Insights and Tips for Medical Students Starting their Clinical Rotations (2)
Disclaimer: I want to preface this by saying that I am not trying to make myself look like I know everything. Short answer: I don’t. I merely want to share my clinical experiences with those who are yet to begin their clinical rotations and provide some beginner insight into what being in the clinics/hospitals of Greece is like. Along with attending the clinics and examining the patients, I too was a patient. I will speak a bit more later on about how that changed my mindset regarding patient communication and overall empathy. I will go over some cases that left an impression on me over the last month, each patient will preface a specific lesson to be taught and applied to one’s self.
Disclaimer 2: Because I have seen far too many cases over the last 1.5 months, I cannot possibly remember all the details for every single case. That is why I am listing some of the most impactful cases that stood out for me the most. Especially the cases that taught me something more about myself and what I should focus on learning (regarding my level of competence in the clinics and life).
INTRO: What this month has been like regarding clinics
This month was really a step up from the last month. For example, I started attending clinics during ER hours in my own time. Furthermore, I began to hone in a lot more on my Greek. I have made it a habit to put myself in situations that I deem initially uncomfortable but vastly worthy afterward. I struggled to initiate situations and push myself to “get into the mood” of being in the clinics. Generally, this month has introduced more “hands-on” procedures. Unlike last month which was mostly me shadowing and struggling like hell to measure someone’s BP..
Anyway, enough BS. Allow me to break this time down into small parts and describe some cases that both changed and helped me improve in the clinics.
Moments that stuck out for me
Attending the ER at AHEPA hospital:
During the period from the end of October to the end of November, I attended the ER on numerous occasions during my own time. Specifically at AHEPA hospital (as it is closest to my apartment and made for easy access). The layout of the hospital is unique compared to other hospitals here in Thessaloniki as the emergency department along with the “rerouting” stations (what I mean is the areas that patients are rerouted to after initially being assessed in the Internal medicine ward) are all laid out linearly rather than having a star-shaped layout with surgical and internal medicine wards all around the central node. A long, murky dark green hallway with doors on both sides (which is especially creepy when empty) comes to life when on call.
I attended my first on-call day on the 9th of November. It was initially quite scary as I was in a new environment. I didn’t know any nurses or doctors and interacting with patients alone made me especially nervous. But I am persistent. And so should you be if you want to get the chance to do anything in the ER. I asked some of the nurses if I could be taught how to do something simple to which they replied through action, by immediately teaching me how to perform an EKG. Being me, I messed it up countless times before I could even remotely get close to performing it correctly, but, I eventually got the hang of it.
A lesson to keep in mind here is, don’t think you know how to do something well unless you have encountered a scenario where you have to do the thing you are practicing but with an obstacle in the way. For example, I started to feel confident about performing ECGs until a patient with an impressive amount of chest hair presented to the ER. None of the leads (except the V5-V6 leads) were sticking to the patient’s chest due to his carpet of hair. To combat this, a nurse told me to use a special adhesive gel (the kind they use for an US examination). It worked! What gave the situation a bit of a comedic twist was that before I attended to the patient, I saw him in the admissions area passionately arguing with a woman who made a sarcastic remark about Greeks (I believe she was also Greek so it just made the situation all the more epic to watch). So yeah, that happened.
More recently (like 2 weeks ago as of writing this) I got the chance to take out arterial blood at the ER in AHEPA Hospital. What’s funny is that I tried it but to no success at Papageorgiou Hospital during my visit to the ER there too, although I was being assisted by a more experienced classmate of mine. At AHEPA, the only person there to guide me through the process was a 6th-year student, but she didn’t help me throughout the process, instead, she would just instruct me on what I needed to do and look out for. I had taken the initiative and said that I wanted to do the procedure even though I hadn’t done it before. Was I scared? Of course. But I allowed my body to do the talking for me. It was as if my body were controlling my actions, not my mind. By getting into a state of determination and following your senses, you put yourself in the perfect position to overcome fear. “Where fear is, that is what you must do”. So I spoke through actions and overcame fear. I DID IT OMG I DID IT WOOOOOOO!!! I had actually managed to pull out arterial blood without adding extra discomfort to the patient on my first try.
Yes, I do consider that a victory, but I shouldn’t let it get to me. For example, an even more recent case of my trying to pull arterial blood after my first successful attempt failed. I only caused the patient a lot of pain and had to give the syringe to someone more experienced than me.
The moral of both events: Never let your achievements get to you, even for a moment (yes be proud of them, but keep climbing).
Papageorgiou ER Hospital experience:
Another case that stood out for me was when I went for the first time to the ER at “Papageorgiou” Hospital was a man who was admitted into the shock room for attempted suicide. Initially, it took me over an hour to get to the hospital. Papageorgiou is a difficult hospital to get to if you live in the center of the city. Only 1 bus type goes to it (bus 28, 28A and 28B) and they do not have a timetable. There is no dedicated time that the buses arrive at bus stops so it is a case where you just have to wait at a stop until it eventually comes. Anyway, I arrived at the ER later than I had expected (around 15:30) and saw that the ER was flooded with patients. After becoming familiar with the layout of the ER I randomly walked into the “Shock room” (basically the room where patients that are in extremely critical situations are treated) to find a bunch of my classmates huddled up around a patient in critical condition. The patient had attempted to commit suicide by lacerating his arms and taking sedative medication to intentionally bleed out. The patient was found in a comatose state and was rushed to the ER. I knew I wouldn’t forget a scene like this. I simply could not imagine myself in that patient’s state. The blood on the floor squirting from the right radial artery, the deep and superficial cuts along both arms along with the cold air in the room made for an eerie feel that I cannot describe.
I forgot the name of the head surgeon in charge of the situation but the guy was a CHAD. Too bad we won’t have him as a professor :( … Anyway, he guided us through the process of handling the patient and even told us that Greece is planning on opening around 16 trauma centers throughout the country hopefully within the next 5 years (if we are talking in terms of Thessaloniki Metro standards, then expect the trauma clinics to be open within the next 15 years..). But if they do seriously open trauma centers then I might consider working in Greece for a few years, who knows?
The head surgeon allowed us to perform some sutures on the patient. This was my first time doing sutures on a patient, let alone a case like this. I know sutures are not anything special, but for me, the mere fact that I could try out something practical felt like overcoming a barrier and reaching a new high in life. I did 1 half-assed suture as best as I could and made sure that I learned what I could’ve done better while performing it.
PRO TIP: It is crucial that you ask those with more knowledge and experience what you can improve on. Be critical of what you do. Learn from those around you and even those who you might deem as “lower” or on the same level as you. Trust me when I say that there is always something to learn from everybody. Especially your patients, they are your true professors.
One of the junior doctors assisting the head surgeon was tasked with fixing up the patient’s left arm. Here’s the thing, we all thought that the patient was asleep or at least in an unconscious state. But as the junior doctor was suturing his left arm up, he woke up and started flailing his arm around everywhere purely out of fear and confusion. I don’t blame him the least bit but it was scary for us. I remember looking at the junior doctors around us and even they were like “wtf…what do we do?”. Thankfully some of the doctors managed to calm him down and gather some crucial information about what the patient went through. Seeing how the doctors had handled the case, I couldn’t help but wonder how many other familiar cases they encounter daily. Is this what it means to be working in the ER?? This might be my calling.
After contemplating what I had just seen and what I just did I had to take a few seconds from life to realize the weight of the moment that had just brushed over my lips. Something primal in me awoke. A feeling of “Yes you enjoy this, this excites you”. For me, to be human means to take responsibility for the thing you have a passion for. As Robert Greene (you probably know him as the author of “48 Laws of Power) puts it in both his books “Mastery” and “Daily Laws”, “Mastery is the process, and discovering your calling is the starting point” (I will provide a link you can go and check the books out for yourself. I highly recommend “Daily Laws” as it is a recollection of main points from all of his books).
Ok don’t laugh at me right now but really, the only reason I got into Medicine was because as a kid I had started watching “Grey’s Anatomy”. Yes…I know, cringe right? Well back then when I first watched an episode, I got a strange visceral feeling coming from within me. Something was physically dragging me to the vibe of Medicine. I had not felt this feeling with anything else (other than Photography of course). It was so strong that I knew I had to take advantage of it. The case of the patient who attempted suicide rekindled that flame. I got that visceral feeling creeping back from within. Robert Greene speaks more about how the feeling of being dragged toward something you inherently love is a primal inclination of humans. But as we grow, we conform to what others expect of us, sadly, this primal drive slowly dies and becomes ever so difficult to rekindle. Our drive toward what we love is another feature that makes us unique as individuals and should be curated, not suppressed.
My heart:
Do you know what strong palpitations feel like? The feeling where you are trying to get something done or either want to relax and try to get into the focus zone of whatever it is you are doing only to be interrupted by a large THUMP followed by a long pause and finished off with three consecutive THUMPS: THUMP………THUMP.THUMP.THUMP. Well…that was me, and still kind of is me sometimes but not as often anymore. I had noticed I had strong palpitations for a while now. I always used to think that it was just my heart beating blood like a normal heart does. But I could feel the frail-like fingertips of fear start to caress her hands down the back of my neck when the chest pain began. As someone who would consistently hit the gym 3-4 times a week and masochistically lift weights to the point of exhaustion, I always assumed that because I had the energy in me to be continuously killing myself every time I would go to the gym, I was still fine and healthy.
But there is a limit to everything. After all that heavy lifting, I began to have consistent chest pains that would get worse as I tried to either go upstairs, uphill or generally do something strenuous. Along with the pain, I also would get bouts of heavy breathing which would be exacerbated at very inconsistent moments throughout the day. I would even feel like I wanted to vomit in some cases and sometimes feel lightheaded. I even got to a point where I could not remember simple things or would just constantly not be noticing things happening in front of me (which only fueled my self-doubt). Enough was enough, I needed to get this checked out.
I genuinely think that the most comedic part about all of this was that I only started to notice what was wrong with me after we had been taught how to assess the heart in clinical scenarios correctly. After listening to many patients’ lungs, hearts, and abdomens, I became more aware of pathological signs that could be present. After that, nothing was the same. I became so self-aware of every kink in my armor that it was almost an obsession. “Every little thing about me that COULD go wrong WILL go wrong” I kept telling myself.
After waiting in the ER for 10 hours to get myself checked out at the IPPOKRATIO Hospital of Thessaloniki, I was told that I might have potential Cardiomyopathy. This was not certain though as assessment was made through an ECG. Keep in mind that a diagnosis cannot be purely made based on an ECG alone but that doesn’t mean that an ECG is not vital to assessing cardiological functioning. The problem I had was that there was some backfiring of potential most probably in some of my “Purkinje fibers”. I was rerouted to a doctor in AHEPA hospital (by Dimitrios Nerantzis, absolute Chad). They told me that nothing was wrong with the assessment (ultrasound and ECG) but that I had quite a few spastic heartbeats that would appear in quick succession after one another. I was told that I needed to wear a 24-hour heart holter to assess my cardiac function throughout the day. It was found that I had spastic heartbeats in roughly 4/100 beats making it around 4% of the total throughout the day. An MRI was prescribed to rule out any morphological issues, just to be on the safe side.
Here I am still waiting to do the MRI and on Beta-blockers (to calm my heart muscle down). As of finishing this blog, it is the 28th of December, 2023. I am going to do the MRI on the 2nd of January, 2024. I have been advised by the doctors to avoid strenuous exercise, and excess coffee consumption, and overall lower my stress. I am fine with decreasing the stress and coffee, but working out…bro that’s too much. Hopefully, I can get back to the gym and continue the grind, but for now, I remain in limbo. Ok but seriously, as long as there isn’t anything seriously wrong then I am fine with reducing everything else.
The lesson to be learned here is that I was able to gain an insight into what it meant to be a patient again. This is crucial in communicating appropriately with patients and overall sharpening your empathy skills. Yes, I just said empathy skills, because some people need be more empathetic and more showing of that empathy. It is possible to sharpen your skills as a human and to treat others as you would want to be treated. By having myself thrown into the position of a patient I had to make the best of it and not ponder on what could be wrong but what I need to do in the moment to overcome life at this instant.
Useful tips and some general advice:
Always assess what you can do better. Ask those with more experience than you what they think you can improve on and try to either fix it or improve your knowledge on the subject.
Know that when you feel a physical drive toward a passion, investigate it further. That might just be what you were destined for. Your life’s task.
Being a patient makes you more akin to what actual patients that you treat think and feel. I am not saying that you must now go and become a patient yourself (please don’t harm yourself for the sake of learning a lesson, I am not responsible for your stupidity :D) but that it can provide a crucial insight into how your patients might be feeling while you are assessing them. Be human, treat them as you would want to be treated.
Conclusion:
I have both seen and learned a lot since I wrote my last blog, but I have not even scratched the surface. I know there is A LOT to learn. A lot to think about and a lot to be overcome. That is the struggle of life, but if I swim in the current of life’s struggle, I will be able to embrace that which I have been destined for. The same goes for you dear reader, embrace the struggle, and life’s fruit will be ever more attainable.
Hope you have managed to learn something from this. See you again in the 3rd blog!
A final note
A closer tie to religion and religious values is another aspect of life that keeps me Human. What it means to be Human can be found by following the common morals that are abdicated in religion. A quote by “Sir Francis Bacon” that stuck with me was “A little philosophy inclineth man’s mind to atheism, but depth in philosophy bringeth men’s minds about to religion.” The more human one becomes, the more he/she personifies the values of religious thought and more importantly, moral values. It is for this reason that I wish to practice Medicine. To be closer to that which is true at heart and palpable in substance. All to follow my life’s task.
