EPUB Ebooks: Free ebook sample of "The Unfeeling Doctor, Unplugged: More True Tales From Med School and Beyond" by Melissa Yuan-Innes (powered by Smashwords)

This collection is called unplugged for a few reasons. Not only is "unplugged" a fun '90s musical reference, but dictionary.com also defines it as "to remove an obstruction from."

No, this is not a gross gastroenterology joke, although I can do those, too. You, the readers of my first Unfeeling Doctor book, have helped me remove an obstruction, namely, any of my lingering doubts about indie publishing. Thank you so much for (temporarily) driving The Most Unfeeling Doctor in the World into the top 0.15 percent of Kindle sales.

In this tidal wave of all-new, all-original essays about life in the medical lane, you'll encounter more clueless medical students (me), more cheap doctors (me), and more doctors trying to hold the emergency room together for just one more shift (hey, that's me again).

Join me?

Part I: Saving the Cat (Tales Out of Med School)

Was I always such a hard-hearted lass? Of course not. I offer you some counter-examples from medical school, when I was a likeable young neophyte.

Screenwriters advise you to have the protagonist "save the cat" (rescue a cat, a child, or something else with big eyes) at the beginning of the movie in order to make the audience root for the hero. And I was one of most wide-eyed innocents around back then. Like, I could've been a stand-in for E.T.

See for yourself.

I Am But an Egg (Family Medicine)

For the first week of med school at the University of Western Ontario, I cruised. I was meeting people. I was going to classes. Everything would be all right.

Then it hit me. Every day, I spent 7.5 hours in class. That was nearly forty hours of solid info dumps per week, a full-time job's worth of information, that I now needed to learn and understand in my "off" hours.

That "free time" included visiting the anatomy labs. We practiced examining each other's bodies. Plus all the anatomy, physiology, histology, biochem, etc. etc., that we could cram in.

Not to mention eating and sleeping.

Sometimes, it would overwhelm me. I needed a break. I would come home and procrastinate, then study frantically until midnight. Instead of falling asleep right away, I'd lie awake, reciting what I'd learned, my heart racing as I realized all the things I'd already forgotten, so I'd get up and study some more.

I called my boyfriend, Matt, who was two hours away, and told him, "I don't know if I can do this."

"Oh," he said. "Does that mean you're not going to support me?"

"Yes. In fact, you might have to support me!"

We laughed. Then I hit the books one more time.

One of my classmates confessed that he hadn't studied one night. A woman leaned forward and said, "You didn't? You're going to die."

I didn't think she was joking.

I wanted to make friends with another woman in my class, but she told me that she didn't have time. "We could study together. Or maybe work out once in a while. But I don't have time for another friend."

A few people had a more balanced approach. One woman studied three hours a night, no more and no less. When she was finished, she went on to enjoy the rest of her life. Another friend rewarded herself with "something fun" every night after studying, like making strawberry muffins. A third, who was one of the most down-to-earth people I met, made time for walks around town.

Still, I made time for an "elective," which was a few hours a week spent with a physician of my choice. I chose Dr. Maxine McKean, a family doctor whose clinic was within biking distance of the university.

Dr. McKean turned out to be a tall woman who peered at me from under heavy russet bangs. "So you're Vietnamese? A lot of my patients are Vietnamese."

"I'm not Vietnamese."

She frowned at me. "With a name like Nguyen?"

I laughed. Her secretary had understandably mistaken Yuan, pronounced YOU-n, for Nguyen. (Remember the correct pronunciation. There will be a test.)

Shadowing Dr. McKean was an eye-opening experience. First I saw a gorgeous, fifteen-year-old Vietnamese guy who was a Hepatitis B carrier. I'd never met anyone with Hepatitis B before.

"It's okay," Dr. McKean told the guy and his sister, rapid-fire. "He's not sick, but he should be careful if he has sex—he has to use a condom. Here, watch this video." She added to me, "Very useful, to have a video in their language."

Meanwhile, I was squirming inside at the idea of my sibling hearing that I should use a condom during sex.

Next, we saw a baby. "This is the anterior fontanelle," Dr. McKean said, pushing on the soft spot on the baby's head.

Obediently, I followed suit, but didn't feel anything. I felt like a dope, pressing on the baby's head, so I finally pretended, "Okay."

"Not there. There." She moved my fingers, and I was enchanted by the softness of the baby's head, covered in fuzzy black hair. It was so endearingly vulnerable.

In the next room, she quickly removed a wart from a boy's toe. "Sorry this is so boring," she said afterward.

"No," I protested, "this is great!"

She laughed at my awed face. "Oh, yeah, I forgot you were in first year. So you're like, 'Wow, warts!'"

"Definitely"

She let me take a man's blood pressure. This turned out to be more complicated than I'd realized. First, I had to wrap the armband above the elbow, with the right degree of tightness, and slip the stethoscope underneath it. Then I had to hold his arm at heart level, bracing it with one arm while pumping up the mercury with my other hand. "Tell me when you hear nothing," she instructed me.

I listened with all my heart, but I could still hear a few creaky noises, not "nothing," so I waited and waited.

The mercury ran down to zero.

"Uh oh," the man joked, "I don't have any blood pressure?"

Dr. McKean laughed and redid it herself. I was hugely embarrassed. Later, I learned to listen to where the heartbeat started and ended and ignore the creaks from the blood pressure cuff itself.

I was almost dizzy from being rushed from patient to patient, but it was child's play compared to Dr. McKean, who spent each spare moment either explaining things to me or rushing around returning calls.

I felt a bit uncomfortable that the doctor directed much more of her explanation to me than the patient. "Don't mind me! I know nothing! Your patient deserves your attention," I wrote in my diary.

Another woman, in her 50s, was there for her annual physical. I was embarrassed enough to see her breasts. Luckily, Dr. McKean didn't expect me to look into her vagina because, she said cheerfully, "She's had a hysterectomy. Not much to see." However, Dr. McKean did demonstrate how to warm the speculum and insert it, so I saw the woman's nether lips and felt mortified again.

I was also astonished to see yeast growing in the folds of skin the patient's belly, as well as underneath her breasts. With more experience, I learned that yeast was a common problem.

Dr. McKean showed me how to take blood from a young woman who was freaked out by all the tubes, and claimed she could hear the blood flowing out of her.

Another woman came with her two small children for an annual exam. She was a slim, pale woman with long hair who looked to be my age or even younger. The daughter howled when she wasn't being cosseted, and the son kept asking incoherently, "Mommy, you done?"

I was kind of suspicious when Dr. McKean proceeded to demonstrate, in great detail, how to draw blood. Sure enough, the doctor grabbed my clipboard and pen, placed them in the baby carrier, handed me the needle and tube, and said, "You do it."

I felt grossly underqualified, but one vein was obvious.

"You should feel a pop," Dr. McKean instructed.

There was no pop, but it felt no more wrong than right, so I pierced the vacuum tube with the other end of the butterfly needle. Beautiful, burgundy blood flowed.

"Perfect!" Dr. McKean crowed, taking over.

After two tubes, the vein collapsed, and she had to poke the patient twice more, "but it wasn't anything you did," the doctor assured me. "You had it right, and I lost it."

I averted my head slightly during the woman's pelvic exam. It seemed so private, especially when a note on the patient chart stated that she was a Christian fundamentalist.

"Come here," said Dr. McKean. "Do you see something that looks like a cervix?"

"Ah..." I couldn't see anything.

Dr. McKean adjusted the light, and then I did spot a pink bump with a little hole in the middle.

I moved away again, but overheard Dr. McKean saying, "You don't mind, do you?" and a faint "No" from the patient. Then the doctor called, "You still got your gloves on? Good. Come over here and feel her uterus."

If I were a cartoon character, I would have had "!!!" above my head at that moment. Still, nothing to do except obey. She squirted gel on my gloved fingers. My hand shook a little. I moved in position, between the patient's legs, but I was staring at my hand.

"Put two fingers in."

"Okay." But I just hovered. I stared at the patient's pubic area, which was almost hairless.

"Just push it right in. Two fingers. Straight in."

I did.

"Now move her cervix around."

I did, wincing in sympathy.

"Now put your other hand on her stomach. You should feel something moving around."

Wow! Something was moving. I could sense that there was an organ in there! I certainly couldn't tell it was more tilted to the right, like Dr. McKean could, but I felt like a genius.

At the same time, I thought, I can't believe my fingers are in a Christian fundamentalist's vagina.

I withdrew my hands and thanked the patient fervently.

One doctor told our class that if the average person did what a physician did, it would be called assault. Now I could see the truth in that.

Cheap Doctors, Unite! (Or Just Fight!)

"We should form a cheap doctors club," said one of my classmates.

"Uh, okay," I said. "Actually, I could use some advice. My parents bought me a case of yogurt drinks, but I opened one and it's moldy, even though it's not supposed to expire for two weeks. I'd bring it back to the giant box store at the south end of town, but I don't have a car."

She shrugged. "Just bring it back to the closest grocery store."

"But they didn't buy it there."

"Bring it back anyway. I do it all the time."

Readers will be astonished to hear that I did not do this, despite my legendary Scroogishness. Why? Because my cheapness gene got sidechecked by my ethics gene.

Still, I did plenty of cheap things in first year med school. First of all, I lived in a house with five other students. I noticed other med students were renting solo apartments or limiting their roommates, but this way, my rent was low, and I got to live in a big, sunny house.

Furthermore, in another wallet-saving move that helped the environment and was kind to animals, I rarely bought meat. Fake meat did the trick.

My two housemates from Alberta could not understand my vegetarian tendencies. They loved their beef.

“Ewww, veggie hot dogs! Why would you eat these?”

“They’re okay. They taste almost like beef.”

“Can I try some, Mel?”

“Sure.”

Bill took a bite and choked. “Oh, my God! That stuff is vile! It doesn’t taste like beef AT ALL! It’s HORRIBLE!”

“Well, once you put on the ketchup and stuff…”

“No way!”

“You mean, if I put all the dressings on and gave you a taste test—”

“I would be able to tell EVERY TIME! Man, that was disgusting! Hey, Ted…”

Ted took a healthy chew. "Oh, MAN! Was that ever raunchy! That was so bad! Hey, Simon..."

Simon thought it was gross, too, but it didn't offend him as much as it did the Albertans, who practically had an orgasm describing the horror of fake beef. It was like our own Fear Factor episode.

However, when it came to doctor accoutrements, my chequebook splayed wide open. An upper year told us all we needed was a stethoscope, but I foolishly bought everything, including my own ophthalmology set for $350. At least I didn't have to pay standardized patients $15 an hour, because my housemates were excited guinea pigs. Bill’s blue eyes were the best, so I spent quite a long time looking into his orbs.

“Oh, my God! The light! I’m blind!" But Bill and Ted kept coming back for more. To be fair, I’d take turns letting them look into my eyes, too.

Bill saw spots for days afterward. After I got some teaching on proper technique, I came home and laughed. “Bill, I’m sorry. We got a lesson on how to use these things, and I wasn’t supposed to have it on the brightest setting.”

He laughed, too.

He didn't laugh so hard when I forgot my Langman embryology textbook in the bathroom. Bill ran out screaming, "Mel left a book of deformed babies in the bathroom!"

When I told another med school friend about that later, she laughed. "Oh, no! I think that's the one they tell you not to show people outside of medicine!"

Even when they were yelling and fleeing, my housemates made me laugh. The whole group threw me a birthday party. Our house also once held a "no calorie Sunday" when we ate ice cream together.

But by the end of the year, we were all getting on each other's nerves and fighting over chores and toilet paper.

My parents loved buying toilet paper by the crate, from the aforementioned box store. They supplied TP for the first two or three months before I said that was enough and someone else ought to kick in. Which my housemates did, until June, when everyone simultaneously decided enough was enough.

The two downstairs people bought some strictly for the downstairs toilet. "This is our toilet paper. Just between us." Of course, this did not stop them from using the upstairs bathroom.

The upstairs group, of which I was one, had almost enough to last until my last exam. The key word is almost. It's like Mark Twain said, "The difference between the right word and the almost right word is the difference between lightning and a lightning bug."

I did what any sensible doctor-to-be paying usurious tuition rates would do. I swiped a roll from the university rest room.

Ah, ethics. Who needs 'em, anyway?

Language, Please

Not only did we have a ton of information to learn, but medicine had its own jargon, almost its own code. Anyone who watched the TV show ER, which I did occasionally, would have figured that out from the way they were always yelling stuff like "One milligram of epi, stat!" So another challenge was figuring out what on earth the doctors were saying, and then using the terms properly ourselves.

In high school, I thought that I ought to take Latin, learning the roots of words so that I could memorize the anatomy terms more easily. But I never managed to fit Latin into my schedule, what with all the science, math, music, and whatever else I was taking. I didn't know if it would have granted any significant advantage in medical school, but I do remember that during one radiology session, the resident asked, "Did any of you take Latin?"

Most of us shook our heads, but my friend held up her hand. "Yes, three years of it!"

"Really," the resident said dismissively. "I took four." Medicine was chock full of these little one-upmanship moments. Charming.

Latin or not, the medical language was so dense that for our first small group learning case, a fictional little boy with swelling of his legs and face, we underlined six foreign words in one paragraph, from auscultation to edema.

It turned out that ausculation meant listening with a stethoscope. Now, why couldn't they just say that? For edema, we reviewed the physiology until the cows came home, but it boiled down to swelling.

I was supremely glad that I'd bought a medical dictionary at a library book sale for 50 cents.

Even our university medical journal played the language game. They had a vocabulary section with ten medical words, a "test your knowledge" sort of thing. I put the journal down in disgust. The only word I recognized was micturation.

Slowly, the code came together. In anatomy, the professor was happy to explain that the chordae tendineae of the heart valves meant "little strings", which is exactly what they looked like. We learned that that medial means "toward the centre," so we now understood what it meant when we saw the word buried in, say, vastus medialus.

One guy proclaimed, "We're in the medial part of the classroom."

We laughed at him.

He insisted, "They say you're supposed to use it in everyday conversation, and then it'll come naturally!"

Slowly, more insidiously than I realized, not only my vocabulary, but my perception, was changing.

In third year med school, I was reading a book that Balaji, Matt's best friend, had raved about. One story mentioned a cultural myth that a golden stool would come down from the sky.

I frowned. What culture would want to imagine gold feces raining down?

I had to go back and reread it. They meant a little golden chair, of course.

I had to laugh at myself. I used to blush and mumble the word stool, and now I couldn't imagine any other interpretation!

Also in third year, Matt and I had trouble with our plumbing. When we washed dishes in our kitchen sink, water burbled backward in the pipes, occasionally making bubbles in the bathroom sink. "It's refluxing," I told Matt.

He shook his head and chuckled.

This was actually a great demonstration of reflux, because the water was flowing backwards instead of forwards. I was glad that I had a new vocabulary that expressed things precisely. On the other hand, I sometimes thought that if I wrote one more admission note that went the same way (65 y.o. [symbol for female], CC: SOB, PMHx: COPD, asthma, CHF, MI '92, LVEF 40%...), I would scream from all the acronyms.

One day, I cut open a green pepper for supper. Inside its smooth green surface lay a mass of twisted green fingers, reaching toward me. I jerked back. It reminded me of cancer.

"It's a fungating mass!" I exclaimed.

Matt, as usual, clucked his tongue and laughed.

"It is!" I insisted. "I don't feel like eating it!"

"Okay, then." He took over the pepper-chopping duty.

At the end of my four years of medical school, I happened to see a copy of the UWO Journal's vocabulary section. I rolled my eyes. It was too easy.

I wasn't the only one who noticed that more than our vocabulary changed. I talked to a rehabilitation doctor once after our group presentations. She said, "You see these people, who are shy, who stumble over their words and aren't very confident? In a few years, you'll hardly recognize them."

She was right. She just forgot to mention that I might not recognize myself.

Anatomy, Baby

On the first day of anatomy class, the prof stripped down to his boxers to demonstrate human anatomy. I was impressed that he'd go to such lengths. It certainly grabbed our attention.

I'd already "met" my cadaver earlier. I'd walked up to the fourth floor, opened the anatomy room door, and walked through the sea of gurneys topped by white body bags. A teaching assistant was sitting in a small room at the back of the lab, listening to rock music. I bought a lab coat and scalpel set from him and asked if I could see my cadaver.

He checked my name on the list. "Sure, you're in group 39. Right over there." He pointed across the room.

Gingerly, I unzipped the body bag a little. I had never seen a dead body before. I had never dissected a frog or any other animal, since my high school science teacher argued against what he considered a waste of animals. I had also never attended a funeral before. So this was my first up close and personal view of a dead person.

In the diamond-shaped keyhole, I glimpsed flesh. But it was the strangest colour, a dingy, greyish beige with obvious pores. In all honesty, I couldn't decide what race this person must be, let alone age or if it was a man or woman.

It took me a minute to determine that it must be the person's back. But there was a cut down the middle of it! Why would there be an incision in the person's back, already brown and curling under?

I zipped him or her back up again and walked to the left-hand side of the room, which was lined with sinks. I washed my hands twice, then went to the bathroom in the hall and washed them again.

Before our first class in the anatomy lab, we watched a video on the muscles of the back. The room buzzed with whispers because our prof hadn't been wearing gloves when he touched the cadaver, a shock to our post-HIV sensibilities.

Even so, I nodded off somewhere past the trapezius. I was exhausted.

I woke up in time to traipse up the stairs to the anatomy lab. As I entered, the school chaplain asked me if I would do one of the readings. "Of course," I answered. "I would be honoured."

My reading was from the Koran. A few other students read, including from the Bible, but between my anticipation of my own reading, and my first dissection, I hardly heard their words.

At last, the moment of truth. There were six of us assigned to each cadaver. We unzipped the body bag.

Now that I could see her fully, and had sort of watched the video, I understood why she had an incision in her back. One of my anatomy mates, Rodney, made it clear. "One of the second-years worked over the summer, preparing the cadavers so that we wouldn't have to dissect for the first lesson."

"That was nice of them." I couldn't help noticing that our cadaver's buttocks were squashed flat, as if she'd been on her back most of the time. She had short, dark hair mixed with grey. Her whole skin was the off-white colour I'd noticed before, but, glancing around, all the cadavers were that same peculiar shade. They were probably Caucasian, then.

My anatomy mates started the lesson, opening the flaps of skin. "Look, here's the trapezius..."

I winced. I hadn't known that.

"Oh, the traps," Vivian said, gesturing like she was in the gym, working the muscle groups.

I hadn't known that, either. Obviously, I shouldn't have fallen asleep during the video. I felt terrible, but I did my best to learn off the others. Trapezius. Rhomboids. Levator scapulae.

I went home and studied twice as hard.

Vivian and Nicole were doing the first dissection, of the chest, and sometimes the rest of us would keep them company.

For this, the cadavers were now lying on their backs, and I got my first look at our cadaver's face. She looked to be a woman in her early 60's, her face not unattractive and not unkind. Her breasts were beautiful, full, with big nipples. It seemed too intimate, that I was seeing them. Her belly had been a big, old-person belly, but it had been squashed flat, like everything else, and thus rendered slimmer. I tried to avoid glancing lower, and got only a vague impression of relatively sparse pubic hair.

One day, Dr. Huang was walking by in his white coat. He paused and said abruptly to Nicole, "Wipe your mouth on my coat."

I stared at him like he was crazy, before looking at Nicole. A bead of white fat lay just above her upper lip. Cadaver fat. On her mouth.

Vivian whispered in her ear. Nicole understood, but wiped the fat off on her own sleeve. She said, in her usual composed voice, "Well, I guess this is something we'll all have to get used to."

Now, that is a mature student.

Rodney and I were immature students. The only way we could handle it was by chortling about it afterward.

Another student said, "Hmm. That's the closest you'd get to cannibalism, eh?"

Ew. I couldn't laugh at that.

I felt sullied for the rest of the day. I wanted to shower. I contemplated throwing up, to see if it would help with the nausea.

I went to aquafit aerobics, and the exhaustion helped block the feeling. And something clicked. I felt distanced from the experience. I remembered what had happened, but it didn't bother me as much. Thank goodness.

I knew that I was learning a great deal of anatomy. I owed an enormous debt to the woman who had willed us her body after her death.

But I also needed that detachment.

My First Real Dissection

For anatomy, we were paired up and assigned two systems to dissect. My partner was Owen, and we were dissecting the legs and the pelvis.

I thought that was a ripoff. Another pair got head and chest, clearly important, and the third pair got the upper limbs (which turned out to be more complicated than I'd dreamed) and the abdomen.

But we didn't get to choose our assignment, and it meant that the first time I dissected was in December, around Matt's birthday and just before the Christmas holidays.

To save money, our group had only bought one Grant's anatomy dissection manual between the six of us. When I arrived, it wasn't in the locker, and I hadn't read it the night before to prepare. Owen hadn't arrived, either.

I forged on. I unzipped the cadaver bag, holding my breath against the stench. I got a paper towel to cover her "bikini area", then looked at my neighbours for guidance. They were frighteningly good, expertly stripping the legs. I was afraid to lift my scalpel.

I called out to our passing professor, "Dr. Huang, I don't know where to start!"

"Why be afraid. Just start," he said, and kept walking.

If my partner had been there, at least we could have started together. "Owen was an anatomy T.A.," someone assured me. "He'll know what to do." But where the hell was he?

I located a dissection manual. Next, a fellow student, Raoul, took pity on me and started coaching me. Reluctantly, I began. I made an angled incision on her thigh, trying to avoid her pubic hair.

"You've got to push harder than that," Raoul said, "I can't even see where you did it."

I could see it, but barely. I pressed harder. I got over the first hump, which was the idea that I was going to hurt the cadaver somehow, that each cut was sacred and immutable. I soon learned that a lot of the superficial flesh is thrown out, leaving only the muscles and vessels of interest, so it didn't matter how I cut.

Then I ran into the second hurdle: fat.

Our culture is obsessed with fat. I considered myself relatively sane on that score (Matt would beg to differ), but that day, fat was the enemy. These margarine-yellow globules clung like the devil, obscuring everything of interest and making my hands too slick to hold the scalpel firmly.

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