Friday, May 6, 2011

Gladiators and Lemmings

Now that I am graduating from medical school, I have come to realize what kind of people medical schools train us to be: Lemmings.

Forget about the long graduation speeches about how we are the future of medicine, the upcoming generation of leaders, blah blah blah and then some. Medical school has spent the last four years of our lives brainwashing us to be clones.

Yep, we are trained to be mindless drones that tag along with our attending physicians like shadows. If you've ever been to a teaching hospital, you'd know this to be true, because you've seen the characteristically long line of white coat ducklings following after a doctor so old that he probably performed surgeries during the Civil War.

So we are lemmings.
"If the doctor jumped off a bridge, would you?"
"Yes, if it would get me a good grade and a letter of recommendation."

As you go along in your medical studies, you find yourself writing the same prescriptions that your attending does, even despite there being newer and more advanced drugs out there. Trying to convince your attending physician that you can use a new drug based on a cutting edge article, is just as dangerous as sticking your head in honey badger cage. You will get eaten.

I'm serious, you ever see an old doctor jump a student, white coat and tie flying as he gets them into a cobra arm bar? It's a major WWF smackdown.

So to avoid getting the crap kicked out of you by a geezer with a stethoscope, you become a lemming. Do as smart Romans do: Adapt to your attending's routine or perish. Sounds easy enough? Yeah, well nothing in medicine is ever easy; it's a ritualistic four years of hazing and torture that would make terrorists proud. Forget about water-boarding, bring medical school before the Senate; they would be horrified.

Anyway, you're stuck in lemming mode just to survive. You become one with your attending physician's routine, which of course changes every month with each new doctor that is teaching you. So you spend the first two weeks of every month in an identity crises until you are drawn into the new lemming mode with your new preceptor.

You know in nature that if you took a lemming every month out of its normal habitat and placed it in a new group of lemmings who believe that jaundiced infants should be treated with phototherapy when their last group thought that they should be treated with hemoxidase inhibitors, then that lemming would die of a heart attack.

One out of every three medical students spontaneously combusts after their fourth clinical rotation. Scientists are baffled.... at how they could even last that long. Researchers have come to discover that while in their natural environment (the hospital) medical students have developed unique behaviors:

After working 12 days in a row at 12 hours a day, med students start to sleep standing up, walk into walls, drool on charts, and trip over their own pride with the patented, "dur?" response to their attendings' questions. Or they try the oblivious, "I concur." If you ever hear a "I concur" come out of a doctor than you know that zombies or a couple of board exams have already eaten his brain.

There are few times when medical students can pop their heads out of the lemming-zone. When they are doped up on coffee and bouncing off the walls. Or when they are goaded into bouts of gladiator-style competition by their preceptors. Attending physicians pay good money to watch a couple med students go all chainsaw massacre on each other.

It is a popular sport. Some people watch cock-fights, physicians watch medical student fights. It's like Mixed-Martial Arts but with lots more blood.

The attendings bring out a bucket of popcorn and start the fight off with: "Which one of you can tell me the most common cause of hyperphosphatemia in a neonate?"

That's when the drone-lemmings turn into bloodsucking spawn of medical hell. Fangs and claws. Maybe a couple battle axes. Then goes the fighting dustball of crazed medical students tearing each other a new one.

After the blood bath is over, the victor stands on top the pile of his fallen competitors with a triumphant grin. "Renal tubular failure. Bwahahahahaha! I am victorious!"

Not for long. No medical student remains in the triumphant zone for more than a nanosecond: medical schools want to train lemmings remember. ;) Normally in a gladiator challenge, the victor is revered and given a seriously awesome meal. Medical students are not so lucky. We get a swarthy nod of the head. That's it.

Seriously have you ever seen a Gladiator fight for nod of the head as his reward? Nope. Well, that's because gladiators are not lemmings.

Then everyone as programmed slips back into the mindless coma, the losers muttering incoherently between slobbers... "I was going to say renal tubular failure."

There have been a few times in history when medical students have attempted to break free from the chain of command. Some have sought to implement new ways of establishing free medical care. Well, that didn't work out to well... Thanks to them we have the TWA. ;-)

Saturday, April 9, 2011

Blood, Guts, and Baby Butts

I never realized that I would end up on a neonatal intensive care rotation at the end of my medical school career. I only have a couple months left before I graduate and go on my residency. So here I am, fulfilling my last pediatrics requirement in a NICU.

NICU is hospital standard for works excessively long-spawned-by-satan-hours with territorial nurses, flirtatious respiratory technicians, a couple nazi lactation specialists, and lots of babies.

Neonatal Intensive Care Unit, or NICU, is the place where the babies whom are premature, have jaundice, or have serious heart and lung problems are brought to in order to keep them alive. If you manage to gain access to a NICU-- it's like Fort Knox on a good day--you must first scrub your hands clean for hours with a scouring pad. Keeping the germs out is important. The little ones are so tiny and delicate that even the smallest bug could kill them.

The NICU is an endless maze of little glowing pods with tiny baby butts in them. Some of these pods, or nesting units as we call them, glow more than others. The brighter pods use blue lights and have little iridescently lit baby beds that put Tron to shame. These babies are are our community sunbathers. Wearing seriously cute shades, they chill it out under lights like burgers at McDonalds. Do you want fries with your baby?

These tiny munchers have hyperbilirubinemia, which is due to the destruction of their blood cells. The sunbathing, or phototherapy, breaks down the bilirubin and the baby can go home after a few days.

As a medical student working in the hospital, you tend to want your patients to go home. It's the first concept that residents teach their students: do everything you can to send the patient home. Residents feel that the most important thing that they can pass on to the next generation of doctors is cynicism. It's like the intern motto. "Be cynical. Be all cynical you can be." Well, that and "Talk isn't cheap: Charge your patient $100 for every minute and it will be worth listening to them."

But as any good medical student wouldn't do, I resist those notions, especially on this rotation. I like having my baby patients. They are cute, adorable, and you just can't help but say every freaking five minutes, "Ahhh how cuuuute!!!" It drives the attending physicians nuts.

That and the nurses have to check your purse every time you leave just to make sure you are not carrying out a baby in it. Yep, most of these babies are so small that you can actually fit them into a normal sized purse.

The downside to this rotation other than the terrible 14 days in a row shifts of 12 hours per day (seriously we only get 4 days off the entire month)... weekends? What are weekends? Anyway, the biggest downside is when the babies die.

This is where a team of doctors, nurses and technicians crammed around a tiny baby the size of a basketball player's palm, trying to shove tubes down its throat to keep it from dying... while three bewildered medicals students stood afar off in stark terror. You ever feel your face turn white? I never thought I would know how that would feel until that day.

I've seen adults code. Adult heart attacks are like a free for all, every one pushing to get a chance to save the patient's life. Medical students have been known to go all Mike Tyson on each other just so they can be the first one at a code. Heck, you rush in there, practically trampling your colleague... (getting ten stitches won't kill her, she'll live)... just so you can jump on the patient's chest and perform that amazing CPR which you've been dying to try. And even as the patient's bones crack under your hands... yes, if you are doing CPR right then the patient's ribs will break... you don't stop, because you are saving a life.

But when a baby starts to code, medical students all go silent... like soulless zombies. No one rushed in, kicking the snot out of their best friend to get to do the CPR. Not one of us was man enough to jump into that case. Okay, so we were all women, but that's not my point... the point is that we were all to afraid that we would make a mistake.

Not one us felt we were able to handle CPR on a baby whose chest was no bigger than an Iphone. This was not a case of "you break it, you buy it." This was a baby.

And fortunately, that baby lived.

I admire neonatal docs.