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From the September ACP Hospitalist, copyright © 2009 by the American College of Physicians

By Melanie C. Buskirk

“Excuse me, I don’t think we ever addressed the subject of question 54,” a classmate interjected during a post-test review with the professors.

“Of course we did,” the doctor responded. “It was in the supplemental text of the flaccid bladder lecture, circa slide 67 or so.”

It’s the first lesson of a medical student: Never forget slide 67, or anything else you’ve ever been taught, for that matter. Although a useful skill in test-taking, my proficiency at medical memorization landed me in unexpectedly unsettling territory during a recent health crisis of my own.

Having entered medical school with a chronic illness that is exacerbated by stress and lack of sleep (feel free to question my intelligence/sanity here), I required surgery by the end of my second year. This was fantastic timing on my part, as second year concludes with patient safety, or the “everything-in-and-out-of-the-body-that-can-kill-you” topic.

The angst that a medical education would bestow upon my surgical experience became clear when an anesthesiologist appeared by my surgical bed, perhaps 30 minutes before putting me under.

“In order to prevent post-anesthesia nausea and tackle your pain a bit better, I’d like to give you a shot of Dilaudid in your spinal canal.”

Given this information, my left brain commenced a counterstrike on my quickly escalating sympathetic nervous system. These procedures are done all the time, this will be fine, the reasoning centers chanted in an effort to lower my heart rate and my blood pressure. After all, no one wants a lacunar infarct just moments before surgery.

Then, the “what ifs” set in: I had a headache last night. What if my intracranial pressure is increased, leading to herniation when the anesthetic is administered?

What if my spinal cord is unusually long, ending past the normal L1 termination point? I may end up with damage to the conus medullaris.

Think! Why does that ring a bell with that darn flaccid bladder lecture?! Slide 67!

As all these thoughts raced through my mind, I believe my outward motor function manifested in a series of small, tight head nods and the words, “Just make sure to aim the needle at a downward angle, please.”

After a little anti-anxiety medication pushed through the IV, the spinal seemed like a great idea. I was even following along with the anesthesiologist: “Yup, palpated the iliac crest, check. Moved to L4, check!”

And then … I was out.

Fast-forward to the recovery room and the anticoagulant precautions taken with every surgical patient. My lovable, motherly nurse, whom we’ll call Cindy, came in with a smile and a syringe.

“Time for your heparin shot, my dear. I promise it doesn’t hurt that badly.”

“Sorry, Cindy. Um, I don’t mean to be difficult, but is that unfractionated or low-molecular-weight heparin?”

Cindy responded ambiguously, then offered to go find out.

My mom looked over at me inquisitively. “Really?”

“Yes, it’s important to know,” I responded defensively. “If it’s unfractionated, I have a three to five percent risk of developing heparin-induced thrombocytopenia. Low-molecular-weight heparin carries one-sixth of that risk.”

My mother rolled her eyes. Usually it is the daughter who does the eye rolling, but she had resigned herself to having a super-Type A daughter long ago.

During the remainder of my hospital stay, I was motivated by what some may think of as atypical reasons for improving my health. My DVT prophylaxis, in addition to my love for healthy lung tissue (in particular, my own), required three or four daily walks around the unit. Each walk would end with a hand-washing ritual to rid myself of Clostridium difficile spores. No pseudomembranous colitis in this abdomen! In order to prevent other intestinal ailments such as ileus, I ensured that my narcotic intake was limited to only that which was absolutely necessary.

Fortunately, my neuroses paid off and I am safely writing this from a pillow-clad couch, urinary-catheter and PICC-line free, as my recovery progresses uneventfully. That is, as long as the feathers used to stuff these pillows weren’t from H5N1- infected species ….

Melanie C. Buskirk is a medical student at the Mayo Clinic College of Medicine in Rochester, Minn.

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