Dealing with Study Anxiety in Medical School.

TBT post

Medicine N' Stuff

Flickr: Ned Dunn Flickr: Ned Dunn

As I sit on a train on my way from Chicago, staring out the window as Maple trees and Midwestern suburbs zoom by, I have an introspective moment. I can’t believe how absolutely relaxed I am. Having spent my spring break with old friends and new, exploring Downtown Chicago and Downtown Detroit, I just feel lucky. I then casually look to my right and see my friend staring intensely into a book. What book is that? I look closer and it’s none other than Lilly’s Pathophysiology of Heart Disease. Dammit. I forgot I’m in the middle of Cardio. Crap, the test is next Friday. I really need to study for that. Do I have a book with me right now? No. Dammit. Well I need something. I look at my other friend pulling up study blue on his phone. I feel my anxiety rise. The unspoken…

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I just don’t understand why these darn doctors can’t solve the problem?

Well ma’am you have a 30 pack year smoking history, COPD, Hypertension, Diabetes, and previous history of a heart attack, breast cancer and lung cancer. Also, your complaint right now is, ”it hurts everywhere”. Unfortunately there seems to be a race to kill you and we don’t know who’s winning.

My Day with Dr. Awesome

To be honest, I already knew my day with Dr. awesome was going to be awesome. Shadowing a neurosurgeon that specializes in the brainstem, the delicate and precarious Pandora’s box of the nervous system, was bound to be a worthwhile experience no matter how it went. Add to that Dr. Awesome’s generally unassuming yet charismatic demeanor and straight talk, he was a professional giant who made you feel at ease.

image provided by: Internet Archive Book Images The part spinal cord looking area under the two globes is the brainstem. It is responsible for coordinating things like breathing, balance, eye and facial movements. A problem in this area causes locked-in syndrome; check it out.

image provided by: Internet Archive Book Images
The spinal cord looking area under the two globes is the brainstem. It is responsible for coordinating basic functions like breathing, balance, eye and facial movements. To see how devastating damage to this area is, check out Locked-in syndrome.

Unfortunately, what I would learn before shadowing Dr. Awesome, was that he was recently diagnosed with a serious and fatal cancer. The kind where the doctor doesn’t even bother to go through treatment options as it’s probably better to just get your affairs in order and spare yourself the futility. Even more unfortunate was that he found himself with a terminal illness at an age when he shouldn’t have. It’s a shame accomplishments can’t get in the way of biology because he would have been fine for years to come. Still, he wasn’t the type to complain about it.

Thankfully, due to the means he gained from his profession Dr. Awesome was allowed the privilege of going to top notch medical centers around the country and enrolled in experimental trials in a last ditch effort to get some time. Rather unpredictably, (as in, even the doctors in the experimental trial we’re surprised) his treatment worked. Five months after a fatal diagnosis and Dr. Awesome looked as normal and spry as anyone his age. Each day he lived was a gift in the truest sense.

So I begin shadowing Dr. Awesome bright and early and right off the bat he drops what he is doing and starts talking to me. Honestly this small action takes me by surprise. Though I expected him to be as nice as anyone, I’ve had people who have accomplished considerably less with more time in their life not even give me a passing glance before sending me off to follow some resident, or simply expect me to sit in the corner like a human statue that smiles and nods when looked at. To have this guy, in this situation give me the respect of a firm handshake and some time floored me.

Right off the bat he starts talking about what he does, what we’re going to do, moves on to his terminal diagnosis, how it is affecting him, and then opens the forum for questions.

With the forum as open as it could ever be, I decide to ask him what I think is important. Throughout the day we talk about his work life balance, the fluctuating state of healthcare, the brainstem, cranial nerves, the business of medicine, baseball, private vs public practice, the politics of being a practicing physician. His analysis is objective, with the personal bias expected of a man of his generation and work ethic.


image provided by: Internet Archive Book Images

He says things like, “It’s stupid to get rid of the 80 hour rule, working 120 hour weeks is necessary so that in your career, when you start working 80 hour weeks, it isn’t so bad”. Uh, ya… not exactly a human opinion.

Or, “Brain Surgeons don’t play nice with each other. Every brain surgeon thinks they’re the best and that creates friction. The only thing that keeps my practice running so smoothly is that every member has significant accomplishments in different fields.” Which is surprising to probably nobody.

Or, “Don’t let a patient lull over a bad diagnosis. Move on to what can be done to help them because ultimately that’s what your there for, and it’s empowering.” Which is pretty solid advice from a guy who has to diagnose the most life-threatening and dangerous cancers.

Everything he says is so thoughtful and real, I’m hoarding what knowledge I can the short time we get together. All the while, I get to watch him in his element, talking to patients; going over their CT scans, meeting people before and after their life altering surgeries. In every case he is still as genial and charismatic as usual. He never interrupts, he never acts pressed for time, and honestly, nothing would lead you to believe that anything was wrong in this guy’s life.

One particularly interesting case involved a teenager with fibrodysplasia of the bone above his eye. What Dr. Awesome had to do was make a 3D model of the teenager’s skull, remove what needed to be removed and then cut the 3D model to the proper dimensions of this kids face. What the mother of this teenager refused to get over was that the boy’s face wasn’t perfectly symmetrical. She was right, there was slight bump that could be noticed when drawn attention to, but really, it was barely noticeable. Yet, for what seemed like an hour this lady would not let this go. She kept attacking Dr. Awesome about it, as if he didn’t in one swoop saved this kids vision, perform an incredibly intricate and specialized surgery that about 30 people are capable of doing in the nation, and also mold the skull perfectly on the fly in the OR so that the kid could avoid going up to six weeks missing a part of his skull. Easy, right? Still, at no point did he lose his cool. He listened to her just like any other patient. I’d be lying if I said I would do the same.

Another interesting case was a child with an absolutely massive hemangioblastoma in his occipital lobe. So big in fact it occupied about one fifth of the brain space. Here’s the kicker, the kid had no neurological deficits. None whatsoever. This is the type of thing that makes medical professional’s jaws drop. Anyone with any passing experience with brain damage (e.g. strokes, trauma) knows the adult brain is as fragile as fine china, one chip and you will notice it instantly. This kid, through the miraculous abilities of a plastic, evolving brain, was able to rewire his brain while the cancer grew to such a massive size. The best part: Dr. Awesome had treated it to a point where it stopped growing. For the time being, Dr. Awesome had basically save this boy’s life and allow him to continue living unpredictably normal for what could possibly extend to the rest of his life. And this was his 3:00 o’ clock.

image provided by: Internet Archive Book Images

(image provided by: Internet Archive Book Images) An example of the fragility of the brain is the part that says speech. If that gets hit, a patient will lose their ability to speak. Here is a video of what happens when this one, rather small area of the brain gets hit:

The day would continue with variations of serious conditions he would deal with patience and compassion until eventually it came time to ask the big question: “Why are you still working?” Seriously, the man is rich, he could travel anywhere, he can retire right now, he can pretty much do whatever he wanted and yet there he was in clinic seeing patients. He replies, “what would I do? Seriously? I love my job. I don’t get the satisfaction I do here anywhere else. I’m going to keep doing this as long as I can.” He then goes on about how you have to do what you love and that he knew he had made the right choice, which was nice, except it’s a lesson he had already been showing me for the past eight hours.

At the end of the day we had some parting words, another firm handshake, and I left the building feeling just a little bit different. I had always heard that I would meet somebody who would truly affect me during my medical training. However, over the course of a day I would find that to be truer than I ever thought possible.