· By Michael Goldberg
The Lowly Medical Student
Students feel they are Big Man On Campus (or BWOC) at the end of elementary school, high school and college. Not so in medical school. While on the wards in the 3rd and 4th years of medical school, the student status is still low, below interns, residents, and attendings. The student is not paid, and often lacks confidence, due to a paucity of knowledge and experience, and the attitude of certain higher ups toward medical students.
You should not feel this way, however. One of the great fears patients have is that they will be lost in the hectic hospital atmosphere. Medical student histories and physicals tend to be longer than those of attendings, and the patient often is quite grateful to receive the extra attention. In fact, the student history and physical may reveal important information missed in the sometimes hasty workup of others higher up in the hierarchy. For instance:
When I was a medical student, I saw a young woman in the E.R. who complained of abdominal pain. She had multiple surgical scars on her abdomen from operations in which she said nothing was found. She had been placed on phenobarbital as a relaxant. One of the first things I asked her was whether or not she had porphyria, a condition that affects the liver and could cause severe abdominal pain. Now, this is probably way at the bottom of the list of important questions to ask, because the condition is so rare (about 1-5 cases per 100,000 population). However, I had just learned about it in class. She told me that she didn’t know if she had it, but two of her brothers died of it. I told the chief resident about this. A crowd soon developed around the patient when the urine test showed the disease. Of course, the chief resident took credit and I was confined to the sidelines unnoticed, with no accolades for making the suggestion. A lowly medical student. But I felt good, especially since phenobarbital exacerbates porphyria, and it would be beneficial to discontinue the drug.
Another time, I was awakened one cold morning in the Einstein College of Medicine dormitory by a woman’s cry “The baby is coming!” I looked outside the window and there was a young woman lying in the frost on the dormitory lawn, with an older woman (her mother) standing at her side. They had lost their way to the hospital (it was the young woman’s first child). I rushed downstairs. The baby’s head was already out. I delivered the baby on the lawn, and by that time other students arrived. With me holding the baby still attached by the umbilical cord and other students lifting the mother, we carried both into the dormitory and put the mother on the lobby couch. The baby was not breathing. I remembered my OB rotation several months before, where we were told “Don’t rush to cut the umbilical cord,” because the baby is still receiving oxygenation from the mother. I rushed into the cafeteria, got a straw, and sucked out the baby’s mouth. By this time, a dorm resident, who for some unknown reason was storing all sorts of surgical instruments in his room, used them to cut and clamp the umbilical cord. The baby was rushed to the hospital, doing well. Later that afternoon, I visited the mother to find out how she was doing. Her response: “Oh, another student who said they delivered the baby.”
Sometimes it is better to remain unknown. As a student, I once walked into the floor exam room, where I found a newly admitted elderly woman lying on the exam table with no pulse or respiration. Not having time to inquire about her history, I immediately started mouth-to-mouth CPR and called a code. The code team arrived, but to no avail; the patient had died. The code chief then angrily remarked, "Who called this code!!? this is a DNR (a patient with orders 'Do Not Resuscitate')!!" I didn't volunteer that I was the one, so sometimes it is better to remain in the background.
As comedian Rodney Dangerfield used to say, “I don’t get no respect.”
Well, there is always self-respect.
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