If you wear this in a restaurant, you are part of the problem.

This article just popped up on my RSS reader: What residents and medical students should wear in the hospital | KevinMD.com.

From the article:

5. Scrubs are for the hospital not for home. As a New York Times article pointed out, no one wants to sit next to someone on the subway wearing scrubs, particularly those with uncharacterizable stains on them. Scrubs are there, in part, to keep you from taking hospital germs into the community. It’s also hospital policy. Unless a resident or student is staying overnight or involved with procedures, scrubs are a ‘dressed down’ look. So plan to change from scrubs to regular clothes before you wander around outside the hospital.

This is so true.  I think one of my biggest pet peeves about some of my fellow med students is that so many of them wear scrubs like a badge of honor, as if scrubs are some sort of social signifier that really sets them apart from the rest of humanity.  I can see why a med student who has studied for a billion years to earn the privilege to scrub into surgery might get the impression that scrubs are some special power garment, but the truth is, they just aren’t.  There are people who have a high school diploma (or less) who have access to that same pile of scrubs in the hospital locker room.  They’re nothing special.

Don’t get me wrong, I wear scrubs in the hospital when I’m supposed to, but you can bet your ass I change out of them before I go out in public.  The other night, a friend of mine showed up to a restaurant wearing scrubs.  Here is a person I respect and whose company I enjoy, but the whole time he was sitting there I couldn’t get over the fact that he was “one of those med students” who has no shame about going out in public wearing surgical scrubs.  I’m sorry, but if you’ve been cutting open abdomens all day long, I don’t really think you should be sitting next to me at dinner until you put on normal clothes.  Is that too much to ask?  Who knows what sort of viscera is hiding out in that fabric.  Ugh.

On the other hand, if you have a pair of clean scrubs at your house, they definitely do make a nice pair of PJs, there’s no denying that!

Aside from that, there are a lot of other good pieces of advice in the article.  Having only minimal hospital experience thus far, I can’t think of much to add to the list in the article.  Any thoughts?

Link: What residents and medical students should wear in the hospital | KevinMD.com.

So, when I was a pre-med, I thought that the best med school for me would be one where I got lots of clinical experience in the first two years. See, in the US, the traditional medical school curriculum has very few chances for clinical exposure during the first two years. Typically, the first two years are composed of basic science classes–and lots of them. Nowadays, however, there is a movement to get medical students out of the classroom onto the wards to provide them with clinical experiences ASAP. I think there are several assumptions at play here that explain why the powers that be are foisting largely unknowledgeable and inexperienced med students on the patient populations at academic medical centers across the country.

1. Clinical exposures early in med school will create more compassionate physicians.
2. Clinical experiences reinforce material learned in the first two years of medical school.
3. The first two years of med school are skewed heavily toward the basic sciences, during which time the students lose sight of the importance of clinical acumen.

There are probably a handful of other reasons why they send us out on the ward before we get to our third year, but for now I’ll just address these three reasons, because they seem to be the ones that I hear bandied about the most.

1.  Clinical exposures early in med school will create more compassionate physicians.

I think I understand the thinking behind this, and honestly, there was a time when I probably believed this myself.  The thinking here is not unlike the rationale behind WWII-era propaganda campaigns–if you can gain access to the hearts and minds of the young and impressionable (1st and 2nd year med students certainly qualify as this), then you can more easily mold their thoughts and actions to fit your whims.  It’s almost as if the powers that be realize that they’re gonna be sick someday, and that my generation is will be their doctors.  They  must think that if they can scoot us onto the wards and show us a couple heart-wrenching clinical cases devoid of the muck and grime associated with real clinical practice (getting pooped on and yelled at by belligerent veterans, etc.), then perhaps they can fool us into thinking that medicine is all daffodils and unicorn poots.

2. Clinical experiences reinforce material learned in the first two years of medical school.

This is true.  Duh.  But for it to actually work, it would make sense to put the clinical experiences AFTER you learn it (in order for it to be reinforced.)  Face it, the first year of med school has almost nothing to do with sick people.  So why do they send us out on the wards to see sick people?  Unless they have one of those incredibly rare metabolic disorders that they teach about in biochemistry,  we likely don’t understand what’s wrong.  And we most certainly wouldn’t know what to do to treat the problem.  So what exactly are they reinforcing?  (More like pre-inforcing, amirite?)  There’s a very good reason why med students traditionally haven’t seen a lot of patients until third year.  It’s because we’re functionally retarded until then.  The less time we spend on the wards to embarrass ourselves and your fine medical institutions, the better off we’ll all be.  (And that counts DOUBLE for the patients.)

3.  The first two years of med school are skewed heavily toward the basic sciences, during which time the students lose sight of the importance of clinical acumen.

Now here’s a line of thinking I can get behind.  It’s SUPER easy during first and second year to forget why we’re actually here.  We’re here because hopefully we want to be good at our jobs.  And our jobs (unless you go into Pathology–and no offense towards the budding Pathologists out there, because I think Pathology is pretty cool) will be to deal with patients.  Our jobs will NOT be reading tons of books, attending lectures, and thinking about the most trivial minutiae of gene translocations, metabolic pathways, and the like.  Our jobs will be about dealing with people, learning from THEM why and how they’re sick, and hopefully helping them to get better.  The point about compassion above should be a given regardless of when you get your clinical experiences.  If you are not a compassionate person before you get to medical school, there is no way in hell that you’re going to magically sprout compassion glands and secrete newfangled compassion juices in the middle of your pre-clinical years when you are constantly stressed out about tests and grades and all that jazz.  Clinical experiences won’t help you there.  But they will help you to remember why you came here in the first place.  Maybe.  If you’re lucky.

But for the most part, these clinical experiences are just a pain in the ass.  I’m sorry, but it’s true.  I’m super excited to start 3rd year and finally get to act like a doctor.  But right now, as my second year is wrapping up, I am looking at weeks and weeks of tests followed by prep for the biggest test yet of my life–STEP 1 (more on that to come soon), and on top of all that I’m expected to go into the hospital and do H&Ps on people every week until the end of the year.  I feel like I’ve been pretty good about being gracious and not complaining about “OMG LIFE IS SO HARD AS A MED STUDENT” because usually it’s not really that bad, and honestly, it beats the hell out of a lot of other options.  But right now I’m pretty stressed out and I really don’t want to go talk to some dude about why he shit his pants the other day.  I’ll be happy to have that discussion, along with any imaginable other scenario come July when it’s time to hit the wards, but for now, please, medical school, let’s just do one thing at a time.  For now, please just let me study.

A blog post entitled “100 Blog Posts You Should Read Before Going to Med School” recently linked to two of my articles–my apparently infamous guide to not being a pre-med douchebag, and my more recent “are you ready for med school” post.  I’m grateful to the blog’s author for including me in the list.  It’s really nice to know I’m not just posting in a vacuum all the time.

I encourage all my premed and med-school readers to check out the article.  There are tons of good articles linked from it.  Someone has taken a lot of time and effort to scrounge together a good collection of articles related to med school, and for that, they should be applauded.

(Cue applause)

Link: 100 Blog Posts You Should Read Before Going to Med School

From that point on, Dax was subjected to over a year of medical treatment against his will.  As he was completely incapacitated, he didn’t have the strength to refuse treatment by walking away–instead, his body was actually physically carried, against his will, back and forth to various modalities of painful treatment such as dips in a solution of bleach, and wound debridement procedures that were, according to Dax, agonizing.  He continuously asked to be left alone to die because he was in such excruciating pain, but his physicians continued on with the treatment despite the fact that Dax continuously refused treatment.  As a result of the accident, Dax was left blind in both eyes and without the use of either of his hands, not to mention disfigured.

One of the reasons the doctors continued to provide him with treatment, despite his refusal, was that they assumed he lacked the adequate capacity to make such decisions, on account of his condition.  During the course of his treatment, two psychiatrists were brought in, and both confirmed that, in fact, he had the full mental capacity to be making these decisions on his own; his decisions to end treatment did not stem from the fact that he was insane–he simply didn’t want to bear the pain anymore.  Regardless, the power to determine his own fate was stripped from him and given to various proxies–namely his mother and his lawyer.

Dax’s case brought the issues of a patient’s right of autonomy, and the patient’s right to refuse treatment into focus.  To this day, Dax maintains that he should have been allowed to die in 1973, even though he is now alive and leading a productive life.

I’ve been thinking a lot about this case.  I agree that a patient should have the right to refuse treatment that is being proposed–especially if that treatment is tantamount to torture, as some of Dax’s treatments were.  But at the same time, this case seems so much more complicated than that, because the physicians knew that if they stopped treating Dax, he would die.  And no physician wants to let a patient die if he or she can help it.  Putting myself in the shoes of Dax’s physicians, it’s hard to imagine myself being okay with letting him die, even though he was practically begging for death.  It’s a really tough case–one that I hope I never have to face!

As I mentioned before, Dax is currently alive and well, and he has become an advocate for patient’s rights.  I found a lecture that he gave at the University of Virginia not too long ago.  I highly recommend it, for those who aren’t familiar with his story.  It’s not for the faint of heart, but it really does highlight the essence of his struggle.

Link: Dax’s Story: A Severely Burned Man’s Thirty-Year Odyssey

Today was the first day of second year.  One might expect/hope for a little more pomp and circumstance for this momentous occasion, seeing as how more than 10% of the original M1 class either failed outright or had to repeat the first year.  I mean, I didn’t expect a ceremony or anything, but it would have been nice if someone would have thought to congratulate us, either literally or symbolically, on making it this far.  But no.  Not even coffee and donuts before classes started.  The first day was basically just business as normal, with the professors jumping right in with a brief introduction to the curriculum, followed by a few hours of non-consensual sodomy.  Seriously, a little foreplay might have been nice, get us warmed up and ready to take it, but no, Pharm just came on fast and hard and now I’m left wondering if the 10% who didn’t come back were on to something…

But I kid.  It’s actually nice to be back.  While I do feel like I could have used a little more summer (then again, who doesn’t?), it was great to be back with my classmates again.  We’re all demented in the same ways now, following first year, and sad as it may be, they’re some of the only people who understand me anymore.

What I’m looking forward to this year:

• path–seems to me the most relevant course material with regards to actually being a physician.
• icm 2–maybe i’ll finally learn what a systolic murmur sounds like.  or something.
• behavioral science and ethics–while they’re the “touchy-feely” classes, they sound interesting to me.  after all, i’m a blogger… it should come as no surprise that I have a touchy-feely streak.
• being a year closer to third year, where i actually get to act like a doctor.
• not having to take gross anatomy ever again.

What I’m not looking forward to this year:

• Step 1–nuff said.
• Finding out if second year is really as hard as everyone says.  (I’ve heard it described as standing on your head with your face in a bucket of shit.  I’ve also heard it described as follows: “the first time you get shit on, it stinks.  eventually, you get used to the smell.”  Most negative comparisons tend to involve feces in some way.  Clearly, this is does not bode well.  We’ll see.)

Any doctors or fellow med students out there care to comment on second year?

When I signed up to do research, I imagined it being something like my past research experiences—lots of time spent alone in a lab collecting data, mulling over research papers, setting up experiments and chilling out while they run. What I wound up with was something very different. Perhaps it’s because my earliest experience with research was in a Chemistry lab, and my current research is quasi-clinical with human subjects, but let me put it this way: if my research experiences were sports, my old research would be golf and my new research would be no-holds barred cage fighting. It’s just fundamentally different.

For instance, I had this notion that over my summer break, I would be collecting data. That’s kinda the fundamental thing about research, right? That you collect data to interpret so that you might support or disprove your initial hypothesis? Well, suffice it to say that my summer “research” has found me not so much collecting data, as being a free helping hand for my PI. I’ve written letters, made forms, attended lots of meeting, and other such administrative chores. But I haven’t collected much data. And the data I have collected has yet to pertain to my specific project. I think the idea is that I’ll set all the pieces in place so that my PI’s research assistants collect my data for me after I return to classes and I’ll swoop in at some point in the next year and evaluate that data. That’s so weird to me that I still can’t quite determine if that’s “fair” or not.

But mostly, I’m stressed out. I signed up for this project knowing full-well that the summer between M1 and M2 is a brief respite of calm in an otherwise brutally punishing curriculum. The eye of the hurricane, if you will. I had expected that my time would be spent rather casually in the lab. Essentially, I thought it would be a low-stress situation.

Boy, was I wrong.

The reason it sucks so bad here is not because the work is hard, or because it’s really mentally challenging or anything like that. No. Instead, my summer has been so stressful because I’m working with a bunch of drama queens who insist on making a soap opera out of everything. My research has been waylaid by the emotional insecurities of my coworkers as they quibble and bicker about the most inane and trivial things. For instance, instead of being able to focus on my research, I’ve been constantly distracted by gossip and drama and whatnot. It’s getting old.

Thank god, I’ll be done tomorrow. Then I have a week off before starting second year. I hope to sleep a lot and play video games.

First, I’d like to apologize to anyone reading this who may have hoped for and/or expected more posts from me over my first year. It was a crazy and hectic time in my life, unfortunately. Aside from being my first year of medical school, which can be dramatic enough in its own right, my personal life went through a lot of other dramatic changes as well. I moved to a new city. My parents got divorced. My mom started drinking again. Then she tried to commit suicide. In the midst of all this drama, my fiancé and I decided a traditional wedding wouldn’t really work, so we opted to elope. So I got married. I adopted two dogs. It would have been a challenging and rewarding year even if it hadn’t been my first year of medical school. Given that I also had to endure the rite of passage of Gross Anatomy and a grueling exam schedule while dealing with a lot of unexpected catastrophes/revelations, I don’t think it’s unfair to say that it was probably the hardest year of my life thus far. At times it really did feel like I was starting to lose my sanity as I sequestered myself in a study carrel and tried to ignore the fact that my family was crumbling around me, and instead just focus on the innervations and blood supply to some anatomical region. Given all this, I hope my few readers can forgive my utter lack of updates. When I started this blog, I really hoped to keep track of my personal life throughout medical school. I never expected my life to change so dramatically and so rapidly. I wasn’t able to keep up with it all.

As I reflect on my first year, I wish I had devoted more time to blogging, I really do. But I had a hard enough time devoting time to eating dinner with my wife. I’m not good at the short post. It usually takes me at least an hour to write a post. Finding that kind of time was very difficult last year.

But I want to do better. Second year starts any day now. From what I’ve heard, it will be more intense, with more studying and more class work. For what it’s worth, my family situation has calmed down quite a bit; I don’t expect to be dealing with the same kind of drama I had last year. I hope to be a bit more diligent in my blogging habits, even if that means more posts that aren’t as well-written.

The fact that I still get comments from people is a testament to the fact that something I’m doing is resonating with people, so I want to do better. I’ll check back in soon with an update about my summer.

Since we’re in the middle of the endocrine unit at school, my first reaction was that I have pheochromocytoma, a catecholamine-secreting tumor.  There’s no way I was having a bad dream, or am just a little over-anxious about the test coming up on Friday.  No, it’s much more likely that I have a disease that is seen in about five in a million people.

This is how I memorize my clinical correlations for the test, by the way.  I actually get the diseases we’re learning about.  It’s a bitch, but I’ve yet to find a better way.

I have a feeling that this will make pathology a very difficult class next year.

If it sounds to you like we’re being disrespectful or unprofessional about dissecting a human body, you’re probably right.  But I would also suggest you try taking a hammer and chisel to the spine of someone who resembles your grandmother, and hearing the bones crack, and feeling them give way from your blows, and then get back to me.  I defy you to do that without throwing up about 1,000 primordial defense mechanisms, because I say it can’t be done.  So yeah, we make some jokes about how her back fat looks like coconut creme pie, and we laugh, because really, we’re all traumatized as shit by having to mutilate a dead person every day.

So yeah, I cut open a human heart with a pair of scissors the other day.  Let me tell you, it sounds way more badass than it actually is.

My cadaver (“Dorothy”) was a pretty big lady (let’s just say she liked her McDonald’s).   She died of heart failure, and her heart was enlarged–probably a result of hypertension, which would not be not surprising considering that she was obese.  In addition, her heart was covered in a thick layer of fat that we had to dissect through to find all the intrinsic vessels of the heart.  I don’t know about you, but I’ve always thought of the heart as this solid, firm organ, kinda tough, but ultimately resilient.  I mean think about it–this thing beats millions of times in a normal person’s life–is more active than any other muscle in the body.  How could it be anything other than durable–that’s kind of the definition, right?  Able to withstand a lifetime of use?  Holding a heart–literally–in your hand, you realize just how fragile the thing really is.  I’m finding the same to be true of pretty much everything we dissect in lab–everything in the body.  It’s kind of startling to think how much work goes into building a human body–thermodynamically, chemically, etc.–that is so easily and irreversibly destroyed with one deliberate swipe of the scalpel.  It took this wonderful woman an entire life to make the body we now find splayed out in front of us in lab, and within a few hours, we’ve stripped her of her skin, or we’ve sawed through her chest and removed her lungs, or we’ve chiseled our way into her vertebral column to expose her spinal cord.  The net effect of all the cuts we make in a normal day in lab would most definitely kill a person, if they weren’t already dead.  It was tough to come to terms with this at first.  But you also know that you’ll never learn any of ten thousand things you have to learn if you don’t get in there and dig until you find it.

There is something very zen about picking away through layers of fascia for long stretches of time in order to find a tiny little nerve, no thicker than a spaghetti noodle.  And then, when you finally do find it, you must exercise the utmost caution not to apply too much pressure, or it will snap.  In a living person, severing that nerve might lead to irrevocable muscle atrophy, or paralysis of a limb, or loss of sensation to some portion of skin.  And if the same thing were done in a living person, it would never heal.

We are such intricate, delicate beings.  Life, in and of itself, is an amazing thing, and I think that goes without saying.  What’s also remarkable, and often under appreciated as the miracle that it is, I think, is that we can not only be born alive, but that we can be born healthy, and stay in relatively good health more or less until we die, riding the crest of a lifetime of subtle physiological equilibria that can usually keep things working as they are supposed to.  Knowing that so much can go wrong, sometimes it’s amazing to me that we aren’t always sick, all the time, and I’ve become hyper aware of my own health.  It’s not much fun.

A lot of cadavers in our lab had severe lung problems when they died.  Let me tell you, seeing firsthand the damage that smoking can do to your lungs will make you never want to touch a cigarette again, and regret the fact that you ever smoked at all.  The lungs of these smokers–the lifetime, pack a day habit smokers–they’re just so much worse than you can imagine.  We’ve all seen the pictures of the smoker’s lungs, dark and cruddy looking.  Well, that’s nothing.  The cadaver at the table next to mine died of lung cancer.  He had little meatballs growing in his lungs, but otherwise his lungs looked fine.  What is troubling are the other ones–the ones who were lucky enough to not get cancer, the ones who never had to quit smoking.  Their lungs are tiny little sacks of black tar, shriveled to less than a third of their normal size.  And they smell–even in a lab full of dead bodies, you can make out the smell of a stale ashtray wafting from these lungs.  And when we open up the trachea, we find congealed black mucous.

I used to smoke.  In college, I probably smoked a pack a day for a while, and even in the last couple years, though I have cut back significantly, there have been plenty of times when I smoked a pack over the course of  a weekend at the bars and then vowed to quit again on Monday.  But that’s all over now.  I’m done.

A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.

-Hippocrates

Last time I updated, I mentioned that I’ve been sick recently. What I failed to mention was what happened. Well, even though it’s a little embarrassing, I’m going to share my most recent experiences with being a patient.

First, it should be noted that I’m a really healthy guy. I’ve been a vegetarian for 8 years, I work out 3-5 times a week, I don’t drink too much, I don’t smoke (except when I drink, which again, is rarely). I’ve never done hard drugs or engaged in risky sexual activity. I’ve always been a firm believer that a healthy lifestyle is important in maintaining overall health. To that end, I’ve been successful. I’ve never been hospitalized or sick for more than a couple days with a cold or flu. I’ve been lucky.

Until recently.

It all started innocuously enough. About three weeks ago, I went to get a mandatory physical exam for medical school. It should have been a routine physical consisting of a nurse taking a handful of vital signs, a doctor listening to my chest, looking in my ear, nose, and throat, and checking my reflexes, then telling me I was in good shape at the end. Really simple. And I almost got away scot-free, but as I was buttoning up my shirt after the doctor listened to my chest, he noticed a red bump on my arm with leading edges that ran from my armpit to my elbow. To me, it just looked like a really big mosquito bite. He asked me what it was, but I had no idea. I hadn’t even noticed it yet.

I mentioned that it might be a brown recluse bite. I had seen them in the house recently, and they’re out in large numbers this time of year. I’ve had one bite me before, and honestly, it wasn’t all that bad. It hurt like a mother for a few days, but I was fine.

But my doctor insisted that I get a shot of antibiotics (ceftriaxone) as prophylaxis against possible infection, along with a prescription for another antibiotic (doxycycline) to follow that up over the next week. He was afraid it might be a tick bite infected with Lyme’s disease. (Not likely, considering I don’t spend a lot of time outside, but whatever.) That shot stung REALLY bad, but at the time nothing else of note happened. I left the doctor’s office feeling fine, having marked off one more item my ever-growing list of things to take care of before starting medical school.

A few hours later, however, things got bad. I felt my blood pressure drop as I got light headed and my heart began to pound out of my chest. I went to the bathroom to check myself in the mirror and noticed that I was developing a diffuse rash over my entire body. On top of all that, I felt like I had a fever. I called my doctor, and he thought it might be an allergic reaction to the rocephin, since my sister has shown an allergy to ceftriaxone in the past. (I had never taken it before.) I was given a shot of steroids to treat the allergic reaction, and sent home.

Okay. Fine.

Over the next few days, however, the rash didn’t get better. It settled into a dark red rash around my trunk and groin, along with dark red patches along the tops of my feet. I wish I had pictures to share, as it really was bizarre–it looked like I had developed port wine stains over a large percentage of my body. Not to mention the itching. No amount of benadryl would make the itch go away completely. To top it all off, the bite on my arm was getting worse every day.

At this point, I was referred to an Infectious Disease specialist in order to rule out the possibility that the thing on my arm was a MRSA infection. He took one look at my arm, and concluded that it had most likely been a brown recluse bite–like I initially figured. He also hypothesized (like my PCP) that I had probably had an allergic reaction to the ceftiaxone, thus spreading the spider venom throughout my body, which explained the weird rashes everywhere. It was recommended that I be given steroids a couple more times, and he put me on another antibiotic (clindamycin) to prevent my arm from getting any more infected. (Which I don’t think it ever was in the first place.)

Things got slightly better over the course of the next couple days, and I went back to work on a Monday morning. But that’s when shit got REAL bad. Within a couple hours, I had run to the bathroom three or four times with progressively worsening diarrhea. Without getting too graphic, I’ll just say there was a large watery volume, but it never got completely out of control. Within a few hours however, I was getting dehydrated, despite forcing fluids and taking electrolyte supplements. So… I went to the Infectious Disease doctor again. He told me I could discontinue my current antibiotics, as my arm didn’t look infected at this point, and he thought I probably just had antibiotic-associated diarrhea. Despite that, he wanted to put me on yet another antibiotic to treat a possible infection by Clostridium difficile. (For those who don’t know, C. diff is a nasty bacteria that exists naturally in our gut, and is normally kept under control by our naturally-occuring bacterial flora. Heavy use of antibiotics–especially Clindamycin–can kill your “good” bacteria and allow C. diff to flourish.) I opted to not take any more antibiotics for the time being, however, hoping that it wasn’t anything too serious. And for the next few days, things got better. My rash went away, and I stopped itching, and my diarrhea went away.

Then, on Thursday, July 3rd, I was at work again, when the diarrhea returned. This time it was more brutal than ever. I was on the toilet several times an hour until there was nothing left in me. I continued to fight to keep my electrolytes up, too, but that didn’t work. I started getting severe muscle cramps and pain. (Meanwhile, everyone was telling me that I was fine, and not to worry.) At any rate, I went on flagyl (metronidazole) to fight what the Infectious Disease doctor thought now was surely C. diff. This time, I was more than happy to take the flagyl. Fortunately, the diarrhea subsided within a few days on the new meds, but it was a very tough drug to take. It made me feel light-headed, extremely anxious, and all-around weird. On top of that, all the antibiotics and steroids I had taken in the last few weeks left me with an oral thrush infection. One morning I was brushing my teeth and I noticed that my tongue looked like it had a white shag carpet on it. I called my doctor again, and I was promptly prescribed an antifungal medication (fluconazole), which didn’t work, followed by a different one (nystatin swish and swallow)–which has worked, but at a glacial pace.

After more than a week on the flagyl, my diarrhea had gone away, but I started having panic attacks. I went to the Infectious Disease doctor one last time. He told me I could safely go off the flagyl, even though I still had a few doses left. He also gave me a small prescription for Xanax in case I had any more panic attacks.

Hopefully, this is the end of my illness. What started out as a spider bite that probably didn’t even need medical attention turned into a two-and-a-half week long debacle. It has been quite an experience. I’ll admit, when I was in the midst of everything, I was scared. While I never felt like I was going to die, it wasn’t exactly comforting to know that people can and do die from C. diff all the time. Fortunately my case was relatively mild and caught early on, but it was a wake-up call. It made me realize how fragile our health can be, and how important it is to maintain good health while you’re able. Once illness sets in, treatments can always cause complications, so it’s important that you try to be otherwise healthy.

Which reminds me. Otherwise-healthy 26-year-old males don’t normally get oral thrush. Sure, steroids and antibiotics are risk factors for thrush. But in my personal experience, I have seen other things cause thrush as well. One particularly horrifying possibility in specific came to mind again and again–I was scared out of my mind that I had AIDS. My uncle is dying of AIDS, and one of the first things that happened to him that made him realize something was wrong was oral thrush. Forget the fact that I have none of the risk factors–I managed to scare the piss out of myself because–and I’m ashamed to admit it–I didn’t know. I had never been tested for HIV before, and well, AIDS would have explained all my sudden ailments rather well. Sure, I can see now that this idea was fueled by a mix of anxiety and paranoia. (That’s what reading too much about your illness on the internet can do to you.) But at the time, that uncertainty–the unknown possiblity that I might be infected with AIDS–played a large part in my panic attacks. I told all my fears to my ID doctor. He laughed at me, and said, “I promise you, you don’t have HIV.” He had me tested anyway, to ease my mind.

I’m fine, thank god.

It’s very humbling to think that all of this was brought on by coincidence. If I hadn’t been at the doctor’s office the morning I got bitten, I probably would have just had a normal reaction to the venom. My arm would have had a nasty hole in it, and I would have been fine in a week or so. Instead, I got WAY too much medical treatment, all of which gave me a dozen side effects, from which I’m still recovering. At this point, the spider bite has practically healed up completely, and yet my thrush is still lingering, and I’m constantly worried that the pressure in my bowels is the harbinger of a C. diff relapse.

In the end, while I’m not exactly glad to have been sick, I think this has been a valuable experience. I haven’t been sick much in my life, and yet here I am, going into medicine to heal people. How am I supposed to be a good doctor if I don’t know what it feels like to be sick? I know that a short bout with a spider bite and diarrhea and thrush isn’t the same as Hodgkin’s or AIDS, but it has been very eye-opening nonetheless. In the last couple weeks, I have been scared shitless by an illness that makes no sense to me. Hopefully now that I’ve had that experience, I can use it to better treat my patients. In the future, when I’m treating a patient who is scared shitless, for whatever reason, I hope I will be able to think back on how I’ve felt in the last couple weeks and use that memory to make myself just that much more empathetic. It’s nice to think that I can use this whole experience to become a better doctor.

We’ll see.