One step back

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If you’re reading this, chances are you came here via a Google search related to ‘medical students’, ‘fainting’, and ‘operating theatre’. Welcome.

So this morning I went to theatre for the first time and saw a laparoscopic appendectomy. I mean I saw ten minutes of one, before backing hurriedly out of a door I really shouldn’t have used and lurching into the corridor. (Yes, I realise this is an embarrassingly low-key surgery to faint in). Did you know it requires two scrub nurses to escort a dazed medical student into a coffee room? This is apparently for health and safety reasons. You’d think they’d have other priorities, such as the girl on the operating table with three holes in her abdomen.

Waking up again is the weirdest part of fainting. I lay there as my brain clicked its way through various possibilities like a surreal fruit machine. Am I in bed dreaming? At a Halloween party, surrounded by revellers dressed up in scrubs? Lying across three chairs in the surgical coffee room, a load of off-duty staff looking at me? I blink and focus. It’s the latter. Oh… crap.

I realise this isn’t an ideal story if you came here looking for reassurance. But don’t panic. I’m here as your somewhat foolhardy guide, proving that it’s not the end of the world and – as the nurse kindly reminded me – it happens to everyone. I got up to go back to theatre, and as I Ieft the room a surgeon walked in… and fainted.

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Deep-sea diving for the non swimmer

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About this time last year I was wondering about the way medicine changes you. I’ve spent the whole year fighting the idea. We’ve learned how medical students are actively socialised into the profession (medical schools isolated from the rest of the university, long working hours, separation from other students, specialised jargon that renders us incapable of communicating with normal people etc) and it just backed up my instinct (read: fear) that after a while of studying medicine I would never be quite the same again.

Of course we all change throughout the courses of our lives. Sometimes we can’t see what’s coming at all until a bend in the road reveals an exciting new path taking us somewhere new, never to return. Any profession might do that. But I can’t help feeling that medicine is exceptional. Once we’ve deliberately pierced a person’s skin or put a hand inside their bowels or seen them die, surely that gives a new view on life and humanity that’s difficult to unlearn.

That’s why, every now and then, I feel the need to say STOP! Hang on just a sec… wait there! This’ll all become old pretty soon and unremarkable, but right now I’m in my very first week of clinical medicine and I want to remember it while it’s still strange and new. While the old me is still here. After all, this is apparently the rest of my life.

After a day in the hospital I emerge as if from a long immersion into deep water. That’s how it feels. From within, everything outside is muffled, blurry, forgotten. I’m in some sea so deep and wide I can’t see the bottom. It’s murky and full of things I can’t see properly and don’t quite understand: acronyms and measurements and anatomy and vital signs, all linked by mysterious threads. I’m trying to find my way about through the gloom and I haven’t learned how to use my gills and fins yet. I have no idea how far the unknown goes. Pretty damn far I think.

That really is it right now; a vastness of unknowns. I’ve been pushed in and am only just about swimming. The mysterious threads are a tangled mess. It seems all-enveloping: to grasp it I’ll need to immerse myself completely, let go of the side and dive, and just trust that the oxygen holds. This is nothing like any university that came before. I’m studying with new people in a new place in a totally new way. Rather than learning the biology of the body I’m suddenly dealing with histories and clinical signs and examinations. And meeting patients, imagining they could be my dad or my grandmother but also recognising that perspective that a doctor has to have. The idea that I might untangle things enough to make a diagnosis one day seems absurd.

And all those medic-y things are starting to come true: I’ve already had some very early mornings, been put on the spot by scary consultants and found the short-cut to Costa. I almost can’t believe it’s me but at the same time it’s brilliant and fascinating and it makes me want to learn and be really, really good at it. God knows if I can, but every time something makes sense it’s as if I’ve just dived into blackness and brought up a pearl. I’m so surprised to hear myself say it but if you asked me if I’m happy and inspired, if I really can imagine doing the job, I’d say yes.

PS Needle update:
Hours spent in lectures on venepuncture theory: 2.
Sessions practicing venepuncture on fake arm: 1.
Disgusting videos about chest drains watched: 1.
Actual chest drains seen: 1.
Anecdotes about amputations endured: 1.
Fainting episodes: 0. But the worst is definitely still to come.

What needle phobia?

Landmark moment alert: I took blood for the first time!

It’s been 15 years since that day I got the TB jab, fainted in the school corridor and inherited my trypanophobia. I even gave myself a black eye once, keeling over face first into a doctor’s carpet. And then there was the time I fainted in the dentist’s chair and woke up disappointed that he hadn’t done the filling while I was unconscious.

It’s a horrible feeling to know that you’ll probably faint or throw up every time you’re faced with a needle. You feel ill and embarrassed and it’s a pain. Coming to medical school I was afraid that I’d make a fool of myself by fainting on a ward or in a clinic. I was more afraid of that than of all the books and exams and late nights. But I never thought of it as a good enough reason not to go to medical school; it seemed so stupid. It didn’t seem worth it. And so I came and crossed my fingers, and I did the CBT and trusted to my favourite strategy of ‘Yeah, let’s worry about that tomorrow’.

Over the last few months I’ve heard many people say they’d love to be a doctor, nurse, midwife or whatever but that they’re too afraid of needles. But I’ve also met a surprisingly large number of medical students who say they don’t like them either. In fact, according to an occupational health nurse here (the last lucky soul to stick a needle in me), med students kick up the biggest fuss of all. We’re wusses, although maybe it’ll make us more understanding when we do it to other people.

But things are a-changing. A year ago I didn’t realise how much help there was out there for needle phobia, and it really does seem to work (though I couldn’t tell you how). Having gone through the CBT process I seem to feel more in control of my body’s responses. I know I don’t have to faint so I don’t, and haven’t done for months. The slightly embarrassing applied tension technique gives me something to do in that nasty anticipation stage; I don’t whether it works by raising my blood pressure or just causes a distraction, but it helps. To the point where, last week at GP, I sat for a hour watching my friends learn to take blood from each other, and then did it myself with absolutely no bother at all. Gloves, tourniquet, finger on the bulging vein, needle, blood, the lot. The first time I ever intentionally broke a person’s skin, which is pretty mind blowing in itself. And I wasn’t even afraid of fainting – I was looking forward to it.

I’m not saying I’m not still worried about going into hospital and fainting – there are needles and there are needles. And then there’s surgery! And I still hate getting blood taken and I’m not about to start seeking it out. But perhaps it’s not as bad as all that, and maybe these things can be overcome with a little willpower. Perhaps we shouldn’t let fears hold us back.

You’re feeling a bit dizzy, aren’t you?

So I have this problem with needles. They make me faint. I remember getting vaccinations one day back in secondary school; everyone was competing to tell stories about how big the needle was and how much it hurt, and I keeled over in the corridor afterwards. Some sensitive 13 year-old boy in my class leaned over me and yelled “Is she dead?”. I’d say it probably started there.

It’s a pretty common thing; they say at least one in ten people suffer from some form of needle phobia, or trypanophobia. (If you’re interested in Greek, the prefix ‘trypan-‘ is also used to describe parasites that bore into the skin). Trypanophobia refers to fear of hypodermic needles and injections, not to be confused with aichmophobia (fear of sharp pointy things) or iatrophobia (fear of doctors).

Who cares, you might think, and I pretty much agree, having coped so far through the cunning threefold strategy of (a) never giving blood and trying not to feel too guilty about it, (b) asking to lie down every time I get an injection and (c) not getting ill or pregnant. However, there’s only so much needle avoidance a future doctor can get away with without looking completely stupid. And I won’t be the only medic to have this problem. Luckily I have the loveliest GP in the world who referred me to a cognitive behavioural therapist, and this is has been the source of a fair amount of surreal experience and hilarity over the last couple of months.

Interestingly, needle phobia is one of the few phobias that can actually kill you – the sudden blood pressure drop that tends to happen after the event and cause fainting can be so severe that you die. So I may become a doctor or die trying. Some evolutionary psychologists say that needle phobia is a survival mechanism; faced with a severe injury, that sudden drop in blood pressure means that less blood is likely to be lost. Thanks body, that’s just great.   

So the general idea is that we, my lucky therapist and I, make a list of unpleasant needle-related experiences, rate them on a scale of 0 (fine and dandy) to 100 (utter hell) and then go and do them, with repeated exposure helping to break the psychological ‘overreaction’. Wonderful. Oh and I practice a highly dignified technique known as ‘applied tension‘, which basically involves tensing all my muscles til I go red in the face, which is supposed to raise the blood pressure and thus ward off fainting.

So far I’ve gazed at cartoon needle pictures, stuck a big photo of a needle up on my desk at work, trawled YouTube for alarming videos, watched people giving blood and sat at home playing with a pile of needles and my own mini sharps box. All that stuff was ok really, probably because I’m adept at disconnecting from reality.

Yesterday I went and got some blood tests. Two, voluntarily, which is a minor miracle for me. I sat upright in a chair while the lovely healthcare assistant talked me through it. I tensed my arms and legs frantically, feeling like an idiot, while she put the needle together. I looked at my bulging vein. I looked away. I looked back at the needle in my arm, wiggling around a bit as she took the blood bottle off. She took it out. I tensed. I felt ok! I sat there. I felt a bit queasy. I tensed. I had some water. She did it again. I looked at the needle in my arm. She took it out. I felt horrendous, properly awful. I staggered over to the bed, panting and sweating and shaking and probably turning a fetching greeny white. I guess there’s still some way to go. But I didn’t die, and I had some more water and we chatted and then I went home and baked a cake. Til next time.