My Advice To Medical Students (And Any Related People); Wisdom From The Past

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It has been a month since I have written anything. Exams, works and social commitment; I felt overwhelmed for the past couple of weeks but now, I've got the hang of it. Today, I'm not going to talk about some complicated medical stuff but rather a topic pertaining to medical students. Is it true that medical student is basically a ghost in a hospital hierarchy?. For those who are now doctors, surgeons and medical lecturers, I'm sure 5 to 20 years ago, you are a medical student yourself; I know I am and 1 year ago, I have graduated from being a ghost, crossing through the dimensional barrier and finally, a houseman which is equivalent to a foot soldier. It is written in the paper that my shift would start at 7 am and ended at 5 pm but in reality, I came at 5 am and return home from work at 10 pm; that's the earliest by the way. The reality is, being a doctor is not as brutal or as cool or as what we thought of when we were watching all sort of medical dramas in the television. It's a good way to acquire inspiration and motivation but not a good way if you were seeking validation and trying to prove that the world should work as what you or any people have envisioned.

Being involved in this world for almost 7 years (I counted my medical student's years as an experience as well), I knew one or two regarding how messy this world can be. Being scolded, extended or blackmailed is equivalent to breakfast, lunch or dinner on a daily basis; the difference is we anticipate the latter but not the former. Regardless, both provide us with a different kind of strength, eating your foods every day provide you with necessary building blocks to get stronger while being scolded and all the stuff I have mentioned above, provide your perspective, experience and knowledge. Some people mentioned that if you committed a mistake and being scolded for it, you will never forget it as our brains are primed to remember things which are associated with emotions. Embarrassment, frustration, disappointment; all are necessary ingredients for us to succeed in the medical field.

Arrogance With Respect To Clinical Achievement

Everyone is susceptible to arrogance. We are easily tempted by all the luxuries and perks being offered to us and somehow, once we got them, we forgot where we came from. I remembered one of my lecturer's advice when he tried to console us after being scolded, mocked and probably got physicals by other specialists:

Those who did that to you forgot that they were once medical students who are helpless, clueless and just tried to learn like all of you right now.

It serves as an important piece of information in my brain to always treat everyone as best as I could and never forget where I came from. People were often proud especially when they achieved something that can be considered a world-class achievement. Have you ever heard the name, Edward Jenner? For those who are not familiar with the name, he was the one who discovered that we can lower the morbidity and mortality of smallpox, a vicious disease in the 1800s which have killed 60 million people (one in ten deaths in Europe). People were clueless as they can't figure out how to treat people who experience symptoms that cause disfigurement. It started as a small blister and proceed to destroy the integrity of the place it develops. It will later spread, cause a variety of symptoms i.e. fever, blindness and eventually death between 10 to 16 days. Fortunately, not all people who were infected died from this disease; smallpox kills 50% of people who are infected. Those who recovered are immune from the disease and of course, physicians are curious regarding this fact. Does Edward Jenner come into the light to save humanity from smallpox? No.

The first attempt to find a cure came from a procedure which has been practised in Turkey for a thousand years called inoculation. Basically, we introduced some aspects of the pathological agent into people to activate their immune response and since they were contracted to a much-weakened virus, disfigurements were avoided in the majority of cases. Pus or any fluid came out from the infected person would be inoculated to healthy people to force their immune system to familiarise themselves with the threat. It's like vaccination, only it is not, because the word vaccination came from a Latin word "Vacca" which meant "cow". Nowadays, the word vaccination has been used to describe every kind of medical procedure which proposed the same mechanics and principles. Although inoculation of pus from infected patients to a healthy individual seems to work, in approximately 2 to 3% of people who underwent the treatment progressed to the full form of the disease. This put everyone around them who were not immune susceptible to get infected thus the possibility of multiple foci of epidemics across the globe. People were reluctant to get inoculated as it is like giving yourself to the disease.

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This is when Edward Jenner came into the light. A few years after the conclusion that inoculation is a bad idea, an English country doctor, Edward Jenner presented his first paper pertaining to the subject to the Royal Society regarding a potential preventative measure that can be taken by the public to ensure their immunity against the smallpox disease. This is based on an observation that milkmaids in the Gloucestershire are immune to smallpox. Throughout their career, they were infected just by working close to cows by a strain of cowpox. Unlike smallpox, cowpox doesn't cause serious illnesses in humans. To prove this hypothesis, he conducted a personal experiment by using an eight-year-old boy as a subject. He took some pus from an infected cow's pustule and injected it into the boy; eventually, the boy got sick but only mild. After the boy recovered, he tried to infect the boy by inoculating pus from infected humans but just like what happened with all of the milkmaids, the infection won't take place. He thus called the procedure vaccination and presented his paper to the Royal Society which was rejected almost immediately. This can be due to a few reasons:

• Ethical consideration, since infecting people with an animal's disease was kind of frown upon
• The number of subjects involved in his experiment is insignificant to suggest cowpox virus as an effective treatment

Regardless, he keeps on conducting a few more experiments to produce results so that the medical society would take his suggestions seriously and eventually he did. Compared to the other people who invented a cure, Edward Jenner is considered one of the medical doctors who saved millions of lives. He received a lot of commendations and awards for his work and successfully reduced the mortality rate related to cowpox from 16% to 1%. It's brilliant and impressive but later when he wanted to further his study at one of the most prestigious medical school in the country, he was rejected on account that he didn't take any qualification test to enter but Edward Jenner thought that the achievement of saving millions of lives as a viable resume. Can you see what kind of point I wanted to make here? Even with the most prestigious award at our disposal, we should, at all time, remain modest so that we can achieve what we truly want to achieve. Edward Jenner was never admitted into the Royal College of Physician as he was deemed unworthy even with all of the achievement until he took the qualification test. It's not easy to avoid arrogance. Sometimes, it came at the most unexpected time. We will not realise why are we behaving like that, of course sometimes, confidence is important but too much of it will result in unexpected consequences.

By the way, I'm not saying that Edward Jenner is arrogant for assuming he was worthy since he discovered a solution to the global problem. I was trying to say that no matter how good things turn for us, we must stay humble and modest.

How Far Would You Fight For Your Patient?

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In medical schools, we are taught to present our argument in a certain way depending on the lecturer which conducted the session. There are a few kinds of lecturers, some like to be challenged while others don't. Regardless, when you were a doctor, it is important to have the skill to argue with your colleague and others. You can't argue with your consultant like how you have been arguing with your colleague vice versa but the most important question is, how far would you go to fight for your patient if you knew that the kind of medicine that we are practising right now can endanger the life of your patient. Courage and determination are two qualities which are lacking among us nowadays. Back in the 1840s, Obstetrics took a huge hit of an increased mortality rate among patients due to an infection of the uterus after childbirth known simply as the puerperal fever or childbed fever. During that time, Obstetrics clinic can be divided into two, one which was run by midwives and another one which was run by medical students. The decision to be admitted to either of those clinics would be determined by the availability of beds or workers and due to the fact that childbirths are conducted every single day, people often lack the option to choose which clinic they will be admitted into.

The mortality rate for each clinic is significantly different; midwives clinic imposed a far minimal risk of maternal mortality rate as opposed to medical students clinics which imposed a 15% risk of maternal morbidity and mortality rate from puerperal fever. People were scared when they knew they will be admitted into the medical student's clinic, some beg the authority for them to be admitted into the midwives clinic and some like to explore other options like homebirth etc. In the midst of the uproar, Ignaz Semmelweis was particularly interested in the phenomenon that took place. Semmelweis is a physician which has been working in the maternity ward and since this finding is kinda interesting, he started his own quest of finding out why both clinics imposed a different risk of maternal mortality. He inspected the clinics, the instruments and all of the available facilities but the only things that differentiate between those two clinics are the people that they employed. After a few years of having no clue at all why this thing happen, one of Semmelweis's friend named Jakob died of a condition which presented almost similar to puerperal fever after accidentally cut himself with the autopsy knife. Back then, a single autopsy knife was used for a few cadavers without being washed. Although it is unfortunate, it is actually a breakthrough as Semmelweis finally has some clue regarding why the risk of contracting puerperal fever was high in the medical student's clinic.

Medical students have their own routines and for some, they would be in the cadavers room, doing an autopsy before working in the maternal clinic. This makes sense since none of the midwives would perform an autopsy on the cadaver so Semmelweis made a new rule.

All First Clinic physicians must wash their hands with chlorinated lime or calcium hypochlorite, similar to common household bleach, to rid themselves of “cadaverous particles"

From the instruction, we knew that they were using the same instrument to perform autopsy and childbirth so it is reasonable to assume that expectant mothers were contaminated by microorganisms which present as result of the autopsy activity. How about the result? The infection rate in the medical students' clinic dropped almost immediately to those of the midwives clinic level so, in part, the hypothesis was indeed true. However, even with the evidence, Semmelweis failed to convince the medical board that hand washing can be the perfect solution to all of this mess. This can be due to:

• The majority of people believe that sickness originated and caused by the imbalance of four elements and each patient exhibit a different kind of deficiencies thus by simply practising hand washing can't be the reason why this problem was solved.
• This is the time when people aren't aware regarding the existence of microorganisms so the notion of diseases being carried by hands is ridiculous. Diseases were thought to be spread by miasma or bad air.
• Suggesting medical doctors to practice "hand washing" before and after attending to a patient is like accusing them as the reason why puerperal fever was caused (it's true actually). The majority of the medical community were offended by this suggestion.

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As a result, Semmelweis was criticized by the public as an irresponsible doctor and he can no longer practice medicine in the Vienna. After being banished by the medical community of Vienna, he moved to Budapest and worked at a small maternity hospital in the St. Rochus Hospital. When he arrived, the condition was dire, puerperal fever was out of control and by instituting the policy he suggested in his previous workplace, he successfully reduced the maternal mortality rate to less than 1%. Despite all of the achievement and medical breakthrough he had proved, the medical board still turn a blind eye to the result produced by Semmelweis. Can you imagine, you have the solution to the current problem but because of the different opinion held by the authority, you are dismissed from a possible breakthrough that could have saved millions of lives. Eventually, Semmelweis experienced a nervous breakdown and he was admitted to a lunatic asylum. Living in a lunatic asylum if beyond what people can imagine, Semmelweis died 2 weeks later after being severely beaten by asylum's guard. He died of a condition relatively similar to the puerperal fever.

Semmelweis experienced a different kind of situation when compared to Edward Jenner. Both of them made a significant contribution in the 1800s but they received a different response to their suggestion. Frustration, anger and depression; all drove Semmelweis mad and eventually he met his own demise. His death was ignored and sadly, no one attended his funeral. He willingly went all the way through to fight for his belief and for all of the mothers out there, no matter the consequence. Will you be able to do that? Fight for what you believe in? Nevertheless, a year after the death of Semmelweis, Louis Pasteur confirmed the existence of microorganism thus supporting whatever has been suggested by Semmelweis and to make thing even more awesome, an English surgeon, Joseph Lister operated on his patient by using the anti-septic technique. He produced a satisfying result which forced the medical board to recognised Semmelweis achievement and he was regarded as the pioneer of antiseptic medicine.

Just Push Your Way Through Your Own Success

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Everyone has a different idea of being successful. Some may be considered as too much and some might be insignificant, but that's not the case for them. The most important thing is to recognise your own ability and strength before you can prove it to others that you are capable of being a doctor. Semmelweis and Jenner, both are great physicians and both are successful. They experienced two different situations but both are for the betterment of the human race. Sometimes, we are afflicted by our own weaknesses but that doesn't mean we are going to drown, just swim to the surface and breath. You will be able to achieve anything if you are calm and determine.

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p/s: One of my friends (@thinkingabout) has started blogging two days ago on this platform. It will be great if all of you can support him as well. He didn't have sufficient RC to reply but he would appreciate your comment regarding his article.

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Source

• Edward Jenner and the history of smallpox and vaccination
• The Doctor Who Championed Hand-Washing And Briefly Saved Lives
• Publish Or Perish; The Sad Genius Of Ignaz Semmelweis

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