Metamorphosis

The interesting thing about learning medicine, is that no matter your personality before you begin, pretty soon you will morph into the stereotypical physician. Yeah, I know... just like mutants have the X gene, residents have the Dr gene. Douse a mutant in a vat of toxic waste and you have a superhero. Douse a medical student in a residency program and you have almighty cynical-holier-than-thou Dr. Beastard. Or so, I hope to aspire too. ;) well, not exactly, but when you find yourself at 3 AM on a night shift in a stare off with a bunch of police in the Emergency department, irked that they brought you new admits, then you know the metamorphosis has taken place. Back in the day, you saw the world with compassionate loving eyes, animals followed you everywhere like Snow White, you thought all mankind were good and patient's didn't ever lie. But after the fifteenth crack-head pregnant woman that asks you to abort her baby with a hanger so she can have her opiates (seriously, a patient or two has asked that of me) and hundreth patient calling you foul names because you bother to wake them up in the morning at 9 AM (remeber you've been up since the Butt crack of dawn worrying about them surviving the night), you tend to morph into the cynical doctor. So here I was at 3 AM, staring down a group of police officers in the ED. Night cops actually are really sweet people. They bring in some of the most interesting cases. The alcoholic that thought he was Abraham Lincoln. The IV drug user that taught me all about how took cook crack cocaine... that was interesting. The two men that got in a stabbing fight but for some reason both blamed it on their dog. Then there was the guy running around in aluminum shorts that was convinced the aliens were coming to get his sperm. Normally, I don't mind the entertainment, but I was tired and cranky. And I just didn't want to admit another crazed lunatic when I already had an intensive care unit full of critically ill patiens to already worry about. So I looked their Sergent in the eye and said with pouting determination, "Oh, no. What ever you brought in, just take it right back out." They laughed for a good ten minutes. I was serious. They thought I was funny. "If it's a face eater you just go and to take it to another hospital." I was still pouting. Two weeks without much sleep can make you pout like a two year old. One of the handsomest cops (either he was really handsome or sleep-deprivation turned him into a coyote-ugly for me) smiled, "Ah, we'd never bring you a face eater. We like your face. We bring those to _____." (I won't say the name of the large trauma hospital 30 minutes south for their sake.) It was true, they had four cases of bath salts sniffers in the past month that they had taken the trauma center. Notice, the paramedics bring in people that don't eat faces. Cops bring in the crazies. Yep. They tend to bring us the blade swingers, the face eaters, the drunk-off-their-skunks, and the good old talks-to-themselves-schizophrenics that run around naked in the middle of the night. At any rate, it doesn't matter if you didn't go into a psych residency, you're still going to get a couple of crazy admits in the middle of the night brought in by the police regardless. It just happens.

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. ;-)

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.

House sucks

I joined the rounds this morning where 8 residents and four specialists, and me, if you can count me, that took upon the cases from the weekend. For those of you who like House: no one looks glamorous at the butt-crack of dawn and when they have stayed up all night working on a patient's case. House sucks.

Doctors love to laugh. We love to enjoy the crazy nuances of our work. But there are days when we just can't laugh. Today was one of those days.

One day you can be talking to a patient about their children and the next you walk in to find them, writhing in their bed completely gone to the world with encephalopathy. Then you watch as they ship the patient down to shock trauma.

One day you see a happy mother talking about what she is going to name her child and the next, she's crying over the body of a still born child.

Today left me exhausted. There was no way to laugh and there were too many ways to cry, but in the end, we know that there is always hope for a better tomorrow.

Run Residents, Run!

In a world operated by pseudo-geeks, the last thing a patient wants to be called is "cool."

You remember when 'bad' meant 'good,' and 'cool' meant 'hot'? Well, that's not the case in doctor-talk.

Cool is bad, very bad. In fact, it is the worst thing to be called. Cool means that a hundred white coats stand around your bed ogling you like you're a laboratory specimen from the planet Plutarkion. Cool means that your disease is so rare that it probably doesn't even have a name yet. Cool means that you're two steps away from meeting St. Peter at the pearly gates.

So basically, if you look in the English to Physician language dictionary, cool translates into big-paycheck. In the medical student handbook, cool means the patient is has more medical problems than Tiger Woods has girlfriends. Not a good thing.

Today, we had a cool patient... poor guy. Worse was that he was 'cool' while in the intensive care unit (ICU). Now that is a pretty bad situation to be in.

Let's just put this in perspective: We had a cirrhosis patient whose skin was so yellow that she looked like she had been attacked by a mob of highlighters. She wasn't considered cool.

Another patient was coughing up enough mucus to lube six semis. He was not cool.

Third one bleeding out of several orifices. Still not cool.

Train wreck as in 'does hamburger mean anything to you?'. Nope, not cool. Considered a total yawner.

This poor man was cool. Now this is not to say that being designated cool does not mean that all compassion for you is gone from the medical community. It actually means that you become the major focus of the day. Physicians work extra hard to keep you alive and even harder to make you feel better fast. But I won't say that your situation would not be a teaching tool for years to come; patient privacy be willing.

And the doctor that I was working with, recognized a good learning experience when he saw one. He knew that the patient needed round the clock care and no one else could do that better than the residents. Bwahahahaha!

Residents are a different breed of medical professional all-together. Physicians balance patient care, politics, and paychecks. Medical students are wide-eyed and excited about everything... we don't even have a chance to think about paychecks. Heck, we don't even know what a paycheck is.

We think that making $40,000 a year is an amazing salary, because we're living off of top ramen and Fruit Loops (refer to last blog on the dietary demands of the medical student). We spend to much time being worried about tests and graduation to even think of anything else.

Residents, on the other hand, worry about three things: sleep, sleep, and sleep. If you read any 'how to survive residency without going insane' book, the first instruction always given is: sleep when you can, eat when you can, and pee when you can. Words to live by.

So here, my good preceptor talked with the resident's head Attending (refer to physician language dictionary under 'clinician professor that runs residents ragged' ) about adding the cool case to their list of patients. I stood outside the Attending's office, while they talked.

The residents appeared out of the shadows one by one cautiously, looking like wide eyed, unshaven, starving wild men. I thought for a moment that I should throw them a piece of meat, but there was a sign behind me that said, "Don't feed the residents."

Then like all creatures of the wild, their ears perked up and they caught wind of the conversation.

As soon as they found out that they were being given another patient, panic ensued. It was like I was on the Serengeti and a lion just jumped into a herd of gazelle. They scattered to the four winds. A couple of them even ran into each other, trying to scramble away for safety.

Seriously, that is how it went down. My jaw dropped. I've never seen sleep deprived, starving people run so fast in my life.

The attending and my preceptor came out of the office, happy. It was set. The patient would not only be followed by my preceptor but also several of the residents. My doctor looked around. It was as silent as the grave. I think a couple of tumbleweeds blew by.

He looked around. "Where did the residents go?"

"They ran." I said, the disbelief still acute.

My preceptor laughed. "Nah. They probably just had work to do."

"No, they ran." It was a flat statement.

My preceptor decided that he could find at least one of them at the respiratory ICU (RICU). When we arrive in the RICO, no residents. Not a single resident to be found.

Just so you know, there are around 40 residents. That's a lot of bodies to hide.

My preceptor asked the nurses, "Where did the residents go?"

The nurse replied. "They heard you were coming and ran."

He just blinked at her surprised then said, "Oh they're probably just in the Shock Trauma Unit (STU)."

The nurse lifted an eyebrow knowingly, and said, "Mmmhmm."

Another lap around the gia-normous hospital and also at STU the residents were no where to be found.

My preceptor looked around, scratched his head and asked the head nurse, "Where are the residents?"

The head nurse replied with a dry expression, "Someone said you were heading this way and they scattered like rats."

My preceptor dropped his head, feelings hurt. I patted him on the shoulder, "Don't worry, you can still catch one." I smiled at him soothingly. "They can run, but they can't hide. You have their pager numbers."

He looked at me with an evil grin. There have been many scary things in this world: Jason, Freddy Krueger, Hannabal Lector, the Ring, King Kong. But nothing compared to that grin.

Glee in his eyes, he dialed the pager number. He had one. The lion had caught its prey and went for the juggler. The poor resident came back in dragging his feet, head bobbing as if he was thinking to himself, "oh alright, I'll do it."

To be continued....

Waiting in Exile...

There is nothing worse for a medical student then having time on our hands.

You'd think that we'd enjoy doing absolutely nothing and use the time to sleep. But, heck no! We're freakin' wired like robots to go 24/7.

The only time we sleep is the moment when we crack open a text book. (image from http://socglory.blogspot.com)

Vacations to us are like emotions to that Star Trek's android Data... we have no idea whatsoever to do with them.

To many medical students, vacations are scarier than The Shining movie: "What?! We don't have to study for tests?! Nooooo!" It's like we become like pariahs. Other medical students run from us as if we're lepers about to drop a toe on them.

And we get the awkward phone calls from our med school buddies. "What? You're not on rotations?" The other end goes silent as if they're expecting the Psycho theme song to emanate from their cell phone. Then the conversation ends quickly with a "Uhhh... hey, man I got to go," as if they're trying to crawl the walls to get away from talking about vacations.

Medical students are an odd bunch, and I can say that without bias because I am one. I gave up normalcy when I got my acceptance letter. It should have been in the fine print: warning, attendance here may turn you into someone who talks about eating while cutting open dead bodies and whom says, "cool" when the grossest diseases are presented to you.

As medical students, we live an odd lifestyle. We eat, sleep, and drink medicine. Our social life consists of our medical textbooks and talking about tests.

We like getting no sleep, not exercising, getting fat, becoming overstressed, and ingesting insidious amounts of sugar, top ramen, and caffeine just to become better health professionals for you. (Image from www.zazzle.com.)

As for you our patients, we nag you about being healthy. As for ourselves, that's a different story. We believe that physicians are super humans that can live off sticks and excessive amounts of caffeine. Oh, and doctors don't get sick--except while on pediatric rotations: those are our Kryptonite. One pediatrics experience can take down the most powerful of all physicians faster than a speeding bullet. Our enemy: children, the adorable little out-break monkies. (Note: I love pediatrics and kids.)

There's a cosmic law out there that states during the exam block weeks that we affectionately call "Hell Weeks" --that's an endearing designation of love if you hadn't already guessed -- medical students must refuse to bathe the entire seven days. It's initiation. No personal hygiene allowed while taking tests. Bathing is vorboten!

Yeah, you can only imagine the smell of more than 300 medical students at a single school with humming armpits and having been eating only bean burritos and noodles all night long. Let's just say that Professors own gas masks.

If a student walks in dressed nice, makeup done, and smelling like a poached lily during block week, the Bugler starts the funeral march, "Ich hatt einen Kameraden," and offers them the Final Salute. (Images of club and stressed students from www.soompi.com/forums/index.php?showtopic=314121)

I know that all too well when the coffee-blooded zombies that were once my classmates hissed at me every block week because I just had to look like a sparkling, prissy chic when taking exams. It was my good luck ritual: there's was snarfing down keggers of Starbucks. Everyone had their "good luck charms." Some people wore their lucky underwear; I chose to Tyra Banks myself.

Then again, I'm not your average med student. I kind of got the Legally Blond motif going for me.

So here I am, in exile from rotations during the holiday break. Soon, I start my next rotation in Intensive Care---which doesn't get it's name of "intensive" for nothing--- and yet, I've got vacation-cabin-fever and can't wait to be back in the hospital to work the long hours and back breaking shifts.

Enjoy your vacations, eat right, and change your underwear. Words to live by.

Christine

P.S. This is my relaxing blog about my medical school and soon-to-be Internship experiences.

I also have another blog at disastermedicine-christine.blogspot.com. It is an educational blog dedicated to wilderness and disaster medicine.