There was once a patient who accidentally injected herself with vaccinia virus (vaccine for smallpox) and developed a rather gnarly bump at the injection site. *Yawn* No blood, no problem for me.

But then there was the patient who accidentally sliced her thumb with some sort of cow cutting/killing device. Now that was bad. Apparently worse for me than the patient even because she was just laughing and talking through it all while I was quietly freaking out as I watched my preceptor nonchalantly stick a needle in her wound to inject some lidocaine for anesthesia before stitching it up. The wound was literally gushing blood. I tried not to look at it, but that didn’t help. She started stitching it up and if I were more of a crazy med student, I would have been right in there watching and asking how to stitch such things, but I was too busy trying not to faint and kicking myself for being such a wimp. The room became excruciatingly hot and started spinning and I prayed that she would finish it up between the talking and giggling before I went facedown on the floor. No such luck, so I had to swallow my pride and ask to step out for a moment (or three). Now that was embarrassing to say the least. But it was a good thing I learned that I cannot magically develop a tolerance for the sight of blood by sheer will or just the sheer fact that I was now a med student and above such things as being freaked out by blood before I got to a point where my wimpiness would matter (say my surgery rotation).

That was my only exposure to blood during my preclinical years. (Un)luckily for me, my current experiments involve surgery and blood, but in animals of course. I found that, although I feel bad for the animals and develop a certain affection for them because they’re soft and furry, I was able to deal with cutting them open and doing stuff to them just fine. I even started assisting by retracting and holding vessels closed during catheterization. Everything was just dandy until one random day, when I felt that same awful hotness and short of breathness that I felt back during that thumb-gushing-blood incident three years ago. More than anything, I was confused because I hadn’t even been thinking about what I was doing and I certainly wasn’t freaking out at the sight of the animal being worked on surgically. Yet here I was again, about to faint. And yet again, I didn’t want to look like a wimp, but I had no choice—better a wimp than fainting on the animal. So I excused myself and stepped outside. And surprisingly, it actually took me quite awhile to recover. Luckily for me, the surgeon was very supportive and understanding and commended me for knowing when to step back instead of trying to tough it out until I end up facedown/hurting myself on the floor/operating table.

These experiences, my general freaking out at the sight of blood/exposed organs, the fact that I get super-nervous and would probably slice the carotid artery through and through with my shaking hands, the fact that I don’t have the stamina to stand for however many hours required for an operation, and the fact that I was not very good with anatomy all point to a very non-surgical career for me. Yet I can’t help but still be intrigued by surgery. So intrigued that I want to try operating on my experimental animals instead of letting the surgeon do it all. We’ll see how that goes, won’t we? Since this post has gone on much longer than I’d planned and because I was supposed to start studying three hours ago (surfing and writing a post at the same time isn’t quite the most efficient way to do things here), you’ll just have to wait until tomorrow to read about why surgery intrigues me so.

As my thinking has evolved, I’ve come to see that my classmates’ money concerns are indeed valid (though I still don’t think that salary should be the number one deciding factor when it comes to choosing a specialty). We spend four years of our lives toiling away to get our MD, accumulating a mountain of debt while we’re at it. Then we spend 3-7 years in hell residency being paid a paltry sum for being worked to death. Finally, after all of that, we’re finally able to start making real money. By that time, how old are we? How far behind are we compared to our lawyer and other professional friends? We want to buy houses too. Have kids. Maybe buy a new car since that one we’ve been driving since the beginning of college is starting to fall apart. These things all cost money. Money that we don’t have, even though we appear to “make a lot of money.” On top of that, I think that primary care physicians work very hard and deal with more than their fair share of difficult patients. I can’t imagine dealing with patients like my mother-in-law and her “I had surgery on my ankle, now I think I’m going to die from a heart attack and I can’t breathe,” “there’s blood in my stool, scope me NOW even though there are plenty of other patients who need a colonoscopy more urgently than I do” and “doctors give me substandard care because I’m poor and I don’t speak English” antics. I know that difficult patients exist in every specialty, but I think (and I may very well be wrong) that there are far more in primary care because of the primary care physician’s role as a gatekeeper. If anything, primary care physicians should be paid more because of their indispensable role. But in real life, primary care physicians are not paid as much as specialists because of the lack of procedures in primary care. I get it—procedures are expensive. But should specialties that aren’t so procedure-based not be compensated as well as those that are? I have to admit that this reality has made me think twice about neurology because of its relative lack of procedures. It’s a good thing that my love for the brain and the art of diagnosis wins out (at least for now) or else I’d be considering something else. How many med students think that same thing and choose money? Some say that this is not and will not be the case, but I’ve already seen some classmates choose their specialties based on that very thinking. Will there be more in the coming years? Who knows. I’ve met physicians who are well into their careers and still have a whole lot of med school debt left even though they probably came out with half the debt of the modern med school graduate. They’ve hinted at regretting their career choice. There are (costly) seminars on “careers to consider when you don’t want to be a doctor anymore.” These kind of things almost make me think twice about what I’ve chosen to do, but only for a split second because I know that there’s really nothing else that I’d rather be doing. I know that I would still do this even if the salary were half what it is now. But you young premeds out there should think really, really, really hard about whether it’s really worth it. Depending on your goals and motivations, it just might not be.

So then came my turn to be the victim. She was more nervous about it than I would have liked. Do you mean that you have really never drawn blood before?! I think I’m in trouble now. She eventually got to actually sticking the needle in, which I of course, could not and did not watch. So there’s the prick. Owie. Don’t be a wimp. Seems like everything’s going okay. I think I can look now. So I take a peek, expecting to see a needle sticking out of my arm with blood flowing neatly into the Vacutainer tube only to find that there’s blood everywhere! I still don’t really know what happened except for that she panicked for some reason (even though everything was okay) and pulled the needle out and then there was blood everywhere. I didn’t react as badly as I thought I would have (i.e., I didn’t faint dead away at the sight of all of my blood not in me or in the Vacutainer tube), but I was definitely not about to let her try again on my other arm (and she didn’t want to anyway).

And that should have been the end of my blood draw guinea pig experience. But curious med student that I was, I still wanted my blood drawn because the medical technologist trainees were going to run some tests on the blood and I (irrationally) wanted to see if anything was wrong with me. So, since I didn’t want to risk another botched attempt, I found a med tech (and not a trainee) who was supervising the whole ordeal to draw the sample. I wasn’t too apprehensive since these med techs are certified phlebotomists and should know what they’re doing (or so I thought). And this time I watched. Okay, good. No blood everywhere. Everything should be okay now. But it wasn’t. For some reason, instead of just leaving the needle in place once the blood started flowing out, this med tech (who must like making people suffer) just kept pushing the needle further and further in. Not further into the vessel but further down (as in, aren’t you going to go through the vessel?!). I kept my mouth shut because I didn’t want to risk any further blunders. Besides, a certified phlebotomist should know what she’s doing. Who am I, lowly med student that I am, to question someone who’s been certified to do this? But when it started hurting, I had to say something. She could have been stabbing a nerve and I really need my right arm! So I told her as nicely as I could that she had the needle in too far. She apologized and pulled it back a bit. And then she proceeded to start pushing it in again! I complained again and she pulled back again. And then she pushed it deeper again! Now I really just wanted this over with, so I just withstood the pain until she was done. But what was once a semi-healthy-not-so-bad fear of needles and blood draws has probably turned into a crippling one. I don’t know for sure since I haven’t had my blood drawn since. And my arm hurt for a good three months after that. I’m just lucky no permanent damage was done. This guy wasn’t so lucky.

A little awhile ago, I wrote about an imaging system that projects veins onto the skin, which aids in the identification of veins for venous access. Would it have helped in my case? No, not really. The problem wasn’t in finding the vein. The problem was in doing the procedure right. And that’s why it’s important that we practice, practice, practice even though it’s really not pleasant (for us or our victims) to be so inept at it. Nothing can really help us become not-so-inept except for experience. And experience involves making mistakes so that we don’t keep making them in the future. So, to all of those patients (and fellow med students) out there who put up with being stuck by med students: thank you.

Let’s not go into why I chose to torture myself so just yet. Let’s just focus on what’s involved in this torture.

The Medical Scientist Training Program (MSTP) was established in 1964 by the National Institute of General Medical Sciences (NIGMS) to address the need for investigators who are well trained in both basic science and clinical research. According to the NIGMS, there are 40 participating programs and 75 medical schools that offer combined MD/PhD degrees without funding from the NIGMS.

So what exactly is involved? At my school, the combined degrees are expected to take seven years to complete. We start out in medical school, finishing the first two years of medical school (the basic science part) and passing our USMLE Step 1 before leaving medical school to start our graduate work in our area of interest. During the first summer of medical school (which is the closest that we get to the summer vacations we’ve been used to), we don’t get to kick back and relax or travel to exotic places or even catch our breath. Instead, we are required to rotate through a number of labs in our area of interest to try to find the lab that we want to do our thesis work in. As I mentioned earlier, instead of going on to the wards during our third year of the program, we start our grad school work. Depending on the field we are going into, graduate courses need to be taken to fulfill the PhD degree requirements. A field closely related to medicine, such as physiology, will have a lot of overlap with the medical school curriculum, leading to fewer courses needing to be taken (or so they claim). In contrast, a field such as biomedical engineering, which isn’t so related to medicine, requires more coursework to be taken. Simultaneously with the coursework, we are expected to be working in the lab (either rotating through labs if we haven’t yet chosen one or in our chosen lab). Graduate programs tend to be a little more flexible with MD/PhD students as well—how this so-called flexibility manifests really depends on the specific graduate program. After completing our required graduate coursework, we must go through the torture that is the qualifying exam just as in a PhD-only program. Then we are free to complete our research, all of which should take a mere three years. Once we’ve completed our thesis work to the satisfaction of the powers-that-be, we’re released back into medical school, where we complete our last two years of medical school. There is supposedly some flexibility in the curriculum for us during the last two years of med school as well, since we usually don’t start right on time to begin “third” year with the rest of our MD-only classmates—however, I’ve heard that they’re becoming less and less flexible (which means I’ll really be screwed by the time I return).

And that brings the grand total to seven years, if we’re lucky. If we don’t complete our thesis work in three years, we just keep going until we do (but the funding just might not, depending on the school and the program).

So where am I in this whole grand scheme? I’m just going over the hump that is the middle. I have one year left before going back to med school IF I stop conveniently sabotaging my own experiments. It wouldn’t be so bad if I knew for a fact that all I have left is this one year. But I don’t. So it’s just sheer torture.

It’s sad, but true, that popping a pill is so much easier than actually dealing with the fact that you just might need therapy to work through issues that you’ve ignored and that are now biting you in the ass. And that it’s also easier to suggest to someone you know who just might need therapy to pop a pill instead. I’m guilty of it myself with my mother-in-law, who probably has some depression mixed in with an anxiety disorder. There is absolutely no way in hell I will ever be able to convince her that she just might have these problems, let alone get her into therapy. And I’d rather not even try because the evil manipulator in her is just waiting for the chance to suck my husband and me back into her guilt-web by giving her more reason to play the victim. I can just see it now, “Poor me. I need to see the therapist 3 times a week. Which means you have to drop everything and drive 4 hours roundtrip to pick my sorry ass up and take me to the therapist (even though I’m perfectly capable of driving myself but would rather use any excuse no matter how lame it is to make you my servants). And you’ll have to do this for me until I get better (which I never will because I’m just pretending that I’m trying to change so that you’ll serve me).” No, thank you! Even the pill-popping idea will be lost on her because it won’t get her what she wants. Since she can’t use it to suck us into her guilt-web, she simply will refuse to admit that she has a problem. Which she does. Because if she doesn’t, then that means that she’s just a mean grumpy lady with control issues. And I can’t stand mean grumpy ladies with control issues. I just avoid them. And I’m trying not to permanently cut mother-in-law out of our lives for my husband’s sake. So she has an anxiety disorder and depression.

I also think my siblings-in-law could also stand to benefit from a little Prozac. Hell, I feel like I need Prozac just to deal with that woman. And that’s the sad part about people with such disorders. In refusing to deal with their problems themselves, they just suck everybody in with their guilt and manipulation, making as many people suffer as possible with them. They make these innocent bystanders suffer so much that they need Prozac just to deal with them. So because of all of these people who refuse to help themselves, we have a whole I-have-a-psychiatric-disorder-by-proxy group of people who need/take Prozac when, in reality, only one person really needs it (but of course, refuses to take it).

And until these people learn to admit that they have issues and deal with these issues in a constructive manner, that’s why we need to add Prozac to the drinking water supply. To keep the rest of us sane. Which was probably the pharmaceutical companies’ evil master plan. They’re laughing all the way to the bank now.

DISCLAIMER: In case it wasn’t obvious, I am not insulting anyone who really has any of these more open to debate “medical disorders.” My intent was to show that anyone (including those who do not have the condition in question) can use that condition as an excuse for bad behavior and that it is these people that I have a problem with.

My poor victim standardized patient was a soft-spoken graduate student working on his PhD thesis complaining of ear pain. I don’t really remember too much about the interview except for my question about whether he had been under any unusual stress recently because we were thinking temporomandibular joint (TMJ) disorder. His answer was pretty non-descript to me: the thesis was stressful (as expected) and he had just recently moved in with a guy. I just went on to the next question: do you grind your teeth at night? When a “timeout” was inevitably called, a fellow group member expressed his amazement at how I completely ignored the whole moving in with a guy part. Well, I thought they were just roommates. It didn’t cross my mind that they were romantically involved, so of course, I didn’t pursue it any further. Oops. But was it really essential that I waste a good extra 20 minutes that I would never have in real life on his sexuality issues? Apparently not because the standardized patient reported that I had done a splendid job despite my markedly non-empathetic-INTP-style of interviewing. To quote him: “I felt that we had a connection and that I could trust you.” Ha! In your face, warm-and-fuzzy doctoring class! It’s comforting, at least for me, to know that there is hope that us INTPs can make it as physicians even though it might be twice as hard for us because we’re not naturally warm-and-fuzzy.

Forget studying for that test! I need to clean the desk/study/house! Besides, the test is still a whole two days away. Don’t I need to turn in that progress report? Well, it’s not due till June so I’ll clean up my desk here at lab first. Then I’ll make that table for my experiment tomorrow. Since I need it by tomorrow, after all. My major professor is on my case about making sure our new data analysis program works but I really need to organize my laptop desktop first. Why? Because I have no need of this program until I actually get some data from my experiments. Until then, why bother? And then there’s the whole studying for the qualifying exam thing. Important? Yes. Big and scary? Yes. Am I studying for it now? No. Why? Because I have a million other things I need to do first, like brushing the dog, cleaning the house, writing in my blog. Blogging is this procrastinator’s dream—there’s always another post I have to write right when I need to get to some annoying task or other.

Ah…to be completely unproductive yet productive at the same time—I’m truly living my life at my pace.