The One Lost in Translation

I can almost guarantee you this situation is happening in some hospital, somewhere, with some patient: the medical team walks in, asks a few simple questions in English, and gets the correct answers. The team then proceeds to explain the entire treatment plan in English, assuming that if the patient can respond to basic questions, they must have a grasp of the entire language.

My experiences this week have made me acutely aware of how dangerous this situation can actually be. When speaking to Guatemalans, I can demonstrate a reasonable grasp of Spanish, and often receive responses that are far more complex than I can fully understand. Sometimes, I just get the general gist of things. Other times, I make incorrect assumptions and miss the point altogether. Or worse, I may not have even the slightest idea what was said, but don’t feel comfortable enough (or can’t remember the words!) to ask them to slow down. But typically, I’m only trying to buy a bus ticket or understand my host brother’s new job, so a few words lost in translation are usually not a huge deal.

But when explaining a cancer diagnosis or the risks and benefits of a surgery, losing words in translation is not an option we can afford. I have no doubt there are patients for whom English is a struggle, but they may be too embarrassed or respectful to interrupt to remind us that they can only handle the basics. No wonder patients have difficulty complying with treatments, or even articulating what exactly their medical problems are.

Though I came to Guatemala to learn Spanish via cultural immersion, this trip is also a firsthand experience confirming the importance of using interpreters, avoiding assumptions, and checking to ensure patients are understanding their providers, regardless of language.

Even More Ways to Know You’re a Medical Student…

41. As fourth year approaches, you tell your long-lost friends that you’re “putting in a standing order for potlucks qmonth.”

42. One of these long lost friends responds, “Phew, my insurance will cover that!”
43. Your favorite GI bug is Bacillus cereus because come on, let’s B. cereus!
44. You’ve perfected your cow drawings and puns to most creatively reserve your team’s COW (Computer on Wheels) for rounds.

Mooooove it along. This one is for Team 3.

45. You crave graham crackers and saltines when you’re exhausted.
46. When your patient tells you that there are invisible people cooking bugs in his house, your immediate reaction is to simply nod and ask, “And how long has this been going on?”
47. Your white coat weighs more than your backpack, and at any given moment you can produce a stethoscope, a reflex hammer, a penlight, 2-3 different texts, patient lists dating back two weeks, and no fewer than five different colored pens.

From A Cartoon Guide to Being a Doctor

48. A small child sees you in the hospital cafeteria and shouts, “LOOK, MOM! IT’S A DOCTOR.”
49. After informing this child that you’re a medical student, not yet a doctor, said preschooler scoffs and rolls her eyes.
50. Your impressive upper body strength earned via surgical retraction is quickly turned to mush by your six-days-per-week internal medicine rotation.
51. It’s not uncommon for someone at a bar to ask how you dealt with “chopping up a dead person and stuff.”
52. You make claims like, “Of course we all have a second stomach for dessert!” because you “learned that in medical school.”

So of COURSE you have room for this!

53. You plan next year’s vacation around the available options for international rotations, just so that the medical school will help fund your next big trip.
54. You spend your days informing patients of the importance of having a PCP and receiving all the right screening tests, but you haven’t actually gotten a physical since you started medical school.
55. You once brought a real human skull home for Thanksgiving, much to the disgust of your mother and father.
56. While spelunking in Budapest, you quickly mark yourself as a weirdo when you begin wondering aloud if the same fungal illnesses exist in American and European caves, because no one wants histoplasmosis.
57. The highlight of your week is when your resident tells you, “It’s Cinco de Mayo. Why don’t you head out and drink some margaritas for all of us?” at 1 PM on a Sunday.
58. Your friend casually mentions that her head hurts, and you immediately slam her with seven follow-up questions. (When did it start? What does it feel like? Have you felt anything like this before? Are you nauseous? Does your mom’s brother’s lawyer’s dog’s neighbor have a history of headaches like this?)
59. You are the only person on the team who is able to take the time to delve deeper into the patient’s history or to listen to their grievances, and you easily earn the patient’s trust and admiration. Sometimes, they’ll even tell you you’ve restored their faith in the medical system.
60. Your blog has been sadly ignored for several weeks while you juggle six day work weeks and upcoming board exams. (But there’s plenty of stories just waiting to be told, promise!)
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Happy Medical Mondays! Can you believe it’s May already? And beyond that, can you believe I have just THREE more work days until I’m completely DONE with third year?! It feels like I just hit the wards for my very first day on Labor and Delivery, and now, somehow I’m gearing up to take my very last shelf examination.
For my new visitors, I’m K, an almost-fourth year medical student in the US just finishing up internal medicine and very much looking forward to having the time to get back to blogging and share all the stories I’ve collected with you. In the meantime, take a look around (and maybe even subscribe or follow me on FB/Twitter), or hop on over to visit our lovely hostesses Emma and Jane to peruse some other fantastic medical blogs.

The One Where Water Poured Out His Nose

“Sir, why don’t you tell us a little about why you came in to the hospital,” Dr. Weekend prompts the elderly patient, despite having heard his story from the overnight resident.

“‘Cause my head hurt. I’m not dealin’ wit’ it. Tired of it,” he snaps, clapping one hand over his left temple. “And I was bein’ confused. I got locked outta my apartment all night!”

“Okay. So your head hurt and you were a little confused. Anything else?”

“And my nose keeps runnin’ and runnin’,” he offers.

“Well, we saw a bit of a sinus infection on your CT, so that would make sense. Is it both nostrils?” Dr. Weekend continues.

“Nah. It just be the left one,” he offers with a sniff.

My attending nods and asks him to sit up in his bed so that she can go through a quick neurological exam.

And he sits up. And that’s when I see it:

He scrambles to hold a tissue to his nose, but not before I notice several drips of watery liquid pouring from his nose. My concern for this man immediately picks up a notch, and I look incredulously from my attending to my resident for signs of worry or surprise. But they don’t react.

“My nose always be drippin’ worse when I sit up,” he notes, humoring the physicians as they walk him through the neuro exam.

“That’s probably your sinus infection,” Dr. Weekend says, patting his shoulder for reassurance.

Now, I’m a third year medical student, the lowest of the low on the medical totem pole. There’s hundreds of diagnoses I have yet to experience, but I have had a run-in with a sinus infection or five. And never ever have I seen anyone with mucus pouring out of their head like water from a pitcher.

Instinctively, I’m sure of it: that’s not mucus. Despite never having seen it, I’m willing to bet this man has CSF rhinorrhea, a condition where the fluid that provides cushion to the brain is leaking through a nostril.

And suddenly, I’m faced with a difficult task: raising the possibility that the attending might be wrong in a world where in many cases, the medical student speaks only when spoken to.

We step into the hallway, and I inhale sharply.

“Dr. Weekend? Is that really just a sinus infection?” I begin slowly.

She nods. “It’s on the CT. There’s a big infection right in that left sinus,” she says insistently.

“There’s nothing else that could be?” I prompt.

“It’s the infection,” she says, her tone effectively ending the conversation. “We need to get an LP on this guy.”

And so we walked away, with me making a mental note to bring it up with the day attending on Monday.

But I wouldn’t need to. By Monday, Dr. Days has already ordered the tests and confirmed that this nasal fluid is CSF, and this man’s brain is bulging out into his nasal cavity.

—————-

This situation raises the dangers of the current medical hierarchy. Though I realize in hearing stories from trainees past, medicine has become much more open to input from students and residents, there is still this dynamic where it becomes incredibly difficult for a student to point out some attendings’ mistakes or oversights without overstepping boundaries or risking a poor evaluation.

I keep wondering if I should have pushed the issue harder with Dr. Weekend or the weekend resident, but I’m pretty sure that they both would have justified the current opinion and shrugged mine off as a silly medical student idea. I have always feared the day when my mistake led to an adverse outcome for a patient, but I never considered the possibility of recognizing a problem and being unable to convince those in power that it was a reality.

I’m grateful this man got his diagnosis, but it terrifies me to think that he may not have or he may have gotten there only after a life-threatening event. If something terrible had happened, would it have been my fault for not doing something? What was I supposed to do in this situation?

Have any of you ever had to stand up to an attending or a physician above you in the rankings? If anyone has any advice on how to approach this type of situation, I’d love to hear it in the comments.

The One with the 2012 Recap and 2013 Resolutions

2012 brought a lot of ups and downs for me.

I started out with heartbreak, which was pretty terrible…

Ugh.

But as cliche as it may be, it ultimately brought me closer with old and new friends, helped me sort out who my true friends are, introduced me to new hobbies, and really challenged me to grow as a person.

Yay! Sunshine and rainbows and unicorns and everything is better!

I spent months and months of the most intense studying of my life in preparation for USMLE Step 1.

 

I celebrated the end of boards with my first trip out of the country: to England, Hungary, and Spain (a trip designed to allow me to experience three totally different tastes of Europe in two short weeks).

I visited the set of Harry Potter in London!

I visited the set of Harry Potter in London!

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I explored beautiful Budapest at sunset!

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I ate traditional paella at a cute restaurant in Barcelona!

I finally began my clinical clerkships, which made all of the countless hours locked away in a study room worth it. I’m so much more excited to go to school now that I spend every day meeting new people and learning just as much from them as they learn from me. I met patients who made me laugh, who lost their lives in my care, who supported me, who taught me life lessons.

I started this blog, which now has over 2000 views in less than six short months, despite my best efforts to completely ignore it at times. (Thanks to all of you who have stuck with me!)

And now it’s 2013, and I couldn’t be more excited. In a week and a half, I will be done done DONE with surgery and rejoining life as a real person, and for the first time, I’m challenging myself to several resolutions:

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…complete with a color-coded system for keeping me honest via marks on my calendar.

Bring it, 2013.

Happy New Year, everyone!

My Surgery Clerkship Has Warped My Thinking

A collection of my thoughts “BS – before surgery” and “DS- during surgery.”

BS: Ugh, I have to wake up at 5:30 AM tomorrow. Life is terrible.

DS: I get to wake up at 5:30 AM tomorrow! I can’t wait to sleep in!

YES!

——-

BS: It would be really terrible to be in a car accident. Physical injuries are undesirable, and I don’t have time to be in the hospital.

DS: It would be really terrible to be in a car accident. I’d be brought to the trauma bay at my hospital and all of my residents and attendings will notice that I haven’t shaved my legs in a week.

It’s like she’s… some kind of Barbarian…

——–

BS: I’m going to take care of my body! Let’s do Pilates and eat healthy foods every day!

DS: I thought about doing exercise twice this week. Then, I promptly fell asleep at 7:30 PM with a handful of my trail mix dinner firmly grasped.

Sometimes, I don’t know whether to eat or go to sleep…

——–

BS: Maintaining my social life in medical school is really important to me and my sanity.

DS: Wait, who are you again?

I’ve never seen you before in my life.

I’ve successfully survived trauma surgery! Tomorrow, I start a two week rotation on “Minimally Invasive Surgery,” which kind of makes me laugh because I’ve been doing laparoscopic surgeries (read: operations with small incisions to insert tools and a camera) for weeks now for appendices and gallbladders gone wild. Realistically, this is the bariatric service, because their main focus is gastric bypass.

Either way, gone are the days of 24 hour call and running to the emergency room for traumas. If only the days of waking up at 3:45 AM would go, too.

…and somehow, even though I know I’m not a surgeon and I most certainly do not love being conscious at 4 AM, I still love what I’m doing. And that makes everything worth it.

The One Worth Thinking About

Though I gleaned countless pieces of information from her, there’s one thing my preceptor taught me to ask this week that is worth thinking about regardless of age, gender, socioeconomic status, employment status, and diagnosis. So today, I challenge you to take the time to stop and think:

In the time you have left, what’s most important? Now, what are you going to do to pursue it?