September 24, 2011

be careful what you ask for

     Checking my email, I notice one in my school account that's from an unfamiliar name.  I open it and it's from the doctor I will be paired up with to start practicing my History & Physical on real patients.  No more actor patients.  Well, we'll still use them for other stuff.  But, at least in part, it's now time to move onto the real deal.  I requested an oncologist.  Normally, they don't like to take requests but the course coordinator knows my story and is more than willing to help me out.  So I get paired up with a breast oncologist at MD Anderson. 
     In the email, he's giving me the time and date of our first excursion.  He asks me to show up at the hospital wing of the complex.  I offer to meet him at his clinic thinking it would save him a trip.  Nope, he informs me that the patients I will be seeing are inpatients.  That means they're hospitalized.  These patients are sick.  Of course, anyone with cancer is sick but they're not hospitalized without reason.  So I'm skipping from playing doctor on actors to real cancer patients in the real hospital.  Couldn't we just start with a patient that has the sniffles or a sore ankle?  Nope.  These are patients grappling with a life and death disease.  I'm terrified while reading the email.  But I asked for this. 
      I immediately flash back to my brother's countless visits to the clinic.  Often, the visit would start off with a resident.  It is a teaching hospital, after all.  And some of the residents inflicted emotional pain on my brother by their ineptitude.  They weren't mean.  They just didn't know what they were doing.  Inexperienced or stupid?  In the end, it doesn't matter to the person on the exam table.  That patient is scared, in pain, confused, and frustrated.  Violating that Hippocratic oath, albeit unintentionally, they inflicted harm upon the patient.  I watched it first hand and it infuriated me.  I even came up with a rule that I'd tell everybody, "don't ask the resident any medical questions.  None.  Ask the nurse, ask the PA, ask the doc, but for the love of Pete, let the resident get out of here with doing as little damage as possible." 
     I'm not a resident.  I'm even further down the hierarchical ladder.  Right above mop bucket is medical student.  That's me.  That will now be me on the side of that doctor-patient dynamic.  It's scary.  Damned scary.  All I can do is trust myself.  Trust that little unconscious part of my brain that takes over during these moments.  It happened when I played football and it seems to happen in medical situations, at least so far.  Something just takes over and does the right things.  That, and practice like hell with my wife to insure I don't inflict a moment of pain on these patients.  I watched it happen on my brother and I'm going to do my damnedest to make sure it never happens to one of my patients on which I'm learning.

1 comment:

Steve Parker, M.D. said...

Be sure to forgive yourself when it does happen. It happens now and then even to docs with decades of experience.