SUICIDE IS SERIOUS (but my cat is immortalized)

Well, I haven’t written anything in a while. I’ve been busy repairing myself, and working on another writing project. It was just published in the Seattle Times today!

https://www.seattletimes.com/seattle-news/mental-health/i-felt-disillusioned-abandoned-and-alone-a-medical-worker-on-why-mental-health-care-is-needed-in-the-field/

My mental health has greatly improved. And my cat is a life-saver.

I’ll write a post again soon. Take care of yourselves!

Suicide Prevention Hotline: 800-273-8255

Andrick

TY: HF, AP, PS, TS, CS, CP, Dr. LE, LMHC CL-K, Mia the Cat

HOOTER TALK: WITH JAIMERS AND ANDRICK

The EKG, female patients, and a male MA

Hey everybody,

In healthcare, there are, of course, procedures that are gender specific. That is, a woman will get a breast exam, while a male will get a prostate exam. For the most part, as patient comfort is paramount, a practitioner of the same gender as the patient will be assigned to the procedure. This is not always the case, and, in my experience, I have found that most patients, of either gender, as long as the procedure is not terribly invasive regarding sensitive areas, are perfectly okay with a practitioner of either gender carrying out the procedure or examination.

No one particularity likes going to the doctor, anyway, so many patients have ‘do what you have to do and get it over with’ kind of attitude. Fair enough. If practitioners are performing professionally, there is an air of confidence about them, of speed, that conveys to the patient that they have done this process countless times, and this is just another day at work to them.

Indeed, we’ve seen it all. Nothing shocks us. Nothing embarrasses us. It is extremely difficult to gross-out or disgust a healthcare practitioner. I helped an MD remove a cyst slightly larger than a golf ball from a patient’s leg once. She had the cyst out of the patient’s leg, grasping it tightly but delicately in a large pair of surgical grips, so that it would not burst. It was still connected to the patient by a thin strand of tissue, and she asked me to cut the connection just inside the abscess pocket in the patient’s leg. No problem. Kinda cool. Please don’t burst that cyst, doctor. These are new scrubs.

However, all of us in the industry are well aware (or damn well should be) that this is not just another day at the office for the patient. From day one, in whatever training you take, the abstract and highly important skills of empathy and compassion are drilled into your head. We may move confidently and business-like, but patient comfort, to the best the procedure allows, is always on our mind. We cannot sympathize, but we do, often heavily, empathize. There is a difference. We hate pain and suffering. We don’t show it, but it kills us when we see it in a child. That’s why I and thousands of others joined this industry. You may not be able to nauseate or embarrass a practitioner, but even the most seasoned MD can be emotionally moved by the site of suffering. But we carry on. The tears are for later, often alone.

But, back to the matter at hand. As I said, whatever procedure a patient is going through, it is often new to them, or, at best, they are somewhat familiar with it. However, an invasive, gender specific procedure can put a patient on edge if the person performing it is of the opposite gender. We are always aware of that potential.

Take, for instance, the common work a Medical Assistant will do. Give injections. Perform a lavage. Dress a wound. Take vitals. Draw blood. And: the EKG.

Allow to me to switch tracks for a moment. The human body is an amazing machine. Simply put, your body has two command systems that boss your other organs around: the endocrine system, which uses hormones to carry out instructions; and the central nervous system, which uses electricity. Both of these systems, frequently in concert with each other, tell the rest of your organs what to go do with themselves.

The tireless, all-important, paramount, primary organ known as the human heart receives it’s commands via electricity, from the CNS. This tireless, muscular organ is the centerpiece of human existence. It’s role is simple; it keeps your blood flowing through your vascular system. Sounds like an easy workload, but the movement of your blood, which, among many other things, carries needed oxygen throughout the body and removes things it does not need, gives us substance that we cannot do without. Your all-important brain can suffer severe trauma, one can become nearly brain-dead, really, and you might still live, most likely with the aid of machines. If your heart takes enough damage, and it is not tended to in time… well, head for the big light. We’ll see you in the whatever comes next.

As an embryo, the heart is the first functional organ to develop , and starts to pump blood in the developing human in about 3 weeks. However, the brain begins to slowly develop afterwards, around 7 weeks of pregnancy, so pain is not an issue, before anyone turns this fact into an abortion diatribe. That’s between a woman and her doctor.

As a human being, the heart is well protected, encased in the mediastinum, a chamber inside the thoracic cavity (upper torso), protected by the rib cage. Makes sense; it’s important, put it someplace well protected. Which is the opposite of the human brain, which is protected by a thin skull and sits, like an easy target, in the head, which sticks out prominently from the top of your body. Not the best spot for it. Just my opinion; I didn’t design the mess called the human body.

Anyhoo, the heart itself, receiving its constant instructions to contract and relax from the CNS, is about the size of an adult fist. It consists of 4 chambers, the upper atria and the lower ventricles. It will beat about 115,000 times a day, pumping roughly 2,000 gallons of blood everyday. This tireless, dedicated organ is truly the running back of the human body.

As I mentioned, the heart is controlled by electricity, from the CNS. It’s a fascinating combination: a grouping of muscular tissues, a collection of cells, really, that responds to a jolt of internal juice. Neato.

Let me run through this quickly: the vagus nerve, from the brain, carries electricity to the top of the right atrium, to a ‘node’ called the sinoatrial node (good Jeopardy fact, there), which then carries the spark through the rest of the heart, stopping briefly at other nodes to ensure that the chambers contract and relax. Contraction is known as systole. Relaxation is called diastole. So, when you get your blood pressure measured, the top number is the systolic, how hard the heart is contracting, and the bottom number is the diastolic, how well the chambers are relaxing. Now you know that.

Okie-dokie, let’s come back around to the EKG, one of the many procedures a Medical Assistant will perform. The electrocardiogram is a fascinating machine. It’s concept is simple; as the heart runs on electricity, the EKG measures this electrical process, allowing practitioners to ‘see’ how the old ticker is doing. Many of us have undergone this procedure.

That the body is manipulated by electricity was first proven in 1790 by Luigi Galvani, who made a dead frog’s legs dance by electrical stimulation. Physicians at the time were… shocked. It was an interesting trick, but Galvani was also obviously kind of warped, to conduct this experiment. Why is the poor frog always taking the brunt of medical research? Frogs are cool. Anyway.

In the mid 1880’s, two researchers named Ludwig and Waller developed their ‘capillary electrometer’ that showed the heart’s rhythmic electrical stimuli could be monitored from a patient’s skin. They were on to something, and they didn’t even have to slaughter a poor frog.

In 1901, Dr. Willem Einthoven, using magnetic poles and silver wire, and a whole lot of ‘let’s try this,’ finally invented what became known as the EKG. The device continued to develop, into the EKG that you will see in a clinic or hospital today.

Healthcare is very pompous and traditional. The device is called the electrocardiogram. However, as healthcare honors tradition more than major league baseball, Einthoven used the Greek ‘kardio’ as his invention was very, very important, and maybe now Dad might like him. Thus, the acronym ‘EKG’ is used.

Here’s a mind-bender for another time, that took me a while to figure out: the EKG uses 10 electrodes, placed across a patient’s upper body. These are the little sticky pads, connected to wires. The electricity is only measured; no current is carried to the patient. Many of us who have had the procedure often find electrodes later on in the shower that the practitioner forgot to remove. Be that as it may, these 10 little sticky electrodes give 12 ‘leads,’ or views, of the heart’s electrical activity. That’s 12 views from 10 electrodes. That explanation is for another time, but as a student, it took me a bit of time to wrap to my head around that one.

These 12 leads, interpreted by a computer, which render a wave-like display, can tell a great deal about how a patient’s heart is performing. Many, many problems with the heart can first be detected with the EKG. It is an invaluable diagnostic tool in healthcare.

There’s a little more to it, and some instruction in its use is needed. I was trained how to use the EKG when I spent a year in Medical Assistant school.

So, let’s bring it back around, to finish, with my opening: gender specific procedures. The EKG itself is not gender specific, but the procedure of using one can be.

The role of Medical Assistant is heavily female dominated. Only about 15% of Medical Assistants are male. Of our class of 9, I was the only male, other than our wise instructor, a patient, erudite veteran. To protect his anonymity, let’s use the name ‘Jaimers.’

We were trained in the EKG early on in our program. We were not quite yet a team, and the group-trust, while growing, was not there yet. As I mentioned, the EKG is not gender-specific. However, with a female patient, it does involve her removing much of her upper clothing, while lying on her back, putting her in a vulnerable and perhaps uncomfortable feeling state. Not every women getting an EKG feels this way, but I can see how one might.

Jaimers asked my fellow 8 female students if any of them would have an issue if I, the only male, practiced the EKG on them. Several of my classmates said they would. I took no offense. However, one particular classmate had absolutely no problem with this.

This classmate and I clicked early on in the program. She was intelligent, driven, and, like myself, determined to bury the program into the ground and come away with a cumulative 4.0 gpa. She has had quite an accomplished life, and I could see her determination. In school, always get a smart friend. Anyway, to protect her anonymity and dignity, let’s call her ‘Heidie.’ As an anecdote, had I been born a female, my name would have been the same, only my parents would have spelled it correctly. And even weirder, had I been born a male, my name would have been Tom. Inside joke!!!

Anyway, Heidie did not give a rat’s ass who worked on her; like me, she just wanted a 4.0. So, I had the honor. Even though she is older than I am, Heidie is quite beautiful, but that did not enter my mind at all when she was lying down on the exam table, her scrubs up, just exposing the bottom of her bra. Like I’ve mentioned, it’s just another day at the office for a practitioner.

But, I ran into trouble. The first two electrodes of the EKG go to just the right and left of the patient’s upper sternum. Heidie had decided to be Pamela Anderson that day. I hope you can see the logistical problem I was having. I needed my 4.0, but Heidie’s damn hooters were in my way. Heidie and I have gone on to be great friends, to this day, but at that moment, Dolly Parton there was annoying me. I needed to place the first two electrodes, but I did not want to molest my classmate. I was frustrated, trying to delicately place the first two electrodes at the sides of Heidie’s sternum, without touching her silicone work. Impossible.

Jaimers, our seasoned, knowledgeable instructor, noticed I was having trouble. He came over to assist me, and briefly instructed me on how to delicately and professionally, explaining what you are doing to the female patient, move her bazingas out of the way so that you can place the electrodes. His advice was spot-on, of course, but at that point, I was ready to just heave the annoying hooters out of the my way and use duct tape to hold them until I was finished. Jaimers and I got the electrodes hooked up, but, of course, Her Majesty happened to be wearing a bra with an underwire that day. This can cause AC interference in the EKG’s reading. I eventually had to move on to another willing female patient. This was the only time in our friendship that Heidie has annoyed me. Of course, she got the last laugh, when she performed an EKG on me. My family is mostly Swiss, with a fair amount of Sasquatch thrown in. That is to say, I am a hirsute man. I shed. It sucks. Whenever I have a girlfriend, the lights have to be off. So the process then, the humility reversed, is that the Medical Assistant has to shave, with a razor, the locations where the electrodes go. Actually, I probably disgusted Heidie. I hate being part Bigfoot.

After class, when everyone was leaving, Jaimers said his daily: “Andrick, may I talk to you for a moment?” I really got tired of hearing that. But that day we spent a good 20 minutes talking, staring out the window down onto Seattle’s downtown, a typical misty day. All we needed was some armchairs, soft jazz, and lower lights. He was quite informative that day. He imparted the (extremely useful) wisdom on how a male patient performs an EKG on a female. You explain what you are doing, politely and professionally, asking for permission, and use the back of your hand to briefly raise the female patient’s breast to place the electrode. It was an informative, bonding chat. So, please don’t miss the next episode of Hooter Talk, with Jaimers and Andrick, Sunday nights at 9:00 PM on your local PBS station. Won’t you donate now, to keep this quality program going? Hooter Talk with Jaimers and Andrick is brought to you by viewers like you, the Corporation for Public Silliness, and the National Endowment of Andrick Smarting Off Again.

All kidding aside, let me finish up this essay with my original opening: gender-specific procedures. I have indicated that the EKG is not gender-specific, but it can be to the patient. On my externship, my mentor tasked me with performing and EKG on a female patient. I asked her if we had checked with the patient to make sure that a male performing this procedure was comfortable with her. My mentor blew it off, saying that it shouldn’t matter. Oh well, I thought. She’s the boss. I grabbed the EKG kit, and entered the exam room.

I could tell there was a problem as soon as I entered the room. The woman looked scared and nervous. I used a soft voice, and politely introduced myself, telling her I was there to perform her EKG. She began to cry. I told her that it’s okay; what’s troubling you? She tearfully asked if a female could perform the procedure. I have no idea if I caused her concern, or something prior. Perhaps abuse, anxiety, or a troubling potential diagnosis. It did not matter. Empathy and compassion. I told her that that would be just fine, no trouble at all, and that I would find a female Medical Assistant. I excused myself.

I went back to my mentor and told her what happened. She seemed surprised. Whatever…

It can also work the opposite way. People are all unique individuals. I was working at a community clinic, and was asked to perform an EKG on a female patient. I entered the exam room and introduced myself. Bam! Off went her gown, off went her bra, she laid down flat, and said: “Okay!” Well! My kind of patient! Who gives a crap? Just do your thing, MA!

None of that EKG encounter with that patient bothered me. Her unabashed style made things quite easier. There is a little dead space in the EKG process, when the MA connects the electrodes, straightens the lines, and ensures that the computer is correctly connected. So she and I talked about Star Trek. It was quite the memorable EKG experience.

So, my final points. You never stop learning, even after school is over. When you practice on real patients, it’s a brand new world. The procedures we do in healthcare may all be similar, but each patient is unique. You never know the full story of what brought them to this place. Empathy and compassion. Most people are fighting a battle you know nothing about. The other thing I learned was: if you are a female patient, and going to the clinic or hospital, please don’t wear a bra with an underwire. We’d appreciate it.

Thanks for reading, everybody! Happy Thanksgiving!

THE FAILURE OF MENTAL HEALTH TREATMENT: THE DIVORCE OF PSYCHIATRY AND PSYCHOTHERAPY

There is a massive problem with the practice of psychiatry in today’s modern healthcare industry. There are several reasons for this, which I will address in a moment, but first, let’s get a few things out of the way.

Many people have a very reactionary, negative opinion of the field of psychiatry. They feel that it does more harm than good. In today’s healthcare environment, they may have a point, but I am speaking in general terms. Psychiatry, to many, is a dangerous science that can damage your brain. Of course; many medical procedures can damage you if administered improperly. That’s why I went to school. Many people feel that psychiatrists have very little clue as to what they are doing. While it is true that the study of the brain, which has remained a difficult and emerging science for a very long time, and will continue to be so, there are millions of Americans who have benefited from what psychiatry does know, and what treatments it can provide. And still others feel as though psychiatry, and indeed, any treatment of the mind or emotions, should be out of the realm of medicine, and kept in either the family or church. While it is very true, and studies have confirmed this, that those of faith, or at least some level of healthy optimism about life, tend to heal much quicker from whatever affliction they may have, that does not mean that medical intervention is sometimes required. Nor does it mean that atheists do not heal.

Plenty of people have a negative opinion of healthcare in general. That is unfortunate. Many millions of people have benefited from the proper treatment of an affliction, and go on to live healthy and productive lives, despite an illness that would have been a death sentence one hundred years ago. The human body is a machine, an amazing construction, the triumph of life on Earth (although the debate about that is for another time). Whether by evolution or design, you and I, and everyone else on Earth, are amazing creatures, composed of practically countless processes, organs, chemical and electrical reactions, and things still yet to be discovered. However, just like any other form of life, like any artificial machine, like any magnificent creation of geology, things can, quite simply put, break down. Sooner or later, it happens to all of us. Have you ever thrown your back out? Well, so have 65 million other Americans. We are wondrous creations, but not entirely perfect. Healthcare plays a role in our repair, and improving our quality of life.

But back to psychiatry. The negative connotations I mentioned above are not entirely unfounded. The history of psychiatry is replete with practices that today seem barbaric, and would never be considered as an option for treatment. What is worse, in modern history, authoritarian regimes have tortured and killed untold numbers under the guise of psychiatry: Nazi Germany, The Soviet Union; even the CIA is guilty of using psychiatry for nefarious purposes.

However, like all healthcare, psychiatry is an evolving field. Healthcare, in essence, is an applied science. That is, it is a scientific endeavor, used for practical means. Many constructive gains have been made. However, the application of these discoveries, when applied to the practice of modern American healthcare, has been severely misappropriated.

I can’t get into the tired debate of whether or not mental illness exists. Believe what you will. Many people, intelligent people, will claim that there is no definitive diagnostic test to prove whether or not a mental illness exists. It is true that nearly all mental illnesses, particularly the behavioral ones, are diagnosed by interview and observation, or that form you occasionally fill out at your annual exam where you check the corresponding box as to whether you are happy or sad. However, you can get out the fancy medical equipment and see it for yourself. In people with anxiety, a part of the brain called the amygdala is overactive. In cases of depression, insufficient monoamines are developed in the neurons of the brain. One could utilize these ludicrously expensive machines if you want to see the proof, but good luck getting insurance to pay for this.

Mental illness exists. I was once speaking to a friend of mine, who had a negative opinion of psychiatry, and said to just get that person with depression some dancing lessons, a cat, and an exercise program. Okay, Tom Cruise. You tell the guy with the gashes in his wrists who’s hanging from a noose to get some dancing lessons, B-vitamins, and some duct tape, and I’m sure he’ll be fine. Sheesh. But I needn’t be snide. Annually, roughly 49,000 Americans take their lives each year. Suicide is the 10th leading cause of death in the United States; however, it is the second leading cause of death for those between the ages of 15 to 34. There are, on average, 132 suicides per day. Perhaps worst of all, according to the Department of Veterans Affairs, 20 veterans die from suicide every day.

To be fair, engaging in activities that one enjoys that are healthy, socializing with others, becoming involved in a community art or political program; these are great ways to alleviate the symptoms of depression. So too with the natural remedies; regular exercise, a healthy lifestyle, artistic expression, prayer and faith, whatever you might like. But many people are too depressed to even get out of bed.

Besides depression, anxiety disorders are the most common psychiatric disorder in the United States. They affect 40 million people. Untreated, this illness will damage those around the afflicted, cost industry labor, and overburden the healthcare industry. People having panic attacks often end up in the emergency room. The number of those with anxiety disorders is no doubt growing, considering the trauma of the last year and a half.

And we’re not even talking about schizophrenia, ADHD, PTSD, bipolar disorder, panic disorder, and a host of others. Intelligent people with fancy degrees will argue that the DSM, the Diagnostic and Statistic Manual of Mental Disorders, is cluttered with debatable mental disorders. It contains nearly 300 diagnostic entries. It should be noted that the ICD, the International Classification of Diseases, contains about 80,000 entries.

But I am severely digressing. The main point I am getting at with this article is the unfortunate practice of psychiatry that one will often encounter when they visit their regular clinic or provider.

Somewhere along the way, a great disservice was done to the field of mental health. Psychiatry and psychology were divorced. This is profoundly wrong, and does not do nearly enough to heal the mentally and emotionally afflicted.

These two sciences, psychiatry and behavioral psychology, go hand in hand. They are deeply intertwined. You cannot simply address psychiatric needs while at the same time giving little consideration, or even downright ignoring, the psychology that goes along with psychiatric suffering. It is analogous to a physician simply giving a person with diabetes insulin, and telling them to monitor their blood sugar at home, while not counseling them on their dietary habits. So with psychiatry. You cannot simply throw pills at them, without addressing the psychology, usually damaged, that accompanies it. This makes no sense.

Unfortunately, that is the solution of much of modern healthcare: throw a pill at it. Also, due to the profit motive, patients are generally allotted 15 to 20 minutes for a visit with a healthcare provider. That is not enough time. The psychiatrist, or MD with a specialty in psychiatry, may ask them how they’re feeling, how’s the job, etc, but that is insufficient time to dig deep enough to treat the illness.

Psychotherapists exist, of course. However, they are harder to find, as insurance will still balk at their treatment, or they are booked far in advance due to the dire need, owing to the stressful times we live in.

Some clinics will not even have a dedicated psychiatrist. Your primary care physician will treat you. I’m sure that person cares about their patients, and has studied, at whatever length, both psychiatry and psychology, but they are much more likely to just throw pills at you, tell you to keep a journal or do some art or something, and come back and see them in a month.

I was diagnosed with a mental illness in my early 20’s. It should be noted that there is no ‘cure’ per se, but there are treatments to alleviate the symptoms, mental exercises to retrain your thinking, so to go on and live a healthy and happy life. I was able to do so. Despite a crippling depression, in a way, I was very fortunate. I was first treated by a seasoned psychiatrist, whom I called Dr. Dispensapill, who knew that psychiatry and psychology cannot be separated. He would see me for an hour. We would talk briefly about medications. Then we spend the bulk of the visit speaking about psychological challenges I might be facing. Then we would wrap it up with any medication or lifestyle changes to consider.

His is a disappearing style. You can still find psychiatrists like him, but they are rarely covered by insurance, and they are frequently booked far out.

Dr. Dispensapill, north of 80 years old, recently ceased being able to practice. It was difficult to find help for my mental health afterwards, but I have found a combination that works. I see, for 15 minutes at a time every few weeks, Dr. Deer In The Headlights, who knows little of psychotherapy, it seems, but knows all about the different medications and how they work. She got a 4.0 in advanced chemistry, I guess. I have also been able to find a very skilled psychotherapist, Dr. How Many PhD’s Does One Actually Need. She has been fantastic.

More than one of the providers that I work with have complained to their superiors that there is a woefully insufficient staff of human resources to refer psychiatric and deeply troubled psychological patients to. They will help the best they can, but they are there to treat skin rashes and broken bones.

This is a great problem in American healthcare. We have made a damaging mistake. The mentally ill are not getting the proper treatment that they so often need. The separation of psychiatry and psychology is, in my low-level practitioner opinion, the biggest systemic mistake modern American healthcare has made. You can’t treat one without treating the other, and vice versa.

Until we fix this problem, and there are other, massive problems with American healthcare, the treatment of the mentally ill will remain insufficient. Many more will take their lives. Millions will continue to be crippled with anxiety, living tortuous lives. And the dangerously mentally ill, with no options for treatment, will continue to commit violence.

I’m not sure why this happened. It shouldn’t have. Just my opinion.

Be good to each other.

National suicide hot-line: 800-273-8255

CRACKING THE GLASS CEILING: I AM A MALE MEDICAL ASSISTANT

In early 2020, when I walked into class for the first time to train as a Medical Assistant, an obvious truth was right in front of me, so evident; but I did not notice. I had been painfully preoccupied with all the preparations required for going back to school. When you are doing it on your own at age 47, trying to also balance a life and another job, it takes all your time: the paperwork, the vaccinations you need, the textbooks you must purchase (at a very reasonable price….), the equipment you need, where you have to go, that sort of thing. But I had squared all these things away. I was ready to learn.

I was admittedly overwhelmed by my surprising mid-life crisis to enter healthcare. I had read through the aforementioned, completely reasonably priced textbook before class started. It was over 1000 pages, and that little voice in the back of my head, the one that still nags at me when I go to work, though much quieter now, was at full volume: What the hell are you doing! But on January 7th, 2020, into class I went.

I am a shy person by nature, and was still overwhelmed and nervous, so I saw a few of my classmates (we were a class of nine to begin with, and a few of us were already there), nodded my head, tried to smile, and took a seat.

The first few days were chaotic. Our program was a hybrid learning system, with in class lectures and clinical training, and at-home, online training modules. My opinion of the online training modules is still not settled. The jury is still out. More on that later. But we all had to learn how to log into the school’s system, we all had to make sure we had all the right equipment and uniforms (I had the wrong color scrubs… more on my instructor in a moment), and all of us, including myself, had endless questions. My instructor patiently addressed all of our concerns, but this chaotic orientation process took a few days.

As things settled down, and I began to learn, I was fascinated by my new decision. I knew I had made the right choice. My instructor was a seasoned Medical Assistant, impeccably dressed, with perfect hair, named Jason. I’m a confident heterosexual, and I have no problem with anyone’s orientation, but Jason was a fine looking man. Sometimes I wondered…. he must have had to get up at four in the morning to work on that hair. Perfect hair, always.

By the second week, we were splitting off into small groups. I got to know my classmates more and more, an interesting bunch. We were all older than your classic college students, all coming from careers that had driven us to make a change. There was Fairahn, a demure American Muslim woman who turned out to be smarter than she thought, gaining confidence; there was Teri, a beautiful woman who always looked like she was about to kill someone; there was Jane, who I never quite figured out; there was Joni, a busy mother who struggled at first but turned into one of our best students; there was Janet, a CNA looking to advance, and was a seriously ineffable person, that I still struggle to figure out; and there was Helen, who had a resting bitch-face that could make a honey badger back off.

Wait a minute, I thought. I’m the only male.

I had no problem with that. Perhaps that was just the way the dice rolled. I certainly did not dwell on it; I’ve always believed that women were just as capable of doing any job that a man could do, and vice-versa. The difference is when it comes to reproduction, but vocationally, I’m glad that women are slowly breaking the glass ceiling: the US military, construction, IT, and now a female Vice-President. We would have had a female President in 2016, (I imagine things would be quite different now), except for that Pact with Hell known as the Electoral College. But I digress; I don’t like to talk politics here.

Like I said, it didn’t bother me, at all, that I was the only male student. One day, after class, I asked my instructor about this, and he replied that the field of Medical Assistant is definitely a female-dominated industry.

He wasn’t kidding: https://datausa.io/profile/cip/medical-assistant#demographics

93% of all Medical Assistants in the United States are female.

I have searched all over this unwieldy behemoth known as the internet, and I have asked professionals, as to why this is. There does not seem to be a concrete answer, other than the time-honored tradition of gender stereotyping. Which needs to stop. And in healthcare, it slowly is.

The fact that I was the only male in my class never bothered me at all. I was raised by progressive parents, and, as I mentioned, the glass ceiling needs to shatter.

But it shatters slowly. In the United States, 3.5% of firefighters are female. 39.9% of financial analysts are female. Women make up 9.9% of the construction industry. 19% of software developers are women.

There are dangers to ‘gendered’ jobs: https://www.businessnewsdaily.com/10085-male-female-dominated-jobs.html

When one Googles the question: What is a male nurse called? (this actually happens), the answer comes up: nurse. Among the more conservative elements of our society, labeling a job as ‘female’ can diminish its authority. There are financial dangers as well. Female Medical Assistants, on average, make about 88% of what their male colleagues do, and men are more likely to be promoted. This pay discrepancy is in no way isolated in healthcare; on average, across America, women earn 82 cents for every dollar a man earns: https://blog.dol.gov/2021/03/19/5-facts-about-the-state-of-the-gender-pay-gap#:~:text=1.,for%20many%20women%20of%20color.

But it was never an issue in my class; we all became friends, a team, and the fact that I was male never became an issue. We all had a group text-chat, and kept in close touch when we were out of school. Remember that at-home, online learning? If one of us was stuck, no problem. Text the gang!

I became great friends with the class alpha, Helen. She was the one with the resting bitch face that could stop the blast effect of a nuclear weapon. Our gender differences were never an issue. There was no sexual tension; we were two dedicated students who wanted to do our best. As our school year went on, and we were presented with harder challenges, some quite unexpected, we backed each other up. She was the Furiosa to my Max; two people who found themselves in a difficult situation, and supported each other to get through. Fury Road. Brilliant film. Anyway…

What I have noticed in healthcare is that nearly all of the supportive roles, from CNA up to ARNP, are predominately female. However, with MD’s, the glass ceiling is breaking quickly. I have worked and met many female physicians. Each one capable, each according to their gifts.

My own feeling is this: the gender stereotyping is hard-wired into society’s heads, and has probably been around for a very long time. I know nothing of anthropology, but, at the risk of oversimplifying things, a very long time ago, men were expected to go out and hunt, and protect the tribe, while women were expected to tend to the village and care for the young. This evolution continued into the modern age; where men do the hearty, rough, dangerous things, with unnecessarily large pickup trucks, while women are expected to keep the house and raise the children. But it doesn’t work like that anymore, it can’t. To make ends meet, both partners need to work, and hell, any female can use a firearm, be an astronaut, or a member of Congress. Why, just look at Marjorie Taylor…. Eh. Very poor example.

I have never encountered it, but there can be gender discrimination against males in the Medical Assistant vocation. Many male MA’s are not taken seriously by deeply conservative patients, doctors, and the general public. Men in this role are more often perceived as effeminate or otherwise inadequately masculine (me? No on the former, definitely on the latter). This discrimination could possibly be due to the concept that men are not adequate caretakers. What a load of BS!

https://www.medicalassistantcareerguide.com/gender-discrimination/

On the other hand, many patients can feel more comfortable with a male Medical Assistant, especially male patients. If the patient has a deeply personal problem, they may find it easier to relate to another male.

Though I have experienced no discrimination of my own, and I have never been treated differently because I am a male Medical Assistant, the problem continues in our society at large. Women are just as capable as men, and should be treated not just as equals, but simply fellow human beings. The glass ceiling has many cracks, but our society still has a long way to go.

So I’ll go to work some day, surrounded by estrogen. It doesn’t bother me at all. I’m here to be the best Medical Assistant I can be. If all of my coworkers are female, so be it. As long as you’re cool and can do the job well, preferably the former, you’re okay in my book. I’ve found that it gives me a different perspective, to experience the female side of society. But that is secondary. I need to learn how to find the damn vein for venipuncture, first. And if a female Medical Assistant helps me with a blood draw, I have no problem with that at all.

EMPATHY FOR THE SUFFERING: ANOTHER DAY AT WORK

“Everyone you meet is fighting a battle you know nothing about. Be kind. Always” -Robin Williams

In my first week of Medical Assistant training school, three concepts were drilled into our heads. They continued to be imperatives throughout the entire academic year, and are expected to be applied in an actual working environment.

The first two are related, and immensely important in stopping the spread of illness. Healthcare facilities are hotbeds of disease, naturally, so these commandments must always be followed. The first two are: medical asepsis and the Standard Precautions. Medical asepsis (a: against, sepsis: the presence of dangerous microorganisms) means keeping your work environment as clean as possible, as well as yourself. These tie in with the CDC’s Standard Precautions: hand hygiene, the use of PPE, sharps safety, sterile instruments and devices, and more.

A brief note on washing your hands: this is the single best invention of healthcare, and one of the most crucial. Here, in the Covid Age, it is vital.

The third concept that is hammered into a Medical Assistant student’s head is more abstract, and extremely crucial in healthcare: the concept of empathy. It is human nature to judge, that cannot be avoided. But empathy requires one to understand the feelings of another, and, in the case of healthcare, to do our best to understand the ill and injured, and the suffering that has come upon them. We never judge. We are not concerned with what brought a patient to this condition, only how we can help them going forward. We do our best to heal, and to educate the patient so that this does not happen again. If the patient is truly damaged, be it from drug use, diabetes, or mental illness, there is an army of healthcare professionals that we will refer them to.

Believe it or not, when a patient leaves the facility, the empathy continues. We do not laugh and make fun of a potentially embarrassing condition. We do not judge behind the patient’s back. None of us do. In fact, in all of my work experience, we express pity, sadness that someone is going through life suffering. It is heartbreaking. Healthcare is not a job for the thin-skinned.

To be clear, we cannot sympathize, only empathize. To show empathy is to acknowledge another person’s feelings. It requires the emotional component of truly understanding, to the best of your ability, what the patient is feeling. You do not share these feelings yourself, but you understand the emotions the patient may be experiencing. Sympathy, on the other hand, means to share what the patient is going through, and to feel the emotions yourself. In healthcare, you cannot do that. You truly do not know the patient’s entire story, even though you learn much about them. You cannot sympathize, and present yourself as someone who shares the same suffering.

The concept of empathy is difficult to be taught in a training program. It is beneficial to be born and raised with this quality. How it it taught in a program is to simply learn about the illnesses and diseases, the suffering of the people you will eventually meet. Once a student understands what they will experience in the working world, the empathy starts to take hold.

During my training, when I learned about the legion of things that can wrong with the human body, my empathy grew stronger. Each of us in our own way is broken. Early on in my program, it gradually dawned on me what I would be doing and encountering on a daily basis. When I was much younger, college did not work out for me. But at the tender age of 47, making a bold career change later in life, I intended to take my studies seriously. I devoured the material. All of it fascinated me, and I knew I had made the right decision. It paid off, sure, with good grades and all, but school cannot prepare you for what you will actually see. I did understand there was no margin for error. In many vocations, if you make a mistake, it can be corrected, and the boss will yell at you. In healthcare, if you will pardon my drama, making a mistake can cause a patient serious harm, or worse. But my empathy gradually grew more into a sense of compassion; a desire to help others. It continued to grow.

I am very fortunate, in a way. I had found a job I love, in a field that continues to fascinate me. I have a job and a hobby at the same time. The human body is an amazing machine.

In 2021 I lost my father, just a few weeks shy of his 93rd birthday. A close family member was dealing with their own, ruthless demons. And I myself had grown somewhat despondent, as my licensing process (that’s a whole ‘nother story… every healthcare worker needs to be licensed by the Washing State Department of Health… usually a 1 or 2 week process, but in the Covid Age, mine took 3 months), and I wondered if anyone would hire a brand new MA like myself. But in a way, this strengthened my empathy, and my desire to help others, as you cannot give up on others if give up on yourself.

Then, I was extremely fortunate, and found work at a fantastic clinic. I was eager to get started, but a new MA is kept on a very short leash. But from the first day, I understood what my instructor was trying to subtly tell us, as he taught us the myriad of ways that a human being can suffer. I saw it first hand, the first day on the job, and I see it everyday, something new, something heartbreaking. I understood what my instructor meant when he spoke of empathy. The amount of suffering in the world, and the amount of people that need help, is truly staggering.

To be sure, much of what I see is fairly pedestrian to healthcare. A bad back, a sore shoulder, a nagging flu. They may be nuts and bolts to healthcare, but that does not mean the patient is not suffering and in need of help.

But much of what I have seen is truly heartbreaking. My personal emotional armor quickly developed, a necessity in healthcare. The suffering I see is my job. I signed up for it. And again, all of us feel for the afflicted. We do not mock the patient when he or she leaves. We acknowledge that we are saddened by what we have seen, and this inspires us to do more to help. All the while, your personal emotional armor must remain strong, or you will break. If you don’t have this mindset, you can’t work in healthcare.

One thing to consider: I work in a family medicine clinic. If a patient is beyond our clinic’s ability to treat, we refer them to a specialist; a cardiologist, a psychiatrist, an endocrinologist. There are those in healthcare who work in emergency departments, intensive care units, and Covid wards. The suffering I encounter does not hold a candle to theirs.

I have seen many things, horrible and fascinating things, in my new career. I have many stories to tell. I must hedge my words a bit. There is a law known as HIPAA (that’s for another time) that precludes me from offering specifics of a patient’s suffering outside of the workplace. So bear with me as I relate.

Healthcare has a habit of using fancy words for everything. If you have wax buildup in your ears, they need cleaning. But of course, this is known as impacted cerumen, treated with a lavage. There are several methods to this process, but the old tried and true is fill a spray bottle with warm water, loosen up that crap, and scoop it on out with a narrow probe. Oftentimes, and by that I mean all the time, the patient does not care for this. I operate as gently as I can, but that stuff has to come out! I use an instrument called an otoscope, and peer into the patient’s ear. Look at all that crap! Let’s get it out of there! A small container is held under the patient’s ear. As I spray, and the patient continues to look woozy and uncomfortable, the water drains from the ear…. full of unspeakable, horrible things. I peer with the otoscope again. Well! More gold to mine in that vein! Then comes the probe. You have to carefully get it in there (there’s fragile stuff in there), and scoop it on out. When I am finished, I try not to show them what I have removed, but they often see. I’ve seen patients gag. But hey, you can hear better now, right?

There is a common parasite called a tapeworm. It often strikes the very young, as they spend much of their time at day-care, or, as I like to call it, the plague palace. Well, the tapeworm likes to live in the intestines, and the colon, feeding off of whatever your digestive system is done with. I have assisted with the removal of a tapeworm. I will spare you the details of how this is accomplished. But again, empathy. Disgusting, yes, but I felt bad for the young patient.

I have not been working long, but I have assisted with circumcisions. The physician does the work, while I hand them instruments, adjust the light, and help hold instruments in place while the physician works. You can film your child’s birth. Sure. But I’m not certain you’d really want to film this process.

Most of the time, an abscess or a boil can be treated with antibiotics. Not always. The physician will inject a small amount of lidocaine (a numbing agent) near (or in… ugh…) the infection. The patient does not always take this well. However, once the area is numb, the physician can get to work. A small incision is made, and depending on the type of infection, it is allowed to drain. Sometimes it drains a lot. Never look these up on YouTube. Trust me. I hold the light for physician, and wipe away the drainage. There is a reason healthcare goes through so many gloves.

But it’s not all fun and games. Some of the worst injuries are ones you cannot see. This is where empathy is the most strongly required.

I was rooming a young person for a relatively simple procedure. The physician had checked this patient’s chart notes before the visit, something we both do, and something triggered in the physician’s mind to check this patient’s blood sugar. Before finishing up with the patient’s rooming, I checked their blood sugar. The glucometer read 300. Something must be wrong, I thought. I ran the test again. 300. I quickly finished up, and went to speak to the provider. The physician told me bring an A1C test, a test that measures blood sugar levels over the last 3 months, while she was with them. I took the sample, made my way to the lab, and secured the A1C results after running the test. I sent a private chat message to the physician, still in the exam room. She asked me to call in another physician. The poor patient had come in for a simple procedure. They left with a possible diagnosis of Type I Diabetes, a life-changing event.

I was rooming a patient once, who had come in for test results on their lungs. In my station, I am forbidden from telling the patient their diagnosis; it’s a bit above my pay-grade. But I could see the notes in the system: three malignant tumors on the patient’s lungs. They wanted to know the results. “Just tell me!” I knew what I was looking at. They did not have long for this world. I apologized, and told them the physician would be right with them.

Perhaps the most heartbreaking, hidden wounds that I cannot see, but I experience nonetheless, are those with mental health issues. In my short time, it has been shocking to see how many people are emotionally hurting. Granted, the Covid Age has inflicted damage on all us, in some way, but I had no idea it was so rampant. Often, I am asked to enter the physician’s notes, after the patient’s visit, concerning their mental health. My emotional armor is growing stronger, but I am still a human being. Some of the notes I enter are quite sad. I remember glancing at the patient’s age once. A young teen. Just a child, really, with dire mental health issues, and a hard life ahead of them.

However, myself and everyone I work with are drawn to heal and help others. We do our absolute best to heal the suffering, the pain that is so rampant. We want you to get better. We will do everything we can. But this is why you see videos of doctors and nurses, just finishing six days of twelve hour shifts, burned out and beaten up, sharing their stories, sacrificing so much to try, in their own way, to make the world a better place. One patient at a time.

But it is difficult work. There will always be suffering. And empathy will always be required.