Tuesday, April 16, 2013

On Fainting

After my comment on MiM mail last night I got mail from a reader who wanted to know more about my experiences in passing out.  I've got volumes in that category.  Here is what I wrote back to her.  

Thanks for your e-mail.  I was always a fainter.  I fainted every time I got my teeth worked on - pulled, new braces, etc.  It was crazy.  Oh and in college when I got my belly button ring (long gone era).  In med school blood draw lab, I did fine when I drew my partner's blood (first, quick and well) but when he was sweating and sticking me multiple times it was just too much and the next thing I knew I woke up on the floor in the arms of a nurse.  I wasn't the only one.  

I sought advice from my sister, a PA in anesthesia (physician's assistant) who is much tougher than me but had similar issues early in the morning before surgery, before I started clinicals.  She learned that was when she was the most hypoglycemic and started keeping small juice packs and sugar candy in her backpack or scrub coat pocket.  I emulated and never once passed out during an early surgery.  I found it pretty easy since the patient's head was all draped and you only saw the one part you were working on - I could mentally separate it from the person and pretend it was arts and crafts.  Which is how I got through autopsies, too.  

I know a guy that got queasy and had to leave the room after watching his first pelvic exam.  If I remember correctly he was the president of our class and is now a cardiologist at Duke.  So it happens to the best of us.

I passed out - almost anyway - needed cold washcloth and head between legs - during the bone marrow because that is an archaic, painful as hell procedure - the patient was prone and miserable, and moaning, and I was 8 weeks pregnant, so low blood pressure already - BTW, do you know your blood pressure?  I have very low, good blood pressure, and I think that is sometimes the culprit of the passing out.  At the private institution I work at now, patients are sedated for marrows, thank goodness.

Gross anatomy - if you still do that these days I hear it is going by the wayside - will be a nice segue to test your waters.  I might encourage you to try to volunteer, if you have time, watching a surgery or a birth or an autopsy or something during your first two years - so it is less stressful since it is not your grade.  Your being a med student will gain you access to many different areas and if you do need to leave the room no one will remember in a year or two.  It happens to a lot of people.

Remember even the toughest cops lose it (vomiting, etc.) during particularly nasty crime scenes.  That's what got me in the crime lab the first day - all those dead bodies and blowflies.  The stench and the bad karma was overwhelming.  Peanut butter crackers and M&M's restored me to a normal state, and I was able to continue.  

Once I had a mole removed by my family doctor, right before I started med school.  I passed out.  I woke up so embarrassed, especially having just excitedly told him about my new adventure.  He told me a story that made me feel much better.  "It's an evolutionary behavior.  Soldiers that passed out on the battlefield were assumed dead, and passed over.  When the battle was over they woke up and lived.  You should not be ashamed."  True or no, that was one of the best things I could have heard.  Made me proud to faint, ha ha.  And put my head in a better state around it.

Good luck, R -  Keep me posted when you get there.

Best, Giz


The Red Humor said...

I also have/had a fainting problem. My worst trigger is childbirth. I became light headed as a pre-med while shadowing a FP and completely fainted as a medical student just after "participating" (ie holding the leg) in my first childbirth. Humiliating. I saw the new daddy the next morning in the parking lot - he yelled "ARE YOU OK?" from across the lot. Oh wow. I fainted after I thought I had just seen my husband die (long story) and again when I was working in a rat lab adn had to cut the eyes out of a rat I had just killed. Nasty stuff. The worst part for me is that once the cold sweats start and my vision gets blurry, there isn't a lot I can do about it. I am going to go down. Once I was smart about it (again another childbirth when I was an MSIII), left the situation and sat on a low stool with my head between my legs. I didn't faint.

But I am totally fine in my normal capacity as an MD. Seen some horrible trauma, big surgeries, etc. I do procedures (minor compared to surgeyr or childbirth) without blinking an eye. And, to be clear, by the end of my OB rotation I was doing fine - I made sure to eat even when I wasn't hungry. I was also told once to avoid locking your knees for long periods of time while you are standing. I Have no idea if it actually works, but I am always sure to bend my knees a little when I am worried about my reacting to a situation. It might jsut serve as a distraction (bouncing up and down that is), but it works for me.

But man oh man that is a horrible feeling.

Gizabeth Shyder said...

I think that is a great suggestion I forgot about - I have heard that before too, so there must be something to it.

LOL about the new daddy. Love that he was worried about you. I guarantee they tell that story all the time and the no longer new baby has probably already heard it too. Your embarrassing incident became an endearing part of one of the most important days of their life.

It is frustrating to become the patient when there is an actual patient in the room that needs to be focused on. That's why I worked so hard to prevent it, and like you, 99.9% of the time it worked.