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It's good for me to hear your experience as a patient, because I'm sort of halfway in between the doctor world and the outside personal world. It's very hard when you're young and alive and you don't know what's going to happen. There is a misconception about, just because one is diagnosed with AIDS And I don't know if I'm going to be an old man, but I also know I've had a marvelous life.
And at 37, I've had many great experiences, and the quality has really been there. And I'd like to see it continue for a long time, but if doesn't, the time I've had has been really, really something. I feel like I've got your emotions Well, you're only a third-year medical student, Jane. It's okay, you've got time. Any time you do a procedure for the first time, your adrenaline goes up, because you don't know what it's going to be like. You know that you don't really know what you're doing, and so you're sort of randomly shooting the needle in. When I was going for the vein, I was really afraid I wouldn't get it.
I was just going to sit there and keep stabbing him, trying.
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And that's when you feel bad, because that's when you know that somebody who knows what they're doing could get that vein on the first try. Or a little nick, right? If you can stay still for a few more seconds? When you get that, advance all the way to the skin. Uh, uh, pull it back. Okay, now hold the wire at the skin. You've got to make sure it's coming out the back before you start pushing it through the skin. Some people like to do procedures, some people don't. I really like them. I think one of the strangest things about coming into this institution of medicine is that human lives and human drama is really an everyday part of your life as a doctor.
And in academic medicine particularly, there's interesting cases. And you sit and you hear about all the interesting diseases, interesting this, interesting that, and all of a sudden you realize that's a person on the other end of this discussion. And the pain came on me, and it gradually got worse and worse and worse. And they put me in the intensive care. You never had surgery before. The good thing will be that you won't remember what's been going on. And then when you start to feel better, you'll feel better, and they won't be giving you so much medicine.
I think being in the operating room is one of the most intense experiences one can ever have. Having your hand on a case and actually helping when you feel needed is probably among the top 10 experiences to have in the world. What's happening is they're taking some vein from his leg, and then some other vessels that are in the chest wall, and connecting them up to where the coronary arteries are, which give the heart blood.
The chest is a great place to see anatomy. Let's wait and see what happens here. Do you understand what's happening right now? His heart isn't working, and Dr. Johnson is pumping, he's actually pumping the heart himself. It's not, it's not working. So that's what's happening right now, as we speak. The responsibility we have now is to kind of keep a calm head and help the family understand it. I feel the way you feel, but I can't go up to them like that.
Well, I wasn't going to go up to them. It's funny, I've never really had a patient that I've gotten to know who's died. And here it just happened. It's like a bad dream or something. Like, "Let this be over already. You're attached in a way that is perfectly appropriate. But you have to understand all kinds of other things. Like, from the start of this operation, he could have, from the aorta, he could have had a stroke, and he never would have worn his kilts again.
You know, it would have even been worse. And I also know he wouldn't have lived with his arteries like that anyway. But it's so hard to watch it. This week, I work at nights and then I try, well, at least I try to sleep during the days. I start in the hospital around 7: And the hardest thing about it is just that your whole sleeping schedule gets all screwed up.
Well, right now we're going to be giving a cesarean section. It should take about, you know, less than an hour. What's really nice is that as you get a little bit more experience and as the attendings and the residents get to know you, you get to do more and more at each delivery. What I think's nice about it is that you get to operate and do procedures, and it's a happy specialty. Most of the women who come in here, you're almost assured that within 24 hours, they'll have a baby. And it's really nice when, at the end of the delivery, the baby's already out, it's nice to see how happy she is.
And I've had a couple of women kiss me after the baby's delivered, and you know, it makes your day when that happens. One couple gave me a box of chocolates, and it really made me feel special. It made me feel very happy that I shared this important moment with them. I was very disappointed when I saw my ob—gyn course evaluation grade because, not only did I think I worked hard during the rotation, I really enjoyed it.
And for several months I was actually considering ob—gyn as a career choice, and I think for that reason it particularly hurt me when I didn't do as well as I thought I was going to do. I felt a lot of the people weren't honest with me, and if they felt I should have been working harder or if they didn't like me, nobody ever told me.
For that reason, I was particularly disappointed. I had an accident with my toe, and I went to the Mass General Hospital emergency room. And Elliott was doing an emergency room rotation at the time, and he actually worked on my toe, and put the sutures in my toe, and ended up giving me his number in case I had any problems afterwards. I actually called him up to thank him for all the work he'd done on my toe. And he asked me out, and we started dating right after that. Actually, the first time I saw Tom, he had held the door open for us, and that's when he was big and gruff, and I turned to my girlfriend and said, "I have no.
Thomas, let me caution you. When you blow out your candle, that has a very special meaning: Are we going to light this together or separate? Do we do this together? Together we do this. Pretty well, pretty well. Pain's pretty good, under control. And I am getting anxious to get it over with. I am going to be an assistant. I'll probably just be the person standing there handing doctor something or being an extra hand. Kidder, who is a year-old woman, developed pain in her hip.
While they were working that up, they found out that she had cancer and that it had invaded the bone of her hip. So about five or six months ago, they replaced her hip. Today, what we are going to do is go in there and put in some plates and some cement to prevent her from actually breaking her leg doing something maybe as ordinary as just getting up out of her chair. I am the anesthesiologist and this is the Harvard Medical student you heard about. I've been taking all these specialties like radiology, pediatrics, medicine and surgery. Now I'm taking anesthesiology, and I really think it's the field for me.
Not only do I find it interesting, it pays well and it's got a good lifestyle. Although you get to the hospital very early, you tend to leave earlier. There is nothing more dramatic and more curative and more decisive than surgery. If I did nothing but stand there and hold the retractor or just stand there and watched, I would really find it rewarding. People think of medicine It's really not the case. What is the case is you can't be stupid and do medicine, you can't be a klutz and be a surgeon.
What I've learned from 1, doctor suicides | Pamela Wible MD
But if you are reasonably well-adept or you are reasonably bright, then you could do either one. Don't use the drill guide. This drill bit will take those threads with it, beyond a shadow of a doubt. It's very intense work. I mean, seriously, you are concentrating every single minute you are in the O. R, unlike in medicine, or a lot of other things where you spend a lot of time around the hospital just, kind of, talking to the nurses, having a coffee break.
I mean when you are in the O. You know what it is like? It is like driving on an icy road for five hours. You did a good job, Tom. Boy, I'll tell you, now that we are fourth-years, we are doing a lot of stuff. You were great, man. You got that P.
Who would have dreamed, who would have dreamed, last year, that you'd be closing up and I'd be, you know, able to do the lines. I'm going to be doing a residency in internal medicine at Boston City Hospital, Boston, Massachusetts. My therapist in medical school told me medical training is a marathon. Jay, you just have to keep going, showing up every day. As soon as you get through one hurdle there's another one. This thing's in Latin. You can't even understand a word of it. It's going to be wonderful to finally be Jay Bonnar, M. I'm going to miss being so much a part of this Harvard medical student experience and I'm going to miss all of it.
My girlfriend gave me a button, "Dr. Dave," and that's what I feel like: Dave, nothing more really. Where you're probably, where you're definitely going to spend the night. It's the first time where I feel I have responsibility, and if I don't do something well, I could cause my patient harm. And that would be the worst thing one could do. I'm on call tonight in the emergency room, so I'm going to be up all night.
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I think that people talk a lot about how stressful it is to work here. I've had a lot of late night discussions, with nurses mostly, about how difficult it is to work in a municipal hospital with fewer and fewer resources and patients who are extremely needy. When I was in medical school, I used to think I had all of these diseases, like, consciously, when I was awake. I'd be worried that I had this horrible thing or that horrible thing.
I think, as an intern, I'm very conscious of how healthy I am compared to my patients. I'm conscious of the fact that I don't abuse myself or my body.
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Well, I mean, being an intern you abuse yourself because you're This is a young lady who was found outside a, what they call shooting gallery, which is where people shoot intravenous drugs. If you have to go, just go. If you have to go, just let it go. We'll clean you up. If you have to go All I can say is that I hope life after internship is nothing like life during internship, because this is not why I became a doctor, and I really am not very happy.
And it's no one thing in particular, it's just being underpaid labor, spending very little time taking real care of patients, doing everything and anything that's necessary because I'm, you know, the bottom line. Our cameras tracked them from the first days of medical school to the sleepless nights of internship, It's not that I don't care about patients, but that I am absolutely strung out and absolutely can no longer think anymore. A unique behind the scenes look at the making of a doctor on Doctors' Diaries.
Elliott Bennett-Guerrero, anesthesiologist and clinical trialist. I was trained as a pediatrician at Harvard Medical School. I am very nervous about starting internship, but I feel ready to make the jump. I expect I'll look back on it and say, "Boy, my internship years, oh, they were so wonderful," but while I am living through it I think it'll be hell, just like Pietro said, hell, hell and then more hell. Doesn't that sound good?
Welcome to the Deaconess. Today's the first day. This is everybody congregating before we all go off to our respective jobs. Dave," and that's what I feel like, you know: Dave, nothing more, really. It's the first time where I feel I have responsibility, and if I don't do something well, I could cause my patient harm, and that would be the worst thing one could do.
I am sure there are certain things we do every day that have negative side effects, and now I am going to be one of the ones doing those things, and I'll cause negative side effects to people, but that's part of what you have to do to treat somebody. But that's a hard thing to live with. The first few months of internship are very, very difficult. You're constantly in a panic, you're afraid you're going to do something wrong. I probably want to hydrate her, but I'm just wondering, do you think we could turn down her W-tracks a little bit?
People say, "This is your doctor," and you are the patient's doctor. You shouldn't be, but you are. And this person is going to tell you all the things that should lead you to understand their disease, but you really don't have a prayer of making heads or tails of it. These are the worst blood gases I have ever seen. I never saw a living person with gases that bad.
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Learning to be a doctor is an apprenticeship. You will give them a large number of man-hours to take care of their patients at low cost, and in return they will teach you how to be a doctor. We'll run rounds today, and we'll use the rest of the morning to catch up. It all seems really cumbersome right now.
There's, like, all these patients, and they all have multiple problems, and they're going for tests, and results are coming back from tests, and you're making treatment decisions based on tests and, sort of, keeping it all straight: What they need next just can be kind of mind-boggling. That's a lot of information to keep track of. She's a year-old lady with a history of many M.
Patient Profiling: Are You a Victim?
She had deep S. Hopefully, in a week, I'll sort of have my system together. And that's what I am really working on tonight, trying to figure out what's going to be a good system for me that will keep me from going back to the chart three times to see if I checked X and did Y and so forth. Right now it's January, and I am in Ward Medicine, which means that I take care of patients admitted to the hospital with basically any problem that doesn't require them being on the surgical service. It is the rotation, which is, at this hospital, one of the most difficult ones in terms of the workload.
I've gotten to a point where it's not that I don't care about patients, but that the fact that I care about. I forget simple basic things. People will remind me, "You didn't do this thing on this patient. Jay doesn't really have very much time to do anything anymore.
He doesn't really read; he doesn't really get to go out too much. He's actually a pretty hyper person, generally, by nature. And then to see him so worn out, just sort of a shell, I mean, what I get is lousy. The best part of him goes away early in the morning, for the whole day, and then when he comes home, what do I have? He's this tired grouchy thing. I came in four hours ago.
So far I have admitted one patient with fever, probable sepsis, and done a lumbar puncture; subsequently disimpacted that patient, which is great fun. What that means is to take all the stool out of that person's rectum by hand. I have visited all my own patients in the hospital, wrote notes on several of them, checked their labs, drawn some blood tests on patients that needed them to be done, and I've just now wheeled up my second admission for the night and will be going shortly to examine her.
I am taking a short food break because I'm getting a little hypoglycemic here.
It started out in the back of my leg, this was in September. I had the operation. Now the front of my leg, from here down, is numb, and every time I take a shower, my whole leg gets numb. I'd like to ask you what exactly it is that you feel and then come to a It may interest you to know that different people mean different things by that phrase. I appreciate that this is something that has you very concerned, and you appear to be a little irritated at some of my questions. I came into medical training, I think, one of the more sensitive people in the field.
I'm going into psychiatry. My whole emphasis is on the emotional and the understanding the mental aspects of medicine. And yet, for all of that interest on my part, I cannot help but become this person that I don't particularly like, even. I have a list of the medicines you've been taking. Have you been taking You think they are giving you pills that are Right now, I'm six months into my internship, and I'd say I'm gradually just getting more and more tired.
I think, in part, because, you know, I never really get a free weekend the whole year. Being married your first year is difficult enough, in and of itself, without your husband working 80 or 90 hours a week and then come home and be exhausted. It's very sad; it's very hard. Half the year I'm on call every third night, and I think what she's realizing is that not only does she not see me when I'm on call the one out of three nights, but the other two nights, especially the night when I'm post-call, as soon as I go home I'm just exhausted. If you are a very, very needy person, and you always need a lot of attention and support from your spouse, you're probably not going to be happy being married to a doctor.
I've decided to work in internal medicine at Boston City Hospital. One of the best features of this residency training program is that we can do home visits. Nei has two major problems that I'm worried about. One is difficulty breathing from his heart and his lungs, and the other major problem is his depression. Nobody cares for me.
And trying to kind of find a way into him, make a relationship with him, to help him I went back a couple of days later to bring him some antidepressant medicine, and he was having a lot of difficulty breathing. And so I called his son, when his son got home, and I told him to bring him in to the emergency room. Ni gen jiang ta ma? Gen wenzhen hao ma? Have you talked with him? Was it okay with Wenzhen? Well, you know what? We're going to work on that. You have a lot of use. Nei looked to death as a solace, as a time when he could meet his maker and his wife.
However, he greatly feared becoming disabled and losing his independence in that process towards death. In spite of my sadness now, his spirit is with me strongly and will be so. I realize it is somewhat unusual for a doctor to have this type of. Nie Chu Ping was not just any patient or any man. Nei's name actually means autumn peace, and I hope that he's achieved it.
Grazette, I'm one of the doctors up on Ellison 11, and I understand you are going to come and spend a day with us at least, Rizzo, he came in for heart failure; he's been in and out of failure for quite some time now and he had problems with his lungs, as well. Lists are terrific memory aides. Be sure to include non-prescription medications and supplements in your list of medications, and note the dose for each. Also, include a list of questions that need to be answered and concerns you want addressed. Franklin Delano Roosevelt perhaps said it best: If you really want complete and thoughtful answers from your doctors, start your conversations with this statement: Before your visit, decide what your three most pressing concerns are, and limit yourself to asking questions about them.
Save less pressing questions for a later visit. If you want to get a clear answer, ask a direct question. When men listen to women talking, they often conclude that women spend a lot of time talking around issues, hoping to gently lead listeners to a question, rather than just blurting it out. Doctors have a much easier time answering pointed questions. See you in 3 weeks! Do you think I have a mental disorder? If you doctor asks about your concerns, open up and share them.
What do you think? A good way to make sure that you understand what your health care provider tells you is to rephrase what he says in order to be certain you heard it right; for example:. These questions help clarify what your doctor tells you, and what you need to do to improve your health.