What Medical School Forgot to Teach Me

My adorable grandparents, who raised me for almost a decade of my life <3

My adorable grandparents, who raised me for almost a decade of my life ❤

My 89 yr old grandpa, with a history of type 2 diabetes, very well controlled, spiked a blood sugar in the 500s (normal is in the 100s) on a Monday in February. He was a little more fatigued than usual, and my mom called me for advice. I was concerned about any infections. His primary care doctor ordered 2 doses of insulin that day.

Day 2, he appeared sicker and sugars remained high. I talked to his doctor’s office asking  very nicely for an infectious workup which includes blood work and cultures, chest xray, and urine studies. The nurse on the phone sounded younger than my sister, and did not know what hyperglycemia meant. The doctor ordered only one part of the labs that evening – a blood culture, and told his nursing home there was no need for a chest xray to assess for pneumonia.

Day 3, the results have returned and the nursing home said they were unable to reach the doctor.

Day 4 AM, my grandpa was in septic shock from aspiration pneumonia, and was admitted to the ICU. He never fully regained consciousness.

My mom called me, and I drove home to LA. The doctor’s excuse for 4 days of delay in care was “he’s old…I don’t want to be aggressive.” He offered no apologies. For the first time in my life, I cried because I was furious. I kept thinking of what my neurosurgery chief once told me “one day, you will know that your job as a good doctor is to protect your patients against the morons in the hospital” and his other advice “the worst prognosis is a nice patient with a nice family.”

I spent my time in the ICU since Valentine’s day. He became vent dependent meaning he needed a machine to breathe, he got tuberculosis (when he tested negative all his life), he got a feeding tube and then had a massive stomach bleed, and finally DIC, a condition indicating severe illness. He also assumed decerebrate posturing, indicating possible stroke, a likely complication of his severe shock. In between all these episodes were his doctors telling us to take him off of life support, a conversation they never fail to deliver when they somehow forget to discuss any other test results or procedures conducted.

My grandpa is on comfort care now, meaning there is no more treatments or blood draws. He gets a morphine drip and some IV. He is dying, paralyzed, and semi-conscious due to gross medical negligence. 

I thought of how much medical school failed to prepare and discuss with me: 

-How our treatment can hurt as much as it can save a life.

-How machines and medications and procedures can prolong not the living, but the dying process. 

-How the consequences of our inaction and negligence, ignorance and fatigue is real. 

-How not to sue another physician, a doctor who’s negligent at the end of his career at 65yrs old, who makes a very humble living as a primary care doctor in a country in gross shortage of primary care physicians. 

-How to act as a family consult with medical knowledge, and objectively decide to terminate treatment for someone I love deeply. 

-How to deal with my mistrust and anger toward members of healthcare when I myself am a physician. 

-How to advocate firmly for the correct course of care when it’s in disagreement with another physician. 

-How important it is to encourage patients and their families to be vocal, and strong advocates irregardless of how stupid it sounds. 

-How important it is for physicians to apologize in times of error, not because of policy or fear of lawsuits, but because the patient and their family deserves it. 

In 2 months, I will become a full time internal medicine doctor. I thought of all the families who have yet to come under my care, and all the things that can go wrong. I didn’t know…4 years ago…when I first began medical school, what tremendous responsibilities this lifetime was going to entail.

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24 thoughts on “What Medical School Forgot to Teach Me

  1. luvnorcal

    So sorry to hear this story about your grandpa. You even asked for the infectious workup and they didn’t address your concerns like they should have, especially since you are a medical professional. Sigh… There is so much I don’t understand about the medical field and the people who work in it.

    Reply
    1. mochabeanie Post author

      I think for the most part. medical professionals are awesome and have the best intentions. BUT I have no words to describe what my grandpa’s PMD was thinking, the man was full code, does that sounds like comfort care or non-aggressive approach. And non-aggressive, a 90yr old man can not handle an episode of sepsis.

      Reply
      1. luvnorcal

        Yeah I agree on the face that most have the best intentions, but sometimes they do things like this and you just don’t understand. You know.. I think that when a person crosses a certain age, like 75 or 80, some start adopting the non aggressive approach due to age, but they forget that this person is someone’s grandpa, husband, father. I was watching a full code in the trauma room on an 80 something woman, and I remember the doc was frustrated when the family decided to remove the DNR (might have already mentioned this to you earlier). The doc maybe didn’t see the use in continuing to try to revive someone who was “circling the drain”. It’s really sad, older patients need the same kind of care and close attention as younger ones.

      2. mochabeanie Post author

        I agree 🙂 It’s weird that primary prevention should be done extra well in the elderly group cause this kind of major health fiasco is so bad and terminal – that is what’s called non-aggressive approach!! But there’s this wrong attitude that some believe non-aggressive is doing nothing, so all these check ups r to collect insurance payments? Ur not getting paid for ignoring a pt’s health issues. The doctors tried having a meeting with us, there were 15 of his care staff and 3 of us to pressure us into stopping the vent, except it totally didn’t work cause the first sentence out of their mouth was a misdiagnosis, a condition he didn’t have.

      3. luvnorcal

        Wow that many staff members in a meeting? That does sound like a lot of pressure. Your family and grandpa are lucky to have you advocating for them. The healthcare field is really difficult to navigate when you have no idea what’s going on.

      4. mochabeanie Post author

        so there were 3 social workers, one really mean one, 1 palliative care nurse, ICU doctor, the chaplain, 5 nurses, and ethic committee who refused to attend. So they started the talk with “not to intimidate you…” and I was thinking “oh seriously, you have no idea what it takes to scare me.” it was strange all around.

    1. mochabeanie Post author

      Thank you so much for ur words! I’m actually doing fine since this has been going on for a while 🙂 but it’s the kind of learning experience no one ever tells u about. Yayyyy life surprise #476336758 haha

      Reply
  2. luvwhatuce

    Hi there. This was an incredibly touching post. One thing came to mind, that I wanted to say. I think because you are already thinking about all that your job will entail; THAT is what will make you a great doctor. Hope that makes sense. 🙂

    Reply
    1. mochabeanie Post author

      Thank you so much! You’re so sweet! I do think everyone knows the consequences, and what the job entails, but the question is how we handle the aftermath of the mistakes that are inevitable. Unfortunately, not every doctor has the communication skills to do it, the ones that do and learn that skill well, is what I think makes them really great.

      Reply
      1. luvwhatuce

        When I think back to Doctors I’ve had in the past…this is so true. It’s the ones who have had good communication skills & compassion. They stay in your heart & are forever your hero!

  3. Raghuraj Hegde

    hello Aida,
    I am a fellow blogger and an Ophthalmologist. i have been following your blog for sometime now but this story touched me in way that i would like it say something……i have been in this profession a few yrs longer than you have been and as I see it, it is very sad case of misjudgment by your grandpa’s doctor. That being said it was also bad luck that has played its part. Your grandpa deteriorated too quickly for anybody to react soon. Not all cases of hyperglycemia end up with pneumonia, sepsis or MODS. i’m not trying to belittle your emotions on this issue but i’m trying to be objective. doctors after a certain age are not malleable to change. older doctors think what had worked till now will work in the future as well. It was a rank bad call from this doctor period. but mistakes happen everyday and doctors are just part of this whole system. when you go further in your career you will realize all the mistakes that you make and you will beat yourself for it but mistakes will keep happening maybe lesser as you age but age will not guard you against this….This is the hard part in this profession and you will need to handle it sooner than later. i shall leave you with this excellent quote by Hippocrates “Ars longa,Vita brevis, experimentum periculosum, iudicium difficile” ….the rough English translation is…… The art of medicine is long but life is short, opportunity fleeting, experience perilous, and judgement flawed. Good luck.

    Reply
    1. mochabeanie Post author

      Hello Dr.Hedge,
      Thank you for following my blog and for your words, also for your advice behind obviously far more years of experience than I have in this field. I also know that as a baby physician, I will be (far) more idealistic and passionate about certain things, and experience will wear me off. I agree that bad luck played a huge part. When the situation with my grandpa finally started unfolding, we found out he never had any documented full physical exams with his PMD in the past year (despite PMD’s record of 3 home visits), he had 14 sites of stage 3-4 ulcers reported to the state by the hospital staff on admission, and his care staff reported symptoms of pneumonia that were ignored. We called the second day with his AMS for admission and workup, and nothing was done for 48hrs until he was unresponsive on the 4th day. I understand that bad judgments happen, but this was a little too much to take in. At his age, he would have a horrible outcome with any major illnesses. What really angered us, wasn’t the mistake, it was the lack of apology.
      As far as all the zillion mistakes that I will make in my lifetime, frankly, I’m scared, while mistakes happen, they’re so real in this field, at times irreversible, and have such deep and lasting physical and emotional consequences. You’re completely right that I will have to learn it, that learning process is going to be incredibly difficult. Thank you for offering your advice! I really appreciate it!

      Reply
      1. Raghuraj Hegde

        hello Aida,
        sorry to hear the details of your grandpa’s case. i know that anything one can say in this situation is useless. We should hope that our kind makes less mistakes and also that we forgive ourselves first of the mistakes that we would make. Learning in this profession is beyond the books and knowledge. The biggest lessons are learnt on the job and we should always be guided by the intention to do good. I would like you to read one of my own personal battles in my professional life of doing “too much or doing too little?” the link is below:

        http://raghurajhegde.blogspot.in/2012/08/the-surgeon-conundrum.html

  4. PJ

    I’m so sorry about your grandfather. He looks like a sweet man in the picture. I’m also glad that you’re a doctor. Reading your blog makes me hopeful for the future, because you care so very much. When I’m next in need of medical care, I hope I’m lucky enough to get a doctor just like you!

    Reply
    1. mochabeanie Post author

      You’re so sweet!! Thank you so much!! You will find doctors who care about you deeply, most doctors I’ve met are ones I wanna role model after. This particular example is when things go wrong…

      Reply
  5. thegirlexplorer

    I’m so sorry to hear this; I can only imagine the anger and frustration you must feel. I pray that you and your family find comfort in this time. I’m also kind of in awe of your perspective and maturity in all this. You’re going to be – if you aren’t already – an amazing doctor and caregiver, and a real blessing to those you meet.

    Reply
    1. mochabeanie Post author

      Thank you so much for ur kind words! I’ve been handling it better as it dragged out, this whole episode has been happening since Feb.I think my sister said something interesting about these horrible things, she asked that I don’t let life make me a victim of its circumstances and to not see ourselves as victims. These sad and trying things will happen to all of us, out of our control, but I think we can control how we respond to all of them. Life is overall very beautiful 🙂

      Reply
    1. mochabeanie Post author

      Thank u so much!! I really appreciate it 🙂 it’s already been a week since my grandpa passed away but everyday feels so unreal still. Thanks for ur prayers!

      Reply
  6. Conchibi

    I really enjoyed reading this reflective post. Very sorry to hear the loss of your grandfather 😦 The practice is medicine can be both rewarding and frustrating, even more so for someone training in the medical field. Stay strong, have compassion, and simply think. You will be a great doctor in our budding generation =)

    Reply
    1. mochabeanie Post author

      Thank you so much for ur kind comment! It’s been a pretty tough couple of months, but I’m coming to peace with all of it. Here’s to hoping that we all think thr our every decision carefully 🙂

      Reply
  7. (that's me) in the corner...

    I am so very sorry for the situation with your grandfather. That is so wrong. I wish you and your family the best. Have you ever read the book “Kitchen Table Wisdom” by Rachel Naomi Remen. She speaks of her experiences in medical school, her speciality being cancer, but how backwards and cold so much of the training is. Neglecting the humanity, and spirituality of each patient and their families. It is beautiful and inspiring. Thank you for checking out my blog.

    Reply
    1. mochabeanie Post author

      Thank you for ur kind words! I never read that book but sounds like something I definitely wanna read soon. The training is very cold. My friend brought up an interesting point the other day that the most rewarding times of his medical career wasn’t cases where he did the most, but once where he provided more comfort and palliative care. Thanks for reading!

      Reply

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