When you don’t like your patient

I’m still on the way home, on the second leg of my trip.  I am eavesdropping on the conversation going on in the row in front of me.  13C is coming home from Guyana where he’s been working in mining exploration.  He looks like a young guy, maybe around my age, with a kind of Western or Southern drawl.  He’s describing what he does to 13D and I’m trying to listen for any indication of gross injustices against the environment or local communities.  He’s an outgoing guy and seems really friendly.  He leans over the empty seat beside him and is now chatting with 13A, whose contribution to the largely one-sided conversation is the occasional “ah” or “huh”, “yea…”.  He’s talking about his life working overseas.  He proudly mentions having 4 girlfriends, who don’t know about each other “no, they don’t know about each other”.  He sounds jovial, like someone talking about how fresh the fruits are at the local market or maybe how a dad would talk about his son’s little league team.  I wondered how I would approach this if he were my patient.  Would he tell me about his 4 girlfriends?  How would I respond?  Impassionate, matter-of-fact: “Oh, well do you use protection? Have you been tested for any STDs?  Alright, well we have the facilities here to do that”.  I pictured the movie effect where you have a map with a pin-point on it that just spreads like a black wave, sludgy and oozing across the continent.

I remember one time my mom came home from the office upset.  One of her patients was cheating on his wife who was terminally ill.  His mistress wanted him to promise to be with her.  He was stressed and depressed but didn’t know why.  When my mom asked if he thought perhaps it had to do with his relationship situation, he was surprised and hadn’t considered it.  My mom was boiling the whole hour of therapy, as she was reminded of being cheated on herself so publically by my dad.

As much as Western medicine is about micromanagement and control of biology (at least we like to think that), we’ll eventually end up with patients who we will feel crappy listening to.  I’m thinking of the simulated patient we had who was abused by her husband but didn’t want to admit it.  Doctors are legally mandated to report child abuse and elder abuse but not spousal abuse, and I can’t imagine what it will be like to have to see some women walk back out into trouble despite all the counselling you give.

I guess part of becoming a health professional is always keeping a professional front.  Obviously my mom couldn’t bring her own baggage into the care of her patient.  The trick will be finding the balance between being jaded and being human.

Go home

One of the most frustrating things about my school are the other students and the things some of them say.

On my way home to Toronto via Trinidad, the first leg of the flight was in a Turboprop with about half the plane full of students.  In this small plane, some are talking about how desperate they are to get off the island and never return.  You couldn’t pay me to come back, one said.  When the cabin was sprayed for mosquitos, one joked about the next thing waking up in a strange place, Hostel-style.  Reply was that even being drugged and abducted and tortured would be better than staying in Grenada.  And so on.

It’s embarrassing to be in the same group as these people, so harshly ripping into an amazing, beautiful country in front of people who have grown up there and live there now.  Totally without a clue, these guys are.  I feel pretty certain that they’ve hardly ventured out from campus except the usual trips to the IGA or beach, and doubtful that they’ve had a conversation with a Grenadian outside placing an order for food.  Because that’s the only way I can explain how anyone can live here for 1-2 years and still talk like that.

Iron-man for jerks

I know it hasn’t been that long since i was there, and that there isn’t really all that much different between us except that i started school a year before them, but lately everything term 1s do seems extremely annoying. Including studying at the same table as me, quietly doing anatomy questions together.

On a related note, exam time is a great time to reflect on how irritable and cranky of a person you can be. It’s like competing an iron-man and realizing you had it in you all along, but for downers. On the upside, it’s good practice for trying to stay aware of feeling annoyed, and keeping perspective. Emphasis on the practice. Having appropriate reactions to situations can be hard!

Tomorrow’s my Clinical Skills practical exam. We dress “professionally” in white coats and see our standardized patients. 6 days until the Path exam. 13 days until home and Christmas break. Whew.

Politically incorrect medical terminology

There is lots of it.

Corynebacterium, often described as looking like "Chinese letters".

More chinese letters. I don't see it.

Invasive lobular carcinoma of the breast has this "Indian File" pattern of cell infiltration. Like footprints of Indians walking through the sand. Obviously.

"Mongoloid facies" of Down Syndrome.

Images link to their sources.

It’s not funny.

During today’s 8am Clinical Skills and Physical Diagnosis lecture, the professor was demonstrating various gaits and the class would guess which gait he was performing.  There was the hemiplegic gait (one foot sweeps out and around, kind of like a dragging on the floor), the Parkinsonian gait (stooped over, short shuffling steps), the paraplegic gait (scissor gait, criss-crossing legs) and the sensory ataxia gait (i.e. drunk gait, wide steps as if your feet are magnetized to the ground).

Maybe it was because it was 8am and a poorly attended lecture.  Maybe because we all looked disinterested and he was feeling desperate to get us to pay attention.  For whatever reason that seemed good to him at the time, after demonstrating Parkinsonian gait he joked “It looks kind of like a retard. Do I look retarded?”

My grandma died the winter before I started med school from complications of Parkinsons.  It was a slow but dramatic decline that spanned over a decade.  I remember my mom and my aunt arguing with my grandma about why she needed to take her medications.  My grandma didn’t want to because she was afraid of the side effects.  I sided with my grandma because she seemed so upset, and told my mom maybe she should leave my grandma alone because she really didn’t want to take the drugs.  I was about 11.  When I was in high school I went with my mom and brother to see my grandparents off at the airport to Hong Kong.  My grandma was put in a wheelchair for the first time and my grandpa told me and my brother in Cantonese that they loved us.  It was my first time hearing that from them.  They never came back to Toronto.  We finally sold their house this year.  For the last few years before she died, my grandma could no longer shuffle “like a retard” and was completely bedridden.  Her mind was still sharp but she spent her days staring at the ceiling of her bedroom or choking on food during meals.  She had told my mom she wanted to die, and had nightmares every night – another complication of her Parkinsons.  After my masters me and my brother and my mom visited my grandparents in Hong Kong, just as she started bleeding profusely from her GI and was hospitalized.  We spent our mornings and evenings sitting in her hospital room with masks on.  Sometimes she chanted Buddhist prayers under her breath and waved her skin-and-bones arms, sometimes she stared at the cartoons flickering on the TV in the corner, but mostly she slept.  They went in to scope her GI and found food and crushed up pills stuck in her oropharynx.  My grandpa, with his OCD tendencies, could barely get himself to visit her in the hospital because he was so afraid of germs.  She died with my mom, cousin, uncle, grandpa and my grandpa’s secretary in the room.  Me and my brother were outside joking around on my mom’s computer.  I was making a cartoon about him.  My mom came out and said “Paw Paw died.”

She was totally different when I went in to see her, just a body.  I was so acutely aware that her life was gone.  It was scary to look at her.  I thought she might jolt up, zombie-style.  I kept thinking “This is now an object.  We are just objects.”

Ten minutes after calling the Parkinsonian gait “retarded” the prof made a joke about Schizophrenic patients wanting to tear up and eat a sealed and stamped envelope, rather than mailing it like a reasonable person (part of the mental assessment test for judgement) and people in my class who are studying to look after people of all illnesses mental or physical, laughed.

I visited my grandpa last summer, just me.  It was my first time visiting him without my mom there, and he opened up to me about my grandma’s death.  He told me how she was the love of his life, that they were together for 80 years and that she had dropped out of high school to marry him when the war started and he needed to move to Macau to run the family factory.  He told me after she died his heart has been broken and he thinks about her every hour, 24 hours a day.