Friday, May 24, 2013

Things Medical School Has Taught Me

Sorry for the long interlude without a post--things have been busy, what with the graduating and commencementing. And now that med school is all over, and I is officially a doctor, I thought I'd post a few of the things I've learned in the last five years--some technical in nature, some more to do with matters of the heart. A quick run-down, in no particular order.

1. To quote an anesthesiologist colleague, "It's pretty hard to kill a breathing patient." That's why the ACLS algorithm (Advanced Cardiac Life Support, for those wondering about the abbreviation--don't feel bad, I had to look it up myself) goes Airway, Breathing, Circulation. I don't know why, but I find this oddly comforting--as long as they're breathing, and you keep them breathing, things are (relatively speaking) pretty good. Which leads into our next point--

2. What doctors mean when they say someone's "sick" and what everyone else means are COMPLETELY different--and it varies a little bit from specialty to specialty. From what I've gathered from ER and surgery/trauma folk, their "sick" means "this person is going to die within the next hour unless someone does something." Internal medicine folk are a little more liberal with it, and as long as someone's basically OK at baseline (ie, doesn't have kidney failure, heart failure, diabetes, AND hypertension), someone can have a pretty gnarly pneumonia or acute liver failure and still not be "sick." Psychiatrists' "sick" has more to do with whether someone's talking to people who aren't there and smearing feces on walls.

3. Speaking of feces. One of the main things I learned during my time on labor and delivery is that, while childbirth is a beautiful, natural, ethereal experience in theory, in practice there is a lot of grunting and screaming and, now that I think about it, literally every secretion the female body is capable of producing. This is not a soft-filter Lifetime Very Special Event with gentle lilting flute music in the background. There is sweat and blood and vomit and feces and don't even get me started on meconium. And there's nothing wrong with that, because pushing another human being out of your body is miraculously awesome and I think entitles you to do pretty much whatever while it's happening. It also taught me that, while I do want kids, I think I probably want my wife to have them, or that if I do any child bearing, I want an epidural early (like, the beginning of the third trimester would be nice).

4. Also from my time in OB/Gyn land: lots of women are allergic to something in Always pads, and Kotex (or another non-Always brand) will often work better, and by 'better' I mean 'not cause a painful, itchy rash in the lady regions.' Also, there is no reason to douche, ever, and most of the products sold for 'feminine refreshment' (I don't understand--does my vagina want a glass of lemonade?) actually make things worse by mucking up the natural pH balance and allowing yeasts, unhealthy bacteria and other interlopers to set up shop. I don't completely understand why anyone thinks women's bodies are supposed to smell like a summer's eve or a spring morning or a dog day afternoon, but they aren't. If things are getting kind of...malodorous in the region, you don't need to be spraying Febreze down there, you need to go to the doctor. If things smell just fine, you don't need to be fancying things up with new car smell anyway.

5. As for psychiatry, I've learned a ton, but the most interesting is that ECT is actually not a scary, mediaeval procedure. In fact, it's one of the safest and most effective procedures in all of medicine, especially for people who are seriously depressed and who need a quick response to treatment. For out of control psychosis, Haldol can be like a magical elixir. For folks with dementia, unfortunately, medications like Namenda and Aricept do virtually nothing. Also: for people with pretty much any mood or anxiety disorder, a companion animal (in conjunction with an SSRI or mood stabilizer, of course) can be just what the doctor ordered. If my cat hadn't come to me with a name, I probably would have named her Zoloft--Zoe for short, of course.

6. To quote an internal medicine colleague, "Often the shortest road between despair and hope is a good night's sleep." This is true not just for overworked, hyper-stressed interns and medical students, but for everyone.

7. Drinking caffeine in little bits throughout the day is more effective at keeping you awake and functional than chugging a large coffee all in one go. Eating a little protein snack will also help you stay alert. Avoid processed carbs like the plague. At least for me, a bag of Cheez-Its from the vending machine might as well be cheddar-flavored Ambien.

8. Never pass up a chance to eat, sleep or pee. It may not come again for a while. As for sleep, I learned during my surgery rotation that it is most definitely possible to fall asleep standing up--and during rounds, no less. In fact, it's probably easier than falling asleep in a call room bed (which is often only a bed in the loosest possible sense of the word). I'm sorry to disappoint all you Grey's Anatomy fans, but call rooms are approximately as romantic as that Motel 6 out by the highway, with the added possibility that someone could come in the door at any moment. I can't imagine anyone ever having sex there. Then again, I can't imagine anyone having sex in a hospital room, but I've definitely heard of patients who have managed it.

9. On a more serious note, it's OK to cry with patients sometimes. It's OK to cry with colleagues sometimes. And sometimes it's OK to find the nearest bathroom, lock yourself in a stall and have a good sob. I've done all of these things, and from what I've gathered, so have a lot of other doctors (especially the crying in the bathroom).

10. Everyone wants to feel heard and to feel validated. "Tell me more about that," "I can understand why you feel that way," and "I hear what you're saying" will almost never go amiss. This isn't only true for patients--it works with families, with other healthcare professionals, hell, even with yourself.

1 comment:

Karin said...

Thanks for this post, Anne! I can totally attest to the utter messiness, yet miraculous nature of childbirth. Actually, Bill could really give you stories. :)