Like death and taxes—failure, embarrassment and regret come for us all. But for the duration of this episode we ask that you simply hang up your hangups and revel in the mistakes of others. As these stories were generously donated by some very smart people for the benefit of your personal edification, please refrain from snickering. However, feel free to partake in feelings of relief and gratitude, as well as to act upon all impulses to share in social media. (We're big fans of sharing.)
Endless thanks to doctors Patsy Bowman Aiken, Nicholas Rowan, Daniel Maselli and Zina Semenovskaya for the virtual master class on grace, humility and perseverance.
This transcript is for Episode 6 of the medical podcast My First Cadaver.
DOC: My First Cadaver is sponsored by Med School Tutors.
MARTY: I wish I knew about them before I took my exam. I can’t believe I failed!
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MARTY: Go where, doc?
DOC: Back -- to the outro!
DOC: Let Med School Tutors be part of your origin story. Together, we can save the world.
FAITH AERYN: “I’m Faith Aeryn and you’re listening to My... and you're listening to My FirstCdvr… son of a... What the fuuuu....? I'm Faith Aeryn and you're listening to My First Cadaver. YES. Jesus...” Have you ever seen that poster of a cat wearing a bowl of spaghetti on its head with the caption, “Nobody’s Purrfect”? Well, your middle school guidance counselor was really on to something. And while it isn’t exactly headline news that everyone who has ever existed has blown it BIG TIME at one point or another, it’s nice to be reminded that those we admire had their struggles, too. Even brilliant doctors and superstar med students have their moments of shame. And, as our special gift to you, for the next 20 minutes or so, you don’t have to worry about making a fool of yourself! Just sit back, relax and enjoy as Dr. Patsy Bowman Aiken kicks off the schadenfreude.
DR. PATSY BOWMAN AIKEN: So I was in pediatric surgery and I was on a very small team. There was this one young woman who was a teenager who, she had had a procedure done and she had some other issues going on with respect to her sexual health and the fellows and the residents, the surgical residents didn’t feel comfortable going to her and talking to her about this. So all fingers pointed to me. I had the unlucky task of being the one to go in and talk to this young woman about her situation. “Ok, that’s fine.” So, I go in and I start talking to her and it’s a very awkward conversation and she’s not really handling it very well. Which, teenagers don’t and that’s fine and I was ok with that but I’m trying to be the voice of the team. We’re having this very serious conversation and her IV was hurting her a lot and it was really distracting her. She was getting to the point where she couldn’t even really talk to me any more because she was fixating on it. So I said, “Ok, let me go out and get a heat pack for you and it will help a lot. Then you and I can finish this conversation.” So I go out, go to the nurse, I get the heat pack and it’s one of those deals where you have to smush it a little to break the interior bag. At this point I’m a little flustered, I’m looking at the clock, I’m behind. I’m uncomfortable with the situation I’m in. I go in the room and say, “Here’s your heat pack.” I must have been using my extra strength pack myself and I smash this thing and it freaking explodes everywhere! I mean everywhere. It painted the walls, it splattered on the window, it splattered all over me. Thank the lord, none of it hit her. I don’t know how that was possible because it literally went everywhere. It was up my nose, it was in my hair, it was on my scrubs, it was on the window, I had crust in my bangs! I yelled out something inappropriate when it happened and so the patient is horrified and is laughing at me like I’m the village idiot. So I have to go out to the nurses station. The nurses are sitting there and all look up and they’re like, “Oh my god! What happened?” Meanwhile, I’m feeling this just start to corrode on my face and like, “Jeez, wipe your face off!” So I wipe myself off and at this point I just gave up. I didn’t even go back in the room, didn’t finish the conversation. At that point I felt like I had lost any medical authority that I had at this point and I have to be in the O.R. in 15 minutes and I go back to my team and they’re getting ready to scrub in and they look at me and, “What happened?” I said, “Just...don’t even ask.”
DR. NICHOLAS ROWAN: In ENT we do lots of tracheostomies and we do this surgery called a laryngectomy.
FA: That’s Dr. Nicholas Rowan.
NR: Once somebody has that kind of surgery, you’ve been breathing through your nose and your mouth for decades and you always humidify your air through your mouth, through your nose. You’re used to really having pretty moist air by the time it gets down to your voice-box. Now that you start breathing through your chest it’s a whole different world. Really tough on your lungs and your airway and you have lots and lots of mucus. So even when you’re just trying to talk you cough a lot of this mucus up and you learn really quickly that you do not stand directly in front of a patient who has had a tracheostomy or a laryngectomy because, inevitably, you will have mucus balls fly all over you. It happened to me. I was doing away rotations and so this is the time to be totally professional and impress people and show them all of your vast knowledge. I can remember being on rounds and literally everybody else was on the side of the patient's bed and I was the sole guy standing at the foot of the bed and I’ve been attacked by lugies the size that you can only imagine come out of somebody’s airway. That is just like...it lands on your white coat and you’re marked for the rest of the day. Medical students you get one white coat so you get to go home that night and wash the thing so you’re not walking around with your lugie mark the next day and being the laughing stock of your team.
FA: Let’s go to Dr. Daniel Maselli
DR. DANIEL MASELLI: On my first rotation of third year’s family medicine and I was interviewing this patient. He was a very pleasant older gentleman wearing this thick brillo pad of a sweater with all these celtic knots in it. He was here for this...kind of mid chest pain that was worse when he lay down at night and eating food kind of exacerbated it. It was becoming very clear to me even in my sort of limited medical expertise, “Ok, this guy has gastroesophageal reflux disease.” I was over the moon because I thought I had nailed this diagnosis and I’m going to make a great presentation to my preceptor. Not only that, but I just took my boards and I know the treatment that I can give this guy for his gerd. My preceptor said, “Ok, good thought but why don’t we try ranitidine, Zantac.” And I thought, “Ha. Oh I’ve got him!” I have got this guy because I know that omeprozole is like a far superior drug than this like puny little ranitidine. Like he’s resting on the laurels of his grey hair and white coat and medical degree and he’s just this dinosaur of an attending. I’m totally going to one up him. You know, professionally but I’m going to let him know that he’s made sort of a mistake. So I, as I said, professionally, politely decide to correct his error. I’m like, “Well you know, ranitidine is not as good as omeprozole. Omeprozole has been shown to be superior becuase of x, y and z.” and he’s like, “Oh ok. Good though.” And I thought, this is great, he’s struggling with this idea where the student has now, like any sort of superhero movie that I got so familiar with in college because I never went on dates on Saturday nights I just stayed home and watched superhero movies and now the student is becoming the teacher and he’s going to squirm a little bit. Instead he said, “You know that’s a good thought but actually, for this patient, for this man in particular, ranitidine is better.” and I thought, “Well...why?” He said, “Well you know, this guy he has this particular insurance and ranitidine is cheaper. The best drug you can give a patient is not the drug that was shown in all of the trials to be superior. The best drug you can give your patient is the drug that the patient’s gonna to take.” You can have the best medicine in the world it doesn’t make a lick of a difference if the patient doesn’t take it. So if this drug is cheaper he was gonna go get it, he was gonna take it and he was gonna have his gerd improved and he was less likely to do that on omeprozole. This is something that my preceptor, this family medicine doctor who had known this man for years and years and knew who he was as a person and his financial situation and that he would be way too stoic to say anything in an interview about, “Oh. that drug is too expensive can we use something else?” He would never have said that and this preceptor knew it. Which is something I never would have gotten from a 15 minute interview and it was a real eye opener for me. Not only because it kind of made me question everything I had ever learned for the boards like, “Why did I spend the first two years of my medical school paying thousands of dollars to learn information that’s not even applicable to the patient in front of me? Crap...that stinks.” But also just because it was very interesting to see that medicine was as much an art form as it was a science and I had neglected to consider the art form part of it.
FA: Ahh humility!
DM: You gotta learn sometime!
FA: That ya do, that ya do.
DR. ZINA SEMENOVSKAYA: This was about halfway through my intern year but it was my first maybe my second month in the emergency department.
FA: That’s Dr. Zina Semenovskaya.
ZS: The ambulance brought in a patient who’d been playing tennis and developed severe chest pain. So they did an EKG on the scene and it definitely looked like he was having a heart attack. So as soon as we looked at the EKG that they had done and we did our own we immediately sounded the alarm and called the catheterization lab. So the patient is in the ER with us and about 20 or 30 minutes have gone by, cardiologists are there everyone is there and we’re very concerned because blood pressure is dropping and he’s not doing that well. He’s still awake and talking to us so he says to me, “Please, please, I really feel like I’m gonna die. I really just want to talk to my wife.” And his wife had actually just arrived and I was the intern so I was basically just there trying not to cause too much trouble trying not to do anything wrong. So I asked the cardiologist who had basically taken over the leadership of the care for this patient. I said to him, “You know, hey, can I bring his wife in she’s just outside. He wants to talk to her.” And the cardiologist kind of dismissed me and yelled at me and said. “Absolutely not, can’t you see the critical patient? We’re taking care of him. You absolutely can’t bring any family members in that’s crazy.” So I was like, “Ok, ok. I’m so sorry. I’m so sorry! Absolutely.” I told the patient, “I’m so sorry the cardiologist says we can’t bring your wife in right now but as soon as we can I promise, I promise I’ll let you speak to her.” So another 10 minutes go by or so and the catheterization lab is still not ready to take the patient. We’re still waiting, the patient is getting sicker but he’s still awake and he says to me again, “Please, please, I’m really afraid I’m gonna die. I really want to talk to my wife.” And again, I sort of tentatively approach the cardiologist and again I talk to him and I say, “I’m so sorry to ask you again. Really, really sorry but the patient really wants to talk to his wife. Are you sure I can’t bring her in just for one minute? Please for one minute.” And again he looks at me with disdain and says, “I already told you! Stop bothering me. Absolutely not! You’re getting in the way.” and I’m like, “Ok, ok. So sorry. So sorry!” and so I don’t let the wife in. I do step outside though and I tell her, “Hey your husband’s been asking for you. I promise as soon as I can I’ll let you into talk to him. I’m not allowed to right now because he’s so sick but I promise as soon as I can I’ll let you in.” and she goes, “Ok.” Obviously she was very worried but she says ok. So another maybe 5, 10 minutes go by catheterization lab is just about ready we’re just about to transport him upstairs when he codes. So he goes into cardiac arrest and we’re all in the room working really really hard to bring him back and we work for probably about a half an hour and unfortunately were not able to bring him back. And so he dies...and so everything is over...the cardiologist and the fellow and a few other people are standing in the ER talking to each other and I’m sitting at the computer writing my notes about everything that happened and I find myself just crying. I’m a pretty together person generally...I think...but this really shook me up. I mean, not just because he died. I realize that there was nothing I personally could have done to help him live. We did all the correct medical treatment, everything was done right. Maybe he would have lived if the catheterization lab had been ready sooner, maybe not. Ya know, nothing to say that he wouldn’t have coded upstairs but what I was really devastated about is that the one thing that I could have done for him, which is let him talk to his wife, I didn’t do. And I didn’t do it, not because I didn’t want to, but because I listened to this cardiologist who told me not to. In retrospect, I realized that was a crazy decision. Who cares what he said, who cares if I got in trouble this was a patient, that was his last opportunity to say anything to his wife. So me being me, being so upset, I kind of lost some common sense for a minute and I got up and I marched over there and I tap this cardiologist on the shoulder and I said, “Excuse me, excuse me.” And he looks at me and it’s him and a couple of other, all the other doctor’s in that group are male, and he looks at me and I say, “I just want to tell you that what you did was wrong! You told me not to bring his wife in but that was wrong, that was terrible. I should have brought his wife in. He died and he didn’t get a chance to say goodbye. That’s all we could have done for him.” I said, “I’m never listening to you again! Never listening to you again!” and then I sort of storm away. My attending, the emergency attending, kind of sees all of this. She looks at me and she’s like, “Um do you wanna take maybe 10 minutes and compose yourself and come back? You doing ok there?” and I said, “No, no I’m fine. I’m fine. I just needed to say that.” But then something kind of amazing happened. This same cardiologist another 10 to 15 minutes later actually comes up to me and he says, “Excuse me.” he says, “I’m sorry. You’re right. You’re right. I was really caught up in taking care of the patient and I was very stressed because the cath lab wasn’t ready and it needed to be ready and I didn’t know why they weren’t ready yet. So I was just really agitated but you’re right. You’re right, we should have let his wife in. We should’ve and I will. I will in the future.” and he walked away. That story, what happened, really haunted me and it’s definitely changed the way that I practice and when I feel like something is the right thing to do ethically, morally, I tend to just do it now as opposed to listening to what someone else said and I try to bring the family in no matter what. To me, that’s become paramount because of that experience.
NR: If I’m looking to give advice it’s really important to realize that, number one, you are going to make mistakes. The bottom line is, it hurts. But I think it’s important to know that going into it and I think you need to learn from it and not let it bring you down so hard. You’re never gonna get out of the field of medicine alive if you do and I always say that communication is so key because we’re all in it together. We’re all trying to help people and you need to use the people around you to help you because you can’t take care of everybody by yourself. It really is a village that takes care of patients. So you have to communicate and you have to tell people what you’re doing and why you did something. You can’t go out there and be a rouge medical student or resident or whoever. You’re not House, you’re not MacGyver you’re a team. Over the years that’s been the most important thing that I’ve learned. Upfront, I really took a lot of this stuff personally and it was easier for me to take that burden on myself and be torn up about some of the mistakes I made. Even if they were pretty small, we’re all super type A we’re all perfectionists but if you communicate what you’re doing and you seek out help the outcomes are always better.
DM: We’re not very good at saying, “I don’t know.” At expressing self doubt, at asking for help when we need it. Because we think of ourselves as these pre-doctors as needing to know the answers. Being so sure of our self and our skills and our goals and how we’re gonna get there. So one thing I would really caution medical students against is being uncomfortable with that uncertainty. I think that uncertainty is just a fantastic part of your education, it’s pivotal for it. We shouldn’t think of uncertainty as this kind of comrade in arms to inadequacy. It’s not that at all. It’s more of a champion against complacency. If we’re uncertain it doesn’t mean we’re bad it means we’re reassessing ourselves, we’re making sure we’re good enough. It says study harder, check back in with the patient, broaden that differential. So uncertainty is healthy. Really embrace that, be comfortable with it, be comfortable with your discomfort because it makes you a better medical student, it makes you a better doctor, it makes you a better person.
FA: So, it’s my first week of high school, and in true, questionable 90s style, I’m wearing my cute little dress and my brand new clogs, and I’m carrying this massive, ridiculously heavy backpack as I walk up the main ramp to school with my girlfriends, when I completely wipe out. I spectacularly crash to the ground in a belly flop, my backpack flies over my head, pulling my dress up with it pinning me to the ground with my bright pink granny panties exposed for everyone to see. My girlfriends and what felt like the entire student body were too busy laughing to help me up. And yet, somehow I did. Big humiliation, eventual recovery, and plus I learned the importance of making a grand entrance. In such a competitive environment as medical school — where so much value is placed on high scores — it’s easy to forget that failure is as much a part of the learning process as any coursework. How else are we to measure what we know — and what we don’t? Identifying what we don’t know or can’t do is how the great discoveries are made. That’s how we get better, smarter, more confident and knowledgeable about the world and ourselves. So lucky us, the mistake-makers in the spotlight have the opportunity to strengthen our “getting up” muscles and demonstrate to the laughing masses what it means to be a learner, someone who is growing. And kudos to those brave docs who put their metaphorical “panties” on display and proved to us that there’s still life — and career — after a perceived disaster. But for those of you leaving our podcast safety zone to enter the real world of potential embarrassment and missteps, I will leave you with the immortal words of another cat poster of tortured adolescence, “Hang in there!”
Thank you to Doctors Patsy Bowman Aiken, Nicholas Rowan, Daniel Maselli and Zina Semenovskaya.
The My First Cadaver Team
Papa Claire Music & Compulsion Music
Our Nerf-blasting friends at Salted Stone
And special thanks to Robert Meekins who is NOT a doctor.
Stay tuned for Episode 7 — coming soon to a listening device near you.
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Med students, if you’re listening, check out our exclusive Episode 6 content on our sponsor’s blog at MSTblog.com.
And last but not least, remember everyone: Don't shoot cacti with your shotgun, or you could become someone's first cadaver.
DM: I was interviewing this patient, this very pleasant older gentleman wearing like this thick brillo pad of a sweater and with all these celtic knots in it....
FA: For a second I thought you were gonna say that he had like a cat up inside his big scratchy sweater or something. I was like, “Where is this going?”
DM: He may have, he may have. I don’t know. I only spent 15 minutes with him. I’d have to ask my preceptor, he’d probably know better.
FA: Seriously, I was like, “Did he just have like a bramble inside that thing that when he laid down it was rubbing against his solar plexus or something? What’s going on?”
NARRATOR: This episode of My First Cadaver was sponsored by Med School Tutors. With-- Hey! My Script!
MARTY: We’re at the outro, doc. Where’s the ad?
DOC: We must have removed the podcast from the space-time continuum. If the episode doesn't finish, the outro won’t be get made. That's why the script is disappearing!
MARTY: Let me see.. “MST’s tutors are compassionate, dedicated to your success and have scored in the top percentiles of their exams. You can trust them to be your personal flux capacitor -- yeeesh -- and get you to 1.21 giga…” You’re right doc, it’s fading away!
DOC: We gotta go back, Marty.
MARTY: Back where?
DOC: Back -- to the intro!
DOC: Let Med School Tutors be part of your origin story. Together, we can save the world.