Tuesday, April 27, 2010

Med School Lesson # 1

It's hard to drive in high heels.

I can press the brake just fine, but the gas pedal is going to be the end of me! After several seconds of wondering why I'm not going anywhere and cursing Toyota for making a defective gas pedal, I remember that it's just easier if I take off the high heel and drive barefoot (which is possibly illegal, don't turn me over to the cops).

What does this have to do with medical school?

Nothing really, except let's just take a moment to marvel over the fact that I actually wear high heels now. My mom is reading this and having heart palpitations over that last sentence because I do not dress up. Ever.

I think I aged my mother 10 years when we had to buy a suit for my med school interviews, because I hate shopping in general, and I'd rather drink battery acid than shop for suits. My mother is a saint for not murdering me and stashing my body in a changing room. So the fact that I voluntarily wear high heels when I "see patients" (which, by the way, are people that get paid to pretend to have something wrong with them; like Kramer did once on Seinfeld) is nothing short of a miracle.

A year ago I was wearing Old Navy flip flops with my work clothes and buying my work pants a size too big so they resembled pajama pants instead of actual slacks (slacks makes me sound like I'm 80. My grandma wears slacks and she was born in 1920.). Now I put on heels and dress pants that actually fit. Well, only on days when I have to actually dress up. You couldn't pay me money to wear dress pants if I didn't have to. I might have "grown up" but I'm not insane.
Someplace in my med school damaged brain, wearing heels equates with being a grown up.

But now I'm in medical school, and I'm pretending to be a real adult that knows something about medicine, so when I have to wear professional dress to see patients, I wear heels. And that makes me feel old (and about four hundred feet tall, but I'm getting used to that). I feel like I'm playing dress up because when did I get this old? I'm pretty sure I'm still 18 and skipping Classical Mythology because it was after lunch and who went to class right after lunch anyway?

Medical school is the weirdest combination of real life and high school (which is another post for another time) and half the time I don't feel old enough to be here, and HOLY CRAP, I'm learning how to save lives and I'm not old enough to have that type of responsibility. The reality of this blows my mind sometimes because most of the time I feel like I'm still in college. I go to class (and I skip class), and I study, and I turn in homework, and I take tests (and I sleep with my notes under my pillow the night before the test because osmosis totally works).

I have to remind myself that, unlike college, if I don't learn this information, my grade won't be the only thing that suffers. If I don't learn this stuff, my future patients will suffer. Which brings me right back to, "Who let me into medical school; I am not mature enough for this?"

I guess the only cure for this is the ole' fake-it-until-you-make-it. Pretend to know what you're doing until you actually do. So I'll keep wearing high heels and pretending to be grown-up. Well, that and saying a prayer of thanks that in medicine you don't make a decision unsupervised until you've been a doctor for almost a decade.

Wednesday, April 21, 2010

So It Begins

At my medical school, we use a teaching tool called the Human Patient Simulator or HPS. Basically its a mannequin that lays on a gurney, hooked up to a bunch of machines, in a pretend ER room. Apparently they are a big selling point for prospective students. We'll be practicing medicine on these dummies so we don't have to subject real human beings to our complete lack of doctoring skills. Poor mannequins.

These HPS dummies are incredibly high tech. You can take their pulse, stick a tube down their throats, give them drugs and watch their vitals react. Pretty cool. During orientation, the second year students tell us that we will have our first HPS lab towards the end of orientation week. Sounds easy enough. Then they tell us that this first lab is commonly called the "Shock and Awe" lab. Um... I think I signed up for medical school, not the military. That sounds bad. Apparently people have been reduced to tears during this exercise.
Welcome to medical school.

The day of lab arrives and I'm not too nervous. Yet, anyway. I figure that if the professors in charge of this circus actually expect up to know what we're doing then they wouldn't have done this 72 hours into our first year.

My little group gathers outside the ER room with a resident. We read over the patient’s history. 25 year old female. Presents to ER with severe shortness of breath and a blue tint to her skin. History of asthma. Used her prescribed inhaler. No change. Simple enough.

So we troop into the room, wearing our white coats that are so new you can still see the crease marks from where they've been folded in their plastic wrapping. We're all fiddling with our new stethoscopes, trying to surreptitiously figure out which way they go into our ears. It seems like it should be obvious, but its not. One of the docs turns mine the right direction for me. Maybe our first class should teach us how to use all the gadgets that come with our intended profession.

Three or four doctors line the perimeter of the room. One shuts the door and stands in front of it. Maybe he thinks we’ll try to escape otherwise. In the middle of the room is our mannequin, Jane Doe. Apparently Ms. Doe likes to cross dress in her free time because "she” is wearing some awesome acid wash 80's man pants, men's tennis shoes that look like they lost a fight with a lawnmower, and a t-shirt that’s three sizes too big. The least they could have done was stick a wig on her.

We all gather around her, not sure of what we're supposed to be doing or even if we're supposed to start pretending to know what we're doing. They're not big on directions here apparently. This must be part of the "shock and awe." I hope they took bets on who cries first. I’m praying the didn’t decide that it’s me.

"So what do you do first?" one of the doctors asks, like we are complete idiots. So we all mumble something unintelligible to our patient. I sincerely hope that everyone else is having problems with the fact that we're talking to a mannequin.

"Is she contagious or something?" the scary doctor asks. "Move closer. She's probably scared. You're her doctors now, you're supposed to comfort her."

We all dutifully shuffle toward her. And then immediately shove our hands in our pockets and glance uncertainly at each other, willing someone else to do somethings. One of the doctors finally takes pity on us and tells us to check her vitals. We're all abuzz now that we have some direction. Vitals! We can do this. It doesn't take a genius to count how many times she breaths in a minute. So I do. 30 bpm. A couple people work on the blood pressure, somebody gets a pulse.

Look at us! We totally know what we're doing.

Or not. "You should be telling your patient what you're doing every step of the way," a doctor admonishes. Oops. "You should also be asking her how she's doing."

We all hesitate for a second. I'm sure we're all thinking the same thing. She's a mannequin for crying out loud, she can’t talk! Someone steps up to the plate and asks her how she’s feeling.

And then... she speaks. Well hot damn, the mannequin just talked. The 28 year old cross dressing mannequin spoke in the voice of a 60 year old woman with a 2 pack a day smoking habit. And she can throw her voice because its not coming from the dummy, its coming from the ceiling. A speaker in the ceiling to be specific. In all the tours we'd had during the interview process, not once did anyone mention that the dummy speaks, or rather, that they had someone in the weird Star Trek command center next door speaking for it. Or maybe they did, and I missed it because I was too busy staring at the awful fashion choices.

Well we were all over that, like, well, like med students on As. All of us, with our varying degrees of Type A personality disorder, not wanting to be the least of the bunch, were asking questions left and right. We're asking about her asthma and her allergies and what she ate for lunch and the name of her childhood pet.

The professors have to keep reminding us to touch her, to let our patient know that we are here for her and that we care about how she's feeling. So there I am, standing by a cross dressing mannequin, patting her weird plastic hand over and over thinking that this might just be the weirdest thing I have ever done. Thinking that I have a good imagination but even I can't suspend my disbelief long enough to truly pretend that I care about this fake patient whose vitals are being controlled by the Wizard of Oz behind the curtain in the Star Trek command center.

And then it hits me. I am in medical school. It hadn't really sunk in until that moment. Even though I'd had my white coat ceremony and I'd sat through a couple of biochemistry lectures and I'd been to see the cadaver I'd be working on in the coming months, it hadn't truly felt like medical school. It felt a lot like college: same material, different hairstyle. Until I was standing there holding the plastic hand of my asthmatic dummy. This was it, the thing I've wanted to do since I was three and obsessed with my fisher price doctor's kit and the endless supply of surgical booties my dad would bring home.

My very first lesson on how to be a doctor didn't involve some inane biochemistry equation or even a good look at Oscar, my anatomy cadaver, but a mannequin in 80s clothes. My first lesson on how to be a doctor was possibly the single most important thing I will learn in the next four years: Empathy. On the importance of extending empathy to my patient. To every patient regardless of how hard it might be to do so. Even if "she" is just a machine covered in skin-toned plastic and dressed like an 80s nightmare, my patient deserves my compassion, my understanding, and my best. And if I can comfort a plastic dummy, then surely I can do the same for my human patients.

My patient needs my empathy, deserves it even. And I can't think of a better first lesson.

Welcome to medical school.