Cognitive Dissonance

As I sat in A7 near the Academic Rotunda, I was trying to differentiate between

the different time frames of neurologic ischemia and how these effects manifested on

histopathology slides; I knew the random name generator that was not so random when

it came to me would ask me this later today. I kept massaging my left trapezius ridge,

futilely trying to resolve an aching sore muscle that refused to silence. From the tough

cadaveric dissections we performed in HAL earlier this week, I figured it came with the

territory of being a medical student who also does not have time to stretch like I used to

as a dancer. I was greeted by a friend walking by who peered into my room and asked if

I was ready to go to class. Noticeably, my movement was pain-limited and slower than

normal. Ignoring it, I packed my stuff up and started to walk with her when I felt my

chest tighten and my respirations increase. It felt like someone was holding my lungs

like a person would hold a balloon while someone was trying to blow it up but, in this

case, my lungs were the balloon. I could not get a full breath. It was like a panic attack

was starting but without the initial, inciting panic; I couldn’t breathe. Figuring it was my

anxiety manifesting differently, I talked myself down and told my friend I’d meet her in

class. I knew it’d get better once I sat down and was comforted by the stories the

histology slides would tell me.

Except it didn’t. I confided in my lab partners, and ultimately out of fear, I told my

professor I needed to go to the emergency room because I was not feeling well. To

which he replied “Oh of course! Have a great day.”

I was lucky enough to find one of my friends in the hall who agreed to walk me

down as I was fighting back tears. This was embarrassing, I am probably fine and

shouldn’t be going. They rushed me for the EKG which showed a new right bundle

branch block but then walked me back to the waiting room. I thought to myself “phew!,”

there are people sicker than I am.” A terrible thought, but I was comforted by this.

I then spent the next 8 hours of my life being poked and prodded in a room

separated by a curtain with a patient getting up every 20 minutes to yell at the nurses

for not fixing her. The ED is a place full of frustration, but again, I was comforted by the

fact I was able to be irritated by this, it meant I must not be sick and I’m fine; a

comforting thought as my 10-hour exam was approaching.

Then, a radiologist tech came in and said “Hey! I’m here to take you for the CT

scan of your chest.” Panic. This is the panic I was trying to push down the entire time I

was sitting here alone. This must mean my D-dimer was positive! How could no one tell

me this? How could your tone be so positive when this is so terrifying? Panic. I couldn’t

breathe again.

As I choked back tears, I asked “What was my D-dimer?” They weren’t sure what

I was talking about. They said it was one of their first days here. Clearly uncomfortable

by my PANIC, they showed me the results. What if I didn’t know how to ask this? Maybe

I’d be better off not knowing.

I was brought back into the CT, a place where I’ve brought so many of my

patients for stroke evaluations or post-traumatic injury evaluations. I saw it in a new

light. The tiny board I was going to have to lie on, the contrast hanging from the ceiling,

all the noises and radiologists ready to run behind their door to avoid what was going to

hit me at full force. He explained to me what was going to happen, and I nodded, but I

couldn’t tell you what he said other than “and it may feel like you have to pee.” What

kind of warning is that when the contrast passes through your kidneys so quickly that it

feels like you did urinate? I didn’t, though, as he reassured me while I apologized

profusely.

It was negative. After 8 hours of being in an environment that was severely

triggering for my PTSD and immensely stressful and uncomfortable from having ADHD,

I didn’t have any answers and I was getting more and more frustrated by the beeping

noises and my roommate, who would not stop getting up to bother the busy nurses. Can

someone get me out of here, please? I was overwhelmed, panicked, and wanted my

family. One of my friends came to sit with me because he said I shouldn’t be alone

during this unpleasantness. I was, less panicked now, but still thought GET ME OUT.

Why do I feel like this? This was weird because I love the emergency room as an EMT

provider. In fact, I am pretty confident I want to pursue emergency medicine or

something close to it.

OK, conclusion: they discharged me with a diagnosis of costochondritis and a

new RBBB. I went to the cardiologist a few weeks later and found out I have mild

tricuspid regurgitation. He said I was fine, though, so I’m not really sure what to make of

it.

As I reflect on this, I am in shock by how many times I was not communicated

with, especially about my D-dimer. I am even more in shock of how many times I was

communicated with and yet, very few words resonated with me. You would think that as

a medical student, I would be able to recite back to you what is happening and why.

Perhaps I might have been able to in the moment, but if you asked me what I was

feeling during those 8 hours, it has one word:

PANIC.

If someone were to interview me about this experience, I would hope I would be

brave enough to talk about this cognitive dissonance and how unsettling it was for me to

be a medical student who felt so vulnerable and unaware in that moment. I hope they

would ask me this so people might be comforted. At the same time, I am not sure how

comfortable I would be sharing this; as a hopeful future emergency medicine physician,

I’m supposed to always be calm. In fact, I have always been calm in emergencies,

calmer than I am in any other aspect of life. Yet this experience contradicts this. Overall,

although I might be defensive to this line of questioning, I think it could be cathartic for

me and almost healing to myself and others. As a medical student, I put so much

pressure on myself that I was almost ashamed of my experience because it caused me

fear. In reality, this has already influenced how I interact with patients in acute and non-

acute settings.

I am much more in tune with their emotion, I can sense if they do not understand

what I am saying, and I am comfortable with the silence while they process my

explanation. In some weird way, my experience of fear and panic makes me better able

to meet my patients where they are and to sit, be fully present, and actively listen to

their stories. If anything, I want to appease their fear.

By: Anonymous