Nov 16, 2014

A seminar to die for?

Let me tell you something that happened to me the other day.

It was not exciting. None of that hospital stuff where medical students (like me) stumbled upon horrible gruesome stuff that makes your eyes widen in horror as you read. Heck, I did not even went to see patients (or dead bodies) this time.

This time I want to tell you about a 2-hour seminar I had that morning.



My university takes professionalism and ethics quite seriously. Over the years the course strand keep changing names but as of now, it is called Patients, Doctors, and Society (PDS). In stage 4, it is PDS5, meaning that the previous 4 PDS are taught during stage 1-3. And one session out of this strand (and which I had this morning) is "Difficult Communication - Brain stem death and Organ donation".

Let not the title confuses you. It hardly matters. What I want to share with you is what it is all about.

There are 2 parts of the session and both involve a mock consultation with a relative of a patient. This is where we practice talking to patients or relatives. It may look simple to you and you may not even consider this type of session as necessary in medical school. Like, what the hell man. Isn't it enough that students are dying like crazy trying to pass the exams and all that? Why complicate things like doing mock consultations, practicing all kinds of communication etc. I will get back to this point later.

So, the first part has a scenario more or less like this:
"You are the junior house officer taking charge of your patient, Mr Malik, who was scheduled for a minor surgery of removing nasal polyps this morning. During the surgery, he was under effect of anaesthesia and later something wrong happened and he did not awaken from the sedative. He was pronounced dead during surgery and they have to do autopsy to investigate the cause of death.
You have called his brother to immediately come to the hospital. You were not involved with the surgery but you have to break the bad news about his brother's death to him and explain about the autopsy."
It is very vague, and you would feel that there are certain details that you don't know.

And you might pass it off as a simple practice, but for me it does not make it any easier.

I think I may have taken things too seriously at that time. Or is it I am too sensitive? *roll eyes* But the point is I realized that I was really not ready to face this. When Dr Elaine asked for the first volunteer to have a go I really clenched my hands tight, making a fist and just sit still. There is no way I'm going to go there. And when Ginger went first and started talking, I couldn't even look at them. I was looking down, cringing. Dr Elaine saw me and she tapped my knee, saying, "Look. You have to look."

And to me it went as bad as I had thought it would be. Ginger certainly is a genius guy, confident etc. and he handled the interview quite reasonably well. He had a Freudian slip when he said "anaesthesia is used to kill the pain." Really bad choice of words there, considering you are in the middle of telling him that his brother had died on the operating table and it might be our fault. And maybe because he knows they are just doing a simulation, towards the end he kept explaining things about what will happen next etc. I mean come on, man. Lower down your intonation. Don't keep letting out that aura of being a know-it-all. Show some empathy. Maybe a few short silent moment here and there can top it off nicely.

Dr Elaine said that sooner or later I will have to face this. I refused to take part in the simulation till the end and I know it is not something that I can pretend doesn't exist. I will eventually meet a situation where my patients will die while in my care. And God forbid that it was my negligence that cause their death. Breaking bad news of someone who has passed away is hard enough. I don't think I can take it when it was me who had caused it. But having said that, I agree that it is part and parcel of being a doctor. People who don't know about doctors easily accuse them of being heartless, desensitized and whatnot. What they don't normally realized that when it comes to dealing with patients, it is so hard, so nerve-wrecking and it's a emotion rollercoaster horror in the making. They deal with by being busy with other patients, they laugh with each other, or they just appear emotionless because if you single them out and observe them for a while, you'll see that most doctors wear a thin, fragile mask to cover what they are feeling inside.

Towards the end, Ginger asked Dr Elaine whether she had cried when she was facing this problem. I was surprised at Ginger because honestly, that is quite personal, and also at Dr Elaine, for answering the question. She admitted that she did, once or twice, when no one was watching. And to think that she is specialized in dealing with difficult kids.

So in summary, I think that the sessions are necessary. I personally took this simulation as a reminder that this is what awaits me in the future. That in Year 5, there will be more Difficult Communication session (I think a big part of Year 5 is about those kind of stuff) and if I am not ready now, at least the best I can do is to prepare for next year. True, simulation is not the same as the real life of a doctor, I know that very well (that's why I don't care much about whether my friends can do it well or not during simulation. It doesn't mean a stick) but I guess I will give it a try.

Salute and kudos to those who manage to deal with it properly and survive with their souls intact.



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