Everything I Learned in Medical School: Besides All the Book Stuff by Sujay M. Kansagra Md

Author:Sujay M. Kansagra Md [Kansagra, Sujay M. Md]
Language: eng
Format: epub
Tags: Nonfiction
ISBN: 9781451587616
Amazon: 1451587619
Publisher: CreateSpace Independent Publishing Platform
Published: 2011-01-01T16:00:00+00:00

Chapter 16

Keeping a Healthy Distance

As a medical student, it is easy to get attached to patients. Since a student usually only follows two or three patients, we have time to get to know our patients better than anyone else on the team. This allows us time to meet the families, to hear their stories, and to get to know the person behind the diagnosis. Some may say that getting attached to patients is never a good idea, because one can’t allow personal connections and emotions to factor into medical decision-making. Others would argue that this level of involvement is a wonderful thing, and this attachment is part of caring for patients. Coming into medical school, my mindset was more towards the latter. Thoughts of helping others were still fresh in my head. But I came across two patients that pushed me a little more towards the “keep your distance” side of the equation.

The first case happened to be the very first patient I ever took care of as a student. To maintain patient confidentiality, let’s call her DeeDee. She was a child who suffered from gastroschisis, a disease in which you are born with part of your intestines hanging outside of the abdomen through a hole in the abdominal wall. No one is exactly sure how this disease develops. The abdominal wall closes in from both sides when we are developing as fetuses inside the womb. For some reason, the wall does not form completely in children with gastroschisis, and the intestines (and even other organs like the liver) may stick out from the hole. It is no doubt a frightening sight when your child has parts of their intestines hanging out of the body. Luckily, the gut can usually be put back into place slowly over the first few days of life, and the hole in the abdomen can be easily fixed with stitches. Unfortunately, sometimes the gut has a hard time getting blood to parts that are outside of the belly, and therefore, pieces of the intestine die. These pieces have to be cut out, and the living parts reattached. Sadly for DeeDee, she was born with gastroschisis, and much of her bowel had died and had to be removed. She was left with short gut syndrome, a state where you don’t have enough intestine to properly absorb enough nutrition. It’s a devastating illness, because these kids have to receive nutrition directly into their blood stream. To do this, a central line must be placed, which is essentially a tube that is inserted through a large vein (often the subclavian vein, in the upper chest), and pushed through until the tip reaches into the heart. The other end of the tube is outside the body, where the nutrition can be given. Often, these kids don’t live long, due to a combination of malnutrition and infections caused by bacteria entering the blood stream through the very line that keeps them alive.

DeeDee was in the hospital for the entire month I was on the pediatric inpatient rotation.

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