18 February 2007

let the healing begin...

There's a saying, popular among those in the medical profession, that says that doctors make bad patients. Over the past few weeks, I've gotten a first-hand glimpse of patient life (again) and it hasn't been pretty. I've decided that I make for a rather impatient patient....

Although I haven't hit the big 3-0 just yet (I have a few months left!), I have, in my short time on this planet, managed to lose many of my "spare parts." It all began in my early 20s with a ruptured appendix, followed by the near-loss of a fallopian tube, and then the ubiquitous removal of my wisdom teeth. But, because my body clearly wanted to end the decade in the manner in which it began, last week I lost another part--my gallbladder.

I cannot even begin to describe how mad I was about having to go under the knife again. For those of you who witnessed my appendix debacle (it took 2.5 months to diagnose my ruptured appendix; yes, I should've died, but I didn't), I know I don't need to explain any further, except to note that it happened again: medicine failed me. This may seem like a strange statement coming from a medical student, but one of the reasons I decided to attend medical school is precisely to prevent such mishaps. This time, although my health care providers all pointed in the right place (my gallbladder) based upon my symptoms, the first ultrasound I underwent missed the very obvious fact that I had gallstones. Here's where I begin to have difficulty with the current practice of medicine, particularly in the U.S.: we rely too much on tests and too often ignore our own instincts.

I'm guilty of it myself. When I underwent the first ultrasound, the technician performing the scan wouldn't talk to me. Now, I know, techs are trained not to engage with the patient about what they're seeing. But most are friendly enough to at least TALK to their patients, and many will allow the patient to watch the scan on the screen provided that the patient doesn't ask for an interpretation of what's been shown (since it's the radiologist's [<--aka physician who reads the x-rays or scans, etc.] job to do the interpreting, not the tech's). So I was a tad surprised that this particular tech was so reticent. I recall thinking, "whatever, this person is probably having a bad day." But the scan took a long time. A really long time. And ultrasounds aren't known to be the kind of tests that take more than, oh, twenty minutes or so, max. Again, though, I brushed off my feelings of doubt about the tech's competence and went on my way. Here's a little known fact about medical testing: some tests are only as good as the technician performing them. This is particularly true in cases of diagnostic medical imaging, like ultrasounds. Since the radiologist can only read the images provided to him/her by the technician, the technician's role becomes crucial to the radiologist's ability to make the proper diagnosis. In my case, the scans utterly and totally missed the fact that I had gallstones. Because of this, I entered into a veritable wild goose chase to find a "cure" for my abdominal pain. After countless blood tests, x-rays, CT scans, an upper endoscopy, several trials of medications, and a trip to the ER, I ended up having another ultrasound done in the beginning of January. In this case, the technician proved friendly. He turned the monitor so that I could watch what he was doing and within the first two minutes, before he even said a word, a nice big image of my very sick gallbladder appeared on the screen. It was obvious enough that even I, who have only seen a few ultrasounds throughout my textbooks, lectures, and random experiences thus far as a medical student, knew at once what was evident on the screen. Luckily, my suspicions were confirmed when he began pointing structures out to me (he technically wasn't supposed to talk about what was there, but since I mentioned I was a med student, he gave me a personal tour of my innards that day). So...a diagnosis of gallstones befell me. Unfortunately, gallstones are one of those nasty little problems for which the best cure remains surgical intervention. I spent a good week agonizing over what to do. Had the stones been caught the first time, I could've had surgery over the holiday break and recovered in time to be back at school without having to study while recovering. Alas, no such luck. So, I had to make a decision as to how to proceed with my health care while simultaneously managing my second semester of medical school. *Not* an easy decision to make, let me tell you.... With gallstones, it isn't so much the pain that they cause that is the biggest medical concern, although anyone who has experienced an attack of gallstones will tell you that the pain is not trivial. Rather, because of where they're located in the gallbladder, the stones can pass out of the gallbladder and into the duct that goes from the gallbladder to the intestines. Unfortunately, part of this duct is shared with the pancreas--the organ responsible for, among other things, providing us with some really important and potent digestive enzymes. If a gallstone blocks the duct, the enzymes can back up in the pancreas and cause it to start eating itself. <--this is not a good thing (read: death in about 24 hours). The pancreas is not on the list of spare parts. Since it became clear that I'd already passed a gallstone (my liver enzymes had been elevated and I'd gone to the ER in extreme pain), my case was one that my PCP aptly described as "not a matter of 'if,' but a matter of 'when'" the next stone would block the duct. So, I decided to have surgery, in the form of my third laparoscopy. All said and done, the procedure went well. I gave the surgeon a bit of a challenge with some unusual arterial structure (one artery formed in a W shape instead of the usual Y configuration), but otherwise mine was a standard operation. The after-effects have not been as easy. I had the very unpleasant experience of having my bladder seize up post-op--a not altogether uncommon response that some people have to surgery such that they cannot pee afterward and have to be catheterized. OUCH. I also have managed to develop an allergic reaction to the adhesive in the bandages; as I write this, I'm doing my best not to scratch my belly, but it isn't easy! All this aside, however, I must say that recovery from this surgery is a whole lot less painful than recovering from an appendectomy. For this, and the fact that the whole ordeal is over, I am extremely grateful. For you voyeurs who like the nitty-gritty, seldom-shared details, here's a closeup of the aftermath:

Now, I have to go figure out how to learn all of cardiac and renal physiology in time to pass my PBL exam on Friday; a task which, ironically, feels a lot more scary than undergoing surgery! My revised favorite expression for the experience of medical school: this too shall pass, like a GALLSTONE! ;-)

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a little disclaimer...

i'm a medical student. just a student. so please, don't take anything i say too seriously. remember that i was an english literature major as an undergrad, so there is much fiction to be found in these pages. do you think i'm telling a story about you or your illness? more likely, you're tapping into my sense of "everyman"--that is, your story resonates with what i write here because it's not so uncommon after all. need help? please, please go see your physician. <--i'm not her. yet. ;-)