- What's up guys, it's time
for another Reddit thread. I scour the internet,
you know what I found? "Nurse and doctors of Reddit, "what is your they never
taught this in school moment?" (drum roll) (upbeat music)
(electricity buzzing) The first thing that pops into my head is actually something
very meaningful to me that I'm gonna be doing a whole campaign around in the coming months. It's about the fact that we,
as doctors in medical school, were not properly trained to take care of those with disabilities. As doctors we're trained
with simulated patients on pelvic, prostate
exams, running code blues, difficult interactions, but not with patients who
may be blind, may be deaf, these are important things that we need to learn as medical students. Like when I had my first patient
who happened to be blind. I didn't know the proper etiquette. I didn't know if I should show
them the way to their seat. I didn't know if I should tell them what I'm doing before I do it. We need more education,
we need to step up there. Come on medical schools, pay attention. All right, let's get
to this Reddit thread. "A patient being treated
for HIV purposefully tried "exposing staff members to his fluids. "That was a sobering experience." I think that could be considered a crime. I think that police would get involved in a situation like that. Interestingly enough, in the hospital, if you are performing, let's say, a procedure like an injection and you accidentally give
yourself a needle stick, you have to test yourself
and start taking prophylactic medication to try and decrease
the likelihood of exposure. But first thing you have
to do if you get any kind of injury like that with a
needle stick or a scalpel is wash, wash, wash your
hands with soap and water. That decreases the rate of transmission of a lot of infections. Most people don't think about that. They could cut themselves,
they start covering it to make it stop bleeding,
but you gotta wash it. You gotta wash it out as best as you can and as fast as possible. "Took care of a young man with
a GSW wound to the abdomen. "He had many complications. "He was in the hospital for over a year. "He had an ostomy bag for a while, "but when they finally
removed it he was so nervous "because he hasn't pooped in so long. "His call light goes off and he says, "'Go look in the toilet, "'you're never going to believe this!' "I go in there and there
is poop in the toilet, "his first solid poop I
had seen in over a year. "I walked out and gave
him the biggest hug. "He was so proud of his poop. "I walked out of his room
with tears in my eyes. "Nursing school never prepared me "for crying outside a patient's room "because I was so happy they had pooped." (laughing) That's when of the most
heartwarming stories I've ever heard. So when you have any kind
of injury to the intestines, let's say through an
infection with a perforation meaning that the intestine
actually ruptures or a stab wound, gunshot
wound, what have you, a lot of times what you have
to do is create an ostomy, which is an opening in the abdominal wall where you have a little baggie, and your poop essentially
collects in that area. And you have to constantly
open it and drain that bag. Not it's not very
comfortable, but the goal is, usually to have this as a temporary site, where then you go in
and do a second surgery and reconnect and have the
patient start pooping again. This is a very tedious
process, nerveracking process, and you have to really wait and hope that the poop goes well. The fact that this happened, the patient was very happy about it, this nurse had to experience
this, I mean, this is awesome! It's like feel good... Feel good fairy dust all over it. "When my mum was fresh out
of nursing school in the 80s, "she got a job at the hospital
that had a high concentration "of geriatric patients,"
AKA elderly patients. "One particularly frail man took out "his dentures before sleeping, "then passed away in the
night during her shift. "His cheeks were so alarmingly sunken in, "my mum and another nurse
tried to put them back in "as to not horrify the family. "However, rigor mortis had
already started to set in. "She said nursing school definitely didn't "prep her for that nightmare." I could see that being difficult. God, there's so many
different things that happen when the patient passes, that
you have to be so respectful, and you're not ready for. Part of what you have to do as a resident, especially as an intern, is to do something called pronouncements. It's when a person
passes you have to go in and do the time of death. You listen to heart sounds, lung sounds, you check a few reflexes. And you have to certify that
the patient actually did pass, notify next of kin, the doctor,
start the death certificate, all these procedural steps you have to do. No one can prep you for that. In fact, the majority of
these death pronouncements are done on patients
who are on hospice care, so that you know that
they were gonna pass, at least the family is ready
for it, it's still never easy. It's probably one of
the most difficult parts about being an intern. You're just not ready to
have these conversations, but also just having so many of them. "Women will pee and poop during labor." It absolutely happens. "Ribs crack during CPR,
and it feels really weird." Yes, you have to understand, the person that you're doing
CPR on is technically not alive and you're trying to bring them back. A broken rib is worth
bringing someone back to life. "Student nurse here, how
to hide the looks of shock "when something very
surprising or awkward occurs. "I remember one time a
doctor grabbed me when I was "in the hall it hold something
for him when he was putting "a patient's prolapsed
rectum back in, awkward." You know what, that is actually tough. And in the last Responding
to Comments video, someone mentioned like, "How am I a doctor with a gag reflex?" it's tough, look, just
because we're doctors doesn't mean we're not human. You try and be respectful as possible, and you become more
attuned to these things as you have more experience, but early on, if something happens and you
inappropriately respond to it, own up to it. Patients appreciate that. Look, they're humans too, they
understand what's going on. But if you truly care for someone and you're not just faking
it, it's gonna show, whether you laugh at something
inappropriate or not. "All those things you
encourage your patients to do, "eat well, exercise, get enough
sleep, also apply to you. "I know too many nurses who
don't take care of themselves "mentally, physically, or emotionally "in a very draining environment. "Self care is incredibly
important and sometimes "we'll lose sight of ourselves "in trying to take care of others, "but we're of no use to anyone "if we're running ourselves ragged." This is so true. Doctors, nurses, physical
therapists, pharmacists, we need to take care of ourselves. We need to make sure that if
we're gonna teach patients about how they should live their lives, we should do that for ourselves as well. Even for myself with this channel, I tell you guys that you should get seven to nine hours of sleep. When I get less, I feel like I'm not being honest or genuine with you guys. So I'm trying to become more cognizant and take care of myself
so that I can inspire you to make those same changes. And if I can do it with
a crazy hectic schedule, bouncing around all over the place, I want you to know that you can do it too. And if we slip up every now and then, it doesn't mean anything bad. It's about getting back up on that horse. "That you will get yelled
at by a doctor, patient, "fellow nurse, charge nurse, et cetera, "for something what was not your fault. "The first time I was yelled
at about not calling in "a morning lab that
wasn't a critical result, "it was hard not to take it personally "and I did need a minute to recover. "Since then, I take criticism better, "but sometimes we all yell, "especially in high-stress situations." This happens, this absolutely happens. Hospitals are high-stress, not only high-stress in the moments where it's like you need to
think quickly like a code blue, but also when you've
been up for 24, 36 hours, you're not the nicest person. So have I seen doctors
say mean things to nurses? Absolutely, do they regret them
and work it out afterwards? Absolutely. It's really important
that you also let things roll off the shoulder a little bit, do a little Floyd
Mayweather shoulder roll, because otherwise it's very
easy to choose to get offended by something and lose
focus of the greater goal, which is to become better every single day as a medical professional and
to be a better person overall. "I'm a psych nurse in a
mental hospital, 90% of my job "is 'They never taught me
this in school,' moment." I get that, you can't prepare for psych. There's just too many unknown variables. What you have to do is
know how to stay safe in all types of scenarios
because it's very easy to have things get out of hand. But once you know that, you can then adapt and learn
from your own experiences. There's been plenty of times
I've been on the psych ward and patients approach me
and I think it's someone, a family member, asking for help, when in reality it's a patient
having a full conversation as if they knew me from day one. It happens. "Being comfortable with uncertainty. "In the beginning being
unsure of a diagnosis or treatment plan seems like "a personal failure of knowledge. "This leads to over-testing,
over-treatment, "all to fill an overwhelming
sense of missing something. "Over the years, I have
come to realize that most "of the time there isn't one
right answer or approach." I wanna upload this comment. This is a really good comment here. This is someone who's
actually practiced medicine and knows what's up. A lot of time patients
come to us for answers and we feel like we need to please them by telling them that we know
or we will figure it out. And most of the time we can figure it out or a least have some steps
towards figuring it out, but the most honest thing we can say is, "Here's what we can do
to try and figure out, "but we can't promise to have an answer." So if a patient comes to me
and they have all the signs and symptoms of a common
cold, mild fever, runny nose, clear rhinorrhea, which
means clear mucous, maybe a mild sore throat, or mild cough, I can tell them that I think
they have a common cold. Am I 100% sure? No. Do I even know what upper
respiratory virus they have? No, could it be something
much worse than that? Absolutely, but what we
do in medicine is we pick the condition, not pick, that
sounds kind of arbitrary, we decide based on the
history presentation, the physical exam, maybe
the tests that we order, what we think is going
on to be most likely. We rule out the things that can hurt you right now in the given moment, and then we say that's
what we think is going on, and we work off that. Now that's called a
differential diagnosis. You name a list of things
that you think are going on with the top one being most probable, and you work out to figure
out which one is most likely. And maybe you start
treating the first one, if the treatment is not so harmful, or you're very confident
in your diagnosis, and you work from there. But will you have the
answer every single time? Absolutely not. Will you make a mistake? Absolutely. There's been countless number
of times a patient comes in with, you know, a mild abdominal
pain, a little belly pain, that I say, "You know what,
it's only been a few hours, "we found this incidentally,
let's see what happens." Next day they come in with
full-blown appendicitis. Did I miss it? No, I can't assume everyone with a little bellyache has appendicitis, especially if it's not presenting
in the most typical way. So we label it abdominal
pain and then when it becomes appendicitis, then we
have a proper diagnosis. It's very tricky. Medicine is one of those
fields you have to be very comfortable with being uncomfortable. "No one quite prepares you for
the first time someone says, "'Great, the doctor's
here, what should we do?' "The first time you have real
responsibility and authority "after graduating medical
school is terrifying." This is absolutely true. You go from one day to
being just a med student who's there to learn
and just ask questions to the next day, nothing changed, just overnight a few hours went by and now you're coming in
as an intern, as a doctor, where people are gonna ask you questions. It's quite scary. I remember my first day. I asked a lot of questions
of my senior residents, simply because I didn't
wanna make a mistake. The nurse pages me about a patient having high blood pressure after surgery, I call the senior residents, I'm like, "Look, I know what the options are, "but how do you know
which ones you choose?" And they said, "Well,
which one do you think?" And we went from there
talking about the differences between the medications. But unless you have someone
who's capable of answering those questions for you and
guiding you along the way, it's very hard. That's why I recommend all students to speak up during clinicals, to ask questions so that
they can make their mistakes when there's no lives on the line, because when you're a doctor, whew, those mistakes count and cost a lot more. Taking on Reddit is fun and all, but have you ever seen
me take on Doctor Google? Click here for that playlist. We'll watch it together as
we stay happy and healthy. (upbeat music)
