Sometimes It Won’t Get Better

Doctors want to help people and fix things, but we are frequently confronted by our own limitations

by Alan B. Sanderson, MD

She came to my office complaining of right hand weakness and severe, constant, distressing pain in her right shoulder and arm. As I examined the shrunken muscles in her hand and reviewed the data from her chart I began to feel a pit in my stomach. The patient was hoping that I would give her good news, but good news was not what I had to give.  I braced myself for the awful task of smashing her hopes forever. Continue reading

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What Is Death?

What do Mormons believe about death, and how does this affect the way we live our lives?

by Alan Sanderson, MD

One of my patients died a couple of weeks ago from amyotrophic lateral sclerosis (ALS). He was a wonderful man, and I really loved having him as my patient, but I was always sad about the circumstances that made our paths cross. I remember the first time I explained the diagnosis to him, and his good-natured acceptance on that day and throughout his disease course was inspiring to me. From the very beginning he refused any kind of intervention aside from pain management, and he died a little over 2 years from the onset of his first symptom. At every clinic visit he made me laugh, and I will always remember the way he smiled in the face of death.

How could he smile in the face of death? Because he understood that death is not the end of life.

We have discussed the topic of death in several previous posts, but always in the context of some other topic. I want to hit it head on this time. What do Mormons believe about death, and how does this affect the way we live our lives? Continue reading

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It Becomes You, Part VI: Living the Dream

Adventures and lessons from my first years in practice

by Alan B. Sanderson, MD

This article is the sixth of a six-part series, written in the hope that 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:

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

EPSON MFP image

During medical school orientation one of the speakers gave us all a piece of paper and told us to draw a picture of ourselves in the future as a practicing doctor. This is what I drew. When I showed it to my wife recently she laughed out loud. “The misshapen head! The baldness! It all speaks of being terribly misused, for years,” she said. (It also speaks of my primitive drawing skills; necks are optional.) It is true that a lot of my hair fell out during my medical training, but I suspect that most of it would have fallen out anyway, and thankfully my head did not become deformed. But residency does take its toll on your life in the neglect of your personal relationships, hobbies, health habits, and everything else which is not directly related to your work. This last part of the series will discuss the process of trying to put your life back together after the trial is over. Continue reading

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It Becomes You, Part V: Keep Your Nose Above Water

Stories and memories from the dark days of internship and residency

by Alan B. Sanderson, MD

This article is the fifth of a six-part series, written in the hope that 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:

  1. First Decisions:  Deciding to become a doctor
  2. Apply Yourself: Undergraduate studies
  3. The Academic Eating Contest: Medical school preclinical years
  4. Academic Vertigo and the Identity Crisis: Clinical rotations and 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. Sign up for email updates here or follow us on Facebook or Twitter to get notified of new posts.

My mother taught me to swim when I was about three or four years old at the city pool. She would stay near the edge of the pool, and I would dog paddle out a few feet and then return to the safety of the edge. One day my mom pushed away from the edge, and I followed her out into the pool thinking that she would return to the edge. But she didn’t turn around. She just kept swimming farther and farther into the pool, and I started to panic as I realized that I couldn’t go back to the edge by myself, but I couldn’t keep up with her. I called out for her to help, and I paddled along as quickly as I could. She led me through the middle of the pool and to the opposite side, and I swam the whole way. A lot of pool water ended up in my nose, and in my stomach, but I made it across the pool!

I remember feeling angry with my mom at first for scaring me like that, but this experience became an important milestone in my becoming an independent swimmer. It is also a pretty good analogy for what residency is like. Continue reading

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It Becomes You, Part IV: Academic Vertigo and the Identity Crisis

Thoughts and memories about medical school clinical rotations, specialty choice, and applying to residency

by Alan B. Sanderson, MD

This article is the fourth of a six-part series, written in the hope that 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:

  1. First Decisions:  Deciding to become a doctor
  2. Apply Yourself: Undergraduate studies
  3. The Academic Eating Contest: Medical school preclinical years
  4. Academic Vertigo and the Identity Crisis: Clinical rotations and 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. Sign up for email updates here or follow us on Facebook or Twitter to get notified of new posts.

2004-10-17-038

I was so excited to wear my first white coat!

My life changed abruptly and irreversibly in July of my third year, when I started my first clinical rotation in the hospital. This gave me my first opportunity to see how hospital teams function, and what role doctors play on that team. I remember the “A-Ha!” moment when I first comprehended the difference between what doctors do and what nurses do. (Recall my breathtaking ignorance described in Part I of this series.)

Every month or two for the next two years I rotated through a different type of practice. I started with internal medicine, then surgery, then family medicine, psychiatry, neurology, pediatrics, obstetrics and gynecology, radiology, addiction medicine, emergency medicine, etc. Every month (and sometimes every day) I had a new team of doctors and residents to work with in an entirely different hospital or clinic setting. As soon as I got my bearings and felt like I knew what I was doing, it was time to move on to something else. In addition to these frequent changes of venue, I also found that I was no longer in charge of my own schedule like I had been for many years. Weekend and overnight work assignments were frequent. Even when things are going well this sort of instability is stressful. Continue reading

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It Becomes You, Part III: The Academic Eating Contest

Thoughts and memories about the first two years of medical school

by Alan B. Sanderson, MD

This article is the third of a six-part series, written in the hope that 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:

  1. First Decisions:  Deciding to become a doctor
  2. Apply Yourself: Undergraduate studies
  3. The Academic Eating Contest: Medical school preclinical years
  4. Academic Vertigo and the Identity Crisis: Clinical rotations and 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. Sign up for email updates here or follow us on Facebook or Twitter to get notified of new posts.

2004-005

The main lecture hall early in my first year.

The first few weeks of medical school were the most remarkable time in all of my 26 years of formal education. There were about 200 students in my entering class, from diverse backgrounds, religions, and races, and a general feeling of openness and goodwill prevailed. I turned over a new leaf by going out of my way to talk to people and make new friends, and I felt a strong sense of camaraderie with all of my classmates. We had all worked hard to get there and we were all in this together. Continue reading

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It Becomes You, Part II: Apply Yourself

Thoughts and memories about undergraduate studies and applying to medical school

by Alan B. Sanderson, MD

This article is the second of a six-part series, written in the hope that 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:

  1. First Decisions:  Deciding to become a doctor
  2. Apply Yourself: Undergraduate studies
  3. The Academic Eating Contest: Medical school preclinical years
  4. Academic Vertigo and the Identity Crisis: Clinical rotations and 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. Sign up for email updates here or follow us on Facebook or Twitter 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.

Continue reading

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