First Year Medical Student Bingo
Based on at least my first month of medical school!
I hope you enjoy.
That is the question—
Whether ‘tis Nobler in the mind to suffer
the doctors and patients, outrageous lectures,
Or to take Arms against a Sea of troubles,
And by opposing end them? To skip, to sleep—
all day; and by a sleep, to say we postpone
the suffering, and the thousand Natural shocks
that medical school is heir to? ‘Tis a consummation
Devoutly to be wished."
— Shakespeare interpreted by a medical student (via diarymdstudent)
And I wish I could tell you a story about fancy heroics - about an exploratory laparatomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life. But I can’t. But I can tell you that I saved a life.
She was 16 years old, and moved here four years ago from El Salvador. This was her follow-up appointment for an otitis media. It was her second time visiting a doctor in the United States. She was seen just three weeks ago and was prescribed amoxicillin for her ear. The doctor her told to follow-up in 2 weeks. It’s been three weeks, and she is now coming in to the clinic. She missed her last appointment because her mother couldn’t find the time to bring her to the doctor.
I take a look at her chart before entering the room, and I noticed that she’s in the 3rd percentile for her weight and 50th percentile for her height. Odd proportions, if you ask me, and I decide that I am going to dig a little deeper than ‘how’s your ear’…
I open the door to see a bright, cheerful young girl dressed in a paper gown. She takes one look at me, and immediately blushes and wraps the gown tighter around her frail body. I immediately try to make her feel comfortable by making a joke or two, but I can’t seem to connect. She’s avoiding eye contact. She seems self-conscious, maybe? I introduce myself to her and her mother. Her mother speaks only Spanish, and she speaks English. I ask her mother if it’s acceptable that I interview her in English. She obliges.
"I understand this is your second time here, so I just want to learn a little more about you, if that’s ok with you…"
I begin to ask questions about her ear, about the antibiotic regimen, her hearing, associated symptoms. She answers the questions, but she still seems too timid to make eye contact. I still can’t connect.
She has absolutely no past medical history, no past surgeries, no medications, no allergies - I am flying through this history. I begin my physical examination, and other than some mild tachycardia, she appears perfectly normal. Even her tympanic membranes are normal. Her ear infection has been cured.
And just as I am ready to wrap up the interview, I take one glance and notice four small scars on her wrist under her bracelets. And in that moment, I remembered that she was in the 3rd percentile for her weight - I think. I walk over to the chart, and confirm my thought.
I take a careful diet history, and I find out that she doesn’t eat much.
"I am just never hungry," she admits.
And I find it odd that a growing 16 year old girl isn’t hungry. I tell her that I want to ask her more personal questions, and I ask if she would rather that I ask her mother to leave the room. She says that her mother can stay. And I gauge that she’s comfortable with that because her mother doesn’t understand English. I look at her mother, and she doesn’t look at me - almost oblivious to the interview, almost negligent of her child’s health. I mean, what parent doesn’t want to pay attention to what their child has to say, even if its in a different language?
I ask her about her menstrual period, and I find out that she hasn’t had a period in 2 months.
“Is there any chance that you might be pregnant?”
After a very long five seconds, she answers, “No.”
I knew she wasn’t too sure of her answer, and I decided to take that as an opportunity to dig even deeper. To investigate. To get to the bottom of her lack of eye contact, miss periods, and odd scars under her bracelets.
I learn that she recently lost her virginity to her boyfriend, and he broke up with her a short time later.
“Fucking asshole,” I think. But I can’t let it show. I find it devastating how one person’s actions can take such a toll on another person, with the offender being absolutely unmindful of the damaged they have caused.
I learn that she recently started throwing up her food after she eats, mostly because she feels fat.
“I have a big belly,” she says.
I learn that she was hospitalized two months ago because she fainted in a store.
I ask her mother about this in Spanish. “It’s because she didn’t have breakfast,” she says.
I ask about the scars on her wrist, and I lose eye contact. I walk up to her, place my hand on her hand, look in her eyes, and tell her what I know.
“I know that some people cut themselves whenever they feel angry or sad. Do you know anyone who does that?”
She nods, hesitantly.
“Do you have any friends that have done that?”
She shakes her head, slowly.
“Have you done that?”
She looks me in the eyes, and doesn’t say one word. And I know.
I ask her if she’s ever told anyone about any of this before – about the vomiting, the cutting. She puts her head down, and shakes her head.
I ask her if she has friends, relatives, or a parent that she feels comfortable talking to. She keeps her head down, and shakes her head, ever so slowly.
I ask her if she has ever thought about killing herself. She looks me in the eyes, and doesn’t say one word. And I know.
And just then, it occurs to me that this is a girl crying for help. A girl who is broken behind that big, beautiful smile. A girl who needs someone to talk to, someone to confide in, someone to listen. A girl who might do something destructive to herself if she doesn’t get help soon. A girl who was waiting for someone to ask the right questions.
I leave the room to consult with my attending, and we decide the best course of action is to call the ambulance to take her to the emergency room. And she leaves.
And just then, I realize that she came in for an ear infection.
Today, I saved a life.
Read it. Read it all, and see what we mean when we say that medicine is an art form.
(Great job, colleague!)
not kidding, I felt my surgery-numbed heart thaw when I read this. this is why I went to med school.
You can always count on docedace to have beautiful, touching narratives.
Beggars Med students can’t be choosers.
More doodling. I have a new idea for photos and drawings using this sign! Coming soon to a Tumblr near you.
Join the crazy fun, just for fun. Post a pic of yourself (you don’t have to show your face) and tag it “med students can’t be choosers.”
Anonymous said: Hi! I'm so happy I stumbled upon this blog. Can you please tell me if choosing a different major other than a life sciences undergrad is really important? I mean do med schools really care about that? Do they like English majors? If you don't mind, where are you going for med school, what do you want to be, and what did you choose as your under grad major? Thank you!
Hi back at ya! I’m glad so glad you stumbled upon this blog too ;) Hope you enjoy it!
Med schools like well-rounded applicants - so basically what’s important is choosing a major that you’re interested in. You can be an English major and still be on the pre-med track. I’ve answered most of these questions in this previous post.
I’m currently attending the University of Medicine and Health Sciences in St Kitts. I’d like to be a pediatrician and a writer of sorts. My undergrad major was Biology, and I did a minor in English. I also went to grad school for English Lit.
So go ahead, and pursue what you love! You can have
your cake and eat it too the best of both worlds!
— John F Kennedy - Moon Speech at Rice Stadium, 1962
The following is a teaser, perhaps from the 'I See How Your World Shakes' series, which is a continuous work in progress…
Problems of being an introvert. Eating cookies and stressing away. Retrospect. Introspect. Don’t be shy, speak up. No Professor Arrogant, Pinenut did not do the dissection. It was me, can’t you see? Can’t you see? She tore away my ascending cervical. Said she was “cleaning it up.” Pinenut, you just ripped our ascending. Who me? No, she says. Sigh. Our dissection does not need cleaning. Clean your side, not mine. Look at the superior cervical ganglion I found, she says. But no it wasn’t you. It was my group that cut yesterday. Very nice, says the professor. I stare down. Pinenut points to me for a split second. Yes it was me. Can’t you see? Can’t you see? No, of course not. I’m not working hard enough. Drink more coffee. Doesn’t matter. More coffee. Another cookie. I had studied for that last exam. But nothing to show for it. Take a break. Internet not working. Can’t watch, can’t Google. Where’s my Kindle? Crumbs in my book, crumbs on my lap. Can’t take a break, can’t take a break. Nothing works. Nothing’s right. Island life. Med life. If only. You could have done better. The past. Stop sleeping. Speak up. Chocolate chip cookie. Everything’s crumbling. Matches the coffee stain on the page. Look there’s the tear drop that smudged the letters of those antibiotics. Yes, my lacrimal glands are working. So many words. Too many words. Blurred vision. What future. Always working. No shortcuts. But never any credit. No credit. Doesn’t matter. No, I’m not working hard enough. Read, study, memorize. Understand. More pictures, more slides. No Professor, nothing’s ailing me. I just don’t know what’s wrong with my brain. Histology. Pathology. More “-ology”. Don’t panic, the good professor says. But I used to be top of the class. I won’t panic. You can do it. Speak up. Don’t be shy. Think of all the patients you can treat. Think of all those smiles. Everyone looking up to you. Big sister. Retrospect. Introspect. Meibomian glands. The ascending cervical is gone. Because that’s the way the cookie crumbles.
Malcolm Gladwell recently asked Permanente Medical Group CEO and physician Dr. Robert Pearl to “help people understand what it is really like to be a physician.” This is Dr. Pearl’s reply.
Pre-meds and med students, take notice. This is 100% real life.
The only statement I can disagree with in this article is “Most nights, physicians go to sleep fulfilled and grateful for the honor of becoming a part of their patients’ lives.”
Most nights, I go to sleep tired. Real tired.
"Self portrait with Dr. Arrieta," Francisco Goya, 1820.
Wendy Smith* had thinning hair, penciled in eye-brows, and a frame so thin that you could see, in painstaking detail, the bluish-grey veins underneath her pale skin. Cancer had taken so much from her that she almost didn’t look human.
But the feeling in the room was extremely human. Fear. Palpable fear. Fear made all the more palpable because this was an aggressive, rare form of cancer. Fear made all the more palpable because she was only in her early 30s. Fear made all the more palpable because the cancer had been discovered during postnatal care following the birth of her first child.
It was hard not to detect a little desperation in her husband’s voice as he kept asking about new, experimental treatments he had read about in his own research. It chills my blood to think that the notion of single fatherhood has probably crossed his mind.
Susan James* was older and had already experienced breast cancer, which had reoccurred several times after several lumpectomies. The cancer has now reoccurred. This was not the reason for today’s visit.
Today’s visit was to tell her about the tumor in her bladder.
Her visage was blank, almost hollow. The word “surgery” snapped her out of her shock. Waving her hands, tears welling in her eyes, she said she didn’t want to hear about surgery; she didn’t even want to think about it. She had been under the knife already, a half-a-dozen times, endured radiation, chemotherapy, and now she had to consider surgery to remove her bladder—it was just too much. Too much, at least for today. The doctor, wisely, pulled back, consoled Susan, and urged her to go home, be with family for the holidays, and maybe even take a vacation. Decide in the new year. No rush.
John Peters* was different. A veteran of cancer fights, with the scars to prove it, John was nonchalant about his medical condition, nodding along to some of the doctor’s medical jargon (which I should note she only used due to her relationship with the patient, and her recognition of his acquired expertise), and tossing out some of his own. As we left the exam room, he casually asked for a syringe with some saline solution, so that he could flush out his own nephrostomy tube, which, he noted in a matter-of-fact way, had become clogged after bleeding from his kidney.
The distance between Susan and John is remarkable. I cannot imagine myself ever advancing past denial and disbelief if and when I am diagnosed with cancer. Given its prevalence, and my own family history, I can’t help seeing this as an inevitability later in life. But I’m going to be a doctor so nothing bad can ever happen to me.
There is a tendency, on the part of some, to dismiss patient-centered care—being “extra-nice” to patients is itself a nice concept, but ultimately irrelevant, and even naïve. I’ve sensed this attitude not only from practicing physicians, but also from fellow students. Intellectually, I know I should respect this view, just as I expect my more humanistic take on medicine to be given credence…
***REGISTRATION IS OPEN!*** & ends March 15th!
MedWAR, also known as the Medical Wilderness Adventure Race, is a competition that combines wilderness medicine and racing. Teams of four compete to see who can finish first. The teams will have put their minds together and
find solutions to the many medical scenarios constructed throughout a course, which involves running, hiking, biking, and canoeing. MedWAR is an annual event created and coordinated by Medical College of Georgia students and emergency medicine physicians. Now in its fourteenth (or fifteenth? something like that) year, it has expanded to a series of races in the US and Canada.
I was one of the administrative directors for the race last year, in charge of advertising & helping plan the medical scenarios (which are always Awesome by the way), & I’m helping out again this year! Pass this along to anyone who is interested or let me know if you are!!
Special note to the anon docs/med students I follow: You guys are amazing and I respect your anonymity. Feel free to sign up / e-mail me and let me know you are interested. No need to let me know how you heard about it or let me know your alias, I just want you to enjoy the race!!
Contact me @ email@example.com if you’re interested!! OR just go ahead and sign up ;)
A note: Anyone can participate :) So bring it on.
You can also go to the website (http://www.medwar.org/southeast/) or facebook page (https://www.facebook.com/medwar.southeast) to see more about the event. OR if you’re in a different region, check out the website for the race near you!
More info below the cut:
As I said last year when signal-boosting this event — I would totally do this if I had the time…
OR MAYBE I’LL ACTUALLY BE THERE THIS YEAR, UNDER MY REAL IDENTITY, AND NOBODY WILL EVER KNOW.
(Kind of a reverse April Fool’s prank?)
But for Rumnock, as for the students, there’s also more: a collision between performance and reality that surprises him.
Being an SP has awakened his inner hypochondriac: “Every time I do a diabetic,” he said, “I’m convinced I have diabetes.”
It has also changed how he regards the doctors he comes across in his own life. When a cousin was recently hospitalized, gravely ill with liver failure, Rumnock watched a physician stumble through a discussion of her care.
The doctor talked and talked, but it was clear to Rumnock that his cousin didn’t understand that she was dying — and that the doctor didn’t grasp that.
"We are so isolated," Rumnock reflected. "We don’t know how to communicate anymore."
At his cousin’s side, he started asking questions that steered the doctor toward spelling out the truth.
He tried to do it gently, the way the best medical students learn to do.
She’s 58, but appears maybe three days older than 42. Her eyes are sunken, tearful, worried, anxious. She tells me about her two grandchildren, and how she just visited them in Michigan. She came to the hospital, straight from the airport. She’s worried.
She’s worried because her shortness of breath hasn’t gone away for over a month now. She has had breast cancer, and opted for a more conservative approach - a lumpectomy with axillary node biopsy without radiation. She’s admitted, and gets a chest x-ray and a CT scan, which show a pleural effusion with what looks like nodules in both lungs. ’Likely represents metastatic disease,’ reads the official radiology report. She knows, so I don’t bring it up again.
'I am just a medical student,' I think.
On the second day, she undergoes surgery to evacuate the effusion, and her lung is biopsied. Now, we wait for the pathology report. I visit her everyday as we wait, sometimes two or three times. I’ve met her husband, and we know each other by first names. Her daughter and son are also beautiful people, just like her. They ask me questions, and I keep my answers limited to what I’ve read in the chart. They never ask me about the cancer. They know what the radiology report said, so I don’t bring it up again.
'I am just a medical student,' I think.
She never complains. Not from post-operative pain, not from shortness of breath, not from coughing, not from anything. I take my time with my physical exam, ensuring that I don’t miss any tenderness. I don’t want her to suffer unnecessarily. ”Surgery is painful,” I tell her, “make sure you let us know if you are in pain.” She agrees, but never complains.
The nurse corners me one afternoon, and asks me, “Is there any way to put in an order for morphine PRN for her?”
'I am just a medical student,' I think.
"Why?", I ask.
"Because when her family isn’t here, when she’s alone, she cries. She’s in pain, she’s scared, but she’s a silent sufferer."
I am the first person she sees every morning, and I try to make sure she’s comfortable. I offer extra blankets, water, anything I can do just to make sure she is as happy as she can be. She appears more and more cheerful, and I spend what seems like hours holding her hand and chatting about life, the weather, her family, my family, my future goals, my girlfriend. I show her pictures. We laugh. We smile. But her eyes remain anxious and worried.
She says she likes my bowties, so I make sure to wear one everyday for her. And I tell her, “I thought of you when I put this one on this morning.” She smiles through those tearful, anxious, worried eyes. I smile back. And that is enough to make my day.
I walk in with my bowtie and smile around 6:30pm. She just got back from the CT scanner, and her family is around her bed, as per usual. I visited, just to say good-bye for the day. The sun dips a few degrees further West, just enough to peak through the curtains, and her husband turns to me and says, “Edwin, thanks for bringing the sunshine.”
I stand there, in a loss for words, armed with little more than a bowtie and a smile.
'I am just a medical student,' I think.
"There’s something of yourself that you leave with every meeting with another person…" — Fred Rogers
Anonymous said: Today I got the results of my exams to get into med school and I totally failed, I feel helpless, I can't stop crying and I don't know what to do. I just want to end everything, Im not srong enough to get up
Cry it out and let all those negative emotions go away.
Now, stand up and know that you are strong. I’m not sure if you’re talking about the MCAT, or maybe you’re in another country, but there is definitely no need to end everything. Think about all the hard work you’ve done to get where you are - you should be proud. Now just think about why you failed - evaluate the exam, how you studied, your exam taking skills, etc. You can definitely take the MCAT over again - talk to a professor and/or your pre-med adviser to get more help and advice on how you can improve.
Trust me, it’s not the end of everything - you just need to be confident and stay positive. There are plenty of people who have failed, and tried again, and succeeded into getting accepted into med school. Where there’s a will, there’s a way - if medicine is your passion, you’ll find it in you to get the strength. You can do it!
Best of luck Anon! If you need to vent, talk, ask questions - feel free to use my askbox. But please, don’t do anything silly while you’re upset. A lot of times we wonder why things happen, and certain things seem like it’s the worst that can happen - but times always do look up - you just have to wait and work for it. And later, you might realize that something even better happened, that you never even thought of.
— Winston Churchill
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