On Being a Patient
Annals of Internal Medicine
Reflections on a Whipple
A
lthough it is said that physicians make the worst patients, there is compelling evidence that medical students set the bar: They know just enough to be terrified of everything. Med Student Syndrome, the very real fear of acquiring every rare disease that we study, is endemic in medical students. In my first year, a particularly heavy menstrual period was endometriosis, my fibrocystic breasts were rife with cancer, and the occasional stress-induced headache was a fast-growing tumor. It thus came as no surprise to me that, shortly after a close friend was diagnosed with colon cancer, I began to have abdominal pain. I had been no stranger to stomach pain, but after 3 days without relief I visited the student health center. From there, I was sent to the emergency department for imaging studies to rule out appendicitis. The CT showed some thickening of the terminal ileum, probably caused by a viral infection that would resolve on its own. It also showed a large cystic mass in the head of my pancreas. A fine-needle aspiration biopsy confirmed the diagnosis of a solid pseudopapillary pancreatic neoplasm, a rare tumor found primarily in young women. And so, in November 2012, three months into my second year of medical school, I had a Whipple procedure. All of the anxieties and apprehensions of Med Student Syndrome were suddenly replaced with genuine fear. But, as I threw myself into my schoolwork and making arrangements for the 6 weeks required for surgery and recovery, those initial feelings of terror and helplessness faded. Only on the morning of my surgery did a more stark reality set in, and I began to feel like a patient rather than a member of my own health care team. I had spent some time researching solid pseudopapillary neoplasms and had watched videos of Whipples, but that morning it became clear that my preparations were irrelevant. I knew something—very little—about how to treat a patient in my condition; I knew nothing about how to be a patient with my condition. On the morning of November 14, I said goodbye to my parents and was wheeled into the preoperative area. I was trying so hard to be brave, to put my trust in a field that I believed in enough to choose it as a career, but I was holding back tears. Hunched over, I grasped a nurse’s hands as the anesthesiologists inserted my epidural. I wish that I could remember what that nurse said to me to calm me down. I remember thanking her profusely for talking me through that first frightening and foreign experience. She claimed that I would not remember her when I woke up, and although I do not recall her face, I remain tremendously grateful for her presence. The surgery took 7.5 hours. I awoke in the PACU completely and unsurprisingly disoriented—and thirsty. My vision was hazy, but I could sense people hurrying around me and heard voices asking whether I was in pain.
“Yes,” I replied to no one in particular, “but I’m mostly thirsty.” I still remember the sting in my cracked lips when I spoke for the first time. I had not noticed the nasogastric tube protruding from my nose and did not understand why I could not drink. After what seemed like hours of begging for water, a nurse stuck a green sponge in my mouth. For 36 hours, I sucked on green sponges soaked in ice water while a thick, murky liquid drained from my stomach through the tube in my nose. The tube was removed on postoperative day 2 at the same time that my menstrual cycle arrived—3 weeks early. The stress of surgery had shocked my body into premature menstruation, apparently a not-uncommon phenomenon for women in their reproductive years. Had I learned that fact in a lecture, I would have found it noteworthy; instead, I just found it cruel, further evidence of my body’s betrayal. Drains, IVs, and catheters protruded from me at all angles. Sweat poured out of me constantly. And the heparin shots— how often in the recent months had I seen that characteristic bruising on the abdomen or upper arm of a patient? At the time, I was not familiar with the fierce burn accompanying the twice-daily subcutaneous injections. Blood trickled from both arms for hours after each shot, staining my sheets and furthering my sense of filthiness. I began to smell. When my Foley was removed, I expected to regain a certain sense of control. I was wrong. I required direct catheterization twice before the Foley was eventually reinserted. What followed was a very uncomfortable but largely inevitable urinary tract infection. Even now, with the benefit of 6 months’ detachment and a positive prognosis, the stresses of recovery, exhaustion, and physical accommodation and the particularly excruciating burn in my nostrils from vomiting bile are as tangible to me as this morning’s rounds. But those are just the details of my personal experience, and the most important thing I have learned is that my experience as a patient does not give me authority on anyone else’s. Spending 5 days sharing a room with a fellow Whipple patient sharpened my appreciation that, although we had the same procedure in the same world-class medical facility, our experiences as patients were unique and incomparable. Young and otherwise healthy, I thought that I would recover in no time. Although my surgical team told me that recovery would take 6 to 8 weeks, I had planned to return to school in 4. I was foolishly unrealistic. While I was still chewing on ice, my roommate— 40 years my senior—was tolerating solid food. Her epidural was removed days before mine, and, as I suffered the wrath of a nosocomial urinary tract infection, she was urinating comfortably and freely.
434 © 2014 American College of Physicians
Downloaded From: https://annals.org/pdfaccess.ashx?url=/data/journals/aim/929862/ by a Duke Medical Library User on 07/09/2017
Reflections on a Whipple
When I tell a patient that he or she needs to be straight-catheterized, I now know firsthand how that feels. But that knowledge does nothing to change the fact that it will be an invasive and uncomfortable experience for my patient. My experience as a Whipple patient—although insightful and relevant to my medical education— does not in any manner lessen or offset the experience of my patient. I cannot change the fact that direct catheterization is invasive and uncomfortable. One small thing that I can certainly do is consolidate orders for laboratory tests to minimize inconvenience and needle pricks. As health care workers, it is critical that we be as aware as possible of what our patients are going through and work to minimize discomfort and excess hardship where we can. When I was home recovering, my family and I often discussed the effect that my surgery would have on my future career. Would I be a relatively more compassionate and sympathetic physician given this experience? Or might
www.annals.org
On Being a Patient
the experience have a more counterintuitive effect? That is, might I become less tolerant of a patient’s minor aches and pains given the severity of my own? Although I would hope for the former and at least guard against the latter, my experiences as a patient— disruptive and incredibly frightening— undeniably offered a perspective that my medical studies could not: There is nothing relative about a person’s experience. Carolyn Kanter, BA New York University School of Medicine New York, New York Requests for Single Reprints: Carolyn Kanter, BA, New York University School of Medicine, 56 Saint Mark’s Place, 1D, New York, NY 10003; e-mail, [email protected].
Ann Intern Med. 2014;160:434-435.
18 March 2014 Annals of Internal Medicine Volume 160 • Number 6 435
Downloaded From: https://annals.org/pdfaccess.ashx?url=/data/journals/aim/929862/ by a Duke Medical Library User on 07/09/2017
Annals of Internal Medicine
Reflections on a Whipple
A
lthough it is said that physicians make the worst patients, there is compelling evidence that medical students set the bar: They know just enough to be terrified of everything. Med Student Syndrome, the very real fear of acquiring every rare disease that we study, is endemic in medical students. In my first year, a particularly heavy menstrual period was endometriosis, my fibrocystic breasts were rife with cancer, and the occasional stress-induced headache was a fast-growing tumor. It thus came as no surprise to me that, shortly after a close friend was diagnosed with colon cancer, I began to have abdominal pain. I had been no stranger to stomach pain, but after 3 days without relief I visited the student health center. From there, I was sent to the emergency department for imaging studies to rule out appendicitis. The CT showed some thickening of the terminal ileum, probably caused by a viral infection that would resolve on its own. It also showed a large cystic mass in the head of my pancreas. A fine-needle aspiration biopsy confirmed the diagnosis of a solid pseudopapillary pancreatic neoplasm, a rare tumor found primarily in young women. And so, in November 2012, three months into my second year of medical school, I had a Whipple procedure. All of the anxieties and apprehensions of Med Student Syndrome were suddenly replaced with genuine fear. But, as I threw myself into my schoolwork and making arrangements for the 6 weeks required for surgery and recovery, those initial feelings of terror and helplessness faded. Only on the morning of my surgery did a more stark reality set in, and I began to feel like a patient rather than a member of my own health care team. I had spent some time researching solid pseudopapillary neoplasms and had watched videos of Whipples, but that morning it became clear that my preparations were irrelevant. I knew something—very little—about how to treat a patient in my condition; I knew nothing about how to be a patient with my condition. On the morning of November 14, I said goodbye to my parents and was wheeled into the preoperative area. I was trying so hard to be brave, to put my trust in a field that I believed in enough to choose it as a career, but I was holding back tears. Hunched over, I grasped a nurse’s hands as the anesthesiologists inserted my epidural. I wish that I could remember what that nurse said to me to calm me down. I remember thanking her profusely for talking me through that first frightening and foreign experience. She claimed that I would not remember her when I woke up, and although I do not recall her face, I remain tremendously grateful for her presence. The surgery took 7.5 hours. I awoke in the PACU completely and unsurprisingly disoriented—and thirsty. My vision was hazy, but I could sense people hurrying around me and heard voices asking whether I was in pain.
“Yes,” I replied to no one in particular, “but I’m mostly thirsty.” I still remember the sting in my cracked lips when I spoke for the first time. I had not noticed the nasogastric tube protruding from my nose and did not understand why I could not drink. After what seemed like hours of begging for water, a nurse stuck a green sponge in my mouth. For 36 hours, I sucked on green sponges soaked in ice water while a thick, murky liquid drained from my stomach through the tube in my nose. The tube was removed on postoperative day 2 at the same time that my menstrual cycle arrived—3 weeks early. The stress of surgery had shocked my body into premature menstruation, apparently a not-uncommon phenomenon for women in their reproductive years. Had I learned that fact in a lecture, I would have found it noteworthy; instead, I just found it cruel, further evidence of my body’s betrayal. Drains, IVs, and catheters protruded from me at all angles. Sweat poured out of me constantly. And the heparin shots— how often in the recent months had I seen that characteristic bruising on the abdomen or upper arm of a patient? At the time, I was not familiar with the fierce burn accompanying the twice-daily subcutaneous injections. Blood trickled from both arms for hours after each shot, staining my sheets and furthering my sense of filthiness. I began to smell. When my Foley was removed, I expected to regain a certain sense of control. I was wrong. I required direct catheterization twice before the Foley was eventually reinserted. What followed was a very uncomfortable but largely inevitable urinary tract infection. Even now, with the benefit of 6 months’ detachment and a positive prognosis, the stresses of recovery, exhaustion, and physical accommodation and the particularly excruciating burn in my nostrils from vomiting bile are as tangible to me as this morning’s rounds. But those are just the details of my personal experience, and the most important thing I have learned is that my experience as a patient does not give me authority on anyone else’s. Spending 5 days sharing a room with a fellow Whipple patient sharpened my appreciation that, although we had the same procedure in the same world-class medical facility, our experiences as patients were unique and incomparable. Young and otherwise healthy, I thought that I would recover in no time. Although my surgical team told me that recovery would take 6 to 8 weeks, I had planned to return to school in 4. I was foolishly unrealistic. While I was still chewing on ice, my roommate— 40 years my senior—was tolerating solid food. Her epidural was removed days before mine, and, as I suffered the wrath of a nosocomial urinary tract infection, she was urinating comfortably and freely.
434 © 2014 American College of Physicians
Downloaded From: https://annals.org/pdfaccess.ashx?url=/data/journals/aim/929862/ by a Duke Medical Library User on 07/09/2017
Reflections on a Whipple
When I tell a patient that he or she needs to be straight-catheterized, I now know firsthand how that feels. But that knowledge does nothing to change the fact that it will be an invasive and uncomfortable experience for my patient. My experience as a Whipple patient—although insightful and relevant to my medical education— does not in any manner lessen or offset the experience of my patient. I cannot change the fact that direct catheterization is invasive and uncomfortable. One small thing that I can certainly do is consolidate orders for laboratory tests to minimize inconvenience and needle pricks. As health care workers, it is critical that we be as aware as possible of what our patients are going through and work to minimize discomfort and excess hardship where we can. When I was home recovering, my family and I often discussed the effect that my surgery would have on my future career. Would I be a relatively more compassionate and sympathetic physician given this experience? Or might
www.annals.org
On Being a Patient
the experience have a more counterintuitive effect? That is, might I become less tolerant of a patient’s minor aches and pains given the severity of my own? Although I would hope for the former and at least guard against the latter, my experiences as a patient— disruptive and incredibly frightening— undeniably offered a perspective that my medical studies could not: There is nothing relative about a person’s experience. Carolyn Kanter, BA New York University School of Medicine New York, New York Requests for Single Reprints: Carolyn Kanter, BA, New York University School of Medicine, 56 Saint Mark’s Place, 1D, New York, NY 10003; e-mail, [email protected].
Ann Intern Med. 2014;160:434-435.
18 March 2014 Annals of Internal Medicine Volume 160 • Number 6 435
Downloaded From: https://annals.org/pdfaccess.ashx?url=/data/journals/aim/929862/ by a Duke Medical Library User on 07/09/2017
