Everything I Learned in Medical School: Besides All the Book Stuff

Everything I Learned in Medical School

Also by Sujay Kansagra

Why Medicine? And 500 Other Questions for the Medical School and Residency Interviews

EVERYTHING I LEARNED IN MEDICAL SCHOOL
:

Besides All the Book Stuff

By

Sujay M. Kansagra, MD

Copyright © 2011 by Sujay M. Kansagra

EVERYTHING I LEARNED IN MEDICAL SCHOOL

Besides All the Book Stuff

All rights reserved. No part of this publication may be reproduced or transmitted in any form without written permission from the author, except in brief quotations in literary reviews.

Notice: The advice and medical information contained in this book are the opinion of the author. The author assumes no liability for any injury and/or damage to persons or property arising from this publication.

ISBN-13:
978-1451587616

ISBN-10:
1451587619

To Mom, Dad, Susan, Shayri,

Rajesh, Neil, and Baa,

for their everlasting support.

And to my wife, Sejal, who

has voluntarily agreed to

spend her life with me. I’m still

not sure why.

Author’s Note

These stories are all true. Where appropriate, names have been changed to protect the identities of patients, physicians, and medical students.

Contents

Preface
ix

That Sinking Feeling
1

The Switcheroo
7

The Hierarchy
12

I Don’t Even Know You Anymore
18

The Pressure’s On
22

“Nursing” Homes
30

The Cocaine-Snorting Organ Donor
35

Saying Goodbye
41

The Reoccurring Refrigerator Incident
47

Mistakes
57

Big Pimping
61

Reading Between the Lines
64

Blood and Gore
70

The Explosion
73

The Medical Student
81

Keeping a Healthy Distance
86

Awkward Moments
95

Off With Their Heads
101

Every Student’s Enemy
107

The Anatomy Lab
110

The Match
116

Seizures and Pools Don’t Mix
121

A New Flavor of Chip
128

The First Patient
130

The Bad News
133

Those Three Little Words
138

Know-It-All
150

The Delivery
153

The Road
164

The End?
168

Preface

This book began as something much different. In the beginning, it was something just for me. It was a way to remember how it felt to walk into my first patient’s room, to relive the exhilaration of delivering my first baby, and to remember the frustration of being lost in a world with an entirely new language. I wanted to look back after becoming old and gray, and remember how the world of medicine looked to someone seeing it with fresh eyes. These eyes were free from years of becoming jaded and were filled with curiosity, excitement, and nervous anticipation. But as this work took shape, I began to realize it could be more. It could be a way to show others this strange new world and to share the lessons I learned along the way that applied not only to medicine, but to everyday life. And through this journey, I came across those patients and doctors that were just so entertaining, so over the top, they were almost asking for their stories to be told. This is my way of sharing those stories. So here I am, giving you a glimpse into a life of medicine as I first saw it during medical school.

Please do not mistake some of the jokes and criticisms of medicine in this book for cynicism. Not a day went by during medical school that I did not feel grateful to be a part of medicine, to have the privilege of hearing about intimate aspects of people’s lives, and to help them through their most difficult times. And at the same time, there are situations where it’s okay to laugh at ourselves, laugh with our patients, and laugh at the insanity that surrounds us on a daily basis in the hospital. It keeps us grounded. So here it is, my four years of medical school -- the serious, the stressful, the funny, the unbelievable, the unexplainable, the sick, the struggles, and the stories that taught me everything I learned in medical school (besides all the book stuff, of course).

Chapter 1

That Sinking Feeling

My body jolts awake to a familiar sound. After a few blind swipes, my blows hit their target, and once again, there is silence. The air in the room is cool, crisp, and every fiber of my being wants me to remain in the welcoming warmth under the covers. It is Saturday morning, and any other Saturday of my life I would be waking only when my body was ready. But this month was different. My body no longer called the shots.

I clumsily make my way around, grab my towel and clothes, and walk out of the room, squinting at the bright lights in the living room. My roommate, still up playing video games, looks at me, then his watch, then back at me.

“Wow, one of us is pretty pathetic.”

“I think we both are,” I reply.

It is 3AM. As a second year medical student, rotations have taken over my life. This particular month happens to be dedicated to pediatric surgery, one of the many fields through which I would rotate this year. I’m quickly learning that the popular notion that medical students are sleep deprived is popular for a reason. I’m also beginning to realize that life’s priorities have a funny way of coming full circle. When you’re first born, your main priority in life is sleeping. When you’re nine, the priorities are Saturday morning cartoons and baseball cards. In college, it’s staying out late and partying. But in medical school, your priorities go back to the beginning -- sleeping. This becomes more evident the longer you are on the wards.

Imagine falling into a pool filled with caramel. You try desperately to swim out, but you slowly sink to the bottom, and there you are, looking up to see a brown-tinged world. Despite all of your best efforts to swim out, the caramel is just too thick. You barely get halfway to the top before you give up, and defeated, find yourself sinking back down to the bottom. This is how it feels when the sleep deprivation starts kicking in. There is a constant fog over you. The minute you sit down to relax or for a lecture, it starts. You become one with your chair, as you feel yourself settling in. Your eyelids feel like they are attached to lead weights. Your body goes into shutdown mode, and slowly but surely, you start sinking into the caramel pool. There is nothing you can do to swim out of it. I’ve tried it all. Caffeine was of little use. A few times, I tried pinching my leg as hard as possible when no one was looking. It helps for about 30 seconds, and then I’m back to where I started. One time I tried asking a question during a lecture to force myself to wake up and pay attention, only to have the lecturer reply that she had been answering that very question for the last ten minutes of the lecture, making me look very foolish. That worked at getting me awake, but at a price.

The sleep factor plays a larger role during some rotations more than others, namely, Internal Medicine and Surgery. Shifts in excess of thirty straight hours are commonplace for residents in these fields. Despite regulations which mandate a maximum of 80 hours of work per week, logging false duty hours and working over 100 hours is not unheard of. It is all part of the “suck it up” mentality that runs rampant and unchecked in medicine. I’m convinced that the interview process for these two fields involves keeping applicants awake for 48 hours and then asking them to do Calculus. It’s just unreal. During this pediatric surgery rotation, I finally reached the end of my rope.

We spent a good deal of time in the operating room during this month. For a medical student in the operating room, our job consists solely of three things: cutting, holding, and suctioning. We cut suture when the surgeon is finished tying, we hold back flaps of skin with equipment called retractors, and we suction fluid and blood using a small vacuum tube. After days and days of waking up early, this can get a bit boring. Well, on one particular day, it was 9AM, and we had already seen two surgery cases. This was the third. The case was a simple inguinal hernia repair, so unfortunately, there was no suctioning, cutting, or retracting to be had, so I stood there, with arms crossed in front of me, so as not to touch something accidentally and contaminate the entire surgery. About ten minutes into the case, I could feel the sweet voice of sleep calling my name, but I hung on. The case continued, as they operated on a very small area that I could barely even see. My mind began to wander, as I thought of how nice it would be if I were anywhere else. The image of my room and my warm bed arose, almost like an oasis for a bone-dry wanderer through the desert. And just then, out of nowhere, my body felt a unique sensation. It was a numbness that went through me, and was followed by the sensation of falling. But just then, I felt my body jerk, and as quickly as it had started, the numbness and falling sensation stopped. For the first time in my life, I had fallen asleep standing up! But not long enough to fall over, just enough to jerk to one side and catch myself, not unlike the head jerks you see people doing in the classroom. Except this was a full body jerk. Luckily, the movement was subtle enough that no one noticed. I guess they were too busy operating.

After this, the sleep-while-standing incidents (which I call “steeping”) were happening on a regular basis in the OR. During just about every surgery, I would have the now familiar sensation of falling and quickly jerking awake. Even if there was a retractor in my hand, I slowly faded out, and the tension on the retractor would slowly give way, only to be awoken by the surgeon grabbing the retractor and repositioning it. But, despite this, no one noticed that I was actually falling “asteep”, not even the nurse that would hand the surgeon the various instruments. On one occasion, I actually fell towards the surgeon and bumped him while he was operating. Luckily, the senior resident had the scalpel at the time, and I disguised my bump as an effort to get a better look at the surgery. That was a close one. Thankfully, this was near the end of my rotation, and there was never a serious incident.

The battles with sleep are not unfamiliar to medical students. One of my fellow students was standing at the foot of a patient’s bed while the entire medical team was in the room talking with the patient. This 6’4” guy fell asleep and landed directly on the patient! Luckily, there were no injuries, except perhaps to the student’s grade (and pride). I quickly learned that sleep cannot be cheated; it always gets its just due, one way or another.

Hopefully, when I finish all of my training and become an attending physician, the priorities will shift back in the cartoon direction. But the huge pool of caramel known as residency is around the corner, and there are no life guards on duty.