• I’ll Sleep When I’m Dead

I'll Sleep When I'm Dead

~ writing my way through motherhood, doctorhood, post-PTSDhood and autism. sleeping very little.

Tag Archives: medical school

Of Angels and Devils

22 Thursday Jan 2015

Posted by elizabethspaardo in christianity, doctors, empathy, Evil, outrage, PTSD, Rape, Sin

≈ 7 Comments

Tags

empowerment, Justice, love, medical school, medicine, silence

gelfand

From January 2015:

Dr. Steven Gelfand died on January 18th after a brief battle with cancer. He was 66 years old. He was also amazing.

I’m going to tell you about him. And just from reading about it, you’ll be better off for having known what little I can tell you here.

I met Dr. Gelfand July of 2009. He was the attending of my very first clinical rotation as a medical student. The first two years of med school are spent in the classroom and the last two years are spent on rotation. You get to leave the classroom and spend time actually doing medicine.

I’d had PTSD for about a year at this point. My perpetrator, a fellow medical student, had been arrested in August 2008. My trauma officially ended with his arrest I suppose, and then came the PTSD.

After he was arrested, my medical school became upset with me. You see, the FBI released my name (even though they didn’t need to) and implied a lot of things about my personal life, sex life, and mental health in the affidavit they used to arrest the sociopathic child molestor I’d turned in. Some of what they wrote about me was accurate and some of it wasn’t. Two things made very clear by this affidavit were:
1. He was a dangerous sadistic pedophile
2. I had risked my life and the lives of my children to turn him in.

I’d like to think a medical school, an institution charged with shaping the physicians we place our trust in and rely on for our lives and health, would be appreciative of a future doctor risking her life and the lives of her children to stop a fellow future doctor who is a sadistic pedophile from hurting any more women or children. But that’s not how it went.

Quite the opposite.

My school chose to punish me instead. They placed me on probation for having morals below the standards of the community (in reference to the affidavit’s inference that I had engaged in consensual, kinky sex with the perpetrator before The Ordeal began). More than this, they waged psychological warfare on me. They brought in a speaker from the state board of medicine (and an alum of the school) who spoke in front of the entire student body about me, saying I really should leave med school now because I wasn’t fit to be a doctor. Warning them not to be like me. A sexually immoral person. The head of my school told me I would never be a doctor. She said no doctor would take someone like me on for clinical rotations and that even if I somehow managed to become a doctor, I would never have patients because I was so disgusting, they wouldn’t want me touching them.

Such cruel words coming from the head of your medical school, coming to you in an acute post-traumatic state, has such an impact. I didn’t even realize at the time how much I believed her.

I was able to get a lawyer and, after a legal battle, get her off my back (but not before suffering the utter humiliation of being forced to apologize for my behavior to the faculty of my school.) But she had gotten inside of my post-traumatic soul and planted herself there.

Fast forward a year to my first day of clinical rotations. The day she said would never come.

The PTSD had obliterated my self-confidence. Deep inside I was afraid she was right, that I wasn’t going to make it and I should have cut my losses when I had the chance.

I know there is a God because it cannot be chance that I wound up on Dr. Gelfand’s doorstep. By the end of my first day with him he’d shared with me that he had no respect for the head of my school. In fact, he told me, he’d once told her to go f*** herself. He was a Jewish, cursing, bold as all hell, certified angel.

He told me she had once punished a medical student he had rotating with him after he gave the student time off to spend with her mother who was dying of cancer. He responded by sharing his feelings as above.

I ended up telling him what had happened to me. The brave deed I’d done and the evil she’d paid me with. He told me I’d done a courageous thing, the right thing. And he told me not to tell any other doctors like I’d just told him. It could ruin my medical career.

Over the next two years, he became my two special needs sons’ neuropsychiatrist. He was, by far, the best doctor they’ve ever had. He became a mentor for me too. He told me I was going to be a great doctor. And part of me actually believed him somehow.

He was a tough attending. He let you know every single detail you got wrong. But he also let you know when you got something right. And when he did, it really meant something.

He went into medicine for the right reason. He cared about his patients and worked for and advocated for them fiercely. He was good and he knew it, and he earned it.

Dr. Gelfand was right that I shouldn’t tell the other doctors I would be rotating with what she’d done to me. It wasn’t the time for it. She still had the power to end my career. I wasn’t emotionally ready to speak publicly about it yet either.

But I have been healed of my PTSD after seven long years. I am getting ready to graduate from a wonderful, supportive residency. And I’ve never been one to keep quiet.

It was Martin Luther King day on Monday so we talked to our kids about the civil rights movement. We talked about the turning points like Rosa Parks and how those were just moments that sparked off a movement that ha been building for a long time. My son asked me why those particular events set things in motion and I told him no one could say for sure.

The passing of this amazing man has changed things for me. Something has been brewing within me that would inevitably, eventually come out. I didn’t know when.

The silence ends now.

Jeremy Noyes raped me, tortured me, threatened to kill me and my babies. My medical school punished me for risking all of that to do what is right as a physician and as a person. He is now serving 45 years in federal prison. What my school did was wrong and dangerous. They sent a clear message to that school full of future doctors that turning in a child predator could cost you your career. It was unethical, immoral, and unacceptable.

Your seven years is up, LECOM. Let’s talk.

Better Living Through Science

21 Wednesday Jan 2015

Posted by elizabethspaardo in autism, doctors, empathy, kids, medicine, parenting, Sin, special needs

≈ 2 Comments

Tags

addiction, autism, forgiveness, medical school, natural parenting, residency, truth

I’ll admit I spend a good amount of time on Facebook. I like to see what politcal/social justice type things my friends from college are up to. I like to post pictures of my kids for distant friends to see. Sometimes I’ll take one of those quizzes: Which Golden Girl are you? (I got Rose, in case you’re wondering. I was really hoping for Dorothy but I guess I haven’t matured to her level of sass and pith quite yet). One thing that dominates my feed is posting from my fellow doctors and nurses bashing parents who don’t vaccinate their kids. And yes, I mean bashing. I don’t mean expressing concern for their children. I don’t mean seeking to find ways to turn the tide of increasing numbers of people not vaccinating their kids. I mean, bitching about them and how they’re screwing up herd immunity for the rest of us because they are bad people who ignore science.

I have issues with this.

Ironically, these people of science are not being scientific at all. The whole argument is that these crazed non-vaccinators are ignoring science. They’re irrational. They’re backwards. They’re stupid. They’re ignorant. The problem with this argument is that the accusers here are ignoring the fact that *they* themselves are not being scientific. Let’s look at the facts:

-By and large, non-vaccinating parents are highly educated with average to above average intelligence. That’s what the research shows us. Most of them have read everything their doctors have read and come to the decision that it’s not compelling evidence to them for one reason or another. So, calling them stupid or irrational simply isn’t accurate.

-Most parents who do not initially vaccinate will vaccinate their children within a few years. The vast majority of patients questioning vaccination cite their doctor as their most trusted source of information. But here’s the rub: the research shows that if their doctor comes at them with the attitude most doctors hold, these parents actually become *more* likey to not vaccinate. What has been shown to work, scientifically, is for physicians to engage in respectful, open minded dialogue with them and not engage in scare tactics etc.

We have an obligation as physcians to pediatric patients of these parents and also to the greater community and society. We’re tossing aside evidence based medicine and compromising both with our attitudes towards these parents.

Why? Basically because this topic makes most doctors really really mad. And we allow really really mad to get in the way of our obligation to these kids. We find it emotionally comfortable to get angry and make it into a moral failing in these parents. Some of it is righteous anger in defense of community health. Some of it is control issues. We don’t like it when patients don’t do what we say. We got into medicine to help people and now they’re not letting us help them. Maybe it makes us sad to see them hurting themselves. Maybe it pisses us off they’re messing up our plan.

I was discussing a law recently with some fellow residents that I read about going into effect recently in a southern state. They were starting to arrest mothers who did illegal drugs while pregnant once the babies were born. Two of us thought it was a terrible law because addiction is a disease and criminalizaing it really wasn’t the answer. Putting a baby’s mother in jail soon after birth is incredibly obviously not good for a baby. Knowing she’ll go to jail if she delivers her addicted baby in the hospital will inevitably lead to some of these mothers delivering their babies at home and not getting proper medical care. They’re certainly going to be more likely to lie to their physicians about what drugs they’ve been doing. The resident in favor of the law was adament that these women must be punished. They’ve harmed their child and they must be punished. The fact that this law was only going to hurt these babies further was not the issue here. Addiction was not a disease, it was a moral failing.

The truth of it is, it is simply easier and more satisfying to write these non-vaccinating parents off as kooks and lost causes. But if you truly believe not vaccinating their children (your patient) puts them at risk, you have a moral obligation to not write them off as a lost cause. You are that child’s advocate. You are a physician practicing evidence based medicine. So act like it.

Parents who are simply questioning vaccinating may or may not know much about it. So, guage how much they know and offer them education in a respectful way. Talk when appropriate and listen when appropriate. Don’t engage in scare tactics. Show them some compassion. This will maximize the chances they will vaccinate today or soon therafter. In case we’re not clear on this: making them sign a release recognizing they’re placing their child’s life at risk by not vaccinating is not productive in this regard.

Some parents are at the point where they are refusing to vaccinate and have probably read up on a lot of what you have to tell them about vaccine safety and efficacy. If you can tell they’re already familiar with the information you have to offer, it’s time for you to sit and listen. Ask them why they don’t want to vaccinate and listen respectfully and compassionately. If they’re open to your responding, then go ahead and respond. If they’re not, then thank them for sharing with you and let them know you truly believe vaccination is the best thing for their child and that you hope the dialogue can be kept open at future visits.

If the above approach chafes your chaps, if it seems just plain wrong, that’s a perfectly valid feeling you’re having; but it certainly isn’t scientific.

Instead of reading self-congratulary after self-congratulatory article on how awful these non-vaccinators are, you’d be better served to read up on why parents make that choice. Better yet, try talking to a few of them. As a mom of a child with autism, I can tell you there are plenty of parents in that community who would be more than willing to talk to you about it. Step back from the moralistc thinking and consider all the psychological and social reasons parents might have to make this socially unpopular choice. What life experiences have they had that have led them down this path?

One thing I try to stress to my interns starting out in residency is that there’s a place for book knowledge but most of what you need to know about being a good doctor comes from experience. Your experience as you go along and learning from the experiences of the doctors teaching you who’ve been at it so much longer than you. If you’ve seen a child suffering from a vaccine preventable disease, you’re most likely eager to share that with your patients. But, you’re better off trying to find out about their experiences affecting this decision. Scientifically speaking.

One common misconception amongst the American public that upsets physicians is the idea that vaccines cause autism. How can so many people believe this stil?! It’s been scientifically disproven! Heck, it’s even been anecdotally disproven in the case of thimerosol. Let’s get rid of the exclamation points and ask that question for real. Why is it that people still believe all vaccines or MMR or vaccines containing thimerosol cause autism? Is it all due to that villain Dr. Wakefiled who published that now discredited study in the Lancet? Has he mesmerized these foolish parents? Or could there be a more logical explanation. Perhaps one explained by medicine?

Let’s set aside the vaccine facts for a minute here and consider some facts that are at the core of every family’s life who has a child on the autism spectrum:

1. Doctors do not know what causes autism
2. They’re pretty sure it’s a genetic predisposition that gets triggered but they don’t know what’s triggering it
3. But they’re pretty sure it must be mulptiple things because they can’t really find any one thing these kids have in common
4. Doctors have no cure for autism
5. Doctors don’t even have a very good treatment for it
6. Most PCP’s don’t know nearly as much about autism as an informed parent. As PCP’s, we’re generalists and it’s not something stressed in med school
7. The rate of autism keeps climbing and the truth of it is, scientifically speaking, we don’t really know why

Can you honestly tell me a parent in this situation would be irrational to question things that are dogma to modern medicine such as vaccines? Modern medicine has failed them. What they need from you is not a lecture or an anecdote of what can happen to unvaccinated kids. Assurance of the rarity of adverse events from vaccines (and yes, there are rare but quite serious effects at times) will not comfort them. They need their trust in medicine restored. And that begins with you, the PCP. I say begins because it is a process that can’t be rushed. You have to sit with them, sit with the uncertainty and anger and helplessness that comes with special needs parenting. You need to show them their child is your patient who you care about. That you see the challenges and the joys of their life. To show them that this isn’t about a battle for control. That you want what’s best for their child. And that you’re open to learning from them. That it really is a dialogue and not a lecture.

Only 1% of parents in Pennsylvania choose not to vaccinate their child, but the lessons we can learn from this issue will make us better doctors in a lot of ways. And better people for that matter.

Listen. Empathize. Validate. Assert. Repeat.

I often tell my kids: it’s okay to get angry. It’s not bad to feel angry. But when we get angry, we have to make good choices of what to do with that anger. I think we could all stand to hear that on a regular basis. So, my fellow physicians: it’s okay to get angry about vaccination. It’s not bad to feel angry. But you need to make good choices.

You’re a physician practicing evidence based medicine. So act like it.

I Know You Feel Like Your Doctor Doesn’t Care, But That’s Just Because He Doesn’t

27 Tuesday May 2014

Posted by elizabethspaardo in medicine

≈ Leave a comment

Tags

empathy, medical school, residency

I often get patients telling me they feel like I’m really listening, like I really care. Unlike that other doctor, Dr. So-And-So. Sometimes I’m surprised by the name they drop as so many of my colleagues genuinely care about their patients and have, as far as I’ve observed, a good bedside manner. Some patients will always complain, regardless of how physicians behave. We tend to hold our doctors to a pretty high, oftentimes impossible standard. Other times, I’m not so surprised to hear Doc So-and-So has rubbed them the wrong way. Some physicians certainly have a gruff bedside manner. And others, probably more, are nice enough to patients, but don’t really feel the kind of empathy and concern patients expect from their doctor. They follow the script, but you feel like they don’t care the way you want them to. Having spent time behind closed doors with medical students and residents, I can tell you, you’re probably not wrong.

Multiple studies on the empathy levels of medical students, residents and practicing physicians have shown we tend to have less empathy than the average person. One study in the journal Academic Medicine showed that empathy levels actually decrease as medical students move along in their training. Cynicism goes up, compassion goes down.

The widely accepted reason for this is, basically, that medical training is a real bitch. The first two years, where students are taught the science of medicine in a classroom setting, are competitive and stressful. Actually, the words competitive and stressful do not convey what we go through. I’m talking people crying in the halls after exams, weeping and gnashing of teeth. Eating disorders and binge drinking galore. Keep your grades up or get the hell out. I once asked for an extension that I thought was pretty reasonable. My son was in the ER getting IV fluids for dehydration and would possibly need admitted to the hospital and the exam was the next morning. It was the only time I’d ever asked for an extension. I knew leaving sick toddlers at home with my mom, no matter how sad and guilty it made me feel, was part of the deal when I started medical school. I thought the fact he was in the hospital and that I wasn’t one to ask for special treatment might cause them to grant the extension. The professor refused my request and went further. He said, your scores haven’t been that great lately, you’d better do very well on that exam or maybe you’re just not cut out for med school. Damn.

Empathy levels drop even further after the third year of medical school. That’s when you finally start seeing patients so you’d think the battle weary medical students would become more compassionate, not less. That thinking ignores what third year of medical school is really about: pimping. I recall the confused look on my husband’s face the first time I mentioned getting pimped on rotation that day. I’d forgotten the term has another meaning altogether outside the medical bubble. Pimping here refers to a style of teaching employed by attendings with medical students and residents. Oh, how civilized that sounds! The attending, generally an intimidating person who makes no effort to make you feel comfortable in the least, asks you a series of questions about medical facts. A surgeon might ask you to list off the blood vessels and nerves that run through the area he’s currently operating on (as you stand in an awkward, turned and bent over position holding a retractor with each hand). He then might move on to having you trace the blood vessels back to their origins. You’ve just spent two years drinking from the proverbial fire hydrant of medical knowledge, so you search your cluttered, fact-saturated mine desperately looking for the answer. If you fail to produce (which every one of us does at some point), you’re made to feel very small.

As you progress, your wrong answers or, worse yet, no answer at all, move from eliciting comments and looks that merely make you feel like a moron, to comments like, “You’re going to be a resident next year. What if a nurse calls you in the middle of the night with a patient in such-and-such a condition and you don’t know the answer? People’s lives are going to be in your hands. Haven’t you thought about that?”

This is part of the explanation used to defend pimping. If we’re going to be in high presure situations with patients’ lives hanging in the balance, then hadn’t we better learn to deal with pressure? I’ve yet to see the research showing that idea is valid and I doubt I ever will. Because it’s not. What I do see is the culture of physician training where change is resisted and the hierarchy fiercely protected. New doctors really ought to show appreciation for their suffering. It’s how mere humans become physicians.

I have to admit, I’m guilty of it myself. My residency recently moved from 24 hour call shifts to 12 hour ones. It really bothered me. I mean, really bothered me. And I couldn’t figure out why. We know from the research that sleep deprived residents make more mistakes in patient care and also get in more car accidents on their way home. The work hours of residents have decreased in recent years as new guidelines were instituted. We cap out at 24 hours of direct patient care now (no more 30 or 36 hour shifts). First year residents aren’t even allowed to work 24 hour shifts anymore. There’s also a minimum number of hours you must be given off between shifts and a weekly cap on total hours. (An average of 80 hours per week over a four week period). We’re also supposed to have at least one 24 hour period off of work each month. Are these guidelines followed to the tee across the board at all residencies? Oh hell no. But, the point is, the times they are a-changing. Now, back to me and my own old fashioned ways. I was really bothered by the end of 24 hour shifts at my residency and I couldn’t figure out why.

After much soul searching, and many discussions with my fellow residents (none of whom minded the change at all) that ended with “You’re seriously not upset? Really?!”, I came to realize I was so upset because it took away some of what makes being a physican special. There aren’t too many professions out there who work 24 hours shifts on a regular basis for several years straight. Residency is grueling (and mine is one of the kindest ones out there) and people know it. For me, we endure this because medicine is a calling. Not just a job or career or profession. I wouldn’t give up so much time with my husband and children for a mere career. I wouldn’t ask them to make the sacrifices they do for my profession. I do these things because I have been called.

There is no clocking out when you’re a doctor, especially not during residency. I remember the time intern year when I needed to talk to the family member of a patient about placing the patient on hospice for her terminal condition. I’d been there since 6am when I placed the call to the patient’s son at 4pm that afternoon. I’d already spoken to her older son and he felt hospice was the best thing for her, but he wanted me to talk to his brother and him together before making the decision. Her younger son was audibly upset as I told him what I needed to discuss with him. His mother hadn’t been doing well for a while, but who’s ever ready for their mother to die? He told me he was at work, but he would be getting off at five and could come over right after. I was supposed to be done at five o’clock, barring any disasters (always a possibility when you’re working inpatient service), but I told him I would wait. He said he worked about twenty minutes away, maybe half an hour with traffic. I was missing my babies, ages 8, 6, and six months and I knew they were missing me (not to mention how my mom, the one who’d been watching them for twelve hours, felt). But I also knew this family needed me to stay. This was not something I could sign out to the intern coming in to begin night shift. This was something I needed to do for my patient.

Traffic was heavy and then there was an accident. He didn’t make it in until 6:30. I sat at the computer in the ICU, going through emails, finishing up notes from the day’s admissions, waiting. He eventually got there and apologized for being late. I told him he didn’t need to. And I meant it. We talked about his mom’s condition, about their options. Her sons talked about what they thought she would have wanted. The younger son cried on his wife’s shoulder. And then they made the decision to make her hospice. They thanked me. I told them how much I’d loved taking care of her and assured them of how loving and brave their decision was.

I left then, headed home to my family. Soon after, the upper year on night shift called to let me know my patient had passed. She lived less than an hour after the uncomfortable BiPap machine was removed and the morphine drip started to make her comfortable. She passed peacefully with her sons at her side. I cried a little, but there was dinner to be cooked and homework to be done. The baby needed a bottle. I needed some sleep.

I look at the changes being made in medicine these days and I worry it is losing its identity as a calling. Family doctors once saw their hospitalized patients in the morning before going to the office. If their hospitalized patients needed something in the middle of the night, they fielded the call. Now, family medicine is being divided into hospitalists and outpatient docs. Small practices expand bigger and bigger, cutting down on the frequency of call for each doc. Graduating medical students look at the lifestyle a particular specialty will provide as much as the kind of relationship they will have with their patients. Will medicine soon be little more than a job? A paycheck you put your hours in for? Clock in, see patients, clock out.

Perhaps this is what the older physicians worry about when they think about giving up things like pimping and 100 hour weeks. And perhaps, in order to hold onto our humanity,we must remember that not only are our patients feeling human beings, but so are the young doctors we train. We are human beings with limits. Limits to what we can do physically and to how much we can take emotionally.

In the end, it is not 24 hour shifts that makes medicine a calling. It’s certainly not the battle scars of impossible exams and pimping. It is the compassion we feel for our patients. What determines if it is a calling is the motivation that brings us to this job with its blurred borders of where it ends and the rest of us begins. You can go without sleep and endure overhwhelming stress with a hardened heart. You can bring this sacrifice and an abundance of medical knowledge and procedural skill to your patients, but if you don’t really give a damn about who they are, you aren’t really a physician. All the technology and constant outpouring of new medical knowledge and developing of drugs doesn’t change what is most important about us. We are healers, much more powerless than we like to admit. If we can serve with a humble heart and keep from doing too much harm along the way, I’d count that a worthwhile medical career. And I bet my patients would too.

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