Queasy & vasovagal about blood and guts. Medicine as a career out of the question for me?

[JimboAA]

Couple potential huge obstacles here:

(1) I'm about to turn 40 and am considering going to med school (still need BIO and OChem which I can complete at a local JC.

(2) I get nauseous (vasovagal) when I see someone cut up, blood, etc, etc.

Based on these two issues, logic would suggest that a career in medicine is not for me. But I'm stubborn, and I really want to pursue this goal so I can become a family doctor (GP).

I've already read a few posts on going back to school at a later age, although I will gladly welcome any input/advice in this dept. I did well as an undergrad at Berkeley, got a B.S. in stats, did some engineering for a few years, before getting into sports handicapping, which I've done for the past 9 years. I've made quite a bit of money and can fund some of my med school bills. I do have a wife and 3 year old, but they are great, and they are always so willing to give me peace and quiet when I need to review tape of a game, go over stats, etc.

But my MAIN question is about my vasovagal type reactions. Is this a red flag, telling me that I really shouldn't pursue medicine? Can you really get desensitized to this and have a 180 with how you react when you do see something gruesome, i.e. complete unfazed to it over time? My drive for wanting to get into medicine isn't to see all the blood and guts, but to establish great patient-doctor relationships and help people--this is a big need of mine. I have seen the joy it has brought my father over the years. (he's a still practicing DDS at age 76, God bless him). I also happen to really enjoy the geeky aspects of medical science.

So any comments would be much appreciated. Sorry for the long-winded post. I'm a thorough person by nature, and I hate omitting anything I feel might be pertinent. Jim

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[QofQuimica]

Yes, you can. I think most people are sensitive to blood, vomit, or other body fluids to some degree, especially at first. I had to step out of my anatomy class the first day of med school and go sit out in the hall for a few min. I've had a few other times where I've had to do the same, once even as a resident. The key is to admit when you're feeling lightheaded and sit down some place cooler until the feeling passes. As one of the surgeons said, don't pass out forward into the field.

I suggest that you start by doing some shadowing or clinical volunteering. Just get into the environment and see how you like it. Worst case scenario, you could always do psych. They see patients, but no blood or guts.

 

[Nasrudin]

I'm sure some measure of desensitization is possible. But, family docs train in surgery, EM, and OB-the queen bee hot mess speciality. So your hands in places you wouldn't have thought congenial and all manner of wound care are part and parcel of the trip.

When I saw your title I was all ready to mention pathology, radiology, derm, and psych etc as potential career choices, but family med is the one stop shop specialty--you have to be ready for all of it.

Some type of hands on clinical work should be able to provide you the information you seek.

 

[Nasrudin]

Yes, you can. I think most people are sensitive to blood, vomit, or other body fluids to some degree, especially at first. I had to step out of my anatomy class the first day of med school and go sit out in the hall for a few min. I've had a few other times where I've had to do the same, once even as a resident. The key is to admit when you're feeling lightheaded and sit down some place cooler until the feeling passes. As one of the surgeons said, don't pass out forward into the field.

I suggest that you start by doing some shadowing or clinical volunteering. Just get into the environment and see how you like it. Worst case scenario, you could always do psych. They see patients, but no blood or guts.

You beat me to the punch. But good point about being queezy and that it's ok. One time as an ER tech the incision and drainage of a swollen infected finger and the wringing of puss from it nearly caused me to vomit when the smell stung my throat.

I almost fainted during a c-section when a uteran artery sprayed blood on my face mask and I thought the lady was gonna die. The uterus is a crazy resevoir of blood. Unbelievable. It was nothing to the experienced people around me.

.....yay psych!

 

[cabinbuilder]

You can pick a specialty that really doesn't deal with body fluids: Rads, Path, and for the most part IM (before I get flamed, I know plenty of IM who only write scripts). That being said, you will have to get through rotations in medical school since you will be exposed to all the specialties - no way around that. I"m sure if you pass out enough in the OR, the nursing staff will ban you

 

[JimboAA]

Thank you all for the responses. All sounds very practical. I am very open to specializing in a less than bloody field (such as pathology or psych), but don't ALL doctors have to go through an ER clinic at some point before they specialize, being that psychs are general MDs too? In other words, should one choose to specialize in psych, s/he will still be seeing some blood and guts along the way right? I assume that's a given, I just don't know how much of it you'd see in schooling or as an intern...but assumed it was a lot, like tons and tons.

 

[cabinbuilder]

Thank you all for the responses. All sounds very practical. I am very open to specializing in a less than bloody field (such as pathology or psych), but don't ALL doctors have to go through an ER clinic at some point before they specialize, being that psychs are general MDs too? In other words, should one choose to specialize in psych, s/he will still be seeing some blood and guts along the way right? I assume that's a given, I just don't know how much of it you'd see in schooling or as an intern...but assumed it was a lot, like tons and tons.

Dude, it's not like TV. Unless you are in some crazy trauma ER blood in the ER really is minimal. Even in the OR there is not that much since most is laproscopic anymore. Open heart is bloody to a point but not too bad. I think I saw the most blood/fluids with childbirth. Most ER cases are medical problems. Sure you get the broken bones, car accidents but if you choose wisely where you rotate, even ER is minimal.

 

[Chip N Sawbones]

Depending on what school you go to, emergency medicine might be a required rotation, yes. If it is required I think it'll just be three weeks or so. You might be able to do the rotation someplace rural that doesn't get too much trauma. Remember that emergency medicine isn't only big juicy car crashes and stabbings like you see on TV, it's mostly non-bloody stuff like chest pain, shortness of breath, stomachaches, psychiatric illnesses, drug seekers, and so on. You will also see some blood in your internal medicine, pediatrics, surgery, and OB/GYN rotations. If you go to a school that uses cadavers for gross anatomy class you will be seeing plenty of blood and guts, although it doesn't look anything like living tissue anymore. Just like anything else in the world, you'll get used to being around blood and other bodily fluids with continual exposure. A surgeon told me that plenty of surgeons faint or feel ill their first time watching an operation, and that it's nothing to be ashamed of, just as long as you don't pass out into the sterile field.

As a nontrad former carpenter, logger, sailor and fisherman, I've got the opposite problem. After all these years spent using knives, chainsaws, and power tools, I'm delighted to be going into an occupation in which I'm not the one leaking red blood cells.

 

[JimboAA]

As a nontrad former carpenter, logger, sailor and fisherman, I've got the opposite problem. After all these years spent using knives, chainsaws, and power tools, I'm delighted to be going into an occupation in which I'm not the one leaking red blood cells.

Hahaha. Nice.

 

[Law2Doc]

You can pick a specialty that really doesn't deal with body fluids: Rads, Path, and for the most part IM (before I get flamed, I know plenty of IM who only write scripts). That being said, you will have to get through rotations in medical school since you will be exposed to all the specialties - no way around that. I"m sure if you pass out enough in the OR, the nursing staff will ban you

I would say that after surgery and maybe EM, the three specialties you listed can actually involve the most bodily fluids. If someone has a big abscess, who do you think aspirates it or puts the drain in these days? Radiology. Who spends the entire day dicing up parts of the body to make frozen section, doing autopsies, and analyzing various components/cells of bodily fluids? Path. And who is the guy dealing with the patient who is stooling blood or puking every time you walk into the room? IM.

Psych and PM&R come to mind as less bloody fields. Some subspecialties of IM (eg rheum), but you have to wade through a Lot of bloody nights in the ICU before you can specialize.

I think there are definitely people whose vaovagal reactions are so strong they can't do med school. Go volunteer in the local ER and face your fears. If you can, then continue with med school. If not, it's not for you.

 

[JimboAA]

I think there are definitely people whose vaovagal reactions are so strong they can't do med school. Go volunteer in the local ER and face your fears. If you can, then continue with med school. If not, it's not for you.

Good tip!

 

[blesss]

Slightly off topic, but your job title caught my eye and my interest is peaked. Could you elaborate on what it is that you do?

 

[Chip N Sawbones]

Slightly off topic, but your job title caught my eye and my interest is peaked. Could you elaborate on what it is that you do?

Whose job title are you referring to?

 

[cabinbuilder]

I would say that after surgery and maybe EM, the three specialties you listed can actually involve the most bodily fluids. If someone has a big abscess, who do you think aspirates it or puts the drain in these days? Radiology. Who spends the entire day dicing up parts of the body to make frozen section, doing autopsies, and analyzing various components/cells of bodily fluids? Path. And who is the guy dealing with the patient who is stooling blood or puking every time you walk into the room? IM.

Psych and PM&R come to mind as less bloody fields. Some subspecialties of IM (eg rheum), but you have to wade through a Lot of bloody nights in the ICU before you can specialize.

I think there are definitely people whose vaovagal reactions are so strong they can't do med school. Go volunteer in the local ER and face your fears. If you can, then continue with med school. If not, it's not for you.

I have never seen a radiologist drain an abcess. I have not seen an IM stay in the room when there is a huge body fluid mess- they leave, inform the nurse and come back around later. Plenty of body fluids in psych folks in padded rooms smearing feces on the walls? All comes down to how you run your practice. Bottom line is regardless of specialty there is no way anyone will get through training without seeing blood or body fluids.

 

[blesss]

Whose job title are you referring to?

My bad I should've quoted. Was referring to op ("sports handicapping").

 

[1727]

All doctors and nurses are human, so I am sure just about all of them have had adverse reactions to the clinical setting. I think, and I am not anywhere near an expert, that you just do it. For instance, I have two children; my first when I was pretty young and unprepared. We had an extremely intense labor and delivery, and it involved more blood, fluids, and, the worst part in my opinion, the visible and audible signs of intense pain on another human, and I handled it fine, most likely because I felt horrible for my wife. Our second kid was a precipitous labor and delivery, and it was like a walk in the park, so to say. I think everyone adjusts; remember you aren't the patient, you are there to help. Also, I think everyone has very idiosyncratic triggers.
For example, I once shadowed a family physician who did two ear irrigations for cerumen buildup and it really flustered me. I was pretty nonplussed at the fact that I have shadowed, watched two births, and have a slightly weird obsession with seeing what I'm reading about, that the discharged waxy chunks made me sick. But shadowing and volunteering, as others have recommended, will hopefully help you overcome some of your concerns.

 

[Law2Doc]

I have never seen a radiologist drain an abcess...

Then you don't get out much ( or are at an extremely small community hospital). Nationally, this is who does most of thes procedures these days. Anything in the abdominal or pelvic cavity and most deep soft tissue collections are ultrasound or CT guided procedures. And honestly if you are on IM and can't stay in the room with your hemorrhaging or coding patient, that's not right -- it's not something appropriate to hand off to nurses.

But I agree that there is absolutely no way to get through training without getting bloody.

 

[Law2Doc]

All doctors and nurses are human, so I am sure just about all of them have had adverse reactions to the clinical setting. I think, and I am not anywhere near an expert, that you just do it. For instance, I have two children; my first when I was pretty young and unprepared. We had an extremely intense labor and delivery, and it involved more blood, fluids, and, the worst part in my opinion, the visible and audible signs of intense pain on another human, and I handled it fine, most likely because I felt horrible for my wife. Our second kid was a precipitous labor and delivery, and it was like a walk in the park, so to say. I think everyone adjusts; remember you aren't the patient, you are there to help. Also, I think everyone has very idiosyncratic triggers.
For example, I once shadowed a family physician who did two ear irrigations for cerumen buildup and it really flustered me. I was pretty nonplussed at the fact that I have shadowed, watched two births, and have a slightly weird obsession with seeing what I'm reading about, that the discharged waxy chunks made me sick. But shadowing and volunteering, as others have recommended, will hopefully help you overcome some of your concerns.

Many people can adjust, some unfortunately definitely can't. If you can't desensitize, you can't do this job.

 

[Elewynne]

I have had a couple occasions where I felt lightheaded and had to sit down and recover for a time. I realized it was because I started sympathizing with what I was seeing occur - doctor poking at an open wound ("Ugh that really hurt when it happened to me"), anesthesiologist having a hard time getting an epidural needle to go in (I once had to be poked about 20 times by 5 different people to get a blood draw), stuff like that. I realize my issue is internalizing what's occuring on the patient. I'm still working on overcoming this but have found that doing mental exercises to distance myself has helped. I'm hopeful it'll only get easier as I'm more exposed and experienced with these things.

 

[cabinbuilder]

Then you don't get out much ( or are at an extremely small community hospital). Nationally, this is who does most of thes procedures these days. Anything in the abdominal or pelvic cavity and most deep soft tissue collections are ultrasound or CT guided procedures. And honestly if you are on IM and can't stay in the room with your hemorrhaging or coding patient, that's not right -- it's not something appropriate to hand off to nurses.

But I agree that there is absolutely no way to get through training without getting bloody.

NO, I don't get out much to bigger cities (I don't work in those places) . I don't work "nationally" I do rural medicine where I"m lucky to have a general surgeon who maybe visits once a week. Don't ever have a radiologist on site. Most of the places I work rads are a few states away. I never said leaving during a code, I was more thinking of during rounds when there is vomit present in the room. Codes are whole different entity, don't misconstrue.

 

[Law2Doc]

... I never said leaving during a code, I was more thinking of during rounds when there is vomit present in the room. Codes are whole different entity, don't misconstrue.

Sure, but my point is that a crashing liver patient with hemoptisis, or a code is a good exmple of the kind of times you are likely to get blood all over your scrubs in IM. I'm assuming the OP can survive a little vomit or a bit of urine/feces, but some of the fluids we see go way beyond that. That's less likely an issue for an outpatient career like psych or PM&R. But you have to wade through a Lot of blood before you get to that point.

 

[cabinbuilder]

Sure, but my point is that a crashing liver patient with hemoptisis, or a code is a good exmple of the kind of times you are likely to get blood all over your scrubs in IM. I'm assuming the OP can survive a little vomit or a bit of urine/feces, but some of the fluids we see go way beyond that. That's less likely an issue for an outpatient career like psych or PM&R. But you have to wade through a Lot of blood before you get to that point.

Ok, I give you that. A lot of it comes down to where you train. I have never been splashed with blood. Comes down to the size of the hospital I suppose. If you train where the sickest patients are - sure, it's gonna happen.

 

[QofQuimica]

Ok, I give you that. A lot of it comes down to where you train. I have never been splashed with blood. Comes down to the size of the hospital I suppose. If you train where the sickest patients are - sure, it's gonna happen.

This. I'm doing residency at a tertiary care trauma I hospital. No matter what specialty you're training in here, you're going to see (and do) lots of yucky stuff. In case anyone was wondering, the human body (including the fluids and solids that emanate from therein) is pretty disgusting. Premeds, they call it "gross anatomy" for a reason.

 

[Chip N Sawbones]

I didn't think anatomy was all that gross until my cadaver started dripping and making a mess on the floor. Anatomy class is a good example of how you get used to grossness, though. At the start of anatomy class both the girls at my lab table were pretty uncomfortable with the idea of cutting a dead body apart. By the end of the block they were tearing the cadaver apart by hand, no scalpels necessary. Just like anything else, you get used to it with continual exposure.

 

[Law2Doc]

I didn't think anatomy was all that gross until my cadaver started dripping and making a mess on the floor. Anatomy class is a good example of how you get used to grossness, though. At the start of anatomy class both the girls at my lab table were pretty uncomfortable with the idea of cutting a dead body apart. By the end of the block they were tearing the cadaver apart by hand, no scalpels necessary. Just like anything else, you get used to it with continual exposure.

Experiencing a cadaver and a live human are very different. A lot of people who faint in the OR or during bloody or odiferous procedures got through anatomy lab just fine. It helps the desensitization but it's not close to the end of the road.

 

[Gfliptastic]

I am w/ Law2Doc's posts. YES, there are careers in medicine that can be quite "tame" however, there is no way to opt-out of anything on the road towards that blood-free residency.

You might not eat cold cuts for awhile after anatomy lab. Still, there is weeks and weeks of OB and Surg to get past before you even get to the Rads residency. Do people pass out sometimes? YES, however, vasovagal is also a combination of very many factors for all intents & purposes. You need to have a vasovagal reaction AND hypoglycemia or dehydration. It's very difficult for JUST the vasovagal (neurogenic) aspect to cause fainting. And if it IS just your neurogenic response you can't say that medicine is still in the game.

Intern year has something to do w/ Internal Med. Doing shifts in the ED. (If I'm wrong please correct me). And the worst thing to happen would be to have a patient requiring assistance AND then the intern also on the floor.

So I support going on ride-alongs w/ your EMT's. Or even just spending time in the ED. There are ways to desensitize yourself. Your kid gets a cut, be the 1st one to put a bandaid on it. Don't defer to your spouse. YOU do it. Get in there!

To say that all forms of blood and guts can be avoided is asinine. You are trying to get into medicine. Where you specialize in the human body.

Good luck!

 

[Nasrudin]

Ok. But anatomy is by far the grossest thing if you ask me. Your dismantling a corpse slowly over months that has been soaked in noxious chemicals to ****** its decay. A lovely odeur of death and chemical warfare.

Whereas a even a post-partum vag splash between your toes is a living person. Fresh....so to speak. Infections and death are the worst. Worse than poopiness to me at any rate.

 

[Chip N Sawbones]

Experiencing a cadaver and a live human are very different. A lot of people who faint in the OR or during bloody or odiferous procedures got through anatomy lab just fine. It helps the desensitization but it's not close to the end of the road.

I know they're different; my point was that if you can get desensitized to cutting up a cadaver, you can get desensitized to seeing live people cut up.

 

[EMDO2018]

I would suck to get all the way to med school then realized you have extremely strong vasovagal reactions.

I have had a couple occasions where I felt lightheaded and had to sit down and recover for a time. I realized it was because I started sympathizing with what I was seeing occur - doctor poking at an open wound ("Ugh that really hurt when it happened to me"), anesthesiologist having a hard time getting an epidural needle to go in (I once had to be poked about 20 times by 5 different people to get a blood draw), stuff like that. I realize my issue is internalizing what's occuring on the patient. I'm still working on overcoming this but have found that doing mental exercises to distance myself has helped. I'm hopeful it'll only get easier as I'm more exposed and experienced with these things.

What mental exercises did you do???

 

[squat]

The only day that I dry-heaved in anatomy lab was the day we were emptying the very full bowel of our cadaver. Oddly enough, I was simultaneously laughing uncontrollably.

In all seriousness, I thought I'd have trouble with dissection and I even anticipated having a few nightmares. I did fine. You will find that you are not alone.

Keep in mind that you will have classmates that will elbow you out of the way to get a chance to dissect. There's something for everyone in med school!

 

[Law2Doc]

I know they're different; my point was that if you can get desensitized to cutting up a cadaver, you can get desensitized to seeing live people cut up.

Some can and some cant. Most find cadavers less "real" than a bleeding animated live patient.

 

[katiemaude]

You can definitely become desensitized through repeated exposure, and Q's advice about stepping out or sitting down somewhere cool if you feel faint is a good one.

I am a fainter, and I have felt nauseous and faint on numerous occasions in my premed adventure.

Dissecting cats in undergrad anatomy - I learned to eat light before lab, to swipe a little Vicks on my upper lip to deal with the stench, and I still left the room a couple times the first few weeks to get the blood back to my head. By the time the final rolled around, I wasn't using Vicks and I wasn't bothered by the sight of those poor cats.

Cleaning up human waste - As a nursing assistant, drawing blood, changing dressings and cleaning up vomit never bothered me. Urine and feces? Gag gag gag. I got over urine, but feces still gets to me. After a year on the job, I ended a night almost throwing up *in a patient's bathroom* after I emptied his colostomy bag into a container and the residue was not coming out of the container, despite repeated washings. Thankfully I had locked the door and he had the TV on loud.

Surgery - the first few weeks of putting the operating bed back together (I'm a periop tech) after gynecological cases was touchy. I almost did a head dive into some splayed female anatomy when I slipped on the contents of an upended kick bucket. The fear of landing face first into that had me sweating every time I walked into a gyn room. The sight of a breast reduction surgery triggered it for me, too. I have never fainted in the OR, but I still choose not to watch knee scopes. There is something about knee surgery... I don't know. But cleaning dead patients and tagging them? Watching trauma surgeries? No prob.

 

[Elewynne]

What mental exercises did you do???

It sounds bizarre, but I mentally repeated to myself that it's just like preparing food for cooking. Focused on the task/procedure, and tried to distance it from the knowledge that it was being performed on a person not a steak. I also second the idea that each time I had a episode was when I had low blood sugar and hadn't eaten in as while.

 

[knv2u]

Couple potential huge obstacles here:

(1) I'm about to turn 40 and am considering going to med school (still need BIO and OChem which I can complete at a local JC.

(2) I get nauseous (vasovagal) when I see someone cut up, blood, etc, etc.

Based on these two issues, logic would suggest that a career in medicine is not for me. But I'm stubborn, and I really want to pursue this goal so I can become a family doctor (GP).

I've already read a few posts on going back to school at a later age, although I will gladly welcome any input/advice in this dept. I did well as an undergrad at Berkeley, got a B.S. in stats, did some engineering for a few years, before getting into sports handicapping, which I've done for the past 9 years. I've made quite a bit of money and can fund some of my med school bills. I do have a wife and 3 year old, but they are great, and they are always so willing to give me peace and quiet when I need to review tape of a game, go over stats, etc.

But my MAIN question is about my vasovagal type reactions. Is this a red flag, telling me that I really shouldn't pursue medicine? Can you really get desensitized to this and have a 180 with how you react when you do see something gruesome, i.e. complete unfazed to it over time? My drive for wanting to get into medicine isn't to see all the blood and guts, but to establish great patient-doctor relationships and help people--this is a big need of mine. I have seen the joy it has brought my father over the years. (he's a still practicing DDS at age 76, God bless him). I also happen to really enjoy the geeky aspects of medical science.

So any comments would be much appreciated. Sorry for the long-winded post. I'm a thorough person by nature, and I hate omitting anything I feel might be pertinent. Jim

1. A "vasovagal" response refers to a type of syncope/malaise caused by the vagus nerve. If you are merely nauseated without any syncope or syncope like symptoms, it is completely wrong to say that you are "vasovagal." I'm not trying to be a jerk, but if you are going to be a doctor, you should be careful about using terms of art inappropriately. At the very least, you could embarrass yourself in a medical school interview (although one would hope you would omit this detail) or worse.

2. Many family practitioners can limit their exposure to blood in their own practices, but good luck through medical school and residency. An internal medicine or family medicine residency will more than likely involve time in an emergency department, where who knows what you'll run across. In medical school during your third year, you will do clinical rotations that will include internal medicine (most likely in an ER department) and surgery. You will see blood, guts, and more than likely, death before you graduate. Many internal medicine residencies also have requirements that you are exposed to palliative care (e.g. hospice/end of life), so if you are queasy, you may be uncomfortable there. Other rotations also have there share of gross things (and in my opinion, much more troubling than a little blood and gore). You must do an OB/GYN rotation as well; have you ever seen a vagina foam from a yeast infection during a routine procedure (cauterization)? It happened to my roommate who was more than a bit disturbed by it. Psychiatry is also not a safe bet. Some of my contacts have had psychiatric patients fling excrement around. It's gross yes, but if you are a doctor, you must learn to deal with it and learn how to effectively delegate the gross stuff to your insubordinates (sorry nurses). If you cannot handle blood and guts, would you be able to handle this? If you are a family doctor, you will see some other gross things. You will have patients that you can play a game of "guess what's infected" with and treat STDs and lots of gross things. It's true. I apologize for grossing anyone out, and I hope I am not too discouraging.

3. If you are dealing merely with nausea, talk to your doctor about an anti-emetic. Otherwise, perhaps desensitization by seeing (yes!) blood and guts may help you eventually overcome your problem. See if you can shadow an ER doctor.

4. If you are 40 years old, you must articulate clearly why you want to go to medical school. That will be a very important part of your application. You sound uncertain in your decision. You haven't even completed the most basic prerequisites (i.e. biology and organic chemistry). If you apply to medical school, and are fortunate enough to receive an interview, you will be rejected without hesitation if you appear uncertain. Also, seeking to establish close client-relationships with people alone may not come off as a compelling reason for choosing medicine. Psychologists (Ph.D.), lawyers (J.D.), etc., build relationships with their clients. What are your other reasons?

5. I say everything that I do to be helpful and not to be overly critical. I do sincerely wish you the best of luck.

 

[MedWonk]

I've seen quite a few unpleasant things in the ED. Seeing a really nasty laceration and seeing a central line put in the first time were a bit unsettling. Now I don't even bat an eye. I only just started getting used to urine and vomit. Feces still bothers me. Colostomy bags, G tubes, and J tubes also bother me still but not quite as much as before. I think what you feel is perfectly natural. You do gradually get used to it, I think.