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August 30th, 2006

When I first announced my intentions of going to medical school, probably the second most common response (after “how long does that take?”) was “are you kidding? You’re way too squeamish!”

Well, it turns out that I’m pretty stubborn, and I decided that squeamishness shouldn’t stop me from doing whatever I wanted to do.

I’m cutting this post so that those who are really squeamish don’t have to hear about it. There’s not too much graphic description, but definitely mentions of things that might make you go “ew.”

I figured the first thing I should do was work on my fear of needles. I wasn’t someone who just didn’t like shots (who does?) - I had to be held down for my MMR booster when I was 11, and even once I got a bit more control of myself, I would regularly break out in a cold sweat at the doctor’s office if I saw anything that I thought might possibly be a needle. Clearly this was incompatible with a medical career.

So I signed up to donate blood. The first time was not successful, even though I was perfectly cooperative; the tech missed my vein and had to dig around looking for it. Not helpful! She still didn’t get it, and I guess I was visually uncomfortable, because they told me to go home and try again another time.

I actually did come back again! Stubbornness is powerful. And I managed to donate a whole unit of blood. So I became a semi-regular blood donor. I donated only a handful of times before I came to the conclusion that while other people might need my blood, I really need it too - I always get sick the next day. But it was a good desensitizing experience, even though I never got over sweating a bit beforehand, and I never watched them put in the needle.

Then I came to medical school. The first day of anatomy lab, I spent more time in the hallway than in lab. The first time I felt faint and had to leave was before they even took the sheets off the bodies! I kept coming back in, but every time I did I’d start feeling sick and have to leave again. I was pretty worried about it. That afternoon I talked to a few second-year med students, who were very encouraging. So I decided to see how it went the next day and pursue further desensitization if necessary. As it turned out, I didn’t have any problems after the first day. (Probably it had something to do with the fact that I had been sick and was still recovering at the time.)

I was feeling pretty good about my prospects, but observing procedures in the hospital threw me for a loop. The following procedures have caused me problems:

  • Central line placement. This is an IV that’s placed in a big vein under your collarbone; the procedure is much more involved than a standard IV placement. I was in charge of holding the saline solution while the resident did the placement. I was so proud of myself that I was looking at needles! and blood! without feeling sick. Then I suddenly started feeling hot and clammy, and sick to my stomach, and woozy… there goes my vasovagal response. I had to sit down (luckily there was an extra chair in the room) with my head between my knees. I did feel better and come back to finish my job, though!

    The doctor was very nice about it, basically: this happens to everybody, go get a drink of water and take it easy for the next little bit, and don’t worry.

  • Intubation. At least, I think this was the problem; we were watching surgery prep in two ORs. The first patient was being intubated, and we watched that then proceeded to the next room where the area was being prepped with antiseptic; that’s when I started feeling ill but I’m assuming that even I am not so squeamish I can’t stand to watch somebody’s perfectly intact skin being swabbed with iodine solution.

    The doctor I was with then was really nice about it, so much so that it was actually quite embarrassing. He marched me out of the OR and made me lie down on a stretcher (meant for patients), taking my pulse the whole time. He saw that I had goosebumps (not surprising once I stopped moving around in the cold surgery area) and asked a nurse to get me a heated blanket (again, meant for patients). Then he got me a cup of water and allowed me to sit up to drink it, but I had to keep the blanket on. Once he decided my pulse was strong enough for us to leave, I was allowed to walk but I had to wear the blanket like a cape. It was very sweet.

  • I watched a birth and was fine for the entire time, including seeing the patient experience a tear, until they got out the needles to stitch up the tear afterwards. I had to go outside and sit on the floor for a bit. I was following a midwife, who made me go get orange juice and told me encouraging stories, but wasn’t too embarrassingly solicitous.
  • Stitches. During the summer I was shadowing the doctor I was working with when a patient came in with a gash on the back of his hand. The doctor invited me to watch the stitching. I did fine while he was irrigating the wound (shooting sterile solution out of a needle to wash it out), but I only lasted through one and a half stitches even though I was already sitting down. I think it was because the patient had thick skin, and so the doctor had to push the needle with quite a bit of force, tenting up the skin, before it would pop through. (Sorry for the gross description.)

    The doctor was again very nice. He told me a story about a friend of his who’s an orthopedic surgeon, and actually passed out three times during his training - once falling into the sterile field (essentially on top of the patient). He’s a happy surgeon now.

The list of procedures I’ve successfully observed is somewhat shorter; I’ve seen a few gunshot wounds but nothing really gross and nothing has been done to them while I was watching. And I did see another successful intubation, and various gynecological procedures. I think my success rate is about 50%.

So I still have a needle problem, and I’m generally squeamish to boot. But everybody (well, with the exception of one surgeon who jokingly suggested that I should get used to saying “How does that make you feel?) has been extremely encouraging. They say it happens to everyone and I’ll get over it with no problems. Hopefully they’re right! I’ll post further developments here; I think it might be helpful to other med students.

I expect that my stubbornness will be a helpful asset. On the other hand, I have learned that once you start feeling like you’re going to faint, you cannot turn that process around by pure force of will. At least, I can’t. I’m pretty sure that trying that is how people end up passing out in the sterile field.

29 Responses to “squeamishness and stubbornness”

  1. Emma Says:

    I actually DO really enjoy getting shots. And having my blood drawn. It’s so cool!! Especially when I donate blood to see my blood in the tube going out of my arm. It’s amazing!! I guess I’m weird, but I always watch when needles are getting poked in me. Not to brag or anything. ;~)

  2. nikki Says:

    scientific american mind (a great mag, despite their awful cover graphics), had an interesting article in their most recent issue re: fainting at the sight of blood, guts, etc. they conclude (if i remember correctly) it may actually be an evolutionarily adaptive trait. the lowered blood pressure that causes fainting reduces blood in extremities, allowing clotting before excessive blood loss. those who had the trait survived more often, which is why it’s so common today. so anyway, you may just be more evolutionarily fit!! :)

    seems interesting, if possibly wrong :)

    http://www.sciammind.com/article.cfm?articleID=0000BCFB-D121-14C7-912183414B7F0000

  3. Amanda Says:

    If I only fainted at the sight of my OWN blood I’d be all right! Actually, I’ve only once gotten faint in situations involving my blood, and that was the last time I donated. I think it might have been more due to the worrying about whether the tech with two-inch acrylic nails was really capable of safely extracting my blood.

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