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Death Is Hard

February 9, 2012 by 1 Comment

In the past I have found it easy to say that it is harder to see a sick, hospitalized child than a sick, hosptitalized elderly patient. It is easy to reason that the senior citizen has lived a full life while the child has his future ahead of him. But I think this position ignores the viewpoint of the patient’s family. Sure, sometimes a family is prepared for the death of a dying grandfather who has lived a long life and is going out on good terms. But few are ever prepared for a tragic death that comes on suddenly — no matter what age it happens.

Recently I saw a patient who I shall refer to as Mrs. B. We were not the primary team. I saw her as a consult after she had been in the hospital for a rather extended period of time. At the time the consult came in the team was pressed for time so we split up the duties. I would go and talk to the patient while my colleague would put together a consul note summarizing the hospital course and patient’s past medical history using the patient record as a source.

Without reading anything about the patient I went off to find Mrs. B. All I knew about her was that she had been hospitalized for quite some time and that she was fighting an infection that had spread to the blood. As I walked up to her bed she lie silently with her eyes open. I asked her how she was doing but couldn’t make out what she was saying. I tried to ask her in Spanish but she only responded with a more excited mumbling sound.

I realized that I wouldn’t be able to take a history from her. That sort of thing is difficult in non-communcating patients. So I proceeded to perform a quick physical exam. I noticed scleral icterus (jaundiced, yellow eyes) and a few skin wounds. But nothing else really jumped out at me. I left, but not before looking over her chart and collecting her vital signs for the last 24 hours.

When we began rounding our attending began writing out Mrs. B’s information across the large white board that hung in the workroom. Everything we had been able to find from the review of the patient record went on the board. We dissected and discussed the details and the big picture. And, after almost two hours, our attending decided it was time to go and see the patient.

We paused at Mrs. B’s door to pull out some gowns. A nurse ran up to us and whispered, “She just died. The family is inside.” And, while looking at the nearest clock she added, “She died about an hour ago.”

I was shocked. I didn’t know what to think. I had just seen her and touched her just over two hours ago. And now she was gone. At the time I saw her, I had no idea how sick she was. And my physical exam didn’t tell me she was so close to death. During our discussion, though, our attending noted how bad her labs looked and that she would probably benefit from palliative care.

I don’t know how the family took her death. I didn’t go inside the room. I didn’t come back later. To me her death was sudden. I was not expected it so soon. But death, it seems, waits for no one. When it’s time, it’s time.

It is hard to care for sick children in the hospital. But I think it can also be hard to care for sick adults who face tragic endings as well.

Death is hard. Period.

Filed Under: Medical School, My Life Tagged With: , ,
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Fitness, Health, & Relationships

February 6, 2012 by Leave a Comment

A few years ago I heard of husbands (or fiances) requiring of their brides(-to-be) a contractual agreement to maintain their figure throughout their marriage. I laughed. Ridiculous, I thought to myself. Even as a male who accepts that males are visual creatures, I thought this to be a very shallow and superficial thing to ask of someone you love.

I won’t pretend to know what the motivation was behind those requirements. If they were solely for physical appearances, then I’m still in disagreement with them.

But almost 2 years after I’ve started regularly seeing patients (even as a medical student), I wonder if that sort of requirement is a bad thing. But before you call for the firewood and stake, hear me out.

Preventable medical diseases make up more than half of the medical problems plaguing this country. And in the short time I have been on the wards, I have watched as patients and their families suffered because they did not take care of themselves. Pain and suffering because people didn’t prioritize a healthy lifestyle — for whatever reason. Perhaps they just didn’t know any better. Perhaps they just didn’t prioritize it. Perhaps they just didn’t think about it.

One thing I have said to classmates is that being in the hospital and caring for our senior citizens has got me terrified about growing old. It is true that we only see the sickest, and that those that take care of themselves are able to avoid many of the outcomes/conditions that freak me out. Nevertheless, I see how bad it gets when one doesn’t take care of one’s self. I see it in the end-stages.

I am not advocating maintaining a figure solely for aesthetic purposes. That is just a plus. I am for being healthy. A couple weeks ago, I decided that for this coming new year I wanted to commit to radically changing my diet and exercise habits. I reasoned that starting in July, I will be seeing my own patients. And I cannot sit there trying to convince patients to eat healthy and exercise regularly if I am not willing to do the same.

And so, I have been reading more about nutrition. I am hoping to plan out menus for myself because I realize that diet is crucial to the picture of health.

But I recently thought to myself that the best gift I could give to a wife, children, or anyone else I love, is myself. I owe it to them to hang around for as long as I can.

They say that men need to feel like they are providing for their family. What is more important than providing yourself and your time? I almost feel like it’d be irresponsible of me to start a family if I wasn’t doing everything I can do stick around for as long as possible.

And so I’m not looking at this from a vanity standpoint. I’m looking at this from a health standpoint. Because I’ve seen and watched what the end-points of preventable diseases can look like. And THAT scares me.

Perhaps the requirement to keep a figure is a wrong thing. Perhaps, though, the motivation behind the requirement is what should be scrutinized.

So here’s to a new year. To a radical change. To a healthier year.

I partly write this here so that I will be accountable. They say that is what happens when you share your goals with others.

I also write this because it’s always fun to do things with company.

Filed Under: Medical School, My Life Tagged With: , ,
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Tears

February 5, 2012 by Leave a Comment

I used to say that I am immune to tears. I grew up with a baby sister. I saw many tears. And admittedly, some were caused by me.

But I have realized that I am not as immune to them as I thought.

I am only immune to some of them. The kind that are manipulative. You know the kind. The kind that flows like a never-ending river when a child is not getting his or her way. The ones that go along with the sad, puppy-dog eyes that beg for you to give in. These kinds of tears I can handle. I can laugh at them because I will not be manipulated like that. I refuse.

But then there are the other kinds of tears. The tears that flow due to deep, heart-breaking pain. I realized this for the first time when I stood in a patient’s room. The patient lay in the bed, sedated by medications. The attending stood in front of me, trying to explain the circumstances to the family members.

I remember seeing the tears. I also remember hearing the guttural, almost-primal screams of agony and despair. The words they cried out weren’t even in English. But pain needs to translating. Theirs was a pain borne from unexpected outcome. The patient had been discharged home just days before. That night I had worked on the admission and, with the help a translator, been able to communicate with the patient. But over the course of 10 hours the patient had deteriorated and pain and anguish was what was left in the room.

I physically removed myself from the room. I had seen sad situations many times before but this one got to me. I could feel my eyes start to water. My throat got tight. The air was thick and heavy. I needed to take a few breaths.

I used to say that I am immune to tears. I cannot anymore.

Filed Under: Medical School, My Life Tagged With: , , ,
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How Do You Like Loma Linda?

January 16, 2012 by 2 Comments

How do you like Loma Linda?

Over the course of this interview season, this is a question that I have been asked numerous times. The person asking me really doesn’t care whether or not I like the city of Loma Linda. The implied question is whether or not I like Loma Linda University School of Medicine. The question is one that has been asked by fellow interviewees. It’s not unusual. While waiting in a room full of interviewees, conversation usually starts out with asking each other what school one is from. This question is usually followed by a “how do you like it there?” question. Invariably, the answer is positive — or at least neutral.

I don’t think I’ve ever heard an applicant say they didn’t like the school they came from. And for some reason, I somehow doubt that anyone would admit to disliking their soon-to-be alma mater — at least not while on the interview trail.

So how do I like Loma Linda? I like it very much. I think medical schools are more similar than different. We learn the same material. We take the same national exams. Sure, each institution offers their twist on how the material is presented, but the material is the same.

One thing that is different here is Loma Linda’s emphasis on Whole-Person Care. The curriculum is designed to not only emphasize the physical pathophysiology, but to also highlight aspects of spiritual care as well. I feel like I have been encouraged to go beyond the diagnosis — to treat the patient and not just the disease.

I have accepted that I attend a medical school whose name does not carry the weight of an ivy league establishment. I have become accustomed to puzzled looks when I say that I go to Loma Linda University. Many people outside the area have never heard of this place. Saying I attend a medical school in Southern California usually gets guesses of UCLA or USC. But once in a while I do come across people who have heard about Loma Linda.

On a recent interview, a program director in another state noted my educational pedigree. Glendale Adventist Academy for high school. Walla Walla College (now Walla Walla University) for my bachelor’s degree. Loma Linda University for medical school. “You must be a Seventh-day Adventist,” he said to me. He continued, “we like students from Loma Linda. Do you realize that your ethics curriculum is more extensive than most other schools?”

On another interview a resident asked me what school I came from. When he heard I was from Loma Linda he said that it was plus for me since the program liked Loma Linda students — they’re usually a really nice group of people.

It was nice to go outside of the this insulated, geographical area where everyone knows of Loma Linda University and hear other opinions of my home institution from people who have no incentive to say anything nice about it. Or maybe it was just a little bit of validation that I appreciated hearing.

So how do I like Loma Linda? Evidently, I like it very much.

Filed Under: GUIDE, Medical School, My Life Tagged With: ,
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Since I started medical school, I get the occasional item in the mail that looks like this — a letter addressing me as Dr. W. The front of the envelop usually says Jeff W. M.D. above my address.

It always amused me. I suppose you could say it tickled me.

I felt the same way when I saw this today.

And then I realized that after labor day weekend next year, I will have earned those two initials.

I know I’ve made a similar statement a couple of times in recent months. But it’s only because the whole idea is still surreal to me. It hasn’t sunken in yet.

On Thursday I will be taking USMLE Step 2 CS, one of the many exams we need to take in order to get a medical license and DEA number (we need to pass USMLE Step 1, Step 2 CK, Step2 CS, and Step 3).

Sometimes I feel like I’m barreling towards the finish line. At other times I feel like I’m plodding along at a snail’s pace. Regardless of my perception, I’m moving steadily towards May 27 — scared and excited all at once.

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7 Weeks

December 11, 2011 by Leave a Comment

This week I am beginning my three weeks of Christmas vacation. Following those three weeks I have scheduled 4 weeks of vacation time. All in all, that’s 7 straight weeks off.

Upon hearing about my schedule, many residents have sighed and said, “Oh, the life of a 4th year. Enjoy it while it lasts.”

It won’t be all fun and games, though. This first week I’ll be studying for Step 2 CS and taking the exam on Thursday. The following couple weeks I’ll be finishing up my interviews. But then I will have a few weeks off at the end. I’m still not sure what I’ll be doing. There has been some talk about the possibility of going to Korea. My sister is leaving for Korea in about 1 week. She’ll be teaching English there for 4 months. She would like me to come visit. Well, I’d like to go visit too.

But I’ve also considered other travel alternatives. The others are all cheaper than a trans-Pacific flight. One option would be a road trip. I considered just driving east and just going for a week without any planned agenda. I considered flying out to the east coast and just wandering around for a while. I also considered trying to talk my parents into letting me use a week of their time share somewhere — perhaps I’ll go to Hawaii again.

Obviously my mind is all over the place.

We’ll see, though.

Whatever I end up doing, you better believe I’ll be posting about it!

Filed Under: Medical School, My Life Tagged With: , , ,
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Veterinarians and Pediatricians (and Pediatric ER Physicians too)

December 4, 2011 by 1 Comment

I’ve always thought that veterinarians have it tough. They see patients who cannot communicate. Their patients don’t speak or complain of symptoms. So veterinarians have to go by what owners have observed and by the physical exam for most of their data.

It’s kind of like a pediatrician or even a Pediatric ER physician. Little kids might not be able to complain. And when they do, they may be very vague, unable to give a good description of what they are feeling.

I recently worked a Pediatric ER shift where I saw a 4 year old patient who was transferred from another facility. The other hospital wanted us to rule out appendicitis because the patient had abdominal pain and a CT scan that was equivocal.

I went in to see this little patient who appeared to be lying comfortably in the gurney watching the TV hanging on the wall. The patient, who I’ll call Joe, didn’t seem to be in pain. So I asked his parents what the problem was. It turns out that Joe had been vomiting — up to 10 times over night — and that was why he was brought in to the ED. I asked if Joe was communicative at home. His parents told me he was.

Was Joe a child who would normally complain of pain like a stomach ache? Yes, they told me. Did Joe ever complain that his stomach was hurting? No, he didn’t.

At this point appendicitis was getting knocked down lower on my differential (list of possible diagnoses). I proceeded to sit down next to Joe and say hello. He stared back at me. I told him I was going to just take a look at his stomach and started to pull back the hospital sheet that was covering his belly.

Almost immediately he pulled it back. Apparently, this kid liked his stomach covered up. I pulled back a little and pressed on his stomach. He started crying. I tried to observe how he was crying — to see if he was just being fussy or if it was really painful. I started pressing on the left side and worked my way to the right lower area of his abdomen (where appendicitis typically presents with pain) and tried to see if his crying intensified as I neared that spot.

I finally gave up and let him cover up his stomach. But I tried one more time. This time, I pressed on his stomach through the sheet. This time Joe did not cry. I was able to press fairly deep all over his stomach without eliciting any cries of pain.

That pretty much did it for me. And, after more discussion with the parents about Joe’s symptoms at home prior to coming in to the hospital, I concluded that appendicitis was not likely in this little patient.

In the adult world, most patients are able to communicate. Sure, I’ve had adults who were unable to communicate with me, but the proportion of patients who can’t communicate is much, much less. I don’t plan on going into pediatrics or emergency medicine. But I can appreciate how difficult it can be at times. And I am thankful that there are people who choose to do it.

Filed Under: Medical School, My Life Tagged With: , , ,