The Placebo Chronicles: Strang

Book by Farrago MD Douglas

Medical School

The long, grueling process of becoming a doctor begins with medical school. It’s four years of hell after college. It was the hardest thing that I had to go through in my young life until, of course, residency, which was even worse (you will read about that in the next chapter). Just getting into medical school is an incredible feat in itself, the first of many Darwinian trials an aspiring doctor faces. You need exceptionally high college grades, which isn’t easy because competition grows stronger and stronger. As time goes on, the weakest students give up and the strongest students hang around, totally screwing up any type of testing curve. The pressure to succeed is enormous. I remember the shock of my first chemistry class in college. There were five hundred people in it and almost all of them, including me, wanted to go medical school. Only ten or twenty would succeed. No one would have predicted I would be one of those ten or twenty. Not even me.

In medical school, the whole competition process starts all over again. The testing is outrageously hard and the hours are ridiculously long. The first two years, the medical student actually has minimal patient contact since he or she is wrapped up doing the basics of science including biochemistry, neurology, chemistry, histology, etc. When the “clinical rotations” start in year three, the real fun (or horror) begins. Here is where the student spends months at a time seeing patients in such areas as internal medicine, surgery, emergency medicine, and obstetrics. Finally, young men and women who are tired of just the textbooks get a chance to try to treat live patients. This is a real eye-opener for them. This is when they start to see it all and feel it all. This is where they learn to develop their defenses against the gross, the sad, the disturbing, and the outrageous. I am not sure if having such thick skin is a good thing for doctors or not, but it is our basic survival mechanism to deal with these types of things. Seeing children die, arms that were severed, hearts splayed open, yellow patients, green patients, and blue patients are shocking, but a reality nonetheless. Any time taken to wallow in their own pity only takes time away from seeing other patients. The student buries his or her emotions to do his or her job and learns a valuable lesson: Medicine is not pretty.

I remember in my first anatomy class there was this sweet girl who was initially very bothered by the cadavers. The school had done all the right stuff to slowly introduce the new students to their “bodies.” There were prayer sessions for those so inclined. There were warm-up periods so that people could acclimate to the cadaver. Still, people were squeamish, especially this one young woman. I didn’t pay her too much attention because I had enough work to do on my own cadaver. I had totally forgotten about this student until halfway through the semester when I saw her walking by, whistling, with a sawed-off leg over her shoulder like a slab of meat. I thought to myself, “Haven’t we got a little sassy?”

Now picture yourself as a medical student. See yourself trying to save a life all the while questioning whether you know what you are doing. You’re nervous and exhausted. You’re hungry and overworked.

All you care about is sleep (and hoping you don’t kill someone). As you become more and more disconnected from the real world, you fall more and more into the medical one. All you can remember are the basics of survival and those weird, gross or outrageous experiences that occurred during your dreamful “medical student” state. It is these patient encounters or stories, however, which you will remember forever. It is these stories you will collect like a hobby. They are ones you will never share with patients and only occasionally share with one another. They’re not for the faint of heart but they are yours and yours only – until now. The following stories are ones that we have pried, bribed, or extorted from former medical students who have endured this torture. Their collection is now, for the first time, open for your perusal, but it comes at a cost. After reading them, you may become thick-skinned yourself and for that we have but one cure humor. These doctors didn’t laugh about their medical student experiences at the time, but trust us, they are laughing about it now. We hope you can do the same.
STAGES of the PHYSICIAN

I want to help people.
I want to make it through this hell.
I want to make it through this hell without killing someone.
I may have killed someone.
I want someone to help me.

I want to make money.
I want to spend money.
I want to save money.
Where the hell is my money?
I need to make money.

I don’t know anything.
There is too much to know.
I will never know all of this.
I don’t need to know all of this.
I only need to know a little.
I don’t care if I know anything.

I want to be needed.
I love my white jacket.
I love the power of the pager.
I hate this f*cking pager.
I don’t want to wear a stupid jacket.
I want to be left alone.

This patient has some interesting problems.
This patient has some real disease.
This patient needs to be hugged and loved.
This patient has a lot of nothing.
This patient has Sh*tty Life Syndrome.
This patient needs to leave; I need to be hugged and loved.

Our OB-GYN rotation at a busy inner-city hospital was one of the most grueling of medical school. The residents were miserable and as all miserable residents do, they torture medical students for relief. One particularly sadistic senior resident was on call with us on Friday night, one of the busiest of the service. He would extract as much scut from us as possible and he was merciless in his criticism. Any procedure we would attempt was quickly taken over by this impatient resident. Since it was the last day of the rotation, I was eager to finish a call and never touch a speculum again. My medical student colleague, however, had only revenge on his mind.

At around 3 a.m., we were called to the ER to work up a morbidly obese patient with “itching down there.” After our thorough history and cursory physical, we called the senior resident. In his usually abrupt manner, he dismissively listened to our presentation and proceeded into the room for the exam. The patient put her legs on the stirrups, but as with most morbidly obese patients, there was no hint of the vagina except the odor and converging folds of endless flesh. Even the sweat in between the rolls of cellulite gave an additional pungency to the aroma.

“I’m sorry I’m so fat, doctor,” she kept repeating half sleepily. With much reluctance, we each held back a thigh so our fearless leader could plunge into the depths with his speculum for his examination. As our resident diligently probed flesh with his speculum, my medical student colleague looked up at me with a gleam in his eye and a wink . . .

Thwack!!

He had let go of his thigh and I instinctively did the same . . .

Thwack!!

I will never forget the seemingly headless senior resident flailing his arms trying to free himself from the deluge of flesh and odor that was delivered onto his bare cheeks. He was now cheek to cheek with our sleepy patient who barely reacted to the fracas. We quickly regained our composure and insincerely apologized to our resident, who tried his best to proceed with his exam. The rest of the evening just seemed to pass by effortlessly and our senior resident was much nicer to us for the remainder of the shift. _

ER STUFF
As a very green third-year medical student in Bellevue Hospital (NYC) emergency room, I spent much of the time wide-eyed and terrified. With its surreal mix of the heroic, overwhelming, and bizarre, Bellevue ER was a great place for memorable patients and events that have stayed fresh in my mind for years.

One shift I noticed a man on a stretcher having a grand mal seizure. This seemed to make absolutely no impression on the surrounding patients, or the staff for that matter. Just as I was really getting worried, a nurse strode past, said to the patient,
“Oh Jack, cut it out!” . . . and he did.
My story begins when I was a fourth-year medical student at a large inner-city emergency room. I was doing a required rotation taking twelve-hour shifts and working closely with an intern as well as an attending ER physician. I enjoyed the fast pace of the big city ER but did experience significant anxiety when a code was underway or an imminent or a major trauma was unfolding.

The attending wanted me to see patients, assess them, and formulate a plan. I went to see what seemed to be my 100th patient this shift. Ms. Greenjeans was a 76-year-old female who presented with nonspecific pelvic discomfort. She had the usual past medical history including diabetes, tobacco abuse, alcoholism and substance abuse, hypertension, renal insufficiency, etc. Her abdominal exam was unremarkable, but as we all know, “No abdominal exam is complete without a pelvic exam.”

The forty-bed ER was nothing more than a large room separated by pull curtains that do provide visual privacy but do not provide much privacy in regard to conversation. In other words, the whole ER including patients, staff, etc., can hear every word I say to the patient. Ms. Greenjeans was morbidly obese and hard of hearing so this pelvic exam would likely be difficult but, considering I had done two pelvic exams in my entire medical career (counting this one), I thought I could handle it.

Ms. Greenjeans was placed in the lithotomy position with lifting help from nursing (#1: because nurses are much stronger than doctors; #2: because all doctors have “a bad back”; #3: because this patient’s legs resembled large, soft, fleshy bags of cottage cheese). I reached for a speculum not realizing that they actually came in different sizes. By chance, I chose a medium-sized model and inserted it into the vagina. Unfortunately, due to the size of the patient, I could barely see the labia
minora.

The ER nurse who was chaperoning my exam recommended a change in equipment. I looked up at the nurse with total confusion on my face as she handed me a jumbo-sized speculum resembling a small fishing vessel or salad tongs. I again inserted the instrument to get a better look into the vaginal vault. Words cannot describe the horror, surprise, and disgust as I watched several hundred maggots squirming to exit to the outside world. I jumped back suddenly, nearly falling on my butt. “This could not be happening? Why me?” I quickly ran over to my attending to tell him the news; he casually walked over to the business end of the exam table and confirmed my diagnosis.

“Yeah, those are MAGGOTS.” He then informed me that I should tell the patient her diagnosis and then proceed with cleaning them out of there. Sounded like a plan, but, why me, why here, and why now? I stood up at the head of the exam table and in my best doctor voice I said, “Ms. Greenjeans, you’ve got maggots in your vagina.” Suddenly the busy ER seemed so still, so quiet. I was sure everyone in the department could hear my every word. Ms. Greenjeans looked at me with a confused look on her face. She then yelled at the top of her lungs . . .

MAGNETS
HOW THE HELL DID MAGNETS GET IN THERE?
Talk About Blowing It

He was a passive guy and very laid back. When I saw him on the gurney I was surprised how calm he was. The ER physician had called earlier in the afternoon and stated that Frank was back because of his nausea and vomiting. He had a history of multiple admissions for gastroparesis from his diabetes. He truly had the latter disease and was insulin dependent. The gastroparesis was in question and previous testing never proved it. He was in his forties and had an obvious history of polysubstance abuse as well. He loved to smoke and drink and failed detox on many occasions. He also had chronic back problems, as well as the abdominal pain he claimed to have from his gastroparesis. His primary physician was tortured by him because she couldn’t shed him from her practice. She had him on 60 mg of OxyContin three times a day and held him to a narcotic agreement/contract. He never overtly broke the contract, but when he would run out of his narcotic medication early he would coincidentally have severe nausea and vomiting and abdominal pain. Subsequently he would go to the ER for admission to cover those days he didn’thave the medication he needed at home. Since dehydration can make diabetes lethal, it would be inappropriate to just ignore his demands and send him on his merry way. Even though no one ever saw him vomit in the ER, there was no one who would question Frank and chance the possibility of malpractice.

I knew Frank was a fraud and told him right away that I wouldn’t give him any more medication to go home with when I discharged him. He didn’t bite. I was expecting a fight but he just nodded quietly. He then rattled off the combination of antiemetics and narcotics he needed intravenously while he was an inpatient. It made the admission pretty easy and I put him in the hospital in about 10 minutes. By the second day of his admission, I had taken him off all his IV drugs and put him back on regular oral pain medication. Once again, no complaints. In fact, he was as nice as pie. Since I had never met Frank before, I was amazed at how easy admission was going and started to second guess the accusations about him. I told him that he should be able to go home the next day and he agreed wholeheartedly.

The next morning I was seeing a patient on the floor below Frank when I received a page by the nurses taking care of him. Since I was coming up in about five minutes, I didn’t answer, figuring I would see the nurses personally. When I opened the stairwell door to enter Frank’s floor I saw a huge commotion. About four nurses were buzzing around his room and two were frantic by the phone waiting for my call. Then I noticed that security personnel were mingling around as well. This is not good, I thought.