On being a “Gunner”

Medical school is a strange and frightening new world. On top of cramming more information than is physically possible into your brain on a daily basis, you have to learn a whole new language. Granted, a lot of it makes sense. In order to properly describe a patient, you have to be able to tell if they’re a cyanotic dyspneic neonate with stridor (aka – a blue, hyperventilating baby with noisy breaths in). Some of the language, however, isn’t even remotely related to being a medical practitioner. Now I also hear about the gunner getting pimped by the attending (translations to follow).

Let’s go back a few years. When I was in undergrad, I was used to being called a keener. I was often the one spending a little extra time studying, finishing up projects, or even doing some leisure reading on related topics out of pure interest. My friends teased me, yes. Heck, to be honest, I kind of enjoyed being called a keener. It meant I was keen to be there, that my tuition was not being wasted on a frivolous degree, that I had a passion for what I was studying.

Nowadays, this sort of behaviour is described as being a “gunner”, yet the implications are far from the mostly positive ones associated with being a keener. A gunner is someone that tries to impress the professors, someone that has a specialty in mind that they are aiming to get into, someone that will sabotage their peers (or their relationship with them) in order to look better to their superiors by comparison. A quick peek through the urban dictionary definition page will give you an idea of just how poorly these people are seen. I never thought being a keener in med school could be a bad thing, but apparently my enthusiasm for the content could be (and has been) misconstrued as an intimidation tactic to get ahead.

One day, not too long ago, a friend called me a gunner. Granted, I had recently scored 100% on an exam in medical school. I had maybe been teasing them for their soft-science club membership (in what I thought was good fun). Maybe I crossed a line. In any case, they called me a gunner and went on their way. This left me in a bit of a pickle.

Was he serious? Was he actually mad at me, or was I reading too much between the lines? Was I coming across as an overly competitive and aggressive person to those around me?

Don’t get me wrong, I didn’t suddenly descend into an existential crisis. It just gave me pause to consider how things have changed. How maybe I have changed. It made me think about what my priorities were. Was I letting my drive to understand the content and excel at my trade get in the way of developing meaningful relationships with my peers and colleagues?

I can’t honestly say that I’ve found a clear answer yet. I can say that I’ve refocused myself. I’m still driven; I’m still passionate about understanding the complexity of disease and illness. I’m still getting pimped when we go into the wards, but I stress a little less about it (getting pimped meaning being asked very specific, detailed, nit-picky questions in stressful situations, and usually getting them wrong).  Maybe I’m less competitive. The people in school with me are arguably some of the most interesting people I’ve ever met, and I would kick myself for letting my keener side keep me from cultivating what I hope are lasting relationships with them.

In any case, maybe I am a gunner. Maybe I’m just a keener. Maybe the two aren’t so different. All I can be is who I am, maybe I should just stop worrying about what other people think. But then again, maybe I’m in medicine because I care about what people think. Maybe these are just the ramblings of a burned out student that’s trying to avoid looking at her pulmonary notes again. I can’t say for sure, but it’s probably the last one.

Love from your favourite gunner.

Gourmet Gross

As I have studied throughout the past few months, I have noticed a rather disturbing trend in the science of medicine. This trend, as it stands, aims to destroy all the joy I derive from my daily habits. What is this trend? Well, it is the rather unhealthy relationship that our medical professionals have with food.

Only someone who is severely disturbed would describe a collection of macrophages walling off some noxious stimuli as a “caseating” or “non-caseating” granuloma. For those of you without a background in a second language, this seemingly innocuous little title actually serves to differentiate granulomas based on their resemblance to cheese. That’s right, cheese. Some physician way back in the day opened up a patient, noticed a mass somewhere in their body, and said to themselves: “That looks a lot like cheese.” Now, tell me: what normal, sane person would look at this and decide that it looks decidedly like a foodstuff?

I know what you’re thinking. “But surely this is a limited instance! And it does kind of look like cheese anyways.” This would be where I terrify you with further examples of scary pictures described like food.

For example, a relatively common complication of strep throat is what is called scarlet fever. One of the more interesting symptoms of scarlet fever is what is called “strawberry tongue”. This is where the papillae (taste buds) of the tongue become inflamed and appear like seeds on a strawberry.

But two examples don’t demonstrate a disturbing, disturbing pattern, do they? Well, how about the “honey-coloured crust” associated with impetigo? Or salt-and-pepper retinopathy? Eggplant deformity? Chocolate cysts? Red currant jelly stool? Or how about peau d’orange? I dare you to google some of these terms.

Ultimately, I think this adds up to a conspiracy to reduce my food choices down to celery and rice. Oh wait – there’s also rice water diarrhea. Looks like celery and I are going to have some good times.

Surgical Syncope

This week I got my first taste of surgery. After the whole debacle with my clinical skills, I’m sure there’s a little anxiety about the thought of me in the OR. Don’t worry though, I wasn’t the one wielding the scalpel. I wasn’t even standing close to the doctor wielding the scalpel.

As part of my first-year education, it has been mandated that I spend at least 12 hours doing something medically related. I don’t know about the specifics, that was a couple months and a much emptier brain ago. After thinking about the necessary hours and considering all my options, I decided that I would go right for the glamourous world of plastic surgery.

Before we get off on the wrong foot here, let me explain what I mean by plastic surgery. Plastic surgery comes from the Greek word “plastikos”, which means to mold. I’ve had to explain a few times, often to my horrified relatives, that plastic surgery does not only include cosmetic surgery. It also includes reconstruction of the face and hands to fix a congenital defect or after trauma and is a big part of treating burn victims. Did you know the first surgeon to win a Nobel Prize was a plastic surgeon (Dr. Murray), and he won it for pioneering the first kidney transplant? I certainly didn’t. I had all the same hang-ups about plastic surgery as my family had until a very talented surgeon spoke to me and my classmates about his profession.

A couple months later, and I was in the OR with that same surgeon. He was every bit as exciting to listen to there as he was in the lecture hall and while my view was a little worse, the experience was so much more fulfilling.

The first surgery I only saw the back of the resident’s head, and I felt like I was constantly in the way of the nurses. They seemed like they were used to it though, and the other 3 students crammed into that little theatre weren’t in much better position than I. Well, except maybe the fourth year. He was probably 6’6″ and was able to tower over the table without entering the mythical “sterile zone”.

The second surgery, two of the students had to go to classes and I was told to scrub in. Oh boy, it meant I could get closer to the action, and maybe even be useful! Every student dreams of the day where the surgeon barks at you to hold a body part or a tool.

The first time I scrubbed in, I was a little terrified. It feels like such a big deal to soap up outside the OR. Of course, when I got into the room the scrub nurse (the not-so-benevolent ruler of the sterile zone) told me I did it wrong, and to try again. So I did. And then again once more. This time I was finally allowed to put on the surgical gown and everything else.

The second surgery was fascinating. While I have to be sparse on the details, suffice to say I got to see my first abridement (removal of damaged/infected skin) and skin-graft. I was very excited to come in and watch as they used the cauterizing gun to burn through the subcutaneous fat holding the skin onto the arm. The smell was certainly something else, but it was somewhere between B.O. and rotting veggies on the scale of stank; far from the worst thing I’ve ever smelled.

About half way through the abridement, I noticed something weird. I was starting to break out in a cold sweat, my hands were shaking, and I was hyperventilating a little. This only made the smell seem worse. I must have looked off to the nurse because I was quickly rushed out of the OR, sat in a chair and given apple juice. After a good half an hour of trying to scrub in, I must have been in there for only 15 minutes! The big worry, the nurse explained to me, is that you’ll pass out and as she told me, “it’s easier to get you into a chair than to pick you up off the floor”. Luckily, I was spared the embarrassment of passing out in the theatre – one of my professors later told me that her classmate had actually fainted onto the patient while she was in school. Bullet dodged!

After a little while I was allowed to go back into the theatre, but I didn’t scrub in again. This time I hung back and watched as the new skin was stapled onto the freshly skinned flesh, and learned as much as I could from the surgeon as he spoke. Everyone worked together beautifully as a team, and the whole process seemed streamlined and efficient. Kind of how you hope an operating room looks.

As the graft sites were being bandaged, the surgeon took a moment to speak to me. As it turns out, he almost fainted his first time in the OR too! It’s good to know there’s still hope for me, and that if I so choose I may one day be a surgical superstar. Until then, I’ll just keep a juice box in my scrubs.

A Medical Student’s Disease

At the beginning of the year there was a joke that everyone in our class would become a hypochondriac by the end of the year, and at that time everyone laughed. I did too. I thought I was immune to those thoughts. I didn’t even make it to the end of our second block.

I suppose it has something to do with the fact that as a medical student, the vague symptoms of fatigue, malaise, and anxiety are par for the course. Do you know what the differential diagnosis for fatigue, malaise, and anxiety includes? Let me just say that it encompasses every organ system and every type of illness. Fatigue? Boom, diabetes. Malaise? Boom, HIV. Anxiety? Boom, Lyme disease. One of my preceptors once said, “If you’re convinced that [you] have something, you will see the symptoms fitting into a meaningful pattern that may not actually be there.”

It certainly doesn’t help that every day we are shown pictures of the worst possible outcomes – flesh eating disease after a paper cut, or deafness and meningitis from kissing your girlfriend. Another issue is when they tell us the proportion of the population affected by a given disease. When they tell us that more than 1 in 4 people in the world is infected with a particular type of parasitic worm, we tend to wonder which quarter of the class is carrying it.

Then they tell us about the asymptomatic carriers. Those individuals that oh so generously spread around a disease, never knowing that they leave disaster in their wake. To be honest, I recently found out I may be one.

Part of our learning experience is to practice the lab tests that are routinely performed in diagnostic medicine. A week ago, we swabbed each other and did gram stains and cultures using those swabs. This week we got our plates back, rich with natural nose and throat flora. But – horror of horrors – my plate showed evidence of beta-hemolytic colonies. For those of you that may not know what the heck I’m talking about, beta-hemolysis is the process where some bacteria may break open red blood cells on a blood agar plate.

This is usually a fairly clear indicator of Streptococcus pyogenes – the bacteria that causes strep throat. It can also cause toxic shock syndrome, impetigo, and scarlet fever. You know how I mentioned flesh-eating disease a little while ago? Yeah, S. pyogenes does that too.

So now I sit here, freaking out about the scratch on my arm and the bacteria in my throat. I wonder if I’m part of the 25% with intestinal parasites. I worry that I’m the reason my fiancee has been sick for the last week. I’ve gone through more Polysporin, Bactine, and straight up rubbing alcohol in the last month than I did during my entire time in grad school, and I have seriously considered asking my pharmacist for every single anti-parasitic he has. I have dreamed about parasites and infections, and wake up still fatigued and full of anxiety.

I wonder if the fatigue and anxiety are symptoms of anything…?

Clinical unskills

A big part of being a physician, it seems, is being able to perform simple tasks with ease and speed. People expect their doctor to be able to do injections, stitch up wounds, and set a broken bone. It sounds reasonable, right? Well, apparently my doctor is secretly a wizard, because there is no way anyone that’s human could do so many things with only two hands.

Last weekend, I was lucky enough to go to a rural hospital with some of my friends to practice some of the fundamental, simple skills. Whoo boy! Luckily, it seems this wasn’t the coordinators first rodeo, so we weren’t set loose on the unsuspecting patients in the hospital. Instead we practiced starting IVs, doing injections, and stitching up cuts in fake arms, oranges and random pork pieces. It was a tough crowd, I tell you.

One of my good friends, an ex-medical lab specialist, wasn’t satisfied with the fake arm. You see, she was used to drawing blood for the various tests she used to run, and was quite proficient. Apparently once you graduate from silicone arms, it’s hard to go back. Another student volunteered her veins to science, and my friend did her profession proud by starting a lovely IV. She made it look so easy that I had to try, and for some reason she suggested I practice on her. Let’s just say that while I didn’t hurt her or anything, there was quite a bit of blood to clean up. That wouldn’t be a good impression to leave a patient with!

I learned my lesson after that, and stuck to the oranges and pork (the oranges didn’t bleed, and rarely complained). Good thing, too, because while I attempted to do my first stitches I bent my suturing needle. I’ve never had stitches myself, but I think bending the needle is not standard practice. You know, now that I think of it, it might even be frowned upon! Luckily the pork couldn’t run away, and I eventually learned how to tie my knots. I’m still not sure how to hold the needle holder, loose end of the thread and skin edges all at once, but surely that’s not too important.

All in all, I gained a whole new appreciation for the physicians, nurses, and other health professionals that have started IVs and given me injections without traumatizing me. At this point, I think I’ll leave that to the true professionals. For my future patients out there, be afraid. Very afraid.

Taking the plunge

Quick, what do you think of when you think of med students?

If you had asked me this a year ago, a few months into starting my Master’s in biomechanics, I would have likely answered: chronically sleep-deprived; driven; type A. I once jokingly told my fiancee, “I am terrified of med school. They’re all going to be like me, and I can’t stand being around me all the time!” Luckily for my mental health, I found something very different.

Here I am, officially one month and 12 days into classes, and I have met some amazing – and varied – people. I have met people with rich social lives, people with unique and interesting hobbies, and people from all walks of life. I can safely say I have been invited to more parties in the last month and a half than in my entire undergraduate career. I can also say that I have gone to most of these parties, largely because of the caliber of people I am surrounded by. Who would have thought med school is the place to go to party?

I knew when I got my acceptance email (this is the 21st century after all), that my life was going to change drastically. What I didn’t know, however, was how incredibly positive these changes have been. I didn’t realize how quickly my fellow students – my friends, colleagues, support network – were going to be integrated into my life. With all of their own quirks and idiosyncrasies, they have quickly become sort of an adoptive family; and while you can’t always choose your family, somehow you end up loving them anyways.

Here’s to another few years with these chronically sleep-deprived, driven type A’s.