like me, who learn through experience and hand motion.  Of all the specialties I’ve ever considered, surgery, coupled with nephrology, are what I truly want.  This specialty shows exactly how selfish a person can be.
  • GOOD AT: Psychiatry.  Paralysis by analysis for the win!  This specialty requires you to be more of a listener and an elicit-er instead of an authoritative doctor barking out orders to your patient and to exhausted nurses.  Why Psych?  I feel that I can be good at this specialty because I like knowing where people are coming from.  I like figuring out what is wrong with a person.  However, a friend once told me that I’m not really that great a listener because I tend to interrupt a talker to give one (probably unwarranted) advice or another.  Notice the kind of supportive friends I run around with.  Plus, I doubt I would want to hang out with mentally disturbed people on a daily basis.  I’m already mentally disturbed enough as it is.  This specialty shows exactly how arrogant a person can be.
  • NEED TO DO: Community and Public Health.  Remember what I said about Messianic complex?  Studying medicine is a privilege.  Thus, because we have the knowledge and the skills, we cannot just use it solely for our own financial benefit, although of course earning should still be a primary consideration in our careers.  Still, we must allow a large majority to have access to the services that we are more than capable to provide.  Community and Public Health is an advocacy and a commitment… and pursuing this as a specialty, well, kind of  scares me (to death).  I’m still thinking about it.  This specialty shows exactly how cowardly a person can be.

Some people say that medical students should wait until Clerkship Year before truly deciding on a specialty because rotating in the clinics and being immersed in different medical situations will allow you to truly weigh your options.  However, there are many others who say, no BELLOW, that we should be choosing a specialty now so that we can focus our energies on building up our knowledge and skills especially for that specialty.

What they don’t get or probably don’t remember is that deciding on a specialty is like deciding on marriage.  Heller, you’re going to have to wake up to that specialty for the rest of your life!  Does that not sound like marriage to you?  Does that not sound scary to you?  Don’t push now, dude.  Let us take our time.  We have a year until Clerkship Year.  Oh, jeez, a year sounds so freaking short.