After a 5 PM–1 AM shift at the ED a few weeks later, I saw a
guy punch a girl and knock her straight to the ground, literally right in front
of me. I attempted to gently help the girl to her feet. As I lifted her hand
from the ground, everything went black. I had absolutely no recollection of
what occurred after I lifted her hand. My friends told me afterward that the
assailant's accomplice seized me by the shoulders and slammed my body backward
and onto the concrete; my head smashed the ground like a watermelon.
I have a vague memory of going to bed but felt normal upon
waking. I had a mild headache, but I was able to eat breakfast, smile, and felt
surprisingly well. "Dude, we thought you were dead for a minute last
night," my friends said over and over in different ways. We laughed
together. Everything felt normal until around 4 PM, 16 hours after my head hit
the concrete. My headache worsened, I became nauseated, and began to vomit as
the world started spinning. I grabbed onto my friend, who noticed I was walking
erratically, and asked him to take me to the ED. Fortunately, it was the same
ED I worked at. The triage nurse knew me and sensed that something was off. I
was taken in immediately.
My vitals were stable. My mental state was not. I told them
my story like I was fine and survived it without injury. But I was obviously affected
and slurring my speech. The doctor noticed this right away. From what I've been
told—my memory of that day is still severely limited—a doctor who was familiar
with me walked into the room and heard me speak. He wasted no time and wheeled
my bed out of the room and personally pulled me into the CT scan. What did the
scan show?
It's just as you suspected, future doctor: a large brain
bleed. An epidural hematoma and a subdural hematoma, plus a subarachnoid
hemorrhage with a temporal bone fracture with, fortunately, minimal midline
shift. I had experienced what you learn about regarding an epidural hematoma in
medical school: the "lucid interval." My neurosurgeon told me that I
was less than 2 hours away from a coma or death. He performed an emergency craniotomy
and excavated the buildup of blood from the torn middle meningeal artery. The
official surgical document stated, "We opened up the cranium and the
middle meningeal artery was shooting profusely." The blood was drained to
relieve pressure on my brain. I awoke in the neuro ICU with a shunt in my head,
wondering what my life would become.
'You Will Not Make It in Medical School'
The next few days weren't easy. I remember that I couldn't
stand up on day 2 and needed the help of two nurses. Not being able to do
anything on my own for the first 3 days following surgery was discouraging. But
I knew that if I gave up right then and there and didn't go through therapy
without giving it my all, I would never be the same. By day 5, I was walking up
and down the stairs with only minimal assistance. I eventually passed all of
the neurologic exams. On day 6, I was discharged. I had multiple medical
appointments following this injury. Most of these appointments went
exceptionally well, and the physicians encouraged me to continue pursuing my
dream.
I canceled the rest of my interviews. I was stuck at home
with terrible headaches. Going through that with physical therapy, occupational
therapy, and speech therapy was just too much to continue. I committed to Lincoln
Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) at this
time because I knew, even amidst the agonizing headaches, dizziness, and
routine struggles, that I could complete medical school.
All of this testing and work aimed at ensuring that I
remained the same person continued for several months. In May 2014,
approximately 3 months before starting medical school, I felt that I was back
to normal. I had an appointment scheduled with a neuropsychologist who was to
clear me to resume normal activities. This man, with a PhD and MD in
neuropsychology, didn't try to sugarcoat anything. He told me quite directly:
"You will not make it in medical school. You're too slow at recalling
objects, and your short-term memory is poor. You have trouble with spatial
organization as well." As I left his office, I told this doctor that I was
grateful for his time and appreciated his assessment. I then told him that I'd
send him a copy of my diploma when I graduated from med school. And on to
medical school I went.
No Time to Feel Sorry for Myself
I was diagnosed with a major neurocognitive disorder
secondary to traumatic brain injury, with a contusion to the left temporal lobe
region, superimposed on attention-deficit disorder and posttraumatic stress
disorder. Regardless, I was ready to give this whole "becoming a doctor
thing" a shot. There was no time to feel sorry for myself. I was beyond
excited to start my lifelong goal of becoming a physician.
A doctor recommended that the "use of compensatory
strategies or accommodations will be needed to level the playing field."
Being the previous A student that I was, I surely did not think I needed any of
these accommodations. Actually, I didn't even consider any of this doctor's
recommendations. I wanted to go through med school just like everyone else.
I'll admit that anatomy lab practicals were a pure struggle, histology images
were nearly impossible to recall, and microbiology was no fun. I was definitely
more fatigued than I had been previously while learning. The headaches at times
were so unbearable that I couldn't get out of bed. Hell, I was already a
hypochondriac before my injury, and sometimes I even freaked myself out by
telling myself that my brain was re-bleeding. You can imagine how this year was
for my parents, living 1000 miles away...
Then again, what med student doesn't get fatigued and have
headaches? What med student, absorbing all of this new detail about diseases,
doesn't think he has all of them? "My stomach hurts... Oh man, I must have
appendicitis." I didn't think I was any different from my colleagues. I
passed all required courses the first year. I was not an A student, but I did not
fail a single course.
Second year was a little more bearable. I had slightly fewer
headaches and the mental fatigue was mildly improving. The first 2 years were
so densely packed with information that by April of my second year, I was
mentally drained. There was still the beast at the end: Step 1. We were given
April and May off, except for osteopathic classes, to study, and had to take
the exam by June 10. I wasn't sure how to study for this and tried what seemed
like 100 different resources. Looking back, I should have taken longer breaks,
studied over a longer period of time, and overall been healthier.
Don't Lose Hope
As a third-year on my first internal medicine rotation, I
stumbled upon a service called OnlineMedEd. I needed a source that was not just
notecards and not just reading a book, which had, among other things, gotten me
in trouble during Step 1. I watched one of their free videos, on coronary
artery disease, and was immediately impressed by the presentation of the
information and how they made it seem so simple. I proceeded to watch all of
the cardiology videos and knew that this was the source for me.
OnlineMedEd's PACE method, along with the available content,
was exactly what I needed to excel during my third year, as I learned the hard
way the year before that overworking and cramming was not healthy for my
bruised brain. I would read the notes, watch the videos, do associated clinical
cases and questions, and use notecards to reinforce what I learned. I'm being
honest in saying that the USMLE felt like an attending quizzing:
"Hyperkalemic patient with EKG changes; first drug to give?" Of
course, this is easy to answer after you've heard this question on every
in-hospital rotation in your third and fourth year. COMLEX was only slightly
different, because the questions (in my opinion) were more convoluted and I
barely studied the OMM portion.
I know that this is all subjective, so here is the objective
information. My results:
COMLEX Level 2: 622 (+176 from level 1)
USMLE Step 2: 258 (+48 from step 1)
Residency placement at my #1 choice
This story was not meant to make you think that I'm some
crazy miracle. It was meant to tell you something real: I had a gun to my head,
traumatic brain injury, countless sleepless nights, throbbing headaches, and
debilitating neurofatigue, topped off by a dismal Step 1 score. I still made
it.
If you only remember one thing from this, I'd like you to
remember this: Life is going to continually test your strength and commitment
to your goals, but it is solely up to you how you will react and respond. Your
obstacles don't have anywhere near the strength that you do. We have the
amazing inherent ability to control our thoughts and actions. You don't always
get a second chance to redo the day before. But, when you wake up, it is a new
day for you to win or lose. Don't lose hope!
https://www.medscape.com/viewarticle/898993_3
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