Here’s a confession: I almost passed out multiple times during my medical education. I was a squeamish student doctor. Looking back, it seems like a miracle that I do what I do now as an interventional radiologist. This post is about dealing with squeamishness on the path to becoming a doctor.
The first time my body betrayed me was during the first semester of medical school. On the first day of anatomy lab, I entered a foreign environment, immersed in the vague smell of death and formalin. In groups, we’d spend the next several months dissecting each region of a cadaver, identifying the muscles, vessels, and nerves. I’d need to spend countless hours here with my lab partners, as well as extra hours one on one with our subject, to master the material. Our exams would take place in the lab; we would have to identify the sinewy structures and their function on the spot to pass the class. Anatomy was a foundational subject for my would-be medical career.
On the first day of anatomy lab, I had to walk out of the room multiple times. My primitive brain was overwhelmed by the room of preserved bodies, and I became faint. Intellectually, I knew this was coming, but when I arrived, it was a shock. I don’t recall any feeling of nausea, which I would have expected. It was simply the feeling I was going to end up on the floor if I didn’t leave the room. I came back into the lab ten minutes later, having collected myself. Later, at the risk of missing part of the lesson, I needed to leave again, for another breather. How did I know I was going to get through this class? There was no question that I would. I was singularly focused on getting through the day. By the time the second class came, I didn’t miss a moment.
Having a physical reaction to blood or a cadaver lab, it turns out, is pretty common among medical students. At the time, it seemed I was the only one having this issue. To get through it, I’d unwittingly performed a desensitization technique. Extinguishment is a process that involves graded exposure to a phobia until the reaction weakens or goes away. Since my grade depended on attending anatomy lab, I had to get rid of my fear quickly. Flooding is an approach to ridding oneself of a phobia quickly. Entering the lab flooded my senses a few times, and by day two of the lab, I was a fully functional lab partner.
Some time later, we were watching a video introducing phlebotomy. Our class was assembled in our large lecture hall for the video. We were being educated on the basics of performing blood draws before proceeding to the small group study rooms upstairs to perform the procedure on each other for practice. Seated in the front of the dark lecture hall, I noticed as the sound of the video became muffled. The audio became more distant, as my vision darkened at the edges. Finally, I could see just a pinpoint in the center, letting me know I was still conscious. Not wanting to draw attention to myself, I hoped I’d just come back. I slumped in my seat to try to improve the blood flow to my brain. I was just far away enough from the next student, that I don’t think anyone noticed.
I work with blood daily, biopsying livers, kidneys, and thyroid glands. I dig through occluded vessels, and close down bleeding ones with injected particulates and foam. Immersed in the work I’m doing, my phobia no longer slows me down.
Certain situations trigger empathy, making a medical student particularly vulnerable to a physical reaction. During the first surgery I attended, a rhinoplasty, or “nose job,” my attending surgeon appeared to dance on the line between brutal and skillful, as he hammered and chiseled the young girl’s nasal septum. I began to get that familiar wobbly feeling. The operating room nurses kindly rescued me, offering a seat in the corner so I could recover without breaking scrub. Later, I waited for admonishment from the surgeon. A towering, large-bellied man, he laughed and told me my reaction was a good thing. He bellowed, “That means it turns you on!”
The plastic surgeon encouraged me to consider a career in surgery, despite my unseemly reaction to the work involved. Maybe he was a believer in the idea that this autonomic response to gore is a sign of empathy, a good thing in a medical student.
Missing a couple of meals is another common scenario in med school which can make one prone to a vasovagal reaction. Near the end of my obstetrics rotation, some residents and I were scrubbed into a cesarean section. A warm gush of amniotic fluid splashed onto our “moon boots,” disposable knee-high shoe covers designed specifically for the purpose. The force of the fluid emerging from the incised uterus meant it doused those of us nearby, before gathering on the floor and streaming down the surgical drapes. It was at this moment, with plummeting blood sugar, that I almost passed out on the operating room floor. Luckily, I was liked by my OB residents, who surrounded me, tearing off my garb, feeding me juice and candy to revive me. My vulnerability was on display, and they could have eaten me alive. Instead, I was supported.
I was fortunate to experience compassion around my problem as a squeamish student doctor. It’s a common issue, even among those who aspire to be surgeons. Trust me, if repeated fainting episodes weren’t enough to stop me from becoming a great interventional radiologist, surely you can become whatever you dream of.
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.