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Excuse Me While I Kiss the Ground
I was rounding with a physician and she decided to take us to the dialysis unit to see a patient. By this point, it was about 12:30 in the afternoon, and I had not eaten anything all day. We stepped inside the clinic and met a lady who was being dialyzed. I watched the blood running through all the tubes and was fascinated, since this was the first dialysis machine I’d ever seen in use. But as the physician started describing how the machine works, I realized that I was starting to drip with sweat. I could feel the blood draining from my face, and then the world became a little fuzzy. As the doctor pulled back the blanket to reveal the arteriovenous fistula on the patient’s arm, I felt my knees becoming weak. The sweat was dripping down my back, and I could barely see. Luckily, at the last moment, I gathered all my strength and ran out of the unit into the outside corridor.
After I made it outside, I looked around for a place to sit. There was a bench nearby, so I stumbled towards it and collapsed. As I sat there, waiting for my blood to return, I realized that there were patients all around me, staring intently. I guess I must have looked like a mess, covered with sweat, with an absolutely white face that matched my white coat. I sat on the bench for several minutes before I could stand again. I knew I desperately needed sugar, but I didn’t have any change on me, so I just bravely stepped back inside the unit. I was pleased to realize that the other students in my group had covered for me, and I hadn’t made as big of a scene as I had originally thought.
The whole incident really got me thinking, though. If something as innocuous as a lady on dialysis is enough to send me to the floor, how will I deal with a spurting artery? Or a severed limb? Or one of a million bloody scenarios to come? I guess I’m really nervous that I picked the wrong profession. What if I can never overcome the vasovagal response to the sight of blood, or someone being poked with needles? I’m wondering if there are other people like me out there. Did you ever figure out a way to prevent passing out at the sight of blood? Does it eventually just go away after working in medicine long enough? Or is it something that you always have to battle?
January 28, 2008 in Kendra Campbell | Permalink
Comments
This happens to me too! It's always so embarrassing, especially the one time I actually passed out. However, all of the doctors I've talked to about this say it eventually goes away. I sure hope so!
Posted by: Maren | Jan 28, 2008 3:54:19 PM
Hi Kendra,
You wrote, "By this point, it was about 12:30 in the afternoon, and I had not eaten anything all day."
I am going to bet that if you have a good breakfast (or at least a morning piece of fruit) next time, your old blood-comfortable self will return. Even big oafs like me can get woozy when hypoglycemic.
My vote is for you to stick with it. As you said, "I assumed that I had a pretty strong stomach when it came to blood, needles, and medical procedures." Give that stomach the strength you know it has. All it wants is a few calories!
Posted by: Thomas Robey | Jan 28, 2008 5:04:16 PM
I agree with Thomas. A bit of food and you should do better next time. Perhaps a granola bar stash in your lab coat?
When I first started shadowing doctors when I was trying to get into med school, I would get green at the sight of blood. After a couple of shifts, it got better. But if I am hungry, or too warmly dressed, I can still get a bit queasy.
There is a sort of clinical detachment that one gets in, though. The couple of times that I've been able to do suturing on a live patient, I didn't even notice the blood, so intent was I on placing the perfect stitch.
I enjoy your posts.
BB
Posted by: Beach Bum | Jan 28, 2008 6:03:12 PM
Kendra,
Fear not. It's even happened to me once or twice while teching in the ED. Here's the big trick that works even better than food. Hydrate. Having your kidneys conserve water takes amazing amounts of energy, and simple hydration can save enough to stave off "minor hypoglycemic bouts".
But, you'll simply have to accept that occasionally something will catch you, and realize that what may seem terribly embarassing was actually handled with reasonable aplomb. Also, people aren't rats. There is only so far that your brain will take that analogy.
Posted by: Jared | Jan 29, 2008 4:21:53 AM
As to picking the wrong profession: no, although you might want to keep any phobias you have in mind when choosing a specialty. One of my earliest mentors is a pediatric cardiologist. I once saw her literally go grey at the sight of someone's bandaged thumb and turn away, muttering, "I don't do wounds, they make me sick."
Posted by: | Jan 29, 2008 9:41:49 PM
I'm a second year medical student and I get queasy too. But not because of blood. I feel upset and agitated when we watch videos of persons with psychological disorders in class. Yesterday we watched a video on schizophrenia, and 15mins into it, I feel like I was going to jump out of my own skin. Deep breathing and stubborness made me last through the remaining 45mins...it was tough though.
Posted by: grasshopper | Jan 31, 2008 2:57:33 PM
I agree with everyone else; I always stash granola bars in my coat. I think it does diminish over time, but that some things will always hit you, & it's hard to anticipate what it will be or when; for me it's different every time. Deep breaths and vick's vapo-rub for the smells. Good luck! (And if you weren't grossed out at all, you probably couldn't empathize with what patients are going through -- being sensitive to these kinds of responses makes you a better health professional!)
Posted by: kate | Feb 2, 2008 10:47:42 AM
My day came when I watched a pleural biopsy being taken. The patient supposedly had a malignant pleural tap. I knew that the pleura was sensitive to pain and how to differentite between pleuritic and cardiac pain, but that day I understood the sense of it, in the process i felt myself nauseating a little "mind you I ate well" then as I was about to fall, I ran just like Kendra did to the nearby room which had plenty of chairs and no-one. I rested a bit and then went back thinking I can withstand the pressure again, actually I couldn't and just managed to ask the doctor after it was over: How did you do it without inducing a pneumothorax? Yes, it left a mark in my head.
Posted by: B not ben | Feb 3, 2008 6:06:12 AM
you didn't kiss the ground, my dear...from what i've read, you "done fell over" or "DFO".....or is that only in the South...?! Take care.
Posted by: Tracy | Feb 5, 2008 10:29:16 AM
Kendra,
One "close call" does not eliminate you from medicine! After surviving my entire 3rd year and lots of gory surgery stuff, I came close to passing out during a routine procedure a year later. Why? Because I had spent the entire weekend in bed with the flu, it was the first day back and I was underhydrated/underfed. Like you, I made it into the hallway first. Never underestimate the power of blood sugar. Now I always keep tootsie rolls, hard candy or a small piece of cheese stashed in my scrub pocket for just such moments!
Posted by: Lou | Feb 5, 2008 2:22:37 PM
I am now a resident but I personally experienced this during my OB rotation 3rd year of med school. I was on night float in labor and delivery - maybe my second day and still getting used to the schedule and also had not eaten enough. I was just starting to sew up a patient's perineum and started to feel lightheaded. I had to step out and eat something. I think it eventually happens to everyone and it makes a couple of important points:
1. Take care of yourself!!! - because otherwise you can't take care of anyone else
2. Know your limitations - You did a good job by stepping out of the room before you actually passed out. In a patient care situation, you would have been preventing an accident by stepping out as you did rather than trying to stick it out. This extends broader to knowing when you're in over your head - such as when you're on the wards and all of your patients start misbehaving - like dropping their BP or O2sat or whatever - at that point you need to recognize you need help and ask for it.
Good luck with your future career!
Posted by: kinderdoc | Feb 5, 2008 2:29:42 PM
This has been happening to me for a while, even before I started medical school. It always starts with sweating, the my vision gets blurry, and then completely black. Fortunately, I've always taken the clues from my body and stepped away before I actually passed out.
It has happened to me in small surgeries and even in surgeries I've seen tons of times before. My biggest suggestion is EAT! I always keep crackers or graham crackers with me in my pocket or white coat to make sure I have something if I ever feel a little fuzzy.
Don't give up though. It happens to everyone and should have no impact on whether or not to stay in the medical profession.
Posted by: Leiloni | Feb 5, 2008 3:26:44 PM
I've never considered myself to be very squeamish--I can draw blood, place IVs, assist in surgeries, and whatnot--but LPs and epidurals absolutely turn this otherwise strong stomach. So I'll do my best to watch as many as I can and hopefully get over this anxiety. :) I totally agree with those commenters that commend you on leaving the scene before you became a patient yourself!
Posted by: Amy | Feb 5, 2008 3:48:39 PM
We were talking about this in my dept the other day. Even the seasoned folks who have seen "everything" will once in a great while encounter that one moment that puts you over the edge into queasy land.
We figured it has to do with your state of mind/body at that very moment, coupled with the correct "quease maker" event and you're out. It's not predictable either.
Very human though, brings you back to the real world LOL.
Posted by: AB | Feb 5, 2008 9:08:45 PM
hey kendra,, im a 4th year medicial student and that happened to me almost twice,so u r definately not alone!
the first time was my first time in an OR, and i was attending an appendectomy, and that day i hadent eatin nething all day and i went in for the surgery at about 2 pm,, so halfway through the surgery i actually collapsed on the floor!! it was so embarrasing but my surgeons didnt think so lol they said that it was a normal response n that it passes.
But the second time i was smarter, i felt all the symptoms of an anticipated vasovagal response, so i found the closet chair and waited for the feeling to pass. That day it got to me, and i was so depressed. But i realized that i am definately not alone, n it will pass. Plus, as someone mentioned above , feeling this way will actually make u connect with the patient's feelings more, and it will make u a better Dr. So all the best,, and worry not, it will SURELY pass =)
Teena
Posted by: Teena | Feb 6, 2008 10:37:04 AM
Been there done that. For me like Amy above it's the LPs and Epidurals that send me tumbling. I have fainted in theatre and had to sit on the floor once whilst watching an anaesthetic induction. You have no idea how proud of myself I felt the first time I managed to watch a lumbar puncture without having to sit down. I think it's partly about seeing someone else in distress and pain.
As others have said there are lots of good strategies. Try to get enough sleep, ALWAYS EAT BREAKFAST!!!!, bring snacks and at the end of the day if something repeatedly makes you feel queasy, keep going to see it until it doesn't!
Fainting in theatre definitely wasn't my most embarrassing moment. Leaning against the wall and realising in the process that you've turned all the theatre lights off - now that's embarrassing!
Best wishes,
Abi
Posted by: Abi Roseman | Feb 6, 2008 2:17:35 PM
i can truly relate to this topic!
happened to me once or twice ,especially after long hours of standing on necropcys ...
nervous of the coming rotation 3rd year with ...
Posted by: RUDOLF | Feb 6, 2008 2:23:30 PM
Yeah, there's nothing like breakfast at 4:30 am and having people ask you after you feel faint if you ate anything 8 hours ago. Bring granola bars. Drink out of every drinking fountain you pass. Get to know your body. Now you know how it feels, so you can sit before it overwhelmes you, or at least announce you need to sit down. Doctors don't care.
Posted by: KF | Feb 6, 2008 6:41:22 PM
Hi Kendra,
Wow quite a few good messages in response to your post! So i'll only add one thing: there are days when i feel lighter-headed... on those days, i eat as well as possible, and i make sure my intravascular volume is repleted with Salt'n'vinegar Ms. Vicki's chips + lots of water. Hey it's better than IV fluids ;)
Good luck!
Cycy, Med-4
Posted by: Cyrille | Feb 6, 2008 11:00:35 PM
Don't worry. This too shall pass. Make sure you eat (you should do that anyway).
Chip
Posted by: chip | Feb 7, 2008 2:01:24 PM
A quick tip...cross your legs and squeeze your thighs together as tightly as you can....always staves off faintness for me!
Posted by: kath | Feb 12, 2008 1:40:09 AM
Hi Kendra,
I once had a fellow surgeon make a suggestion. Have at least 2 glasses of orange juice before a large procedure. Though this is not always accessible, it does work well.
Posted by: | Feb 25, 2008 5:32:52 AM
Do'nt fear it is usual practice for a medical student to contact with such things like blood, surgery etc. if u r fearing how would u manage in lab while operating a patient.so have trust in God. u r going to serve mankind , be patient.
Best of luck.
Allah Hafiz
Posted by: iftikhar | Apr 29, 2008 2:50:49 AM
I almost collapsed in my first day at surgery. When my group and i greet one of the surgeon he asked us to follow him to the clinic. And there is a patient postlaparotomy lying still in the bed. He came because his wounds is producing some pus.
He asked us "What sould we do with this patient".
And after several wrong answer from my friends, i said we should open the stiches coz it might be some anaerobic infection so it will do good.
So, wihtout further ado he open the wound, and clean it. And in the time of cleaning, hi insert his hand into the patient's abdomen and start rubbing and wiping and sort of thing. At that time i started to feel dizzy, the blood leaves my face, i saw circles, and i'm sweating like crazy. Fortunately my friends got my back, so i'm like clinging to them. If the surgeon pokes that patient abs for 1 second longer, i'll certainly kiss the ground.
However i managed until the end... wihout collapsing.
No, it isnt because i missed my meal, i ate my breakfast that morning. back on preclinic time at medschool i didnt like getting involve with cutting someone's bodypart, i never took any course how to circumsised, etc. So it was my very first encounter with actual human *living one* body.
It took several days for me to get used to cutting and slicing, blood, wound, etc and now i think i'm alright with such view.
Posted by: Ummi Ulfah Madina | Oct 2, 2008 4:50:56 PM
