My Life as a Medical Student
I was not impressive as a medical student. At least I didn't study much and was not focused on learning. I did enjoy insights into patient care, but more on an emotional level than physical malady. This defines system I thinking from systemII in fast thinking slow thinking. Mostly lazy intuitive thought as opposed to thinking and self control. A look at my transcript t shows, to my now chagrin, a note from the assistant dean of the school (Dr Colwell, University of Missouri , Columbia, class of 1969, that I was a marked underachiever. How humiliating. But I had no idea how to fixate myself to a goal of learning and was what I would describer as a superficial student.Most of my life was spent in emotional turmoil.
ANTISEMITISMMy first year was hard. I lived in a dorm and had a few Jewish friends/acquaintances on the floor but I I didn't bond well with anyone as I never have. My forte was criticism though I didn't voice my feelings about others and mostly kept to myself.; I felt inferior to the cool guys, to the smart guys, maybe to all guys. There were 5 Jews and 3 females and 5 out of state students in my class of 93. Oh how I wish I could do that over again. (the year before the class had 5 females and 3 our of state students and they felt they needed more diversity so they switched the numbers around.
And everywhere I saw antisemitism. Well there was some truth to it as we were in a southern town with mostly locals, but to be sure I made sure it would rear its ugly head. I will return to antisemitism but first more chronology.
THE CADAVER I was the youngest student in the class. The youngest was Alan. In strange fashion Alan and I were paired on one side of our cadaver.There is not much question we were the 2 most immature students (though we had rivals) but Alan was also a very good student and I was minimally competent. On the other side of the cadaver were ?Gary a 34 year old engineer returning to school for another career, and DeeDee (and she was a DeeDee) also older though probably less than 30 very square very serious probably OCD . Allen and DeeDee were also concerned with grades. Alan was so smart it was probably not a consideration and I was too emotionally preoccupied to be concerned about anything but passing. Allen and DeeDee were both hillbillies or as close as one could get.
And so Alan and I began our careers together. He was the more imaginative and pranks were our game. This was especially true in anatomy lab. One night Alan brought in a chain saw and we cut off one of the arms of the cadaver. The next day we went to various tables with cadavers and would rest the hand of the arm on the shoulder of a medical student who had his back to us and when he turned around ask if we could give him a hand. Another prank was to tie the wrist of a cadaver with a string and tie the other end of the string to the belt of lab coat of an unaware student and when the student began to leave the room his lab coat belt would pull on the wrist of the cadaver, raising the hand as if to wave goodbye or pull the student back into the room. We had a male cadaver and we constantly taunted DeeDee that she would have to dissect the genitalia. DeeDee, who looked and spoke like a controlled virgin, said absolutely not and we told her that she would because she was concerned with grades she would not want us to lose points in class. Ultimately she agreed with the provision that we could not be at the table when she did the dissection. We agreed to this. DeeDee''s birthday was approaching so the night before the dissection Alan went into the lab and through the abdomen inserted a somewhat rigid thick paper birthday card into the scrotum of the cadaver. As promised the 3 of us stood some feet away behind a pillar as DeeDee began the dissection of the scrotum. As her scalpel began to rub against the card DeeDee's face turned quizzical and she opened the skin further and took out the card and read it to the squeals of laughter generated by Alan and me.
G I TUBE My dalliance at being a student did not end with anatomy class. Essentially it never ended. In physiology we had to pass a nasogastric tube down each other's nose into the stomach. My partner (I do not remember who) decided we would not participate and so we brought ketchup and mustard to class and his out in the bathroom. Toward the end of class we returned to our table and smeared the ketchup and mustard on the rubber tube and handed them in as if they had been used. Of course we had other clowns in the class. John Scholenberger was affable and good looking but gave me the impression of someone vacuous floating through life. John did not appear to have a strong common sense. One night he had a date and they apparently decided to have sex in his car. He pulled alongside the wall of the football field and began some sexual act not realizing the walls were lit up and he was a ready target to be picked up by the police. Thereafter we created the John SCHOLLENBERGER AWARD Schoellenberger awrd given for the most outrageous act by a medical student in our class of '69. There were several contenders but at some level I always felt they were pretenders trying to compete with a screw-up like myself in a role they did not normally fill. We Had a delightful Mormon student, I think the son of a minister, whose name I don't recall. He was serious, smart, a good student, friendly, married. Clean cut. One day, to join the pack of the immature he came into anatomy class with a metal pointer in his hand. Around a cadaver table were a group of students facing the cadaver with their backs facing outward. To an observer their was a row of white coats with identical backs. ?John approach done individual and drove his probe up the coat and into the butt of the receiver. The man jumped, whirled around, and it was the 80 year old chairman of the department. John started bowing and repeating, I am so sorry sir I am so sorry sir. There was a punishment and ?Jon was a candidate for the Schoellenberger award. I forgot to say the award was a replica of a large penis. I don't remember where or when we presented the award.
Such is the consequence of lazy system II thinking that many of my self deprecating predicaments are predicated on not preparing and thinking through tasks that I undertook. I had a lack of fear of performing procedures that I cannot explain in spite of clear lack of knowledge and forethought. I think I appreciated consequences afterward though. In those days, my 3rd year of medical school, we BSP would inject a dye called BSP and measure its excretion from the liver as a measure of liver function. B SP was highly caustic and had to be injected into a vein or upon extravasation it would necrose any soft tissue with which it would come in contact. I was to inject BSP into the arm of a thin female inpatient. She was most kind and smiling but was very thin. While that made her veins easy to spot it may have given me a false sense of confidence in my abilities. I placed the needle in the vein of her forearm and began the slow ingestion through a syringe. The patient winced and said ouch and I (panicked) instinctively pushed in the plunger of the syringe. The dye extrvasated and caused a subdermal wheal. Realizing my mistake I quickly left the room to find help. My supervising resident (a rather tall black haired attractive female) was standing in the hall talking to another medical student. I tapped her on the should attempting to interrupt her but she b rushed me away and said: not now. I repeated the tap with the same result. Finally, attemopting a third time when she brushed me away I said to her I think you are going to want me to interrupt you when you hear what I ahve to say. I told her about the extravasation and she, I ,and the medical stsudent rushed to the patient's room where we attemptined to dilute the BSP with normal saline- to no avail. The skin muscle and soft tissue necrosed requiring the hospital to repair the arm (at no charge) and no subsequent law suit. The next morning on rounds our attending (a somewhat stocky man known for sarcasma dn confrrontation) said to me: Lack, if I get sued over this you will never be a doctor. I took this as a gentle rebuke and paid little attention to it going forwrd. This should have been a warning to me as to consequences of lack of prepartation and forethought.
MULTIPLE PERSONALITY My rotation in psychiatry was pivotal because up until then I had thought I would become a psychiatrist. My entire rotation was emotionally painful and traumatic and convinced me I could not choose this as a career. During my medical school experiences I befriended Dr. Bayer who was a gifted physiatrist and who demonstrated empathy toward patients better than anyone I have ever met. He practiced medical hypnosis, about which I will relate later, and I spent time learning how to hypnotize patients. At the U of Mo. Medical school we had a shortage of doctors so third and 4th year students had a degree of autonomy which was perhaps more extensive than at other schools. We certainly had a shortage of psychiatrists and to some extent social workers supervised us. I was given an inpatient who was very depressed. She was mousy in appearance and affect and was married to a policeman. Through several interviews I learned little about her. Then one day I suggested I could hypnotize her and perhaps learn more about her, to which she agreed. I took her to a room with 2 chairs facing each other. My back was to the door of the room and the room was relatively spacious and rectangular. We sat in the middle of the room along the long axis. I hypnotized the patient and almost immediately she opened her eyes and began laughing (at me) . I became fairly terrified. She spoke in a huskier and more dominant voice that her previous communication and revealed that she =was another personality of my patient. She was in fact a whore tho I don't know if she received money. When her husband would work as a policeman she would go to the streets to sleep with men. She derided her timid self and said she was the dominant person. I understood I had a case of multiple personality but knew nothing medically about the condition nor how to respond. I was 23-24 years old and I felt like a child in her company. I remembered that Dr Bayer taught us that if we got in trouble we could tell the patient they had to leave to urinated but that they could not do so unless they woke up. The reason being that social norms would prevent a patient from continuing the session if it meant peeing in her pants. At the count of 3 she woke up as her timid self and left the room. I never saw her again. A week of so later I was called into the office of the chairman of the dept of psychiatry. He asked me if I had practiced hypnosis on my patient. I said I did so. He said I have only one thing to say to you: children should not play with matches. To this day I do not know how he found out but I presume somehow the social worker knew and not unlikely he also knew the diagnosis of the patient.
RECTAL EXAM The path to physcial diagnosis varies somewhat for each student. In my case we were to do our exams at night after work was done and patients wered resting confortab ly. I was on assignemnt to do my first rectal exam. I went to the floor of the assigned patient and to her bed. She was on a ward with multiple patients (werent all patients?) . She was obese and friendly (as were most patients) and i intoduced myself to her and asked her (or told?) to do a rectal exam. I had her turn away from the wall alongside the bed and moverd between the wall and the patient. I ahd no idea how to do a rectal exam except I knew that 1) 67% of colon?rectal cancer could be diagnosed with digital exam and 2) the only finer I had seen was the middle finger extended to signify "up your ass" tro which I assumed that was the fginerbger to bew used. I spread her largbe and b ulky upper buttock to allow the entrance of my right middle finger but to my despair found that the buttocks denied passage of the knuckeles of my hand so that I could not reach the rectum with my finger. Not knowing what to do I put my right foot aggainst the wall and pushed my body in an attemtpt to advance my finger. The only thing I accomplished was searing pain going through the index and 4th fingers of my right handas they pressed ainto the buttocks as far as they could. Despairing I gave up and thanked the patient for her indulgence3 (I assume she had no Idea whether I was successful or not in my ppurpose. It was about 10PM at this time and I went to the nursing station shagrined and told the nurse on duty of my travail. She was not able to respond as she had fallen off her chair wand was hanging onto to desk in peals of laughter. When she finally regained ehr composure she told me that the rectal exam is performed with the index finger and nmot with the middle finger and that I should revise my procedure the bext time it was appropriate.
THERMOMETER
ANTISEMITISMMy first year was hard. I lived in a dorm and had a few Jewish friends/acquaintances on the floor but I I didn't bond well with anyone as I never have. My forte was criticism though I didn't voice my feelings about others and mostly kept to myself.; I felt inferior to the cool guys, to the smart guys, maybe to all guys. There were 5 Jews and 3 females and 5 out of state students in my class of 93. Oh how I wish I could do that over again. (the year before the class had 5 females and 3 our of state students and they felt they needed more diversity so they switched the numbers around.
And everywhere I saw antisemitism. Well there was some truth to it as we were in a southern town with mostly locals, but to be sure I made sure it would rear its ugly head. I will return to antisemitism but first more chronology.
THE CADAVER I was the youngest student in the class. The youngest was Alan. In strange fashion Alan and I were paired on one side of our cadaver.There is not much question we were the 2 most immature students (though we had rivals) but Alan was also a very good student and I was minimally competent. On the other side of the cadaver were ?Gary a 34 year old engineer returning to school for another career, and DeeDee (and she was a DeeDee) also older though probably less than 30 very square very serious probably OCD . Allen and DeeDee were also concerned with grades. Alan was so smart it was probably not a consideration and I was too emotionally preoccupied to be concerned about anything but passing. Allen and DeeDee were both hillbillies or as close as one could get.
And so Alan and I began our careers together. He was the more imaginative and pranks were our game. This was especially true in anatomy lab. One night Alan brought in a chain saw and we cut off one of the arms of the cadaver. The next day we went to various tables with cadavers and would rest the hand of the arm on the shoulder of a medical student who had his back to us and when he turned around ask if we could give him a hand. Another prank was to tie the wrist of a cadaver with a string and tie the other end of the string to the belt of lab coat of an unaware student and when the student began to leave the room his lab coat belt would pull on the wrist of the cadaver, raising the hand as if to wave goodbye or pull the student back into the room. We had a male cadaver and we constantly taunted DeeDee that she would have to dissect the genitalia. DeeDee, who looked and spoke like a controlled virgin, said absolutely not and we told her that she would because she was concerned with grades she would not want us to lose points in class. Ultimately she agreed with the provision that we could not be at the table when she did the dissection. We agreed to this. DeeDee''s birthday was approaching so the night before the dissection Alan went into the lab and through the abdomen inserted a somewhat rigid thick paper birthday card into the scrotum of the cadaver. As promised the 3 of us stood some feet away behind a pillar as DeeDee began the dissection of the scrotum. As her scalpel began to rub against the card DeeDee's face turned quizzical and she opened the skin further and took out the card and read it to the squeals of laughter generated by Alan and me.
G I TUBE My dalliance at being a student did not end with anatomy class. Essentially it never ended. In physiology we had to pass a nasogastric tube down each other's nose into the stomach. My partner (I do not remember who) decided we would not participate and so we brought ketchup and mustard to class and his out in the bathroom. Toward the end of class we returned to our table and smeared the ketchup and mustard on the rubber tube and handed them in as if they had been used. Of course we had other clowns in the class. John Scholenberger was affable and good looking but gave me the impression of someone vacuous floating through life. John did not appear to have a strong common sense. One night he had a date and they apparently decided to have sex in his car. He pulled alongside the wall of the football field and began some sexual act not realizing the walls were lit up and he was a ready target to be picked up by the police. Thereafter we created the John SCHOLLENBERGER AWARD Schoellenberger awrd given for the most outrageous act by a medical student in our class of '69. There were several contenders but at some level I always felt they were pretenders trying to compete with a screw-up like myself in a role they did not normally fill. We Had a delightful Mormon student, I think the son of a minister, whose name I don't recall. He was serious, smart, a good student, friendly, married. Clean cut. One day, to join the pack of the immature he came into anatomy class with a metal pointer in his hand. Around a cadaver table were a group of students facing the cadaver with their backs facing outward. To an observer their was a row of white coats with identical backs. ?John approach done individual and drove his probe up the coat and into the butt of the receiver. The man jumped, whirled around, and it was the 80 year old chairman of the department. John started bowing and repeating, I am so sorry sir I am so sorry sir. There was a punishment and ?Jon was a candidate for the Schoellenberger award. I forgot to say the award was a replica of a large penis. I don't remember where or when we presented the award.
Such is the consequence of lazy system II thinking that many of my self deprecating predicaments are predicated on not preparing and thinking through tasks that I undertook. I had a lack of fear of performing procedures that I cannot explain in spite of clear lack of knowledge and forethought. I think I appreciated consequences afterward though. In those days, my 3rd year of medical school, we BSP would inject a dye called BSP and measure its excretion from the liver as a measure of liver function. B SP was highly caustic and had to be injected into a vein or upon extravasation it would necrose any soft tissue with which it would come in contact. I was to inject BSP into the arm of a thin female inpatient. She was most kind and smiling but was very thin. While that made her veins easy to spot it may have given me a false sense of confidence in my abilities. I placed the needle in the vein of her forearm and began the slow ingestion through a syringe. The patient winced and said ouch and I (panicked) instinctively pushed in the plunger of the syringe. The dye extrvasated and caused a subdermal wheal. Realizing my mistake I quickly left the room to find help. My supervising resident (a rather tall black haired attractive female) was standing in the hall talking to another medical student. I tapped her on the should attempting to interrupt her but she b rushed me away and said: not now. I repeated the tap with the same result. Finally, attemopting a third time when she brushed me away I said to her I think you are going to want me to interrupt you when you hear what I ahve to say. I told her about the extravasation and she, I ,and the medical stsudent rushed to the patient's room where we attemptined to dilute the BSP with normal saline- to no avail. The skin muscle and soft tissue necrosed requiring the hospital to repair the arm (at no charge) and no subsequent law suit. The next morning on rounds our attending (a somewhat stocky man known for sarcasma dn confrrontation) said to me: Lack, if I get sued over this you will never be a doctor. I took this as a gentle rebuke and paid little attention to it going forwrd. This should have been a warning to me as to consequences of lack of prepartation and forethought.
MULTIPLE PERSONALITY My rotation in psychiatry was pivotal because up until then I had thought I would become a psychiatrist. My entire rotation was emotionally painful and traumatic and convinced me I could not choose this as a career. During my medical school experiences I befriended Dr. Bayer who was a gifted physiatrist and who demonstrated empathy toward patients better than anyone I have ever met. He practiced medical hypnosis, about which I will relate later, and I spent time learning how to hypnotize patients. At the U of Mo. Medical school we had a shortage of doctors so third and 4th year students had a degree of autonomy which was perhaps more extensive than at other schools. We certainly had a shortage of psychiatrists and to some extent social workers supervised us. I was given an inpatient who was very depressed. She was mousy in appearance and affect and was married to a policeman. Through several interviews I learned little about her. Then one day I suggested I could hypnotize her and perhaps learn more about her, to which she agreed. I took her to a room with 2 chairs facing each other. My back was to the door of the room and the room was relatively spacious and rectangular. We sat in the middle of the room along the long axis. I hypnotized the patient and almost immediately she opened her eyes and began laughing (at me) . I became fairly terrified. She spoke in a huskier and more dominant voice that her previous communication and revealed that she =was another personality of my patient. She was in fact a whore tho I don't know if she received money. When her husband would work as a policeman she would go to the streets to sleep with men. She derided her timid self and said she was the dominant person. I understood I had a case of multiple personality but knew nothing medically about the condition nor how to respond. I was 23-24 years old and I felt like a child in her company. I remembered that Dr Bayer taught us that if we got in trouble we could tell the patient they had to leave to urinated but that they could not do so unless they woke up. The reason being that social norms would prevent a patient from continuing the session if it meant peeing in her pants. At the count of 3 she woke up as her timid self and left the room. I never saw her again. A week of so later I was called into the office of the chairman of the dept of psychiatry. He asked me if I had practiced hypnosis on my patient. I said I did so. He said I have only one thing to say to you: children should not play with matches. To this day I do not know how he found out but I presume somehow the social worker knew and not unlikely he also knew the diagnosis of the patient.
RECTAL EXAM The path to physcial diagnosis varies somewhat for each student. In my case we were to do our exams at night after work was done and patients wered resting confortab ly. I was on assignemnt to do my first rectal exam. I went to the floor of the assigned patient and to her bed. She was on a ward with multiple patients (werent all patients?) . She was obese and friendly (as were most patients) and i intoduced myself to her and asked her (or told?) to do a rectal exam. I had her turn away from the wall alongside the bed and moverd between the wall and the patient. I ahd no idea how to do a rectal exam except I knew that 1) 67% of colon?rectal cancer could be diagnosed with digital exam and 2) the only finer I had seen was the middle finger extended to signify "up your ass" tro which I assumed that was the fginerbger to bew used. I spread her largbe and b ulky upper buttock to allow the entrance of my right middle finger but to my despair found that the buttocks denied passage of the knuckeles of my hand so that I could not reach the rectum with my finger. Not knowing what to do I put my right foot aggainst the wall and pushed my body in an attemtpt to advance my finger. The only thing I accomplished was searing pain going through the index and 4th fingers of my right handas they pressed ainto the buttocks as far as they could. Despairing I gave up and thanked the patient for her indulgence3 (I assume she had no Idea whether I was successful or not in my ppurpose. It was about 10PM at this time and I went to the nursing station shagrined and told the nurse on duty of my travail. She was not able to respond as she had fallen off her chair wand was hanging onto to desk in peals of laughter. When she finally regained ehr composure she told me that the rectal exam is performed with the index finger and nmot with the middle finger and that I should revise my procedure the bext time it was appropriate.
THERMOMETER
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