A Blog About An Asian Medical Student. Yes that's redundant.

Friday, November 2, 2012

David Poon and the Road to Medical School: Driven

David Poon and the Road to Medical School: Driven

aka: How I Learned to Stop Worrying and Love the OR

aka: All Cars Should Be Bumper Cars

I cannot stand early mornings.

I think it evokes painful memories of me being 17, getting up at "it's still dark" hours to get to high school two hours before everyone else for an extra credit class called TOK, or Theory of Knowledge - a class where I've driven an icy, barren, labryinth of destitute Regina Saskatchewan streets to make it to a class where we discuss "what is thinking" to an extent that would make a PhD in Philosophy candidate groan from the self important curriculum aggrandizing.


Or maybe I'm just lazy.


The point is, early mornings are terrible.

In medical school, we are sent on a series of rotations. These are essentially a number of 6 week internships to expose us to a variety of specialties, to help us decide what type of doctor we want to be when we (if we?) graduate. It's quite an effective system, with just the right amount of length to inspire us if we're interested, and not long enough to torture us if we aren't.

Well, depending on how much we hate mornings.

The past six weeks I have been on my Subspecialty Surgery Rotation - this is when we learn about cardiac surgery (heart), otolaryngology (ear, nose and throat), neurosurgery (brain). The wondrous thing we really learn about surgeons?

Working an 11 hour day is actually considered light work.

A 6am to 5pm shift is when we are lucky.

And a 6am morning means AT LEAST a 5:15am alarm - which, given my well worn strategy of hitting snooze at least 4 times, leaves me about 15 minutes to rush to the hospital without forgetting my pants.


The orthopods, the bone doctors? They work the hardest. And I don't mean anecdotally, I mean given even the possibility of an alternate funding plan (AFP) where doctors usually work less for the same amount of money, orthopaedic surgeons actually work LONGER hours.

Which means earlier mornings.


The force that pushes the orthopods is incredible - the hours needed to see all their patients, the physical strength to pull a man's spine back together, and a special sort of determination that pushes them forward, that I could have never predicted.

In the short two weeks I spent in orthopaedics, I was ashamed at the frustrations I started to develop. Almost angry, as I, perhaps for the first time, felt patient's damned themselves to their own fates.

At about 11 AM, word came in of a severe MVC (motor vehicle collision) that involved three people. Alcohol was heavily involved, no seatbelts were worn, and all three people were thrown out of the car.

Only one survived to the operating room.

Spinal fracture, brain damage.

I had seen workplace accidents, falls from trees, bad turn signalling, and explosions and oil factories - but I had never seen such raw, self destruction. The complete devastation of life over a bottle, a key, and a bad decision.

I reflected on this as I watched my preceptor and chief resident - they remarked how sad it is, perhaps even had a moment of empathy before getting to the work. In the hopes of ensuring the patient would be able to walk again, they had to effectively, carefully, piece together a broken spine. During a a scraping of her spinal cord that had to be completed, her blood sprayed towards my face in what was clearly a great way to elevate my spirits.

I asked to walk away to wash up and cross my fingers that I didn't contract HIV or something.

Later that day, a many in my preceptor's hometown drives into a middle school. Three young students are pinned under his car. One girl, the most hurt, is sent the our hospital to the pediatric orthopaedic surgeon. Her broken body I can only imagine fought with every pulse to survive another moment.

She didn't.

I can't stand mornings. I can't stand the self destruction. I cannot face another alarm where its only beckon is the prospect of another day of misery.

And the surgeons press on. Persevere. To the next case. Another few hours. Answer the pager, help the next patient.

As people drive themselves into broken fates, the surgeon is driven to rebuild a delicate, fragile future.

And perhaps that is enough reason to get up in the morning.


My sister called me today. She was driving on the highway, spun out of control. As she describes it, she turned 180 degrees, facing down a semi truck.

Which stopped before it hit her.



I saw a patient last week. A 17 year old kid.

Getting up at the "its still dark hours" to drive an icy, barren, labyrinth of destitute Edmonton Alberta streets.

He slides on a patch of black ice.

His truck flips. 

In the OR, I see his spine. Fragile.


In assessing him post operatively, I find out he has lost all sensation in his lower limbs. He is paraplegic.

His 18th birthday is the next day.

He smiles at me.

He presses on.

We talk about video games. Netflix.

We talk about his birthday.

Driven towards a bright, new, morning.

- David

This was written as a Reflective Narrative Assignment for my Subspeciality Surgery rotation. For my reflective surgery assignment, I decided to create an Orthopedics related post for my blog. The topics on my website are based on my thoughts and reflections as a student of medicine, in a series I call “David Poon and the Road to Medical School.” They are all inspired by specific instances and observations during daily ward life. No confidential or identifying information is ever presented. The concept is similar to Parallel Charting, though in my case is as much an introspective on public perceptions of medicine than the medicine itself.

Wednesday, May 16, 2012

David Poon and the Road to Medical School: Hypnos

aka Why I Took Classical Mythology AND Medical Terminology in My 2 Years of Premed

“Why did Michael Jackson die?” I asked sincerely.

A short silence, then an almost amused sigh. My senior physician replied candidly,

“Because he didn’t have an anesthesiologist.”

Heath Ledger, the famous actor, apparently had such difficulty sleeping when playing the role of a psychopath, he inadvertently overdosed on anxiolytics (pills to calm a person). Within a the span of a few months, the death of songstress Whitney Houston was followed by celebrated painter Thomas Kinkade, both, apparently, to similar medications, as well as suspected heavy alcohol use.

And of course, the King of Pop himself, Michael Jackson famously was “killed” (according to the courts) by his physician, a cardiologist, when he was given propafol to help him sleep. Propafol, a powerful and common anesthetic, is used to keep patients sedated during surgeries, where Michael Jackson’s heart doctor used it to get him to sleep. The man who made Thriller died suffocating, as he was so heavily sedated he couldn’t breathe.

This is what the public learns about anesthetics.
Pop culture has pervaded our common sense in a variety of medical facts. Many of the populous truly believe an atrocious number of myths, from fallen food being unable to attract dangerous pathogens due to an inane “Five second rule,” to being under the impression that slamming one’s fist into someone else’s chest while yelling “Live, damn you, live!” will bring anyone back to life should it be a dramatic enough point in the story.

I’d be remiss if I did not say I am subject to these eccentricities myself. 

While it is a widely known fact that medical students are heavy drug users – caffeine is our lifeblood after all – it’s an odd secret that many of us are so wound up from the large amounts of stress, challenge, and coffee that we are faced with that we have trouble sleeping. So zopiclone (a sleeping pill), Ativan (an anxiety pill), and other calming drugs are used more often than we’d admit. I myself use the occasional sleeping pill during a bout of insomnia. And I’ve been terrified quite a few times because of what I see on the news.

And I’m supposedly well educated on the subject (though I’m sure many of my professors would doubt that!)

So I wonder – how does any patient unfamiliar with pharmokinetics face a time where they must receive anesthetics? Before a surgery, does the man fear the sensationalism presented to them from the media, with his favourite pop stars dying from commonly used medications?

During my surgery rotation, we spend a few days doing anesthesia – that’s the doctor who puts the patient to sleep while the surgeon essentially cuts open their bodies. The anesthetist is actually the one technically responsible for the patient’s life during surgery; not only does he or she make sure the patient is unconscious, immobile, and amnesic during the procedure, but the anesthetist monitors the vitals (heart rate, breathing rate) and gives medicine to keep them stable. Legally, if a patient crashes or dies on the table, the anesthetist, not the surgeon, is typically primarily responsible.

This is why the anesthetist has a thorough discussion with a surgery patient before a procedure. I’ve seen many of these over the past few weeks. The doctor typically describes the anesthesia as a very deep sleep, or the anesthetic as a very strong sleeping pill. They cover the risks of having these medications, such as feeling nauseous, feeling sore, feeling weak, and of course, the small but very real possibility of in fact, “dying on the table.”

Which brings me full circle to the base topics of anesthesia. Awake and life.


And death.

With a recent patient I saw going to surgery, a kind older woman having a hernia repaired, watching the propafol blissfully cause the patient to close her eyes, I could think of no more fitting words than those of Homer, the Greek poet:

 "There she encountered Sleep, the brother of Death." 

Quite suiting is that these words are from the Iliad, an epic poem depicting a great battle of high stakes. Much like the Illiad, a patient faces her fears, challenges myths, and is literally set upon a stage of life and death, with only the chance of waking up  being the sole distinction from sleep and its brother.

Thanatos was the Greek embodiment of death, and in these legends, his brother was in fact Hypnos, the personification of sleep. So close are they seen in the popular culture of humanity, that artists ranging from the aforementioned Homer to current day rapper NaS, where audiences are told “… never sleep, cause sleep is the cousin of death.

With this continuous cycle of myth surrounding sleep and death, there will always be the air of tragic hope whenever our eyes close. As we face the medications and surgeries to save our lives, in many cases all we can wish is to awaken once again.

Or, in the immortal words of Kenny Roger’s ‘The Gambler,’ “And the best you can hope for is to die in your sleep.”

Anesthetists in many ways are the keepers of this mythic symbolism. They bring about sleep, and they can fend off death. They are the first voice to awaken the patient after surgery, therefore in some sense, bring about life. With every patient they see to the operating room, they define a journey that some may not survive, though a great many more pass. And like any great odyssey, this is a journey taken out of necessity to live a dream of better health.

Perhaps this has all already been said eloquently: as Hamlet ponders the mortality and morality of man, he muses,

“To die; to sleep; To sleep; perchance to dream.”

- David

This was written as a Reflective Narrative Assignment for my Surgery and Anesthesia rotation. For my reflective surgery assignment, I decided to create a special Anesthesia related post for my blog. The topics on my website are based on my thoughts and reflections as a student of medicine, in a series I call “David Poon and the Road to Medical School.” They are all inspired by specific instances and observations during daily ward life. No confidential or identifying information is ever presented. The concept is similar to Parallel Charting, though in my case is as much an introspective on public perceptions of medicine than the medicine itself.

This was written on 3 hours of sleep and South Park playing in the background. 

The Avengers movie was incredible - I originally wanted to name this post Thanos.