learning and unlearning

medical education is a long process of learning how the body works, even to the details of molecules, how the body goes wrong and what we can do to make it any better.

in that arduous long process, we often learn things we never thought we would have to learn. Inevitable things like priorities, and really tight time management. We learn how to classify people in a list of importance the way we think they should be in, and the way we like it. Then, we learn to give more time to more 'interesting' or more 'severe' cases. Like how a non-ST elevation MI is not as serious as a ST-elevation MI and hence require less attention (that's a whole load of jargon, isn't it?). Like how we have to stop patients from going on their heart-wrenching stories because we really need to get on working. And sometimes, we even learn how to lie to patients, and their relatives. Drop little white lies here and there. We learn how to detach ourselves from patients, because it's just too burdensome to be attached to every sappy story every patient can give. We learn how to lose the human touch, not to think with our hearts but with our minds, giving fully objective explanations to things.

But some of this really makes us much less human and much more mechanical. I surprise myself today as I was talking to a fellow med student. We met up and were just talking about our day at the wards. I told him i had an interesting case, and he said "i had one too. It was nothing much really, just an NSTEMI, but she was really anxious, but it's JUST a NSTEMI. It's quite hard to get her to stop being anxious."

For a few seconds, I actually thought, 'Ah, another typical whiny patient. Just an NSTEMI, nothing interesting."

Then i caught my thoughts, and rewind. It was strange hearing such thoughts in my mind, coming from myself.

It's NOT JUST an NSTEMI (NSTEMI is a kind of heart attack btw. not as serious as another type called STEMI, but still a heart attack).

It's a Heart Attack for goodness sake. It's one whole scary episode. Imagine being an elderly lady at home, doing practically nothing other than switching TV channels on your favourite couch, just after your daughter leaves after a nice long visit. Then you suddenly feel unwell, feel a bit nauseated. Haven't felt like that for a long time now, must be the air you think to yourself. You think you should go and perhaps get some air, but suddenly there's this horrible chest pain, as if you were tied down to your chair with bands across your chest. You're sweaty, gasping for air, wondering What on earth is happening to me, and there you are all alone with just the TV presenter's voice audible. You try to talk but you are in such agony. "I really could die now. I really think this is it. Is this it? Am i gonna die right here like this, with no one around me?" The pain is intolerable. You call emergency and the rest was a blur. Pain, pain and more pain. You doubt your frail body will make it through, but it survives. Goes through a horrid series of needles, drugs, and plenty of people. You don't recognise anyone, everything seems like a blur. Doesn't help that you have a little problem with your memory. "Wanna talk to my husband but he's not there. Is there someone i know who can tell me what's going on? What's this? you want to insert more things into my veins? Moved from ambulance to hospital door, rushed to emergency, rushed everywhere. Alien stuff from sci-fi movies, now attached to me. Tubes, wires, monitors, that horrible beeping noise. That gasp from that old man across the ward. Everytime he gasps for air, I feel like i'm the one dying. The rushing of people from one bed to another, when will they rush to mine and see me dying? "

"Oh I slept, how long was it? What happened? am i still here? What place is this? ARGH! what's happening? can my dear husband just come back right now? Am I still alive? Will i die anytime soon? when's my time coming?"

All this potentially going through that old woman's head. and there i was, arrogant little 3rd year medic, going 'It's JUST a NSTEMI'.

right.

it's becoming easier and easier to brush off things without thinking too much of it, just because someone on the next bed is having something so much more severe. It becomes so much easier to just not bother to talk too much to someone going through a hard time because someone else is going through a harder time. The thing is only us medical people know that. That 'not-as-hard' time some patients have might be the worst they have experienced in their life. It could be a lost world of confusion, hitting them at the worst of times. And to brush that off, can just be a bit inhumane.

No normal human being, i believe, would brush things off when they hear that story i mentioned if it happens to someone they know, someone smacked right in front of them. the least you do is listen, and show some empathy, give some hope, show your support.

but it's a learned behaviour, a side product of med school, to brush things 'less severe' off.

even a nosebleed could mean the world to a patient. that's what my dad says and i actually agree with him.