Everything I Learned in Medical School: Besides All the Book Stuff by Sujay M. Kansagra Md Page B
Authors: Sujay M. Kansagra Md
Tags: nonfiction
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week to see medicine in action. It was entertaining to just sit back, listen and watch how they did business. Then, about one month into this clinical experience, after a morning of seeing patients together, the doctor turned to me, handed me a chart, and said,
“Why don’t you go see this patient?”
“On my own you mean?” I asked nervously.
“Yes, this one is all yours.”
My heart began racing. I had to walk into a room on my own and try to help this patient. The chart said it was a teenager who had a fever and cold symptoms for two days. What should I ask her? What should we do for her? Would she ask me questions? What would I say? All these thoughts raced through my head as I knocked lightly on the door and walked in. Inside sat the teenage girl and her mother. The girl was on the examining table, and she was crying. Apparently, she felt miserable. After trying to comfort her, I made attempts to ask questions, but the girl continued to sob and ignored me. The mother was of little help, and made a few weak attempts to convince her daughter to listen to my questions. After a few minutes of fumbling around with random questions, I realized I was not getting anywhere. I was scared to even try examining her for fear the crying would worsen, so I just left the room.
Outside I found the attending physician, and explained the situation, conveying the information I had gotten during my short interview, which was minimal at best. He gave a slight understanding smile, and we went in together to finish up the visit.
Looking back on this visit, it’s amazing how far a student comes during the course of medical school. Near the end of my four years, knocking on patient doors and walking in to get their stories came naturally, and there was no hesitation. No matter what awaited me behind the door, there was a sense of comfort with the amount of knowledge I had, and knowing that by the end of the visit, I would have some sense of what was causing the problem, and that if the patient had questions, I would at least be able to give some educated answers.
No matter what makes us nervous in life, it’s feeling prepared that gets us through it. Whether it be preparing for a large presentation, or studying for a board exam, the more you know, the less nervous you become. Hopefully, dealing with patients will continue to get easier and easier through residency and beyond.
Chapter 25
The Bad News
When a patient comes into the hospital, something in the body has gone wrong. If all goes well, the patient will make a full recovery, and they will go home no worse for the wear. But this is often not the case, and in the worst case scenarios, the patient will not make it out of the hospital alive. When the inevitable becomes clear to doctors, the next step is conveying this to the patient. Giving a patient bad news is one of the most difficult parts of medicine. The way a doctor delivers the news often distinguishes the good doctors from the great ones.
The first time I had to witness this conversation, it was difficult. We were in the VA Hospital, short for Veteran’s Affairs. The hospital was right across the street from the main hospital, and cared for those that had served in the armed forces for our country. It was one of the benefits they received for their service. This was where I met a man in his mid 60’s that had been diagnosed with liver failure secondary to chronic hepatitis B infection. He had gotten the infection through a blood transfusion he received when he was younger after being shot during a bar fight. When your liver starts failing, blood flowing through it can often slow down, and blood starts backing up in all the veins that drain into the liver. Additionally, your liver makes protein that floats in your blood and helps keep fluid in your vessels. So, in liver failure, fluid starts leaking out of your engorged veins and pools up in places like your abdomen. His belly was huge, and he came in
“Why don’t you go see this patient?”
“On my own you mean?” I asked nervously.
“Yes, this one is all yours.”
My heart began racing. I had to walk into a room on my own and try to help this patient. The chart said it was a teenager who had a fever and cold symptoms for two days. What should I ask her? What should we do for her? Would she ask me questions? What would I say? All these thoughts raced through my head as I knocked lightly on the door and walked in. Inside sat the teenage girl and her mother. The girl was on the examining table, and she was crying. Apparently, she felt miserable. After trying to comfort her, I made attempts to ask questions, but the girl continued to sob and ignored me. The mother was of little help, and made a few weak attempts to convince her daughter to listen to my questions. After a few minutes of fumbling around with random questions, I realized I was not getting anywhere. I was scared to even try examining her for fear the crying would worsen, so I just left the room.
Outside I found the attending physician, and explained the situation, conveying the information I had gotten during my short interview, which was minimal at best. He gave a slight understanding smile, and we went in together to finish up the visit.
Looking back on this visit, it’s amazing how far a student comes during the course of medical school. Near the end of my four years, knocking on patient doors and walking in to get their stories came naturally, and there was no hesitation. No matter what awaited me behind the door, there was a sense of comfort with the amount of knowledge I had, and knowing that by the end of the visit, I would have some sense of what was causing the problem, and that if the patient had questions, I would at least be able to give some educated answers.
No matter what makes us nervous in life, it’s feeling prepared that gets us through it. Whether it be preparing for a large presentation, or studying for a board exam, the more you know, the less nervous you become. Hopefully, dealing with patients will continue to get easier and easier through residency and beyond.
Chapter 25
The Bad News
When a patient comes into the hospital, something in the body has gone wrong. If all goes well, the patient will make a full recovery, and they will go home no worse for the wear. But this is often not the case, and in the worst case scenarios, the patient will not make it out of the hospital alive. When the inevitable becomes clear to doctors, the next step is conveying this to the patient. Giving a patient bad news is one of the most difficult parts of medicine. The way a doctor delivers the news often distinguishes the good doctors from the great ones.
The first time I had to witness this conversation, it was difficult. We were in the VA Hospital, short for Veteran’s Affairs. The hospital was right across the street from the main hospital, and cared for those that had served in the armed forces for our country. It was one of the benefits they received for their service. This was where I met a man in his mid 60’s that had been diagnosed with liver failure secondary to chronic hepatitis B infection. He had gotten the infection through a blood transfusion he received when he was younger after being shot during a bar fight. When your liver starts failing, blood flowing through it can often slow down, and blood starts backing up in all the veins that drain into the liver. Additionally, your liver makes protein that floats in your blood and helps keep fluid in your vessels. So, in liver failure, fluid starts leaking out of your engorged veins and pools up in places like your abdomen. His belly was huge, and he came in
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