Random Neurons Firing In My Head turned 2 today!

One of the first things we’re told while starting medical school is that a few of us will become hypochondriacs. So appropriately, I’ve been studying microbiology intensely over the last two weeks and pretty much burnt myself out with 10 hour study days. I decide to book an appointment for a massage in hopes to reset my mind so I can get back into studying. 

I show up at my appointment, undress and the first thing I notice when I’m about to put my face down into the massage table is that all they have is tissue paper protecting my face to their table. All I could think about was the different microbes that could be living there. All the encapsulated and spore forming bacteria that could survive from previous clients. I decide to just man up (yes, man up in a massage parlor) and just put my face in. The entire massage all I could think about was what bacteria’s I could be infected with if the masseuse accidentally punctured my skin with her nails or if she didn’t wash her hands after using the bathroom. If I was infected, what antibiotics would I use? What symptoms would I get to come up with my diagnosis? FML. 1.5 hours after, I pretty much paid money for a study session. 

*just in case you never heard of the RED advice mallard meme, it basically gives you bad advice. Please don’t be an idiot. Use these “tips” appropriately. 

1. Tell doctors they are doing their procedures wrong and that you’ve read in a text book that it should be done this way instead. Doctors will be impressed by your knowledge and will praise you with compliments. 

2. Point out senior doctor’s bad habits. When you see a doctor just casually wash their hands instead of properly scrubbing in, let them know. No one wants bad habits. 

3. When a doctor tells you to do meaninglessly paperwork, let them know it’s a waste of time and it’s not what you signed up for medical school for. Doctors will appreciate your honesty and will respect your assertiveness. 

4. Haven’t had lunch? Complain to the boss that you’re hungry and there’s too much work to do. Everyone loves a person who speaks up. 

5. Let the patient know it’s your first time doing a procedure, they will be extra nice to you and it won’t scare them at all. Patients love and welcome newbies. All of them want to be your first for an epidural.

My absolutely adorable niece during my visit home for the holidays

Scrubbed into surgery and I decide to read the post surgical report and saw that the nurse entered my name under surgical assistant as J. Chang. MY LAST NAME IS NOT CHANG! Not even close…

A little over two months ago, someone very important to me passed away from bowel cancer. As I spent my final moments with her, watching her health deteriorate, I felt hopeless. Knowing nothing about medicine or any of the treatments the doctors were giving her, I felt the only thing I could do was sit back and watch while I put 100% of my trust into a doctor hands. Meeting him merely minutes before telling me he was going to cut into her was not reassuring. I realized that as a doctor, patients have to invest a lot trust in you. First impressions, confidence and knowledge can determine whether a patient accepts or denies treatment. 

It’s been nearly a month working in surgery for me and I’ve learned and seen so much. Last week I witnessed a left hemicolectomy where the doctor removed a huge tumor from the patients bowels, the same procedure my auntie went through. As I stood there, the surgeon removed 2-3 lbs of bowel, it reminded me of her and how I am now on the other side of the operating doors. Over the last year, I can feel myself growing and becoming the person I’ve always wanted to become. Learning about diseases, medications and treatments which could save lives and potentially could have saved my auntie’s life. If only I knew some of the symptoms earlier, maybe I could have recommended she got her colonoscopy earlier. I hope I can use this experience to help motivate myself to work hard and not only become a good doctor but one that can actually make a difference in medicine. Experiences like these is what drives people to do amazing things. I can make my auntie live on through the motivation that she gives me. 

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If only this worked…

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1. I know absolutely nothing. After completing my first year in medical school and working in the surgical ward, I’ve come to the realization that  everything I have learned up to this point (physiology, anatomy, ethics, etc) hold pretty much ZERO merit while working in the hospital. Sure I can tell you how the body metabolizes specific medications, I can name every single layer of tissue the surgeon is cutting into and the process of coagulation once the surgeon cuts into their patient but once the doctor asks me a simple question “Patient is febrile, what do I do next?” I stare off into the distance and wonder wtf I’ve been learning this entire year to make me feel this clueless?

2. It’s OK if you don’t know anything because everyone in the hospital treats first years like we’re incompetent. Actually I don’t blame doctors for thinking this because honestly we pretty much know nothing clinically related. We don’t learn anything clinically related or anything about pathology until second year. However, it’s still pretty embarrassing when a doctor asks you a “simple question” and you panic because you don’t know the answer. 

3. Once you’re in medical school, you start back on the bottom of the food chain. Remember when you were in undergrad and you looked at medical students as gods and you glared with jealousy as they walked by talking about patient cases? Once you enter medical school, you’ll realize that you have a long way ahead of you. After 4 years of medical school comes residency for another 3-8 years. Following that is another 1-2 years of fellowship. This means that there are students who are 5-10 years older than you who don’t have time to deal with incompetent first years. However there is plenty of bitch work in medicine which sits on a desk waiting for us first years to pick up. 

4. If you think medicine is anything like it is on T.V. then you deserve to be punched in the face. If you are considering entering medicine or if you somehow got into medical school thinking it would be like House or Grey’s Anatomy then you are naive and are entering medicine for all the wrong reasons. Most of the time medicine is repetitive with 80% of the same diagnoses and hours and hours of paperwork. The only breast exams you will be preforming will be on 80 year old grandmas with their boobs down to their umbilicus. Whenever there is an emergency, it’s extremely exciting but it’s also really rare. As for shocking a patient back to life, it never happens and if it does, it’s because a doctor royally screwed up in surgery or a patient was probably going to die anyways from some severe accident in the E.R. 

5. When you become a medical student, you develop the super power of invisibility in the hospital. Doctors never acknowledge you and if they do it’s because you said something or did something inappropriate and you’re about to get yelled at. To doctors, first years are nothing but a house fly following them around in the hospital. They will not speak to you, they will not look at you and they will not even mention you when talking about the medical team. As a med student, you have to just suck it up and accept it. Doctors are extremely busy and they don’t have time to explain every diagnosis and tell you where to go every minute of the day. The key is not to take it personally and try to gain their attention by reading up on procedures to impress them with your knowledge. Also, invest in a comfortable pair of shoes because doctors walk ridiculously fast and will try to ditch you as often as possible. 

6. Nurses hate you. Remember being invisible? Doesn’t apply to nurses. They watch every single move that you do and they won’t hesitate to snap at you for everything you do wrong. To them, you are nothing but a 10 year old kid trying to cause trouble in the hospital. They have no sympathy for you. Once I got a little too close to a sterile surgical table and a nurse ripped me a new one. Medical resident walks in and does the exact same thing and she says nothing. The hospital has a strict power hierarchy and medical students lay on the bottom. Again, just like doctors, you have to earn their respect. I hear nurses like baked goods. Try studying a cook book to earn some brownie points. 

7. You will never feel smart ever again. Remember sleeping in till noon and going out partying till sunrise then heading off to lecture hungover and still getting away with a 3.8 GPA in undergrad? Not possible in medical school. You study a minimum of 8 hours a day just to be called average. There is an unlimited amount of information we’re expected to retain and new medical information is developed every minute for our poor brains to absorb. I’ve studied so much that I’ve forgotten people’s names because I need to make room for drug names. If I accidentally forgot your name, it’s because I’ve replaced it with Atenolol, Lorazapam or Omeprazole. 

8. What you practice in school is completely different in real life. I’ve learned how to take history and how to palpate for masses on other medical students but no one ever taught me how to take history from a 50 year old drug addict rushed into the E.R. screaming his head off in pain or palpating a morbidly obese patient without insulting them by saying “are you sure you have pain here? I can’t feel anything solid…” I’ve learned how to cannulate and the text books tell you exactly how to do it (inserting the needle at 45 degrees) but in real life, no one actually does it that way. Actually coming in at 45 degrees doesn’t even work. Every doctor has their own method and it takes practice because every patient is different. Just this week I’ve made 3 patients cry and one scream so loud a resident had to run in and see if I was murdering them. No such thing as “easy” in medicine. Got to just learn by doing and hope you’re not my first guinea pig patient. 

9. Medicine is a game of probabilities. We tend to believe that doctors diagnose a disease with precision and the decisions they make are either black or white but this is not the case. During my time in surgery, I’ve learned that medicine is nothing but a probabilities game. You make a decision calculating the best probable outcome for the patient. Next time you see your doctor and tell him your symptoms, listen to how they talk. They always say “your symptoms suggests” or “these findings leads me to believe.” They will never say “You have X” unless it’s clearly herpes on your face. Every test doctors run is to eliminate possible diagnoses and increase the probabilities of a likely treatment which may or may not work. See all of those ambiguous terms I used in my last sentence. I’m on my way to becoming an awesome doctor. 

10. Having amazing patients can make your day but don’t let the bad ones ruin your day. This morning I had a crazy schizophrenic patient who yelled at the top of her lungs and degraded every doctor who walked into the room. Security had to come because she was threatening the staff. I had another patient who was sweet as can be and today she was diagnosed with bowel cancer, one of the worst types of cancer with a very poor prognosis. Bad news is part of the job and crying about it will do nothing for you. Moreover, most patients are in the hospital for a reason, because they feel like shit. Therefore, they will treat you like shit. They are in pain and they need to vent their anger. Don’t let this get you down. Remember you signed up for this. Good patients can also cheer you up. I had a patient who I performed my first cannulation on. I stabbed her in the hand multiple times and she bled all over the sheets. She turns to me and goes “I’m so sorry you couldn’t get it. My veins are terrible. I know you can do it though.” Next try, I hit the vein and inserted my first cannula. Shes the type of patient that I’ll remember forever and reminds me why I wanted to enter medicine in the first place.  

Time really flies since my last post about my first month in medical school. I really wanted to keep this page active but I just haven’t had time. I guess it’s just something to add on next years New Years resolution. Medical school has pretty much been what I expected, lots of studying and barely surviving. No more cramming the night before and doing well. Besides the studying, life in Australia has been awesome. I just started my Surgery elective and it has been more than I ever expected. I honestly thought it would be strict and all I could do was watch from a distance but the doctors actually gave me plenty of responsibilities. Over the last two weeks I’ve: 

1. Scrubbed in to surgery

2. Helped stitch and close wounds

3. Stuck my finger inside a patients abdomen to feel a hernia 

4. Helped pull out a lipoma from a patients arm. 

5. Controlled the camera for a Laperscopy 

6. Performed my first cannulation 

There is much more to add to that list but I can’t quite remember everything. Such a wonderful experience. Just one more year and I can return back to America but also till my dreaded USMLE. I must admit that studying for the USMLE has been much more bearable when the information actually applies. I’ve been studying G.I. since most of the patients come in with G.I. problems and studying has actually been “fun.” Did I just use fun and studying in the same sentence? Anyways, one month left until I return home! I’m so excited! I miss everyone and I have a lot of people to catch up with. 1/4 way to being a doctor! Woohoo!!