Tuesday, February 27, 2007

The Hunter becomes the Hunted

In the giant metaphorical food chain of hospital life, we medical students are somewhere pretty damn close to the bottom. Like gazelle on the savannah we tiptoe around in sensible, safe packs, making it much more difficult for any one animal to get picked off by a predatory lion (consultant, sister, hell, even the bloody librarian). Woe betide the straggler, the weak, lame beast that falls behind, because they are lost to the wilderness of trying to get a straight answer out of anybody, trying to find that one convenient second in which to ask someone what there is to do.
When face to face with a more superior mammal, the survival techniques are learnt quickly. Avoiding eye contact when posed with a difficult question. Walking at the back of the pack during rounds, anticipating the obvious thunderbolt of cringing embarrassment when the consultant actually tries to be friendly with the patient.
Camouflage is by no means useless either- carefully positioned stethoscopes and ID badges, plus an air of confident business can easily lead to us being mistaken for junior doctors, an infinitely more respected bunch. As long as you say that the patient in question is not under your care then you'll be untouchable as far as abuse goes.
But maybe the gazelle is not such an appropriate simile- we do have some aggressive characteristics. I admit, it takes a large herd of us, and a fair bit of irritation, but we can bite back. Take today for instance, when a group of 12 of us were being taught by an SpR about the intricacies of the clotting cascade, in which approximately 15 factors get activated, inhibited and promoted by eachother. After ten minutes the diagram had more arrows in it than Robin Hood's practice tree. Not the simplest topic to teach, but when you stumble over your own diagram, lose the thread of the questions and then respond to a perfectly reasonable question about physiology with "that's just nature's way of doing it", then you're dangling a very bitter carrot that might just get bitten off. The poor SpR didn't stand a chance. Bless him, but he didn't quite have the intense theoretical knowledge you need to hold off the barrage of endless curious questions we ask, and the chinks in his armour cracked wider and wider as we rephrased the same questions over and over, finally giving up, stating that "it would be too boring" to keep asking the same unanswered question. We laughed when he couldn't find the relevant section on the picture he'd drawn two minutes ago. We sighed audibly when he couldn't tell us precisely which factors inhibited precisely which other factors in every possible scenario of disease. We closed in for the kill and shared the flesh out in gruesome chunks. All the pent up stress of being preyed upon day after day comes pouring out, and whether you think it's caused by deeply laid cynicism, bruised egos or a desire for mutual respect, sometimes these gazelle grow some claws. We know we're pretty average as status goes, but we're snapping at heels, and we like the thrill of the chase.

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