Medicine is great, but it involves pain, pus and blood. For some, seeing those things is a problem. When I started medical school, I was worried. Before applying, I had spent a night in the local casualty department as work experience. I watched a junior doctor try to prise a splinter from a young woman’s hand. It was hurting her, and she kept yelping. The doctor got irritated and said the anaesthetic “should be working by now”. He kept digging into her hand with a scalpel tip; she started to cry. I felt lightheaded, my skin went cold, I moved my legs to keep the blood flowing, but seconds later I fainted.
They put me on a trolley, checked my blood glucose, and the same doctor explained that only “an insulinoma” could explain such low sugar readings. I got home, looked it up (a tumour of the pancreas), and for several months assumed there was something growing within me. There wasn’t. But the experience had planted a doubt. Was I really cut out for this?
Fainting is a common problem for medical students. A study in 2009 showed that of 630 students, 77 (12%) said they had fainted or come close to fainting in an operating theatre. Half of these were interested in becoming surgeons, and a significant proportion were put off from pursuing that specialty by their experience. The students reported being adversely affected by ambient heat, the smell of burning flesh, wearing a mask, having to stand for long periods, and menstruation.
For me, the first two years at med school were filled with lectures. Even the dissecting room, where the nasal punch of formalin rises up from the dull brown tissues of dead bodies, failed to sway me. The fascination with internal structures and cotton-thin nerves seemed to banish any queasiness. It was nothing like real, human life.
My first postmortem however, was a different matter. The professor of pathology, wearing long green rubber gloves, lifted up a series of pre-dissected organs. I glanced past him to the cadaver, and glimpsed the sawn head; I watched green juices drip off the liver, and … down I went. Apparently, when the professor heard the thump he looked into the audience and called out, “Will someone check to see if she’s alright?” I’m a man.
Then the day arrived for us to practise blood tests on each other. My trembling partner inserted a needle into one side of my elbow vein and out the other, causing a swelling the size of a large marble. As I watched it grow I began to sweat, the edges of my visual field closed in and I sat on the floor with my head between my knees until the blood rushed into my head and I recovered. A close one.
Entering the hospital wards for the first time, I didn’t do as well. We met the house officer and were told that it was our job to do the blood rounds each morning. She assembled a needle and blood tube set, and asked me to roll my sleeve up. Pretending to take blood, showing us how to handle the tube, she held the needle just a few millimetres from my skin. The sweat came on, and I fainted.
Repeated exposure to the causes of fainting is recommended. Of the 77 students in the study who fainted in the operating theatre, 10% benefited from making themselves go back. Others made sure they ate and drank well beforehand, requested frequent breaks from assisting the surgeon, and moved their legs.
The Doceatdoc website, written for students considering a career as a doctor, contains similar advice about keeping your blood sugar levels up, avoiding dehydration, and ensuring there is blood flow to the brain. Here though, they recommend avoiding specific situations that you know will cause a problem (patients screaming in pain, infected leg ulcers and bad feet, for me).
So how did it go for me in the operating theatre? I told nobody about my fears, but I walked in for the first time with trepidation. I did not want to be the one who distracted the surgeon during a delicate phase by fainting.
The patient was an emergency case. His abdominal aorta (the largest blood vessel in the body) had ruptured. I moved my toes and flexed my ankles to keep the blood flowing to my brain. He opened the abdomen and the patient’s blood welled up. It poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. I heard him curse as he nicked the spleen with his scalpel and was forced to remove it. Blood. Negative emotion. Potential calamity. The unholy trinity of faint-inducing factors. Yet I remained standing.
I have since found myself in many faint-prone situations, but I am glad to report that it is no longer a problem. The connection between eyes and brain has been modified by experience, seniority, confidence … who knows what? Rest assured, if you are a fainter, it tends to get better.
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