palliative care.
Last week, I spent a few hours in a palliative care unit.
As medical students, we’re fixated on the living. What drug can cure that symptom. How surgery can remove the cancer. Where we can find a bed so that the patient with diabetes can have her complications managed.
Rationally, we know that everyone dies. We dissect cadavers in our anatomy classes. We read about fatal diseases in our textbooks and see pictures of brain tumours and mangled hearts cut open.
But still, we believe we can save everyone.
The last patient we saw was a little old lady, pictures of her family on a pinboard next to her bed, fresh flowers on her bedside table. A blanket was drawn to her chin, and she smiled at everyone in the room, desperate for some recognition of her existence. I don’t know how much she knew about her prognosis; I doubt she knew what the doctors thought yet.
To me, she looked well. To me, she didn’t look like a woman predicted to die within a fortnight.
I couldn’t look many of these patients in the eye as I walked through the wards, all I could say was a muttered thank you as I left one patient to attend to the next. I didn’t know what to say. I’m lucky. I haven’t experienced much death in my life. I’m yet to see a patient die or a patient code. I know these to be inevitabilities, but I still look at each patient with hope.
Perhaps the hope to live isn’t universal. Perhaps, for those for whom death is imminent, the hope to live is replaced by the hope to die peacefully, in a way that is the least confronting and the least horrifying for their loved ones. Perhaps they want to stay as calm as possible, as coherent as possible, and without the pain that has plagued them for their entire illness.
Perhaps medicine isn’t about operations and pharmaceuticals. Maybe it’s just about helping patients and their bodies survive, and die, in peace.
how to save lives as a medical student.
- Donate blood. One blood donation saves three lives. (In Australia, we’re not paid to donate, but I understand this is different in some countries. Regardless, giving blood makes a difference, and not enough people do it.)
- Become an organ donor. You don’t even have to donate your whole body—you can select to donate certain parts if you need to keep your body intact for religious or cultural beliefs.
- Volunteer. Okay, so maybe volunteering won’t save lives (unless you volunteer as a first aider), but it will definitely make the world a happier, shinier place.
- Keep yourself well. As a medical student, the most important life you can save is your own. Engage with your peers. Take a walk outside. Try not to drink too much coffee (I know it’s hard, and that caffeine is liquid gold. But have you ever had eight cups of coffee before a clinical exam? Because you shouldn’t. If your heart rate is 130 bpm and you’re trying to interview a patient, you know you’re going to have problems). Have fun occasionally. Watch Grey’s Anatomy without feeling the need to comment on the fact that Izzie wears her stethoscope backwards or bemoaning the fact that surgeons are rarely as hot as McSteamy.
- Help the nurses on clinical placement. Sure, the doctors prescribe drugs and write management plans. But in hospitals, the only reason anything ever gets done is because we have amazing nurses. Ask if you can follow a nurse around for a shift. Not only will you get a work-out, but you’ll appreciate the sheer amount of work they do. And most nurses have brilliant communication skills—you’ll learn a lot. And even little things, like settling a baby while a nurse is tending to another patient or offering to find the doctors and get them to chart drugs for a patient can make a huge difference.
- Speak up. Do you think the registrar has missed something? Ask them if it they think it’s important. I was in ED the other night, and a girl was seizing and had a rash over her eye, and my reg hadn’t commented on it, so I asked if it was of significance. It wasn’t, but the reg explained to me what she was actually looking for.
- Talk to patients. Again, maybe you won’t directly save a life. But have you ever been in hospital? It’s a lonely place. Not all patients get flowers and family visiting them. Not all patients have friends to drop by and say hi. Approach them. Ask if you can clerk them. Ask them how they are. Go and say goodbye when they’re discharged. Smile at them. It might make a world of difference to someone.
- Take everything you hear with a grain of salt. Not everything your supervisors say will be right. Always double-check drug dosages.
- Learn because you enjoy what you’re doing. If you learn because you have to, or because you have to be a doctor, not because you want to, you’re doing yourself and your patients a great disservice. Not everything in medicine will be enjoyable. But my colleague gave me some great advice yesterday: “I used to take copious notes during every lecture, but I wouldn’t learn anything. The next semester, I brought a coffee to every lecture, sat back, and let myself enjoy what was happening. Sure, it was more work and I had to make my own notes later, but I learnt things better.” Engage with your learning. Approach everything with an open mind and fascination.
- Dream. Imagine what you could do and how you might change the world. It may be naive, but this is the greatest strength of being a student—we haven’t yet been jaded by the system. We can still find ourselves inspired by medicine—and from this, innovation is born.
med school and relationships.
absence.
Hey everyone,
I’m sorry for disappearing for the last few months. Unfortunately, medicine and I have had a bit of a rough patch, but never fear, I am back and I have stories of little kids and bubble blowing and what I have learnt from six-year-olds!
Love, mylifeasamedstudent
what i learnt about medicine (and life) from a dirty hipster.
I was at the bus stop today (cool story, bro) and this guy started talking to me, as you do when you’re a sociable fellow with half an hour to spare. He told me about his life, and hitchhiking, and travelling with monkeys in Southern Africa, and swapping booze and party drugs for massages (he’s a qualified masseur, or so he said) at festivals.
Maybe he was making it up. But the important thing is that he’s my age—and I have absolutely no life experience.
So as I sat on the bus going home, I started to wonder why I’ve never wandered out of my comfort zone.
Fear.
As medical students, fear is ingrained into us. Fear of failure. Fear of not being good enough. Fear of a seemingly inevitable mistake that kills a patient. Fear of getting an answer wrong in front of a consultant. And after a while, that fear creeps out of our work lives and into our personal lives, and we’re struck with this inexplicable anxiety about everything, both inside, and outside of, medicine.
Our lives become a series of milestones by which we procrastinate. I’ll travel when I graduate. I’ll write when the semester is finished. I’ll do all those things I love when medicine is finished. But medicine doesn’t finish. It doesn’t go away once you’ve graduated or finished intern year or entered a surgical training program or you own the hospital. However, your youth does finish.
I’m not saying go and hang with monkeys and catch monkey fleas and do hard drugs. In fact, I would advise NOT doing any of those things. But have fun. Find passions outside of medicine. Hang out with your non-med friends. Do charity work.
Don’t wait for medicine to enjoy your life.
