It Becomes You, Part II: Apply Yourself

Thoughts about becoming a doctor

by Alan B. Sanderson, MD

This article is the second of a six-part series:

  1. First Decisions:  Deciding to become a doctor
  2. Apply Yourself: Undergraduate studies
  3. The Academic Eating Contest: Medical school
  4. Identity Crisis: Specialty choice
  5. Keep Your Nose Above Water: Surviving residency
  6. Living the Dream: The transition from training to practice

I will post one section each week for six weeks. Follow the blog here or our Facebook page to get notified of new posts.

Getting accepted to medical school was a bit more complicated than enrolling at the university for undergraduate studies, where apparently the only requirement was that I be a state resident with a pulse. The medical school application required prerequisite courses, standardized testing, multiple letters of recommendation, application fees, and traveling for interviews.

The first obstacle was the undergraduate course work, which actually I didn’t think was so hard. Dealing with all of the obnoxious pre-med students was the real challenge, as they filled up the seats in the enormously large amphitheater classes and only seemed to care about what topics were going to be on the exam. These students were intimidating, competitive, and laser-focused on the goal of getting into medical school. I also detected a certain disdain for them among my professors and among the other students. My reaction was to become a “closet pre-med,” mostly keeping my career aspirations to myself.

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It Becomes You, Part I: First Decisions

Thoughts about becoming a doctor

by Alan Sanderson, MD

When I set out on my career path many years ago I had very little comprehension of what I was actually doing. I did not have a step-by-step guide or a mentor to help me avoid the pitfalls. With this in mind, I offer some observations and thoughts from my own experience of surviving the “doctor factory” of medical education. This is not meant to be a comprehensive treatise, but hopefully it will be useful to those who are considering or preparing for a career in medicine, and at least entertaining and uplifting for the rest of you.

This article is the first of a six-part series:

  1. First Decisions:  Deciding to become a doctor
  2. Apply Yourself: Undergraduate studies
  3. The Academic Eating Contest: Medical school
  4. Identity Crisis: Specialty choice
  5. Keep Your Nose Above Water: Surviving residency
  6. Living the Dream: The transition from training to practice

I will post one part each week for the next six weeks. Follow the blog here or our Facebook page to get notified of new posts. Continue reading

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John M. Stang Memorial Scholarship Fund

I am happy to report that my recent post about Dr. Stang has generated interest in creating a memorial scholarship in his name. This effort is spearheaded by Dr. Meredith Broderick from the class of 2003. We are hoping to raise over $50,000 for the fund. I have personally pledged $1,000, and am willing to pledge more in the future. If you are interested in making a pledge, please use the form below.
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Memories of a Mentor

The cardiologist with a big heart, John M. Stang, MD

by Alan B. Sanderson, MD

Lately I have been thinking about John Stang, MD, one of my teachers and mentors during medical school. I am proud to call him my friend, although I do so with mixed emotions.

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John M. Stang, MD

Dr. Stang made quite a first impression. I was sitting through an exceptionally boring day of medical school orientation, but his presentation was different from all of the others. His entrance into the lecture hall was accompanied by rock music (Jimi Hendrix, if I recall correctly) and flashing lights. He expressed his regret that he couldn’t set up a fog machine, or play the music himself. I remember thinking to myself, “Is this guy for real?” Continue reading

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A Disease With Perks

… but you have to look for them.

by Alan Sanderson, MD

I have been thinking about cancer lately, for two reasons. The first was the story I wrote about my aunt Steffanie. The second reason is a blog I recently came across which is written by one of my neighbors, Christie Perkins. She has stage IV breast cancer, and has been really fearless in writing about her experience. Her blog is called “How Perky Works,” and it is a case study in unsinkable optimism. Spend an afternoon with her blog; I promise you won’t regret it!

Cancer lends itself to all kinds of lessons, and the pages of Christie’s blog are full of them. She teaches about how to accept and acknowledge the sadness of a serious illness and still choose happiness. Again and again and again she describes a setback in her illness, and how it tears at her emotions, but she works through it and comes out ahead, with a smile from ear to ear. And you can’t help but smile with her.

So what are the perks of having cancer? Read her blog to find out! I will point you to one example, which is a list of the Top 10 Perks of Wearing a Baby Blue Mask. (She had to wear a surgical mask for a few weeks because her immune system was really suppressed from the chemotherapy.)

Christie is a teacher and a mentor, showing us by example how to rely on God’s grace. Sometimes extreme examples clarify the boundaries of a problem, and cancer has a way of taking us to extremes. As I have said before, disease can be one of God’s most powerful refining tools. Continue reading

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Forced Family Fun (In a Jar!)

A few thoughts about the importance of families

by Alan B. Sanderson, MD

Last week my wife said that she was getting tired of the same old family activities and wanted to change things up a bit. She compiled a list of a few hundred activity suggestions, printed them on paper, and then cut them into individual strips of paper which we folded up and put in a big ceramic urn. Then on Monday night during our Family Home Evening (more on that later), we opened the jar and pulled out one strip of paper. The rule was that we had to do the activity written on the paper that night, if at all possible. We call this game “Forced Family Fun (In a Jar!)” because that sounds better than “Forced Family Fun (In an Urn!)” The first strip of paper we pulled out said, “Visit the place where Dad works and get a tour.”

IMG_20170904_193637270I said, “Alright, everyone. Let’s go!” and we packed into the van and drove to the clinic. By the time we arrived the baby was asleep, so ironically my wife sat in the van while the older kids came with me for our Forced Family Fun (In a Jar!) activity. It was after hours, so no one was in the clinic but us. After a quick tour I had one of my kids sit up on the exam table and I demonstrated a neurologic examination. This went over well, so we went into the other room and I performed a quick nerve conduction study on another kid, who laughed every time his hand twitched, and a neuromuscular ultrasound examination of another kid’s median nerve. I considered doing electromyography on one of them, but I thought better of it and instead did the needle examination on my own hand muscle. The kids were duly impressed with my specialized geek skills, and went home with a better appreciation of what I do every day at work. Even the ones who were initially grumpy about the activity had to admit that they enjoyed it. Continue reading

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Where Is the Pavilion?

A story of family faith and tragedy.

by Alan B. Sanderson, MD

My grandfather wrote in his autobiography: “Sometimes a storm seems to blow up out of nowhere, a tiny cloud on the horizon which brings rain, hail, and winds so fierce that everything is devastated in its wake. So it was with Steffanie’s illness.”

My aunt Steffanie was the third of six children in her family. They lived in Orem, Utah, in the shadows of the Wasatch Mountains. She was a kind and helpful youth, a natural teacher, and was famous for making delicious brownies. Her temperament was described by her mother as “happy, gentle, fun-loving,” and “the joy of our home. I often marveled to think, ‘This child is pure 100% joy!'”

Steffanie and Ivan L

Steffanie with her father, 1947.

Steffanie’s father, my grandfather, had served overseas in World War II and had missed important parts of the early childhood of his two older boys. Consequently he developed a special bond with his third child, Steffanie, whom he saw grow up from her infancy. “How he doted on her!” wrote Grandma. “If ever I saw two kindred souls.”

Steffanie and Doll

Steffanie, about age 2.

When Steffanie was eleven years old her mother had a serious and prolonged illness. During this time Steffanie baked a large batch of bread every other day and picked up the slack in doing all of the household chores. A few years later her mother said to her, “I know your young arms became weary with that heavy kneading and all the work of a large family, but never have I heard you complain or refuse to do what was asked. Instead, you took pleasure in doing it all as well as you could, in making good meals to surprise your family.” Continue reading

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Is Life Fair?

“The Lord gave, and the Lord hath taken away; blessed be the name of the Lord” (Job 1:21).

by Alan B. Sanderson, MD

Diagnosing brain death is never an easy experience, even when the medical facts are relatively straightforward. The old fashioned way to die is to stop breathing, have your heart stop beating, and to cease neurologic function, usually all at about the same time. A primary insult to one of these three functions quickly leads to completion of the other two if no intervention is made.

But modern medical technology has made it possible to temporarily separate these mechanisms from one another. Ventilators can preserve respiratory function to a remarkable degree, and there are also many ways to support and maintain circulation. A body with a severely damaged brain may be artificially supported by intensive medical care; it is possible to temporarily maintain respiratory and circulatory function when there is no evidence of brain survival. What to do in this situation has presented medical practice with an ethical dilemma which is unique to our age of the world. Over the past few decades the concept of brain death, or “death by neurologic criteria,” has emerged to help doctors and families determine when further supportive care is medically futile (which is another concept fraught with ethical difficulty). The main problem is that demonstrating that there is no brain function is not as simple as determining that the heart is not beating, and the criteria are much harder to explain to families. Understanding the concept of brain death and how it is diagnosed requires a fair amount of knowledge about neuroanatomy and neurophysiology, which most people don’t have.

Some years ago I had a patient who was a middle aged-man with a wife and teenage children. When I first walked into the hospital room with my team of residents and medical students his wife was sitting at his bedside reading him a novel out loud. He had more tubes and IV bags and medical devices than I think I have ever seen on one person at a time. This man had suffered a cardiac arrest, and heroic efforts had been made to support his heart, lungs, and kidneys. Unfortunately his brain did not tolerate the cardiac arrest and subsequent medical instability, and I was called to help determine just how damaged his brain had been. Continue reading

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Firsthand Knowledge

Some things are best learned through experience.

by Alan B. Sanderson, MD

I’m a firm believer in subjecting myself to the same things I put my patients through – within reason, of course. (Admittedly this would be a harder ideal to aspire to if I were a surgeon.) A few months ago I was touring the new MRI machine at the hospital where I work. While I was there the MRI technologist asked, “Hey, Dr. Sanderson, you want to get scanned?”

And I said, “Yeah!” I was on my lunch break, so I had time to do the whole brain MRI protocol. That was my first time in an MRI machine, and it was a fascinating experience. The machine was much louder than I expected, and that hole in the machine starts to feel pretty tight after about 30 minutes. Now I understand why so many patients have a hard time holding still inside the MRI scanner, and why some of them won’t even get inside it to begin with.

The MRI was one of my more recent experiences, but I have been doing things like that since medical school when my classmates and I practiced doing blood draws and ultrasound scans on one another. In residency and fellowship we would practice doing nerve conductions and electomyography, and I have long felt that a trainee should not be allowed to do needle EMG studies on patients until they have had it done on themselves.

Perhaps my most memorable experience with volunteering to have medical procedures was when I donated cerebrospinal fluid for a research study, and ended up with a post-LP headache for 10 days. At that point in my residency I had already performed dozens of lumbar punctures, and had seen several complicating headaches, but I didn’t expect it to happen to me. I didn’t complain, though, because I figured the experience would bring me good karma and would help me to understand and empathize with my patients. It also got me out of two overnight call assignments and a day of resident’s clinic. The headache wasn’t that bad, because the pain would go away completely if I laid flat for long enough. My wife and kids loved having me at home lying on the couch for 10 days, and my kids joined me for mealtimes on the floor. I read the book of Hosea a few times, and I also read most of Diagnosis of Stupor and Coma by Plum and Posner.

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Mealtime on the floor with kids when I had a post-LP headache.

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Unspoken Wishes

“In the quiet heart is hidden sorrow that the eye can’t see.” – Susan Evans McCloud (from “Lord, I Would Follow Thee“)

by Alan B. Sanderson, MD

I learned an old piece of wisdom when I was in medical school: “When all else fails, talk to the patient.” The first day I heard this saying I laughed, appreciating its cynical and sardonic humor, but I did not foresee how much this simple maxim would one day help me.

About halfway through my medical internship I had to spend a month working on the nephrology service, taking care of patients with severe kidney diseases. Most of them were in the hospital due to some complication related to hemodialysis. At the start of the month I looked over the list of patients on the service, and one of these was an elderly woman who had a serious infection in her dialysis catheter. This infection was recurrent despite powerful antibiotics and multiple attempts to replace her catheter. This poor woman had a very long and complicated medical history, including a major stroke, and we were informed that she had severe dementia so that she could not meaningfully interact with people. It was pitiful to see her, lying in bed looking ill and unable to talk. Sometimes she would look at me as if she wanted to say something, but no words would come out of her mouth. Once she even grabbed my hand, but I couldn’t tell what she wanted and I didn’t have time to find out, so I had to just walk away.

My senior resident and I worked diligently to treat her infections, and after may days all of her blood cultures were clear. She was ready to receive a more permanent dialysis catheter, which was a procedure done in the Interventional Radiology department, and as soon as this was done she would be ready to leave the hospital. But that afternoon I received a phone call from Interventional Radiology informing me that she had refused the procedure. Continue reading

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