Cate recently wrote that she doesn’t think of herself as having the same body parts or internal processes as her patients. It makes sense–you put up a wall between you and the folks in the beds and on the operating tables so that you don’t lose your mind thinking about the thousands of things that can go wrong in your own body. Sometimes, though, you can’t keep that wall up. Cate came home the other night with the story of a 46 year old man she had seen that day, a father of two with a brain tumor that would allow him another year of life, if he was lucky. Then there was an older woman who was diagnosed with a brain tumor just days after the birth of her granddaughter. And that was just one day at the hospital. I started thinking about how many people’s lives are saved, lost or altered forever in that place on an average day.

One of the things Cate is struggling with now is that the doctors around her don’t show much compassion. Some of them seem to be just going through the motions (the motions of operating on the brain and spinal cord–no big deal). It seems to me that to be a good doctor you have to keep in mind that the old man in the operating room is somebody’s father, somebody’s grandfather. The newborn with hydrocephalus is somebody’s baby.  The wall you put up between you and your patients has to be high enough to let you do your job with a clear head, but low enough to remind you that your job is somebody’s life…

On Saturday, I will conclude my time on General Surgery. Most of you who read this know that some might qualify me as somewhat of a “worrier.” I find ways to worry about the past, present, and future while I’m both awake and sleeping. Sometimes it feels like my world revolves about worrying–what am I currently worried about, what did I just finish worrying about, and should I be worried that I’m not worried about something I should be worried about. That being said, it’s no surprise that I started worrying about rotating through Gen Surg approximately 8 months before I was even accepted into medical school. I imagined that in the O.R., the surgeons basically turned into Hannibel Lecter and ate the tissue samples instead of submitting the specimens to pathology. Makes life easy for pathologists but hell for medical students.

Well, like many of my worries, the energy I had spent fretting about how terrible the O.R. turned out to be fruitless and unnecessary. It turns out that 9/10 surgeons were actually friendly, courteous, and enjoyable to work with. They really enjoy teaching, and they love what they do. 

The other important learning point in this experience is that I’ve regained the confidence I thought I had lost. My incredibly difficult situation with my preceptor last year made me wonder if I was tough enough for medicine. Before my preceptor, I had always thought of myself as the strong, confident woman my mom and dad had raised me to be. Straight teeth, good education, and confidence–the only things a woman needs to be successful according to MrBruAl. Being nearly crippled by my preceptor had caused me to loose 2 of those 3 key tools (and according to Ryan, he was about to take out the straight teeth of my preceptor–so there!). Well good news…I’m back. My resident and attending set up a comfortable, relaxed situation for me and I took it and ran with it, and I’ll never look back. I know I’m smart. I know I truly care for my patients. And I know I can run with the best of ‘em.

To Do List: Worry about Neurosurgery

I know this is a long post, but I have two more things to say:

#1 - In response to Ginger’s comment about my spindly fingers: the correct medical terminology is arachnodactyly. It’s commonly seen in people with Marfan’s syndrome (think Abe Lincoln). Luckily, I don’t have fingers–spindly or otherwise.

#2 - Sometimes I try to get a laugh out of Ryan by filling in the following blank:  Today at my work, I saw/did ______ , what did you do at work today?  Well, today I filled in the blank with “saw a 3 inch worm that had been coughed up by a 15 y/o”  Aren’t you glad you didn’t marry a doctor almost???

spleenz

Two facts I learned today:

#1 - You can live comfortably with 1.5 lungs (I saw half of a lung removed from a 75 year-old patient today)

#2 - 10-30% of the population has multiple spleens. The condition is known as polysplenia. Clever, huh.

Ever since I’ve started medical school (and actually all the way back in undergrad), I’ve had this ridiculous and nonsensical fantasy that the things I read in my textbooks don’t actually happen inside my body. Glycolysis in my cells? Not a chance! Vasodilation when I get hot? Never! Immune cells constantly fighting infection? Get outta here!  As absurd as this may sound, I’m sure it’s a self-preservation coping mechanism. After all, any system that functions in my body can also become dysfunctional. By refusing to believe that I personally could be lumped into the general population’s statistics, I can slightly remove myself from my patients and avoid internalizing their conditions. As insensitive as this may sound, it is truly the only way to survive in medicine. From what little experience I’ve had thus far, I’ve learned that the key is to distance yourself from the patient’s medical condition but connect to the patient’s values.

So for the record, you who are reading this have a 10-30% chance of having multiple spleens while I don’t have a spleen at all!

On a number of occasions, Cate and I have discussed how, as a doctor (or a ‘doctor, almost’), she is obligated at all times by her chosen profession to help those in need of medical attention, both inside and outside of the hospital. For her, this brings to mind a tense scenario in which she is on a plane and a fellow passenger has a heart attack, stroke, or something equally unpleasant. Somebody yells out, “Is there a doctor on the plane?!” Thinking back to a room of a medical students mumbling a little something called The Hippocratic Oath, Cate shoots up out of her seat and saves the day with a portable defibrillator or feels for a pulse and informs the pilot that he can continue on to West Palm Beach as scheduled, ’cause this dude is dead. Then there is of course the understandable dread of having to give mouth to mouth to a complete stranger, or worse, having no idea what to do. Anyway, the point is that Cate uttered these words, or some version thereof:

“I will apply, for the benefit of the sick, all measures which are required [...] I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

…and she’s been waiting for the moment when, during her “off hours,” she’d be required to act. Well, the first such moment came not three hours ago, on our way to dinner with friends. Pulling up to a stop sign, a crowd caught my eye, and I noticed that what they were gathered around was a biker, face down on the pavement, who had clearly just been hit by a car. He was moving, and as he attempted to roll over I noticed a sizable wound on his head. Cate asked me if she should try to help and I said that if she wanted to, I would pull over. After a second of hesitation, she grabbed her phone and was out the door.

Cate basically just confirmed that the man was breathing and told him not to move, and the Fire department and paramedics arrived within about one minute. When she returned to the car, she said that she hadn’t done anything. I tried to explain to her that in reality she’d done quite a lot. She’d opened that car door and run into a situation because she was obligated to do so. It would have been so easy to assume that the paramedics had been called and to keep driving. The point, as I see it, is not that she didn’t actually save somebody’s life or perform CPR. The point is that she opened that door and ran down the street to make herself available to somebody in need. In the end, I think it was a nice reminder of what this med school madness is all about.