Will the Real Doctor Please Stand Up?

Yesterday a woman had a stroke in Costco. Her family and a cashier yelled for medical help, and I walked (ran?) over, thinking that I would help until a doctor showed up. While waiting, I introduced myself and took her pulse, and asked the manager to bring the AED just in case it was irregular. I asked her who she was and where she was, what day was it, and did a mini neurological exam. She seemed confused, and had muscular weakness on the left. I just stayed with her and made sure she was breathing and her pulse was regular, and soon, the paramedics arrived. The manager of the Costco thanked me profusely. I was happy to help. Of course, I would have been grateful to get a free hot dog too, but whatever. Happy to help.

A similar episode happened at church last week. I was walking around the cafe, hoping to score a free muffin (are you seeing a trend here?), when one of the pastors grabbed me. "You're a doctor, aren't you?" "Well, not quite...I'm still in medical school...what happened?" It was a kid that had bounced out of one of the bounce houses right onto his tailbone. He was laying in the grass in severe pain. I talked to him and looked at his backside and assessed him neurologically, and he seemed okay. Since he was very overweight, I advised his parents to take him in for an xray to rule out a vertebral stress fracture, and told him to put some ice on it and give him some ibuprofen.

In both of these situations it became apparent to me that another doctor wasn't going to come...and that I was the most highly trained medical professional in this situation. What? When did this happen??? Will the real doctor please stand up?

It doesn't seem like it should be me...but in these situations it was. I am not a licensed physician, but in these cases I was the closest thing to it. It struck me as a great responsibility, and an honor. You are never "off duty" as a physician. There is always the possibility, wherever you are, for sickness and injury. And you try to help the best you can...even as a little doctor.

A Day Off

I know that a torn ACL should not be a cause for celebration. But when it is my attending's wife having surgery and I get an unexpected day off because of it, its hard not to root for the injured knee. Today was busy- I got to do all the things that usually have to happen during business hours that I am normally not home for.

• I had a plumber come fix the leaky toilet
• I took the pets to the vet for shots, checkups, medicine, and wing clipping
• I paid the water bill in person and got a stamped receipt (rather than my usual routine of poking it through the crack in the door)
• I did enough grocery shopping to sustain us through a lengthy famine, which is probably how long it will be before I can go shopping again
• I mopped
• I made chicken, black bean and rice enchiladas in happy preparation for my sister's visit this weekend
• I actually washed my clothes instead of just buying a new pack of underwear
• I studied (like every day)

I thought being a medical student would preclude any fun and extra time I might have. And to some extent that is true. I don't notice it really until I am around a friend who has a job, has friends, has places to go and money to spend. And then its a little lonely when I need to stay in and study. However, this is actually better than I had expected. I can still cook nice dinners for my husband, pack him a lunch, and visit with my sister. I can work out and work on my house and still be a good student. It gives me hope someday that my practice as a doctor will not consume my life; that I will have time for my husband and children. I want to be able to be a good mother and a good doctor. I think it also depends on the professional choices you make. What specialty you choose. Yes, I've chosen to make medicine my life, and nothing else would be right for me. But I also want other things in my life, and hope that it only gets more balanced from here.

Surprise!

I delivered a baby...always a thrill, but this one had an unexpected twist. I didn't know what sex the baby was supposed to be, so after I delivered the baby I held it up for mommy and said "Congratulations! It's a boy!!!" Well, mom and dad both stared at me and said "they told us it was a girl- 99% certain. We picked out a name- Layla. We have a pink nursery." I said "well, of course you can name him anything you want....but I think he might be teased if he's named Layla." They just stared at me. Finally dad said "are you sure??" "yes, i'm sure...come here." so i pointed out the male parts...a couple times before dad believed me!

I came back the next day to do the postpartum exam, and the baby boy was dressed in a little pink sleeper...mom's parents were coming over with some boy clothes later, but hadn't gotten there yet. Hee hee hee. I love that in this age of modern medicine, these funny things can still happen.

A Sad Story

I love ob/gyn. I love the mommies, I love the daddies, I love talking to them throughout the pregnancy. I love deliveries and c-sections. I love the older women, talking to them about menopause, osteoporosis, and healthy aging. I even like gyne surgery and pap smears, things I never thought I would enjoy. Most of all, I love feeling like I can make an uncertain or uncomfortable time a little more understandable and comfortable for a woman. Ob/gyn is great. The highs are high...a healthy delivery, a healthy mommy. The lows are low.

Today I saw two babies die. One was a second trimester miscarriage, one was an IUGR with not enough lung maturity to survive. In both cases, it startled me because it was supposed to be a normal pregnancy. Only when I saw the mother's water break in her 15th week and only when I opened the uterus did something seem wrong. The 15 week old baby was perfect, 6 inches long, with facial features and tiny fingernails. I don't know why it was born too early. What I do know is that it was my responsibility to help the mom deliver safely and to support her, and communicate to her that this was not her fault. It struck me as a tremendous burden on the physician, to both medically and emotionally care for the patient while experiencing their own shock and grief over the situation.

One way to survive is to distance yourself from the patient and the situation. This to an extent is the calling of the doctor, so he can provide the best care possible. I feel like I am good at this. But I also feel like it is not in my nature to become a doctor who is aloof and distant from patients' needs and pain. One of the main reasons that compelled me to go to medical school was that I care about people.

So my question is this: how does a doctor deal with his or her own sadness over a patient's situation? I suppose in the end it is a mark of a doctor who cares deeply about his patients, and that is the kind of doctor a patient needs.

A Funny Story

It takes awhile for those close to you to get used to thinking of you as a physician. A funny case-in-point:

I had gotten a bad head cold after receiving the intranasal live swine flu vaccine. My mom asked how I was feeling, and I responded "Well, I'm not quite ready to go to the OR yet." Mom said "What?? I thought it was just a head cold!" "As the surgeon, mom, not the patient...."

It takes awhile.

New Blog

Well, I have never blogged before. It seems like the 21st century's solution to "dear diary", and it seemed presumptuous to assume that anyone would have time/interest to read the ins and outs of my life as a medical student. However, it seemed to me that I am experiencing so much that is new on a daily basis, that this might provide a record to me of this unique time in my life- the funny stuff, the first experiences, the hard stuff. Also, much like a diary, perhaps it provides an outlet for me to "work out" problems I have, observing patient pain, doubts about becoming a doctor, difficulties with training. Doctors by definition have a difficult job, as physical suffering is our job to treat, and sometimes it is hard to see patients in pain. I don't know if I feel this more acutely as a student, and this will fade as I become old in the profession, but for now I think this blog will be a good record of my thoughts and progression to becoming a physician.