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On Playing Doctor

An excerpt from “Playing Doctor: Part Two: Residency”

By: John Lawrence, MD

As was her habit, she [the surgical chief resident] had called to check in with a surgical nurse to see how each of her patients was doing. They were discussing each patient when the nurse stopped to mention that there was a code team outside a room on the sixth floor with a collapsed patient.

My girlfriend quickly realized that it was one of her patient’s rooms, then raced back to the hospital, sprinted up six flights of stairs, and dashed onto the sixth floor, where she encountered a chaotic group of people surrounding one of her patients lying unconscious in the hallway.

The internal medicine residents and attending physician running the code were about to shock the unconscious patient because he had no pulse. As we’ve discussed previously, no pulse is bad.

Suddenly, in the middle of their efforts, and much to everybody’s surprise, the 5’1” surgery chief ran up, injected herself into their midst, ordered them to stop, and demanded a pair of scissors.

Nobody moved. The internal medicine attending exploded, wondering who the hell she was and what she was doing. It was his medicine team in charge of the code, and this patient had no pulse. Protocol was shouting for an immediate electric shock to the stalled heart.

Paying little or no attention to his barrage of questions, she grabbed a pair of scissors and now, to everyone’s complete and utter shock, cut open the patient right through the surgery wound on his abdomen.

Let me recap in case you don’t quite appreciate what’s going on: she cut open a person’s abdomen in the middle of the hospital hallway—and then stuck her hand inside the patient!

When the chairman of surgery came racing down the hall, he found his chief resident on the floor wearing a full-length skirt, with her arm deep inside an unconscious patient, asking, “Is there a pulse yet?”

The furious medical attending was shouting, “What are you doing? Are you crazy? What are you doing?”

And she kept calmly asking the nurse, over the barrage of shouts and chaos, “Do you have a pulse yet?”

Suddenly the nurse announced, “We’re getting a pulse!”

Which immediately quieted everyone.

Being an astute surgeon, she remembered thinking that the patient’s splenic artery had appeared weak when they operated on him. She correctly guessed that the weakened artery had started bleeding, and that his collapsing in the hallway was due to his rapidly losing blood internally. She had clamped the patient’s aorta against his spine with her hand to stop any further blood loss.

From the sixth-floor hallway the patient was rushed to the O.R. with my girlfriend riding on top of the gurney, pressing her hand against his aorta, keeping the guy from bleeding to death.

She then performed the surgery to complete saving his life.

The guy took a while to recover. Being deprived of blood to the brain had its detriments; when he awoke, he was convinced the 5’1” blond surgeon in the room was his daughter. When he was informed that no, she wasn’t his daughter, he apologized, “Sorry, you must be my nurse.” That comment, one she heard all too frequently, did not go over well.

To put this somewhat crazy event into perspective, within a day or two, the story became the stuff of legends told throughout surgical residencies across the country—and this was before social media sites existed to virally immortalize kitten videos.

Opening a patient in the hallway and using her hands inside the guy to save his life? This feat, treated by her as nothing more than a routine surgical moment, was akin to knocking a grand slam homerun in the ninth inning of the World Series in game seven to win the game—well, something like that. It’s what little kid wannabe surgeons would dream of if they cultivated a sense of creativity.

And to be fair, I thought it was an exciting episode, but she was always running off to save lives as a surgeon. The moment however, that finally put this accomplishment into perspective for me occurred when I was having dinner with her brother, the ace of aces surgeon, along with several other all-star surgical resident friends. This was a few weeks later, and without her present.

Eventually their surgery discussions (because that is pretty much all that this group of surgeons discuss when stuck together: surgery, ultra-marathon running, and more surgery) turned to loudly bantering back and forth about the whole event.

They boisterously argued about how much better they would have handled the whole situation, and wished they had been there to save the day instead of her:

“You dream of something like that going down.”

“Can you imagine being that lucky?”

“Should have been me.”

“Oh man, I would pay to have something like that happen.”

All the young surgeons agreed that this was their medical wet dream, being the rebellious action hero, on center stage, in such a grand case, in the middle of the hospital, no less, calmly saving a life in front of everyone with attending physicians yelling at you.

Then there was a moment of silence, total quiet as everyone reflected on the event…

“But you know what?” her brother finally said, looking around at everyone, then shaking his head and chuckling, “I never would have had the balls to do it.”

And every single surgeon around the table slowly nodded their head in agreement—they wouldn’t have either.

True hero.

Playing Doctor: Part Two: Residency is a medical memoir full of laugh-out-loud tales, born from chaotic, disjointed, and frightening nights on hospital wards during John Lawrence’s medical training and time as a junior doctor. Equal parts heartfelt, self-deprecating humor, and irreverent storytelling, John takes us along for the ride as he tracks his transformation from uncertain, head injured, liberal-arts student to intern, resident and then medical doctor.

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Well, Well, Well: Products and services compete for shelf space in trendy wellness market, but are they worth your money?

When a friend recently asked me to join them for a class at Inscape, a New York-based meditation studio that New York Magazine described as the “SoulCycle of meditation”, I was skeptical. On the one hand, I usually meditate at home for free, so paying almost $30 for a meditation class seemed a bit silly. On the other hand, my meditation practice had dropped off considerably since the beginning of the year. Maybe an expensive luxury meditation class was just what I needed to get me back into my regular practice. Stepping off bustling 21st Street into the clean modern space, I heard the sounds of, well…nothing. It was incredibly quiet. Before getting to the actual meditation studios, I had to pass through Inscape’s retail space. The minimalistic shelves hold a variety of supplements, tinctures, and powders that include unique ingredients like Reishi medicinal mushrooms and cannabidiol extract. Many contain adaptogens, herbal compounds that purport to increase one’s resistance to stress, though their efficacy has never been quantitatively proven.[1] These products’ promises run the gamut from shiny hair and stress relief to aura cleansing. I may be a super-skeptic, but even I am not immune to the lures of top-notch marketing. With great consideration, I purchased one of the many magical powders for sale labeled as ‘edible intelligence.’

Since wellness has become trendy, a considerable space in the retail market has opened for associated products dedicated to helping people live their best lives. As Amy Larocca pointed out in her June 2017 article The Wellness Epidemic, “[In the wellness world] a loaf of bread may be considered toxic, but a willingness to plunge into the largely unregulated world of vitamins and supplements is a given.” Even a recent episode of Modern Family poked fun at the wellness trend when Haley Dunphy applied for an ultra-competitive job with fictional wellness guru Nicole Rosemary Page. During her interview at Page’s Nerp company headquarters, Page laments, “People say that Nerp is nothing more than a con-job, a cash grab vanity project from a kooky actress. I want to turn Nerp into the next Disney-Facebook-Tesla-Botox. It’s a world changer.” Though Page is a fictional character, I can’t help but wonder whether the character was inspired by the very real Amanda Chantal Bacon, the founder of Moon Juice, which bills itself as an adaptogenic beauty and wellness brand. Bacon’s Moon Dusts retail for $38 a jar and come in varieties such as Spirit, Beauty, and Dream.

The bottom line is that a sense of well-being needn’t come at the price of thirty-plus dollars an ounce. In fairness to those who choose to spend lavishly, I believe that plunking down a chunk of cash might create an intention to use and derive value from a product, thus positively influencing one’s perception of how well the product works. Rest assured, however, that living with intention and gratitude can be just as easily accomplished without spending any money at all. Carving out time in the day to create a small ritual for yourself can be as simple as spending a few minutes in the morning listening to jazz as you drink your first cup of coffee or allowing yourself to become immersed in a good book before drifting off to sleep. These simple acts allow us to bestow kindness upon ourselves that is especially important in our stressful and busy lives as medical students. My suspicion is that by performing such rituals with intention, we derive much of the same benefit whether our mug is filled with the trendy mushroom coffee or just plain old Folgers.

I’m always thinking about ways I can improve my own well-being, but as graduation approaches I also find myself thinking about how these practices might help my patients as well. One of my fundamental goals as a future psychiatrist will be to help my patients see the value in themselves and in their own lives. I predict that for many of my patients, achieving this goal will depend perhaps on medications but also on the deployment of simple wellness tactics such as I described. I’m not going to lie…I’m still intrigued by many of the wellness products that can be found in places like Inscape, Whole Foods, and the Vitamin Shoppe, especially when I think about the potential benefits they might have for my future patients. I figure that if these products do even half of what they promise to, some of them might even be worth the money. So what happened when I added a sachet of intelligence powder to my usual morning smoothies? Pretty much nothing. At one point, I got excited when I began to feel my fingers getting tingly. Then I realized I had been leaning on my ulnar nerve. Not so brainy after all.

[1] Reflection Paper on the Adaptogenic Concept, Committee on Herbal Medicine Products of the European Medicines Agency, May 2008.


Photo credit: Open Grid Scheduler / Grid Engine

Humour Lifestyle

Study Strategies: The Good, The Bad, and The Ugly

The Tortoise
The tortoise is in it for the long haul. He studies for a fixed amount of time, every day. He has a routine. He never has to worry about cramming or catching up, because he’s always on top of things. The med school years for him are simple years; he studies and refrains from indulgence. Indulgence is too time consuming, and throws him off his rhythm. “If I party on Friday night,” he says, “then how will I get up at 6:30 to study on Saturday?”

The Hare
The hare is usually a social butterfly. So much energy, and so productive . . . in spurts. But the hare also enjoys taking time for herself. She takes evenings or maybe even whole days off studying. If she didn’t do this, she would fall victim to the dreaded burnout. At least that’s what she tells herself. Although she is often behind, her ability to catch up is second to none. Many of us have probably heard the adage that it’s impossible to cram in medical school. Well, not for the hare. Cramming for the hare just starts a few days earlier than it did in college. It really is impossible to cram for a neuro test the day before the test, but it is possible to pull 3 consecutive 20-hour cram days and still do well. As for long-term retention, who knows? Only boards will tell.

The Moocher
The moocher is lazy. He keeps to himself most weeks. He does not make study guides or contribute to anyone else’s learning. If at all possible, he will not show up to lecture. When a test is not looming, he can be found in his underwear at home, drinking beer and cruising the interwebs. Then, when a test looms near, he breaks free from his filthy cocoon of lethargy and can be seen on campus and social media snatching up all the condensed study guides everyone else in the class has made in the previous weeks. The moocher usually does okay on the tests, but one wonders how he will perform during rotations and residency when he does not have such helpful resources on hand.

The Memorizer
The memorizer is the queen of facts. Her ability to absorb large tables of seemingly random bits of information is unparalleled. While some may struggle to recall even the names of different medications, the memorizer will calmly recite all of the generic drug names, all of the brand names, how to spell them, how each of them is metabolized, their side effects, and which are contraindicated under what circumstances. She can do this after only going over the material once. Her classmates are in awe of her. Truly she is blessed.

The Reader
The reader… reads! Truly he is a rarity in our times. While he abhors the brute memorization of random facts, he loves to read textbooks. Bringing together a large body of knowledge into a logical system is what the reader enjoys most. He is a systematic learner who loves finding out how the little details fit into the bigger picture. The reader also must have strong shoulders, for textbooks are not known for being lightweight.

The High Yielder
The high yielder is focused first and foremost on the next exam. Perhaps it is a flaw, or maybe just an efficient allocation of her resources, but the only thing she cares about is information likely to be on the next test. She might be heard on campus saying something resembling the following: “Did the professor say that’s going to be on the test? No? Then I’m punting it. I’ll learn it later for boards if I have to.”

The Recluse
The recluse is only seen on mandatory days. Nobody really knows what he does. The only thing known for certain is that he does not go to class or social events. He doesn’t have a Facebook, and certainly shuns the company of others when he is forced to be on campus. The recluse may either be an actual loner, who would much rather be alone than in a group, or he may just be an older, married father of 3 who spends his time with family and studying at home. Either way, whenever he shows up, everybody turns and whispers to each other “Who IS that? Is he in our class?”

The Deity
The deity is revered by all. She is at the top of the class. Her study methods are mysterious. She somehow gets top scores on tests, actively participates in multiple clubs, is on student government, volunteers regularly at free clinics, and conducts research. She has a strong presence at social events and on social media. All of the students and professors adore her. Many have tried to discover her secret, but it remains a mystery. The current hypothesis is that she only sleeps 3 hours per night.

Featured image:
Studying in Starbucks by Nicola Sapiens De Mitri

Clinical Humour Lifestyle

A Guide to the Operating Room for Medical Students Or How I Learned to Stop Worrying and Love the Sterile Field

The summer between MS1 and MS2 I did a research project with an orthopedic surgeon at my school.  Part of the project had me observing in the operating room (OR) a few days a week, watching procedures and helping with any tasks that came up.  This experience was actually my first time being in an OR, and I was pretty nervous leading up to it.  I had heard horror stories about students breaking sterility, knocking over solution bottles, and generally making fools of themselves in front of important people.  While I tried my best not to do anything foolish or embarrassing, it was oftentimes very hard to avoid.  Slowly, I become more confident in the OR, and the blunders came further and further apart.  As a service to all the pre-meds and un-initiated med students, I now present a short list of important things to know before your first OR experience.

  1. Figure out the rules.  Surgeons love rules, and at times it seems as if they have a weird fascination with them.  If you don’t ask then the rules are never really explained to you, and you will be in big trouble when you break one.  Consequently, I think it’s prudent to ask someone what the rules are.  Considering your fear of talking to the surgeon, he or she isn’t the best option.  The resident or intern is probably too sleep-deprived and hopped-up on caffeine to notice you.  Your best bet is to ask one of the circulating nurses or other students who have been on the service for a while.  Believe me, it will save you a lot of trouble later on.
  2. Make sure you’re dressed appropriately.  Make sure everything you’re supposed to wear is on correctly.  Make a mental note of scrubs, cap, mask, and boots.  Aside from actually wearing the right attire, please make sure you are wearing it correctly.  You’re going to feel really stupid when someone points out that your cap is on crooked, or that you forgot to tie half of your mask.  You will also be the butt of many jokes over the next few days when you aren’t there.  In addition to knowing what to wear, it is also important to know what not to wear.  Don’t wear shoes that you actually like, unless you think it’s cool to have fecal matter on your $100 Sperry’s.  Also, leave the personal items and accessories at home.  While that puka shell necklace you made in 10th grade art class may be “totally rad, bro,” it is definitely a sterility hazard and you definitely shouldn’t bring it into the OR.  Also, if you’re still wearing puka shell necklaces in your mid-20s you should probably re-evaluate your life choices.
  3. Know where the sterile field is and how to avoid it.  This rule only applies if you’re not scrubbed in, and the decision of whether or not you get to scrub should have decided before you show up.  Anyway, just remember that the sterile field should be avoided like the plague.  Any blue towel or covering should send off warning signals in your head.  Don’t get close to it, don’t breathe on it, and don’t even really look at it if you don’t have to.  Don’t try to be cute either and inch your way as close as possible, because the scrub nurse will call you out and you will be embarrassed.
  4. Try to look interested even when you’re not.  After the 5th time seeing the same surgery, it’s only human nature to get a little disinterested.  There are only so many times you can be mystified by a hernia repair, and you’ve probably passed that threshold long ago.  It is imperative, however, that you look interested at all times.  Surgeons have an innate ability, almost like boredom-radar, to tell when you are dozing off or doing something else.  These situations usually end up in you getting pimped mercilessly in front of everyone.  To make matters worse, you don’t come off looking like a shining star when your response to the first question is “Huh?”  You can typically avoid these situations by employing certain maneuvers that indicate “interest.”  My go-to method was switching sides of the OR every 20 minutes to get a new “viewing-angle.”  Another tried and tested one is intently looking at the monitors or camera.  Find what method works for you, and stick to it.
  5. If you’re not scrubbed in, find yourself a role.  Surgeons dislike idle people.  There’s nothing worse you can do than to just stand in the same place in the OR doing nothing.  Find a job you can do, and be amazing at it.  Like to record information?  Write down the incision and closing times.  Like to clean?  Become the best darn disinfectant wipe user ever.  Like to retrieve things?  Be the person who looks up and prints all the obscure research papers the surgeon even tangentially mentions during the procedure.  Note:  If you choose the last one, be prepared for incessant pimping later.  Remember folks, nothing is without consequence, so choose your punishment wisely.
  6. Prepare yourself for the spectacle that is a patient waking-up post-op.  This is the part that you never hear about or even see on those dramatized TV shows about surgery.  A patient waking up from anesthesia is most definitely not pleasant.  Prepare yourselves for all sorts of near disasters.  Patients will try to pull out breathing tubes, or roll over onto joints that have just been operated on.  Some will even try to get out of the bed, as they don’t realize where they are for the first few minutes.  People will often kick out their arms and legs, and if they aren’t stabilized someone on the team is bound to get a black eye.  The best thing you can do is to be aware of the possibilities, and find out how the team handles such situations.
  7. Find a place to store food for post-op consumption.  We have finally reached the pinnacle, the crown jewel of my OR guide.  Don’t pay attention to the fact that this rule actually doesn’t correspond to anything taking place in the OR.  After spending countless hours in the OR, the first thing on your mind will be food.  No matter how mundane or exciting the procedure was, human need for nutritional sustenance will take over.  Make sure you have a safe storage spot for food, whether it is in the clinical workroom or in the students’ lounge.  Also, considering that everyone you will be working with (read: vultures) will also be voraciously hungry and will have no problem eating anything lying around, make sure you keep your food in a place only you can find it.  Invest in a locker and a lock if your facilities have them.  You’ll thank me for this advice later.  You’re welcome, by the way.

Featured image:
CPMC Surgery by Artur Bergman