Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.

HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Hi, dear wayfaringmd! I really love your blog and attitude! 

I have a question about the really hardcore blood and gore stuff, how do you cope? Isn’t the feeling of seeing all that surreal, weird? How do yo cope? How do you come back to reality? Is there really switch that you can turn on or off (emotionally, I guess).

I know you just get used to it all, but how was it at first? Are mostly all the med students just ignorant of all that stuff or what? Thanks! You’re a really cool inspiration.

— dartadarta

Ok, before I answer the questions, let me say that you’ve hit on a pet peeve of mine. Many of the Tumblr Spotlight “medicine” blogs are nothing but gory pictures (which I tried to change with my little campaign, to no avail). It bothers me because SO much of medicine has nothing to do with guts and gore. The “hardcore” stuff is the 1%, and the other 99% is pretty tame. It is a rare occasion indeed when you see someone walk in the ER with a lead pipe sticking out of their check or a knife sticking out of their head. Only a few specialties deal with gore on a semi- frequent basis, and these blood and guts blogs grossly (see what I did there?) misrepresent medicine.  

In medical school, I really didn’t see that much gore. Sure, if you do an ER or trauma rotation you might see some nasty stuff, but most of the injuries I saw on trauma looked much scarier on CT than to the naked eye. Most of the stab or gunshot victims I saw had mostly clotted their wounds and weren’t pouring blood.  If you’re lucky on trauma, you’ll see someone crack a chest and do a cardiac massage. That’s pretty wild. 

You see guts on surgery, of course, but it’s not what the internet and tv portray it to be. There’s very rarely blood everywhere (and if there is, something probably went wrong). Surgical fields are kept pretty dry, so mostly you just see the pink flesh color of internal organs. 

The nastiest things I saw in medical school were:

  • An autopsy on a green, smelly, 3-days dead drug abuser
  • A man who was dying as a result of extreme untreated hidradenitis suppurativa and had Fournier’s gangrene
  • A 10-cm deep infected surgical incision
  • A homeless man with a necrotic leg covered in maggots
  • poop vomit

So after all those qualifiers, now I can answer your question. 

If you do encounter a gory situation, you have to realize that your emotions do not help that patient. You have to be calm and level headed so they can get treated as quickly and efficiently as possible. On my trauma rotation, the med student’s job was to be the recorder. People would yell out vitals, exam findings, identifiers, etc, and you had to listen for them and record them. It doesn’t sound stressful, but it is very fast paced and can be a little nerve wracking. 

But in that situation you just have to put aside your freaked-outedness and just do the work. Once the patient is stable, you can go in a broom closet and cry/throw up/pee your pants if you need to, but not before. Pretty much, yeah, you have to find your emotional on/off switch. 

As for coming back to reality, you don’t. All that fast paced, gory, surreal stuff IS reality. People accidentally get their fingers caught in chainsaws. They get thrown from cars and end up with their femurs sticking out of their thighs. They survive shotgun blasts to the face (really). That’s reality. By the time you reach the point in your training where you’re exposed to gory stuff, you’ve been slowly de-sensitized already. You see little things along the way that gross you out until you get to a point where you can handle them and the really nasty stuff doesn’t seem quite so nasty. 

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  4. izdawiz32 reblogged this from wayfaringmd and added:
    Love it!
  5. arrhythmiaa said: Exactly! I much prefer to follow those blogs that deal with day to day trials of being in this profession.
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  12. kvnwng said: Not to mention that surgery today is becoming more and more endoscopic and/or laparoscopic so you don’t need to fully crack open someone.
  13. rubywasnothere reblogged this from cranquis
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  15. cranquis reblogged this from wayfaringmd and added:
    Great post, and quite accurate about the reasons why doctors turn off their emotions in the face of gore and carnage....
  16. ninjatengu said: A.men. To your little schpiel about tumblr medicine spotlight, and your thoughts on gore in medicine/med school!
  17. wayfaringmd posted this