Wednesday, May 13, 2015

People can be stupid, but life usually goes on.

Those were the days, my friend.  We thought they'd never end.
This is the day which the Lord hath made. Let us rejoice and be glad in it, If you noted a trace of irony or mocking in the preceding quote, I contratulate you on your ability to detect sarcasm.

Today sucked in virtually every way a day could suck esxept that no one close ton me, human or animal, died. The same cannot be said, unfortunately, of my patient in :Practice.of Medicine.

Keep in mind that such does not indicate that a real patient died. I would not be nearly so cavalier had a living breathing human had ceased to live and breathe on my watch. Instead, it was a Berkeley Rep "actor" expired because I failed to identify the symptoms as he feigned them in a a timely manner, which led to a delay in the ordering of the correct tests, which caused the professor to look at his watch and declare the "patient" dead. Even though it's all fake, it really bothered me, as I don't like losing even mannequins, much less living and breathing "fake" patients.  

The problem is that the  "patient" was supposed to describe the symptoms of a stroke. Instead, he was ding his best seizure imitation. I ordered 4 millimeters of lorazepam to be administered by slow drip,  (over a five minute interval, which could then be repeated in ten minutes if necessary) and ordered a CT scan and an EKG.

Instead of flailing around n a gurney, the patient should have gone unconscious, then displayed confusion, inability to speak or slurred speech, slurred speech, , weakness on one side of the body in arms or legs, numbness, difficulty in swallowing, severe headache and/or blurred vision.. 

Hasd the "victim " acted out the symptoms he was supposed to display, I would have ordered a clot buster - probably Activase T-PA.

The professor refused to even consider that the "patient" had thoroughly screwed up in acting out the symptoms. The excuse that he, the professor, gave for lack of consideration that the Berkeley Rep actor had screwed up was that sometimes patients display what appear to be atypical symptoms  just as the actors who act them out in our faux clinic sometimes display the wrong symptoms. While such may occasionally be the case in the actual practice of medicine, considerable slack is cut to the misdiagnosing physician if a patient expires quickly after displaying or reporting symptoms inconsistent with a  particular condition that ultimately did him or her in from having  caused a delay in proper treatment or causing inappropriate treatment. 

Furthermore, in this particular case, with the  diagnosis  as eventually reported  (the stoke),  had there even been one, could not possibly have been massive enough to have killed the patient so rapidly. It was the actual E.R. equivalent of an E.R. physician calling off a code and declaring a patient dead after a single  discharge from a defibrillator when thr charge had actually causeed the patient;s heart to resume function. The professor called the patient's death far too fast, even in the opinions of two other  professors, not to mention all the know-nothing first-year students such as mysef who had been in attendance, and even the more astute Berkeley rep actors. (One of them patted me on the shoulder and said, "You got a bum rap, kid," as he walked out of the makeshift E.R. The other "actors" present were all pretty hard on the "actor" I had treated. His excuse, which may very well have been the truth, was that he acted out the symptoms as he was given them and had told he was a seizure patient, -- not a stroke victim. He held up his printed instructions to prove to hi s peers that we was telling the truth. And further still, the prescription of lorazepam or any other benzodiazepene as an anti-convulsant,  immediately mid- or post-stroke is not contraindicated. Had the patient presented symptoms correctly, my only error would have been in not prescribing anticoagulants and clot busters first before giving any other diagnostic tests I ordered were appropriated whether the supected dx had been stroke or  seizure. and, in conclusion, had the correct diagnosis been consistent with the symptoms portrayed by the "patient," the administration of a clot buster would have been contraindicated and could have precipitated a life-threatening bleeding episide..

The professor who was supervising me in this case is not a favorite of any of those in the cohort who are close to me. His actions in this instance demonstrated quite clearly why most of us are less than fond of him.. The man shouted at me until his face was tomato-red.

I understand that the Practice of Medicine clinics and simulated emergency rooms are not situations designed for the amusement of the participants. Even though no one is cured, fails to be cured,  lives, or dies as a result of our good or poor medical work, it's serious business, as we, the members of our cohort, are  marginally over a year away from contact with actual patients,  The mehmber off our cohotyhad the briefest ofencounter in participating in taking vita signs in the urgent care centers, primarily for the prupose of culling out thosre among us who could not even cope with vomit or races of blood, but that experience was hardly significant in light the situations we will soon face.)

On the other hand, our Practice of Medication courses exist  so that we can have experiences and make our inevitable mistakes without actually endangering anyone. The simulation process must  be taken seriously because we're all so very close to having what will sometimes be the initial encounter with any given patent, and,  though it's not designed that such should be the preferred course of action in ant instance , in the rarest of instances as any one of us  may be the only person standing between death and life for a given  patient.

Thus, when a  lapse, misstep, or omission  occurs, it cannot be laughed off. On the other hand, one would expect that the physician/professor charged with supervising the future physician who may have erred in the diagnosis and/or treatment  of  a patient, delaying correct treatment, resulting in treatment which would ultimately cause harm, or, in a worst-case scenario (as much as anything can be a worst-case scenario when neither the patients nor the ailments are legitimate) causing "death," it would be assumed that no reason would exist for anger on the part of the supervising professor/ physician except in the event that the medical student failed to take responsibility for his or her actions or to take seriously the situation, or in some manner laughed off the mishap as being something of a joke or of little consequence.

As the medical student on the receiving end of the judgment, counseling, advisement, or whatever one might have called the session,  I can assure the reader that I did not attempt to deflect responsibility or to make light of the situation even though in this particular case, the acting patient in the case had  misunderstood or had been misdirected concerning the condition he was to simulate. I did not even bring that into the discussion. My only pleas of self-defense to my supervisor were that the tests I ordered were applicable to the scenario that the drug I had ordered, while not the first choice drug in the case of  stroke, was not only not contraindicated but would have been beneficial to the patient, and that had a stroke occurred, the stroke would have been determined to have been  of of such limited  magnitude that ample time would have been present to note the discrepancy, to then administer  the clot-busting drug. In any event, calling the patient's death was ridiculously premature.

I would have done nothing except bow my head and nod at the professor/physician admonishing me except that he went after me in front of a audience and did not merely shout at me, but asked questions and demanded answers. I've learned in my twenty years of life in this planet that there are times when it pays to keep one's mouth shut, but the  professor/physician was not taking nods and "Yes sir" and "I'm sorry, sir" as answers. My assumption was that the discrepancy in what symptoms the actor had been told to portray  and what condition my professor had been under the impression the "patient" was supposed to be suffering would eventually be cleared up, and any black marks on my record would be ultimately eradicated. It would never had been my choice to argue with the physician/professor.

As it ended up, in addition to numerous students, most of whom like me but none of whom have any clout whatsoever, two other physician professors in our  problem observed the entire fiasco. Both have seniority over the professor who raised his voice at me, so the repercussions I will suffer are limited, Furthermore, it was a mere Practice of Medicine assignment as opposed to a portion of the practical midterm we'll take tomorrow and Thursday for that class. On Friday, we'll have our midterm for the Cardio/Pulmonary facet of Human Health and Disease,

I really don't care all that much about this except that I would prefer to go into midterm exams without recent baggage of this event hanging over my head, on top of just having recovered from a nasty bout with a stomach bug and still having a slight limp from the two recently fractured bones in my foot. I had planned to surrender my temporary parking pass this week, but I've decided to hold onto it until I'm able to ride my bike again. I have enough issues without having to show up for exams twenty-five minutes early in order to find a parking space half a mile a way and limp all the way from there to my building, (One jerk has taken to calling me "Henrietta Limpett," which is an apparently obscure reference to some 60's movie starring Don Knotts. This is hardly fair, as my limp is scarcely noticeable unless I've been required  to walk a mile or because parking was so difficult,

Immediately following my having been yelled at be Dr. Idiot, I left the building that housed the makeshift clinic and made my way  a wide cement staircase -- the same staircase I  was pushed down a couple of months ago by a third-year student in a major rush, who plowed me down the steps. The staircase, consisting only of six or seven steps, is quite wide -- wide enough that there was no reason for anyone to have mowed me down to get to the bottom by anyone in a rush; there was plenty of room for the hurried student to have stepped  around me.

It was time for lunch by the time Dr. Idiot finished shouting at me, but my appetite had been ruined, As I sat on a part of the step where it seemed unlikely anyone would to need to walk, I was somewhat overcome by the absurdity of the entire situation,  I didn't want to be seen laughing too openly lest Dr. Idiot walk right past me. He has limited power to make life in any way difficult for me, but why press my luck? I held my head in my hands and laughed at the stupidity to which I had been subjected. Kal Penn [not his real name] and The Cool Guy wondered out of the building apparently in search of me. They sat on either side of me. Kal put his hand on my shoulder and said, "He's an ass. We'll all go to administration for you if you want." I looked up at him. Both he and Cool Guy were relieved t see that I was not crying.

Kal Penn suggested we all go get a beer. I reminded him that I have a bit of trouble being served in bars in the area. The Cool Guy knew a bar nearby that he was sure would served me, We took my car since I have the best parking of the three of us with my handicapped placard. We each had a couple of beers. Because I'm not yet twenty-one, Kal Penn drove. Two beers probably barely registers on his BAC. As someone not yet 21, no amount of alcohol in my blood is legal me for driving purposes.

We were late for afternoon lecture, but no one complained. For that matter, and we made out way to our seats, the lecturing professor said, "I'm really sorry, Alexis." He'd had absolutely nothing to do with it and wasn't present, but news travels fast.

All's well that ends well. Dr. Idiot obviously will not lose his job, but neither will be he promoted anytime soon. My dad still has some clout around here, plus Dr. Idiot (who , incidentally, bears an eerie resemblance to an iguana) is a complete jerk, and such behavior is not typically rewarded. Karma is a bitch.

It's on to midterms, and then we'll go from there.

It's not one of my skilled moves, but in the picture with one of my more skilled maneuvers, my hair was in my face in such a way as to make it appear that a giant booger was hanging from my nose. it wasn't a good look.


  1. Aww... that sounds like a shitty afternoon. Sounds like you have some good friends, though. Unfortunately, this kind of crap will go on until you're well established in your career. Sometimes people with power are jerks.

    Don't sweat it.

  2. He was acting as though i had killed someone. Even had I been an actual doctor and the guy an actual patient, i would have done him no harm.

    1. Yeah. But you know you were right. That guy is just an asshole. Karma will get him.

      I'm surprised the other profs didn't say anything.

  3. Actually they did. It was behind closed doors but we could hear most of it. One told him a douche another said he made himself look even stupider than he normally looks.

    People in med school don't thrive on drama to the degree that high school kids do, but gossip like this gets around, and I'm the current heroine du jour because no one liked this guy anyway.

  4. I've always been on the fringes of the "in" group - not a total nerd, but somewhat nerdy, though affiliated with the cool group by being related to Matthew and by being willing not to give out homework answers to people who hadn't touched the work but willing to compare answers with anyone who had done the work.

    People such as this idiot may eventually make me cool, not that I really care.

  5. That's horrible, especially if the actor was told to portray a seizure. It almost sounds like your prof wasn't paying attention, made the wrong call, and is bullying you to cover his own ass.

    1. t]That would seem to have been the case. Apparently the Berkeley Rep coordinator who supplies the actors has complained as well. Dr. Iguana Idiot will not get into any real trouble, but he has harmed his reputation needlessly. All he needed to do in order to walk away with his reputation intact was to act like a human being

  6. In Buddhism they say that there is one thing that causes suffering-- ego. This professor was not the first and will not be the last person to treat you unfairly. He was yelling at you due to his ego. Your getting upset is your ego.

    I am not saying that you did anything wrong except getting upset never helps a situation and hurts you. I am not saying do not get upset since you cannot control it. Learn things to do like yoga, that will relax and calm you.

    Why did Stephanie March and her husband get divorced when they loved each other enough to get married? Ego! Remember that the show House is all about making mistakes for an hour and in the last minute getting it right.

    On Seinfeld there was a show about actors presenting medical symptoms and Kramer did such a good job, that the people figured the disease right away. To do a good job presenting jaundice, you just need yellowish skin (too much bilirubin in the blood).

    I have read up on strokes and they can be totally different from each other. My mother had a stroke and died 2 days later from a massive stroke while in the hospital. One guy woke up and had blood on his pillow from his ear. They determined that it was a stroke. Then there also mini-strokes.

    Drugs (like aspirin) that prevent ischemic strokes can cause hemorrhagic strokes. That happened to the prime minister of Israel. My mother would go bowling in the evening and then go to a bar after with friends. She did this for many years. She never drank much. As soon as her friends saw something was wrong they should have taken her to the hospital.

    They brought her to my door and she could not walk herself, was incoherent and had trouble hearing. So I called emergency. As soon as the EMTs got there, I said that she needs to go the hospital right now. They looked at her and asked her questions for a half hour before taking her. She had a stroke and they took 30 minutes to figure out that she needs to go the hospital. I told them that she never had any trouble hearing ever-- meaning it was acute not chronic.

    I can tell that the purpose of life is not to be able to correctly diagnose every patient. It is to learn how to keep your ego from making you miserable. Remember that you are a brilliant medical student that is only 20 years old. You will make mistakes and will also be blamed for mistakes that others made.

    You Had a Bad Day :-(