Island Med Student

I’m currently finishing up a gastroenterology elective rotation. Last week, I was working at the clinic, and I interviewed a patient who primarily complained of chronic diarrhea. After evaluating the patient, the attending physician agreed that the patient needed a colonoscopy, so I made him an appointment for a week later.

I happened to be in the colonoscopy suite the next week when he came in. By the time I saw him, he was already gowned up and lying on a stretcher, waiting to be wheeled into the procedure room. I walked over to him to see how he was doing, and I could tell that he was very anxious about the colonoscopy. “I’m scared it’s going to really hurt,” he said. I told him that it wasn’t going to be a joyride, but that the medications would help keep him relaxed. I then touched his hand and told him that I would be in the room the whole time. He smiled and said, “I wish you were my doctor.” I smiled back and told him that I still had 9 months to go before becoming a doctor. He replied, “I know, but I’ve just encountered so many uncaring doctors…ones that dismissed me and my complaints…but you’re the first one to actually listen.” I told him that I knew what he was getting at, and promised to continue listening to patients, even after graduation.

The encounter I just described is not the first one I’ve had like it. During my clinical rotations, I have met many patients who have illustrated the same kind of scenario where they have been dismissed by many doctors. Many of them have had all kinds of bad experiences with physicians, and when I show them even the smallest amount of compassion, they express deep gratitude to me.

Sometimes I think it’s really not that hard to be a great doctor in patients’ eyes, when so many patients have such a negative view of doctors to begin with.

So, there is something that I’ve wondered for a long time. When I first started med school, I believed that the world needed more physicians who actually listened to their patients. As a patient myself, I had encountered many doctors who were obviously not listening to a word I was saying. It made me frustrated, and it made me realize that there is a lot of room for improvement. I wanted to be a different kind of doctor–one who truly listened to their patients, and understood that very small gestures of compassion can go a long way. But I feared that the rigors of med school would beat all of those hopes and dreams out of me. I assumed that many young med students entered the field with these types of aspirations, but somewhere along the way they lost them, and that this is why I encountered so many uncaring doctors.

As I’ve mentioned before, I realize that as a medical student, I don’t have the time constraints that physicians have. I don’t have to see 20 patients in an hour. I also don’t have the same level of stress to deal with. I don’t have to worry about malpractice lawsuits, and I don’t have the ultimate responsibility for the patient’s well-being. So, I guess what I’m trying to say is that I think it’s very easy right now to be a good doctor. I have the luxury of time, and none of the stress of being an actual physician. So, I wonder what will happen when I graduate. Will I eventually become the type of doctor that I once loathed as a patient? Or will I still have patients saying to me, “I wish you were my doctor”?

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I am very content right now. I have a bunch of thoughts rumbling around in my head but don’t have the energy to put them all into coherent sentences right now, so please excuse my words.

Right now I am listening to random Bob Marley songs, and “No woman no cry” just came on. Bob Marley is one of my top 5 (maybe #1) of all musicians, and this song is definitely a very good one. Everything’s gonna be alright. Simple, but brilliant, lyrics.

I had a great day at the hospital today. I do doctor stuff. I know how to do doctor stuff. I know which questions to ask, how to perform a decent physical exam, which labs to order, how to diagnose, how to present a case. I’m still far from being able to function capably as a doctor, but I just keep realizing how far I’ve come. I can say stuff like “patient presented with hematochezia, denies hematemesis, their LFTs are elevated, and their Child’s class is B,” and this actually means something. Before med school, this would have sounded like gibberish to me. Sometimes I hear myself saying stuff and I think, OMG, I can’t believe I even know what all this means. I’ve come so far.

I just updated my “about” section on the right to say “fourth-year” med student. I will be finished with med school in 9 short months. I will be able to introduce myself as “Dr. Campbell.” It’s all a little mystifying.

I had a patient yesterday say to me, “when you graduate, will you be my doctor?” And he really meant it. Today, I told a woman that she didn’t have cancer. She hugged me and cried. It’s all so very surreal. It’s hard for me to believe that my dreams are coming true.

I love my life right now. I live in a city that I’ve always wanted to live in. I have a loving partner who supports me. I have two doggies who are the apples of my eye. I have really, really amazing family and friends. I’m almost a doctor. I enjoy what I do. I have plans for changing the world. I want to break down barriers and make a difference in people’s lives. I believe in standing up for something that is right, regardless of what other people say. I have a dream that one person can be the change that they believe in. And I’m starting to realize that it’s not just a dream. And, well, everthing’s gonna be alright.

Note: Photo is me and my fellow family medicine peeps (Ajay and Ronak) on the train to Manhattan a few weeks ago to celebrate the end of our rotation.

My last post, “That Is So Gay” generated a huge number of comments, and since I don’t have the time to reply to each commenter individually, I decided to write a follow-up post to address a few issues.

Let me start off by saying that I appreciate all the comments, even the more negative ones. And while I do find some of them a bit offensive, I believe in freedom of speech, and as the saying goes, I might “disapprove of what you say, but I will defend to the death your right to say it.”

However, many of the comments seem to be quite off topic. I really appreciated the commenters who actually addressed the points I made in the article. I was not trying to determine whether or not homosexuality is a “choice” or a “lifestyle” or what have you. I was simply addressing the issue of using derogatory remarks towards a group of people in a medical setting. In addition, I was attempting to make some assertions about why certain derogatory remarks seem to be more or less accepted in my society.

I believe that using offensive and pejorative language towards groups of people is inherently wrong, and perhaps even more so in medicine. I don’t think it matters whether or not a person “chose” to be black, or jewish, or gay, or a heroin addict, or to have pink hair. Hate and name calling are hate and name calling, regardless of the particulars of the group at which they are directed.

I also wanted to bring up one more point. It is not the words that people use which offend me. Rather, it’s the context in which they are used. The phrase, “you are so gay,” for example, might not be offensive in certain instances, especially if it was said lovingly towards someone. However, if used in a way that is diminutive or intentionally hurtful, it could be quite offensive. What I’m trying to say is that the connotation and context in which a word is used is much more important than the word itself.

To return to my original point, I am not a hateful person. I don’t like intolerance, prejudice, or hate in any form. However, I do believe that people have the right to speak freely about their beliefs. The American Civil Liberties Union (ACLU) is famous for having defended the right of the Ku Klux Klan (KKK) to march down the streets of Cleveland. I believe wholeheartedly in their decision to defend the group’s right to free speech, even though the KKK basically preaches hate towards non-whites.

However, I wouldn’t feel comfortable having a physician who is a Ku Klux Klan member. Nor would I want to hear a KKK resident or attending make racially offensive remarks about their patients. I also would question whether or not they were able to effectively treat their patients, because of their intolerance.

We are all free to have our own opinions. I personally believe in universal acceptance. I think that hate harms, and love heals. And I believe that I am better equipped as a physician with love and tolerance in my heart.

But I guess that’s just my opinion.

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I am a very easy going person. I infrequently get upset or irritated by people. But there are two things that really tend to get me all worked up: racism and homophobia. I tend to like most people, but once they start making racist or homophobic comments, it’s very difficult for me to continue respecting them. I might not walk away, but it will certainly ruffle my feathers.

During my clinical rotations so far, I have encountered very few racist comments by fellow students, residents, or attendings. Every once in a while I might hear a comment that could be vaguely considered racist, but nothing incredibly striking. Sadly, the same is not true for homophobic comments. Just the other day I heard an attending refer to a homosexual male using the “f” word. This isn’t the first time I’ve heard such comments. I’ve actually heard a variety of disparaging words spoken about homosexual persons.

It’s not just the comments that bother me, either. There also seems to be a general lack of education and awareness in medical education about homosexuality, transgenderism, transsexuality, transvestites, and other sexual and gender orientation topics. I once overheard a doctor talking about their transgendered patient by referring to her as a transvestite, which she clearly wasn’t. It seems that although these topics might be briefly reviewed in some medical school curricula, there is clearly more room for improvement. I could go on to list all the reasons that it’s important for a physician to have a broad base of knowledge with respect to these issues, but I actually think it’s rather self-evident.

So, I started thinking today about why I rarely hear healthcare professionals make racist comments, but have heard them make all kinds of homophobic and homo-illiterate comments. I think it’s likely due to our general acceptance of different cultures versus different sexual or gender orientations. Our society has simply become more accepting of racial equality, and not of homosexual equality. A perfect example is that in this country, it used to be illegal for a black person to marry a white person. Thankfully, these laws were eradicated years ago. However, in this country, it is still illegal for a man to marry another man, or a woman to marry another woman.

Another good example of our society’s level of comfort with other races versus other sexual orientations is our use of derogatory terms. I’ve never heard a medical professional refer to a black patient by using the “n” word. However, I have heard both students and doctors use the “f” word to refer to a homosexual patient. I find this incredibly saddening, and it causes me quite a bit of angst.

Obviously, I’m not the only person to notice the ways in which our society uses disparaging homophobic phrases, without actually considering the consequences. In fact, there is a whole advertisement series (which won an award), featuring various celebrities, the goal being to make people aware of how offensive the phrase “that is so gay” can be. You can view one of the commercials with Wanda Sykes on YouTube here.

I think that everyone should consider the impact their words have on other people. But as healthcare professionals, it’s even more important to be cognizant of the effects. We need to educate medical students on all the various permutations of gender and sexual orientations. I believe that education is always an important step in reducing stereotypical and prejudicial thinking. We also need to take a stand when we hear someone make an off-hand comment that we find offensive. Otherwise, people might never truly understand the impact their words can have on other people.

I encourage you all to share your thoughts. What do you think about medical students and doctors who make racial remarks or pejorative comments about homosexuals? Does it even offend you? If so, have you ever taken a stand?

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Check out my post on Medscape to read my rant about listening to our patients.

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Today was yet another wonderful, great, fantastic day of family medicine clinic. It was also my first day of real pediatrics. Up until this point, I’ve pretty much only dealt with patients who were 16+. Almost all of my patients were adults, and most of them have been older.

I haven’t had pediatrics yet, and in fact I won’t have my pediatric rotation until after I take the Step 2 CK and CS. However, peds is a part of both exams. So, I’ve been a little worried that I wouldn’t be prepared for the Step. The same thing goes for ob/gyn. But family medicine has saved me! Since family medicine includes pediatrics and ob/gyn, I’m gaining experience in both. And I really think this is helping to prepare me better for the Step.

My first patient today was a 4-year old child. She was sick and cranky and wanted nothing to do with the girl in the white coat (me). I consider myself to be pretty good with children. They tend to like my strange hair, brightly colored clothing, and general “clown-ness.” BUT, I have never had to poke, prod, and stick a child. Nor have I approached a child while wearing a white coat. Well guess what? Kids don’t like scary people in white coats trying to stick things in their ears!

Long story short, my patient was not having any of it. She cried when I got close to her, and refused to let me examine her. So, I had a thought. She was wearing an all pink outfit. She had a pink book bag. What to do? Well, my favorite color happens to be pink. So, I asked her, do you like pink? YES!! She loved it. So, I pulled out my pink phone. Many people like to make fun of my phone. Yes, I am a grown adult and yet my phone is covered with a pink cover, decorated with flowers. My screen is almost completlely covered with star and butterfly stickers. You think it’s silly? Well, my patient did not! She loved it!

So I asked her what her favorite cartoon was. Spongebob! Well, I pulled up episodes of Spongebob on Youtube. I made a deal with her. If she let me examine her, I would do so while she got to watch Spongebob on my pink, covered with stickers, phone. Deal!

I have so many other stories to tell, but not the time to write them. But I also ended up examining a 6 month old baby, and several other kids. I gave vaccinations. I bribed kids with stickers. I pulled out my phone on more than one occasion. Maybe my silly habits aren’t so silly afterall. Or at least not when it comes to pediatric patients.

My attending also gave me so many compliments on this shift. She said that I have outstanding bedside manner. She said that I make everything seem so natural. Like I don’t even have to try. The thing is, I don’t. I just like people. Old ones, young ones, purple ones, crazy ones, dirty ones. People are my people. And that turns out to be a very good thing in medicine! I can’t explain how great it is to be appreciated for what I just do instinctually. It’s just utterly amazing, and I’m so grateful to be able to connect with people.

More good stories and thoughts to come!

Note: First photo is me, and my insane phone. And the second photo is of a deserted building I pass by all the time in Bushwick.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I really can’t say enough how happy I am right now. I had perhaps the best day in med school thus far. I took the subway and walked to a health clinic a few miles away. I was set up with a resident and met four patients. The resident was so awesome! He let me do everything. I did the H&Ps, wrote the SOAP notes, and even wrote the orders for all the patients. I did good! My resident and attending both complimented me on my skills.

One of my patients presented with a simple complaint, but when I pressed further, she admitted to me that she’s been under a ton of stress lately. She ended up bursting into tears, and I ended up giving her a hug and consoling her. Is it okay to hug patients? Well maybe not in all cases. But I believe that I did the right thing. I think I’ll write more about that later. But she thanked me. She told me that I was a great doctor. I felt like I did something really, really good.

I am just enjoying family medicine so much. I also really liked my first out-patient experience. Up to this point in med school, and in my personal work experience, I’ve only dealt with patients in hospitals. It was so good to have some actual clinic experience.

I even diagnosed a dermatological condition that my resident had never heard of! Talk about impressed! Both my resident and attending gave me mad props for that one.

The weather was nice. I walked my doggies. I’m getting ready to eat some vegetarian chili. Life is good. Very, very good!

Note: Photo was taken at the end of a recent family medicine night-call. I was tired, but happy.

I just got home from family medicine night call. Wow, what a great night! So far, I am absolutely LOVING family medicine. I’ve learned SO much! And we are allowed and encouraged to pretty much do everything for our patients, including the H&Ps, procedures, writing orders, etc. There is a lot of autonomy, and that’s just what the Dr. ordered for Kendra.

I don’t know if it’s the fact that I haven’t slept all night, or something else, but I am really having some profound life-altering thoughts. Before starting family medicine, I was 95% sure that I wanted to go into psychiatry. But right now I am having second thoughts. I really like family medicine. It’s interesting and good and nice and well I don’t have enough functioning neurons right now to say much more than that. I really like it.

Maybe I will have to change some of my electives. Maybe I will have to change my life plan. I dunno, but I know that I’m really digging it.

Tonight was my last family medicine night call. The next two weeks I will spend in a clinic, and hopefully with a doctor who I admire deeply.

Life is good. Life is great. Life is wonderful. (Anyone get that reference?)

My bed is covered with dog urine, but I know I should go to sleep right now, as I have things I need to accomplish tomorrow.

So, good night world! I am thankful for awesome doctors. I’m thankful for kind and awesome residents. I am thankful for my wonderful patients.

Sweet dreams of large women!

I wanted to thank everyone for all of their helpful comments on my recent post about my surgery evaluation. I’ve since come to accept the grade and have vowed from now on to always seek guidance from my higher-ups as to their expectations of my performance. Also, I couldn’t help but notice one theme running through the majority of the comments, and that’s the advice to just accept my grade by chalking it up to the ambiguity of the grading policies. Since receiving a “B” is a relatively minor incident in the grand scheme of things, I don’t feel bad accepting that advice, being happy with my grade, and moving on with things. However, it really got me thinking (and a few commenters pointed this out) about what it means to accept things because “that’s just the way it is.”

In life, we all have to pick our battles. The world is full of unfairness, rules that don’t make sense, inequalities, and things that just aren’t what we think they should be. Most of the time, I just accept all of this to the best of my ability. But sometimes I witness inequalities or injustices that are so egregious, I can’t just sit back and say nothing. These are the times when I take a stand about what I believe is right. I’d like to believe that I do this more often than most people, but that’s probably just wishful thinking.

But what if we all just said, “that’s just the way it is” about everything? Think about how history would be changed. Black people would be forced to give up their seats on American buses had Rosa Parks not decided to take a stand. Doctors wouldn’t be washing their hands after performing autopsies if Dr. Semmelweis had simply bowed to the popular notions of his time. Didn’t smallpox seem impossible to eradicate before Edward Jenner developed a vaccine?

I guess my point is that, while sometimes it is necessary to accept that things are unchangeable, the world seems like a much larger place, with more possibilities, if we instead reject all notions of immutability and decide to take a stand against things we believe are not right.

In that vein, here is a list of medically-related ideas that are viewed by many people as unchangeable facts:

• Physicians can never be replaced by computers.
• Doctors can’t have pink mohawks.
• Patients will never completely comply with their treatment.
• Medical school has to be grueling.
• It’s impossible for everyone in the world to receive equal and high quality healthcare.
• Cancer is unavoidable.
• Medical education has to be expensive.
• Doctors don’t have enough time to give their “all” to every patient.
• Kendra will never stop complaining about everything.
• Mortality is a certainty.

Perhaps we are just simply farther away from achieving the ones that seem completely ridiculous. After all, isn’t it easier to imagine being hit by a train if you can see a glimpse of the engine on the horizon?

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A few weeks ago, I had an experience that has really stuck in my head. The resident and I were performing a painful procedure on a patient, and I could tell that he was really enduring a lot of pain by the grimace on his face. As I’ve done in the past, I instinctively reached out my hand and held his hand in mine. I allowed him to grip my fingers, and told him to squeeze my hand as hard as he needed to.

He started squeezing my fingers, and suddenly his face turned from a grimace to a smile. The change was rather startling, and so I jokingly told him that I’d never seen a patient with such a huge grin on their face while undergoing such a painful procedure. He smiled even more and said that it was because he was so happy to hold such a “pretty girl’s” hand. I smiled back, and soon the procedure was over.

I think it probably makes common sense that hand holding might bring some relief from pain. We all reflexively hold a child’s hand when they’re in pain. And I believe that even the most callous people might agree that there is something powerful about the human touch. Hugs are an even better example. I don’t know when the hug was invented, but I’m sure that it’s been around for quite some time. People of all races, ethnicities, and cultures seem to use the hug as a means of displaying affection. And while certain cultures might value human touch to varying degrees, I think we all agree on its significance.

One of the most well known studies on the power of touch and the importance of physical and social interaction is that of Harry Harlow. In his famous experiments, he allowed rhesus monkeys to choose either a cloth or wire “surrogate mother,” both with and without a bottle of milk attached. Regardless of which mother had the bottle, the monkeys continued to choose the softer, cloth mothers. He also performed other controversial experiments, including ones where he deprived the monkeys of all physical or social interaction. The lack of physical touch produced monkeys with severe psychological pathologies, and in a few cases led to their deaths from self-induced starvation.

A study recently published in the journal Science also found some interesting results with regard to “warm hands and a warm heart.” The researchers found that if people were given something warm to hold, they subsequently described other people as having “warmer” personality traits, such as being more generous, more social, happier, and better natured. They also discovered that people who held something warm were more likely to behave in a friendly and generous way.

I’ve only begun to scratch the surface of the importance of the human touch, but you can see that the subject is much more than simply skin deep (pun intended). I tried to find some research that supports my anecdotal notion that holding someone’s hand who is in pain can serve to decrease their perception of the pain, but I was unable to find much research on this topic. Perhaps it’s a topic that will be further explored in the future.

But for the time being, I will continue to hold my patients’ hands. Whether they are in pain, or just very sad, or just very lonely, or even just very happy, I will continue to offer my hands to them. And hopefully when I need a hand to hold, someone will do the same for me.

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