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.

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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: https://www.youtube.com/watch?v=NUTpel04Nkc

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.

5 Crucial Lessons I Learned While Working at a Hospital

I took a year off before going to medical school. It was less of a decision than I would have liked it to be, considering I was rejected from medical school my first time applying, but all’s well that ends well. In the meantime, I got a job working as a nurse assistant on a medical/surgical floor, and the experience provided me a very in depth look at a field I had only imagined myself getting involved in – a career I had only seen in episodes of Scrubs and Greys Anatomy as well as random, superficial stints in the hospital via volunteering and shadowing. What I would quickly come to find is that I really didn’t know what I was getting into. Here are some of the things I found most surprising.

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1. Medicine is at best a dirty science.

For all the davincis, google glasses, and cutting edge research that people love to think about when they think of medicine, at the end of the day there needs to be someone to wipe off the poop. For every one patient that is helped by a davinci, there are hundreds that require their bowels disimpacted, straight catheterizations, or wound and bed sore treatment.  It is smelly, dirty, and wholly underappreciated, but constitutes the bulk of what it takes to treat a patient every day.

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2. Being at a hospital sucks.

Imagine being given salt-less hospital food every day while being constantly poked, prodded and turned around the clock, in an uncomfortable hospital bed, all in order to get some intervention that is rarely comfortable. This frequently includes drinking laxatives all day to clear one’s bowels, chemotherapy regiments, not being allowed to eat for the entire day prior to a surgery, and then having to walk around soon afterwards, despite significant pain, to prevent clots. Keep in mind that many patients are unable to take care of themselves due to old age or whatever affliction they may have. This often leaves them completely at the mercy of a busy nurse assistant in order to accomplish even the most mundane tasks such as getting up, going to the bathroom, and cleaning themselves. For certain patients, mainly those with mental disabilities, the hospital can become a prison, where they are stuck despite often having no clue why they are there. I could seriously go on but suffice to say that staying in the hospital sucks in a variety of ways that simply cannot be summed up in one run-on paragraph.

 

3. ‘People’ is a broader term than I ever knew.

One of the things I found most surprising about getting into a hospital is how broad the term ‘people’ actually is. That guy who works the cashier at your local store, the woman who bags your groceries, the homeless man on your way home, the president of a company driving by in a Cadillac; all of these people will at one point go to a hospital. All of the invisible people that you see, but don’t think about on a given day will require being seen and thought about every day. Even the most worldly of individuals will find themselves surprised frequently. Everyone will encounter a person that is a stranger in the truest sense of the word. A schizophrenic grandma who only speaks Russian. A terminally ill patient that’s happier than most young healthy people. Morbidly obese individuals who rarely, if ever, leave their house. Honestly, it is a pretty eye opening experience, and healthcare workers have a unique and interesting vantage point with which to look at the world and the people in it.

 

4. People are painfully fallible.

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Here is the ideal situation: Patient comes in for problem, doctor diagnoses problem and prescribes treatment, patient follows treatment and lives life healthier, making sure, of course, to come back for checkups. Any medical professional reading probably smiled and shook their head a little when reading that sentence. This never happens. Despite having extremely complex brains capable of understanding beautifully intricate thoughts and concepts, people constantly find themselves slaves to basic feelings and emotions. From a logical perspective it seems ridiculous that someone with lung cancer keeps smoking, or a liver transplant patient decides to use alcohol again, or anybody decides to hit children, but it happens, and medical professionals have to deal with it. It’s very real and disillusioning to anyone involved, and continues despite everyone’s best efforts. It’s not something that anybody ever gets used to, but at the end of the day, somebody has to take care of it. As a medical professional, that will be you.

 

5. The end isn’t pretty.

There is nothing I envy about the last days of life. Before I worked in a hospital, I thought the final days of life would be a nice little farewell where I could sit in bed all day, mull over everything I had accomplished surrounded by the warmth of friends and family. Unfortunately, that is rarely the case.  Death in a hospital is often a drawn out affair that grinds on everybody involved. Feeding tubes, fecal assistance devices, chemotherapy etc. coupled with copious amounts of pain and pain medications is usually how it goes. The maxim “do no harm” is quickly replaced by  “let’s do everything medically possible to keep this person alive” as everyone’s best intentions get warped into a misguided vortex of emotion and medical advice that often leads to significant suffering for everybody. The saddest part of it all is that everyone in the situation is doing what they think is best. Unfortunately, nobody thinks about death until it happens. This is a problem, because death requires a variety of tough decisions that require a considerable amount of thought. Thankfully, the field of palliative care is emerging to combat this situation. However, as of right now, the last place I would want to go is at a hospital.

 

So anyways, considering I’m still in medical school and writing like I know everything, I’m still learning every day. I actually love the field I’m getting into because it is so complicated and raw. Nowhere else does science meet business meet law and ethics, all the while requiring constant face to face interaction with every day people in trying times. It’s definitely not for everybody, many of whom find themselves thinking about medical school. It is for those people that I hope this article can paint a somewhat clearer picture of what it’s like to live and work in a hospital.

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What if Medical School was a Religion?

Medical school is not a religion. Sure it takes over one’s life, colors one’s perception of the world, and makes for uncomfortable dinner conversation, but it’s not a religion. That being said, it is definitely like a religion. For instance:

 

First Aid

Flickr | coleman and caroline

This is your bible. I mean that because it is the book that will guide your studying, which for a period of time is your life. In the stressed and uncertain times of learning medicine from scratch, this book will show you the way to a good STEP score, and with it an iota of mental peace. You will memorize this book better than most religious scholars know their religious texts,and its pages will serve as the foundation of much of your lifelong knowledge after you’ve read it.

 

Hospital

Flickr | Peter Ras

This is your church. For the religiously inclined, there is a reasonable chance you will find yourself praying here at one point of your life. For everyone, it is the pinnacle of medicine. Within it’s hallowed halls you will think thoughts and wield powers you won’t anywhere else. Coincidentally, this place will supercede many religious holidays (Emergencies don’t wait for Christmas presents L). Unfortunately, this churches Sabbath can sometimes consist of night shifts.

 

Coffee

neil conway

You will drink this productivity inducing nectar religiously.

 

Study Desk

Flickr | Simon Starr

This is your pew. This is where you will learn the sacred medical words. Amalgams of pre-fixes, suffixes derived from Latin and Greek along with the names of various random guys who discovered things. You will memorize words like Osteitis Fibrosis Cystica, Pseudohypoparathyroidism, Pagets disease (… no, the other pagets disease). Also, say a bunch of medical jargon and tell me it doesn’t sound like this: https://www.youtube.com/watch?v=HX_bjODugDQ

 

Atul Gawande

Flickr | Center for American Progress

The patron saint of becoming a successful doctor while pursuing one’s passion of writing good books, and giving respectable and accurate medical advice to all.

 

Dr. Oz

Flickr | CaWalnuts

The universally likable, double Ivy League graduating thoracic surgeon who fell from grace. A doctor who once knew the ins and outs of the Krebs cycle, cardiology, and the tenets of evidence based medicine now saying things like “this pill (with unsubstantiated claims of efficacy) is magic”, “ buy this (most likely useless, possibly dangerous) new drug” or “ I would give my family this drug (because it probably has no clinically significant effect anyway)”.

 

STEP 1 Studying= Ramadan/ Lent

Flickr | ColorfulFoxes

What good religion doesn’t have a period of sacrifice? Does giving up something you like for 40 days or more ring a bell? (i.e. your social life/hygiene/sanity…) Does doing something up from sun-up to sun-down sound just a little bit familiar? Ya, just like religion, medicine takes a bit of somewhat tangential sacrifice to make it to the promised land. I mean, do all American doctors really need to know the molecular characteristics of Ebola?

 

Becoming an Attending= Heaven, Nirvana

Flickr | tommyscapes

That time every medical student dreams about where one gets to save lives as a respected member of society, in control of their own life and most of all, not indebted to the government. Unfortunately, just like Heaven and Nirvana, nobody knows if this Promised Land really exists. However, that doesn’t stop the legions of would-be followers from applying every year.