Typically, the first two years of medical school are comprised of learning the science of medicine in a classroom setting. You have lectures, books, and exams. Just like college. Except every week is like finals week for the hardest classes you ever took. Years three and four, they ship you off to a hospital where you learn how to actually practice the medicine you’ve been learning and deal with those bewildering creatures called “patients”.
However, my cutting edge ultra-hip medical school decided it was going to be proactive with our clinical training by assigning students six clinical days per semester. This is so that when the students finally get to the hospitals they don’t have a nervous breakdown while seeing patients for the first time. It’s a fantastic idea. In theory. The only problem is when you stick first year medical students into a clinical setting, it becomes readily apparent that we don’t have a fucking clue what we’re doing.
You eventually get relatively cool clinical experiences like Cardiology and whatnot in your second year, but in the first semester of year one, you’re generally relegated to family docs. Dipping your toes in the medical waters before dunking you into the Pacific, if you will.
My first assignment was to work with a family doctor thirty minutes away from the city in the middle of bumfuck nowhere, population = 26. Whatever, I put on my white coat, slung a stethoscope around my neck, typed in the address into my phone GPS, and sped off the fulfill my dream of being a doctor guy. I was gung-ho and ready to put my newfound knowledge and studying to use. When I finally roll up to the address, I circled and circled around the block several times looking for an office building. I was a little taken aback when I realized the doctors office was actually inside of an old house. I walked in and the quaint antique decor reminded me of somewhere my 81 year old grandmother would love spending time in. Definitely not my idea of how I want to practice medicine.
I gave some handshakes, introduced myself, and got down to business. Saw my first patient. Obese person with _______ (insert joint pain, diabetes, fatigue, high blood pressure). Doc says to lose weight. Eat healthier. Exercise. Patient doesn’t lose weight, eat healthier, or exercise. That scenario comprises 20% of family physician visits.
Then for my first real action, we step into the patient room and a young male is standing nervously. “What brings you in today?” He replies, “my butthole hurts” … “I think I might have a hemorrhage”. Doc corrects him – “A hemorrhoid, pull down your pants”. Patient lies on his side, drops his drawers as the doc puts on his latex gloves, spreads his butt cheeks apart to reveal the hemorrhoid. He calls for me to come examine. After the Gregory House-esque diagnosis, the doctor leads us to the procedure room to remove the thing. I keep my distance, standing in the corner, and to my horror the doctor says, “put some gloves on and get over here”… *Gulp*.
After that joy, we saw a few more routine patients while I covertly stared at my watch praying for time to speed up. Towards the end, we walk into a patient room where a young boy, maybe three years old, is running amok and wreaking havoc everywhere. Climbing all around. Screaming. Trying to rip things off the walls. Mom couldn’t handle him. He ran up to me and started punching my legs. I awkwardly looked up and said, “uhhh…” before his mom grabbed him in an effort to restrain him. Although this one was a loose cannon and twirled around the room like a Tasmanian devil. A tornado reincarnated as a small child.
We took a history, asked some questions, and arrived at the conclusion that the child was not developing normally mentally or socially. He couldn’t communicate. Something was going wrong during his development. I’m thinking to myself – poor little bugger is autistic no doubt. In front of the mother, the doctor says, “poor communication skills for his age, poor mental development, what do you think Soze?” Man, is the fucker really asking me, a first year medical student who hasn’t even taken psych or pediatrics yet, to diagnose this little boy with autism? The mother stared up at me waiting for a response. What if I were to suggest that the boy is autistic and he isn’t? I’d look like a real asshole.
I muttered, “I..uh.. don’t know”. The doctor says, “looks like he’s autistic”. *cue the mother delving into the a fit of crying*, “did I do something wrong? Did I not read to him enough? Did I do something wrong while I was pregnant? This is all my fault, isn’t it?” I could feel the pain in her heart. Why would this guy put me on the spot to diagnose a little boy with autism right in front of his mother, when I clearly know nothing about the condition? This became a pattern.
Another time we were in a room with a married couple. Doctor asks me, “Soze, do you know what priapism is?” Well, if I remember correctly, priapism is a prolonged erection. But I didn’t know for sure, and I didn’t want to look like perverted moron and go, “a boner that doesn’t away”. So instead, I figured I’d rather seem stupid and say I didnt know and be wrong and have to deal with the embarrassment of suggestion an erection disorder when it actually had something to do with blood pressure or something like that. “Come on Soze, it’s a sustained erection for longer than four hours”. The doctor and the patients had a giggle at my expense. All these medical words sound the fucking same. Nocturia, dyspepsia, dyspnea, priapism… However, I will now forever remember priapism. As the best possible side effect known to medicine. (Unless you were at work or a funeral or something).
So it went. Every day that I worked with him, the doctor made an ass out of me in front of patients. Maybe it was to help me learn. Although, he never said a helpful word to me outside of a patient encounter so I’m not sure what his aim was.
Another time we saw an overweight man with low testosterone. Couldn’t get it up for the wifey. Low energy. Doc prescribed him testosterone cypionate injections. He reported back a month later, claiming that he was killing it in the bedroom, pleasing his wife like he was 22 again. I mean, he wouldn’t have to inject synthetic hormones weekly to do this if he had just avoided the daily Wendy’s Baconator with a large Coke for lunch and stepped on a treadmill a few times a week, but whatever. Testosterone replacement therapy is pretty cool. The guy proudly claimed he could get boners again and didn’t feel sluggish all day. And that’s what I do love about medicine. Making sure guys get boners. Changing lives, mang.
However, one of my most unforgettable experiences with this doctor was another embarrassment. We went in to see a patient – young boy presenting with a fever, runny nose, and a sore throat. Doctor listens to his heart. He then hands me the otoscope and tells me to check the little boy’s ears to see what I find. I grab the device with the long, protruding spicule and stick it in his ear to look for whatever the hell I was supposed to look for. The doctor quickly says, “Soze, this is how you do it. If you hold it like that and the child jerks his head, you could stab his eardrum”. The mother looked up at me in horror. A simple correction or private instruction back in your office would have sufficed, but no, freaking out a young mother and embarrassing me was definitely the right move. Thanks doc.
And that’s how it went with the family doctor in the middle of nowhere. Clock watching, thinking about how much rural America depresses me, and being embarrassed in front of patients.
The other doctor I worked with over the semester was a doctor in a mental hospital. Moreover, one of the biggest and highest security mental hospitals in the state. My first day, I had to do a training course. For what you may ask? For self-defense. Because, you know, every first year medical student needs to learn how to swat a punch and put a guy in a proper chokehold when we’re trying to provide compassionate patient care. In addition to the self-defense, the instructor gave us several guidelines:
- Don’t wear ties. A patient could strangle you with it.
- No pens in your pockets. You could get stabbed.
- Don’t drop your security ID. If you do, a patient may pick it up, put it on and escape.
- Don’t accept any gifts or notes from patients. They may think you’re dating and have a mental breakdown when you don’t return.
- No wristwatches, bracelets or jewelry. They may attack you.
- No white coats. They may think you’re some secret evil Nazi mind control doctor running torturous experiments on them.
Fuck yeah! Who’s excited? This guy.
When I finally met with the doctor, he gave me even more precautionary instructions – don’t make eye contact with anyone and don’t engage in conversation. Okay. Got it. I followed him past two levels of security doors until we were in the the main ward. This shit was straight out of “One Flew Over the Cuckoo’s Nest” or any other sort of televised depiction of an insane asylum. People muttering to themselves. Pacing around strangely. Doing all sorts of funky shit.
The highlight of my experience with the doctor in the psych hospital came one afternoon when we went into see a patient. She was a woman, around 40 or so, in full body restraints, screaming bloody murder. And it was our job to go in and take her history and check her out.
The doctor asked her questions and she replied by screaming the most nonsensical blabber that I’ve ever heard in my life. One sentence of nonsense leading to another sentence of completely unrelated nonsense.
I kept my distance while the doctor asked the typical questions between her maniacal rants.
- Doc: Do you know why you’re here?
- Lady: Fucking Josh. I’ll cut his cock off!
- Doc: Have you taken any drugs?
- Lady: Drugs? Fuck yes. Yes please. Drugs, give em here. Mr. Smith I wouldn’t trust him nope never
- Doc: What kind of drugs?
- Lady: XANAX. Need it. FUCK.
- Lady: Donald Trump fucking asshole, I’d FUCK HIM.
- Lady: Where are you at Carmen, come to mama. Carmen!
- Doc: Ma’am are you allergic to any medications?
- Lady: I do not trust Trent. I do not trust Trent. He wants to kill me. 1997. The dog ran away. I can’t work there anymore. Fuck ’em.
After a few more minutes of the most vulgar, ridiculous, psychotic babbling, it was apparent that her mind was indeed gone. She couldn’t string together two consecutive thoughts.
Then she looked at me:
- Lady: YOU. The actor. I WILL FUCK. YOUR. COCK.
- Doc: Ma’am…
- Lady: I told him not to do it son of a bitch went and done did it. Carmen, come to mama baby! Mary Anne.. is.. a fucking… CUNT. Hear me.
- Doc: Do you have any family history of cancer, diabetes, or heart disease?
- Lady: Mary Anne fucks EVERYBODY. Whole fuckin’ city knows too. HAHAHA. I bet you know!
- Doc: Ma’am, does cancer, diabetes, or heart disease run in your family?
- Lady: CANCER. Did you fuck Mary Anne? You did. I know you did. Everyone knows you did. They’re trying to kill me. I’m going to piss all over. The tavern has best burger in town, no doubt about it, no doubt about it. Fuck Josh. Jesus Christ is my lord and savior and he will kill you. January of last year, that’s when I fucked his brother. And you know what? I’d do it again. Carmen, baby, mommy has a treat for you. World Series game 7. I’d fuck the whole town.
We both looked at each other and simply shared a small laugh. The doctor had finally heard enough and said, “check her brachial pulse and lets go”. I creeped to the side of the bed and put my finger pads to her arm. While she was in wrist restraints, she still moved her hand enough to touch my leg. I jumped back and the doctor said, “forget it” and we left the room.
It was at that moment when I decided that I’d rather declare bankruptcy and forget medical school than become a psychiatrist.
Walking through the psychiatric ward, the doctor stopped to talk to a guy, leaving me standing there with nothing to say or do. A patient came up to me and introduced herself. I said hi back and quickly looked away. Fifty-some years old, a missing tooth or two, and completely deranged. She told me, “I split with my man. Ohhh no. I’m free now. Ain’t no man controlling me. I’m a single gal”. I barely acknowledged the comment, trying to avoid the interaction while also not pissing her off. She continued – “I don’t need no jealous man telling me what I can’t do! I’m single and happy as ever. Yes sir. This piece of ass is back on the market”. She then poked me in the chest and said, “how old are you?”. I replied that I’m 23 and she said, “Mmmm mmm. I like em young. I’d do ya right. I’m single and ready to mingle”. 50+ years old, meth mouth, and in a mental hospital. Sorry babe, but not quite my type. I know I happen to attract some crazies, but this one was a new milestone. At that moment the doctor realized my situation and we walked away.
After those two occurrences, we saw another patient and I reviewed the chart with the doctor before going in. 30 some year old female. Recently attempted suicide and claimed to kill anyone that would stop her. Said that she was broke, had a baby, no family support, no money, and wanted to die. It’s sobering and sad to see people who’s lives are so depressing compared to your own. She was now normal and stable. Doc said she’d have a short stay and her case is one of the most mild you’ll encounter there. A relief from the psychosis. We went in, gave her a physical check up. Doc told me to listen to her heart. He asked me, “How does it sound?” Well doctor, she seems to be alive. Her heart is beating and such. Beyond that, I can’t tell you a gotdamn thing.
So it goes with every first semester of med school clinical experience. I’m simply a dude playing dress up with my white coat and stethoscope. I have no idea what I’m doing.