Will My Squeamishness Subside During Medical Training?

Sara Cohen, MD

Disclosures

December 29, 2009

Question

I finally got into medical school but am finding that I'm squeamish at the sight of blood. I didn't think this would be a problem before I got here. Any suggestions?

Response from Sara Cohen, MD
Fellow, Polytrauma/Brain Injury, VA Boston Healthcare System, Jamaica Plain, Massachusetts

If you're a medical student and still have episodes of feeling faint around blood, you're not alone. A 2009 study revealed that 12% of students at a large medical school reported an episode of near or actual syncope while assisting in the operating room.[1] I've struggled with this issue myself during medical training, and along the way, I developed some techniques to deal with it.

Ever since I was a kid, I've always thought of myself as squeamish. I used to hide my face when movies got bloody or gory, and the first time I saw real live stitches, I almost hit the floor. Oddly enough, this never influenced my decision to become a doctor because I always figured being a doctor was about being smart rather than being elbow-deep in someone's chest cavity. While I was technically right that you have to be intelligent to be a doctor, sometimes (at least during training) you also have to be elbow-deep in someone's chest cavity.

As a teenager, I volunteered in medical settings and noticed that my squeamishness held me back at times. When I was given an opportunity to see a patient with cervical dystonia receive a botulinum toxin injection in his neck, I started to feel sweaty and lightheaded before the cap even came off the needle. When I was offered the opportunity to watch brain surgery, I wisely declined.

When I was pre-med in college, I asked my physician advisor whether it was wise for someone squeamish to go into medicine. He said to me, "Don't be ridiculous. You'll get over it. Everyone gets over it."

But as medical school approached, I heard some stories that worried me. I heard about one student whose squeamishness got progressively worse, such that every time he entered the hospital, he started to feel faint. He eventually had to address it through cognitive behavioral therapy. I had always assumed my squeamishness would improve, and it never occurred to me that it might get worse.

When the day of my very first anatomy lab arrived, I was nervous about how I would react to coming face-to-face with a cadaver. Luckily, the body was face-down, and as long as I didn't think about the fact that I was cutting through a person, I was fine. This technique is called dissociation, and it worked well for me. Unfortunately, I can't say the same for all of my classmates. Every so often, we'd hear the loud THUNK of a first-year student hitting the ground. They say everyone eventually gets used to the cadaver, but one of my lab partners seemed to get sick and had to run from the room every time we moved on to a new organ system. They say that the most squeamish person in the class is the one who ends up becoming a surgeon. In my lab partner's case, however, she became a radiologist.

With anatomy lab out of the way, I was able to immerse myself in biochemistry and physiology -- things that were unlikely to make me pass out. It wasn't until my second year, when we had a workshop to learn how to place IVs, that I became worried again. When the person I was injecting was awake and talking to me, I couldn't dissociate myself like I did in the cadaver lab. This was exactly the kind of thing that made me lightheaded in the past, so I was determined to remain conscious through this workshop.

It's a little embarrassing to admit what I went through to desensitize myself. I downloaded videos of phlebotomies and watched them over and over. When I started feeling queasy, I did a simple trick: I counted to 10. Deep breath, 1-2-3-4-5-6-7-8-9-10. This technique is called distraction.

On the day of the workshop, we watched a video beforehand about phlebotomy, and I started to get lightheaded during the video. That seemed like a bad sign. But I counted to 10, and the feeling passed. I managed to get an IV into my partner on my very first jab, and he actually commented, "I can't believe it, that didn't even hurt!" Then he fainted.

I also had some less promising experiences. For example, when I tried to watch a kidney biopsy at the beginning of my third-year medicine clerkship, I got so queasy that I had leave the room. I was so determined to get through this that I attempted to go back in the room, only to get queasy a second time and have to leave again. I was very embarrassed, and moreover, I was worried about what would happen when I started my surgery rotation.

My surgery clerkship began in January of my third year, and stories were already going around about classmates who had hit the floor in a less than graceful manner. However, much like the cadaver lab, surgery was surprisingly not that big a deal for me. After spending 20 minutes scrubbing each finger 30 times and figuring out how to put the gown on without having to scrub all over again, then trying not to contaminate myself in the first 60 seconds of the surgery, I already had a lot of distractions. It also helped that the surgery we were doing was a carotid endarterectomy and the portion of the patient's neck that was exposed was barely recognizable as a human body part. I also tried to focus on the very important task given to me by the surgeon: suctioning Bovie fumes. I survived that surgery intact, as did the patient.

Since my surgery clerkship, I've yet to see anything that could faze me. My next rotation was in the emergency department, and I recall a patient with a gash on his hand down to the bone saying to me, "I don't think a little girl like you can handle seeing this." But I examined his hand and sewed up his laceration without a second thought. I've scrubbed in on brain surgeries, and I've administered the same botulinum toxin injections I couldn't watch back in high school. Like my own advisors, I can now assert that it's true that everyone eventually gets over it. And if not, there's always radiology.

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