A few weeks ago, I reluctantly became that patient. At about 11PM, I started having gnawing abdominal cramps. By 3AM, the pain had moved to my right upper quadrant and I was writhing in bed, unable to find a comfortable position. Tylenol didn’t help. The pain was in the right spot to be my gallbladder, but I wasn’t nauseous and I don’t exactly fit the traditional patient profile of someone with cholecystitis. My wife called off of work for the next morning and took me to the emergency room. I didn’t know what else to do.

When you’ve spent the past four years thinking from the physician’s perspective, becoming the patient is an odd experience. You know what to expect, but you don’t know what’s going on from one minute to the next. You find yourself trying to help the nurses, but there really isn’t anything you can do besides give a thorough history and be a good pin cushion. Unfortunately, most hospitals don’t keep an ultrasound tech on hand past midnight these days. By the time I left the ER, I was given some Zofran and a recommendation to follow up as an outpatient. I’m not really sure I expected much more than that when I came in.

The next morning, I called the family physician that I was on rotation with. She thought I should get the ultrasound, and I agreed. At that point, I had an inkling that I’d be getting my gallbladder taken out the next day. The exam showed acute cholecystitis, and I went straight back to the emergency room. This time, I had to wait nearly 3 hours to be seen by a physician. When you’re working in the ER on a busy night, it’s not uncommon (or unreasonable) to see patients with non-life threatening conditions wait extended periods before being treated. When you’re a patient in that same ER who’s sitting in the waiting room with no medication for your pain, that’s another story.

Fortunately, the ER wait was the worst thing about my experience in the hospital. Once I got up to my room for the night, it was almost as if I were staying in a nice hotel for the weekend. The only thing I had to do was wake up in the morning, answer a few questions, take a nice medication-induced nap, rest again, and go home. Everyone in the hospital from the transport team to the nurses and physicians were incredibly friendly and helpful. Having attentive nurses made me feel so much better as a patient because it compensated for my feelings of helplessness (or rather, futility) lying in a hospital bed.

As I was wheeled into the operating room the next morning, my wife was more nervous than I was. We’d both scrubbed in on quite a few laparoscopic cholecystectomies, and we both knew what to expect, but I was actually excited to finally experience everything as a patient. I know it sounds weird, but I wanted to know what it felt like to be put under with anesthesia and to wake up groggy and loopy. I wanted to know what the different pain medications we hand out so freely to patients actually do to your body. And I wanted to know what sutures and dermabond feel like. Now that I’ve experienced all those things, I’ll know what to tell my future patients to expect. I’ve gained more respect for my future colleagues, more appreciation for everything that the nursing team does for their patients, and, perhaps most importantly, more empathy for my patients.

To get caught up and make a long story short, I decided that I want to go into emergency medicine instead of pediatrics. The whole process of how I came to the decision is documented in a few posts on Match Game, beginning here. Unfortunately, the decision complicates things a bit. My wife recently matched for a neonatology fellowship in St. Louis, Missouri. Had I stayed with pediatrics, it would’ve been easier for me to land a residency there. As it turns out, though, there are only two emergency medicine residencies in the state, both of which are allopathic, not osteopathic.

So instead of applying for a residency spot directly from medical school, I applied (and matched into) a one-year traditional rotating internship at home in Cleveland at the hospital where I did the majority of my third and fourth year clinical rotations. It means I’ll have to to the entire match process over again next year, and it’s yet another year spent in a different city than my wife. But it’ll improve my application for emergency medicine and make it more likely that I’ll land a spot out in St. Louis.

That’s about it for now. Graduation is coming up in June. It really can’t come fast enough!

Talking with the patient and getting a better idea of his medical history revealed that just a few months earlier he had undergone a complete resection of a craniopharyngioma. These tumors are usually benign masses that grow near the pituitary gland in the brain. The term benign can be somewhat misleading, however, because the growing brain mass can cause increased intracranial pressure, disrupt function of the pituitary gland, and damage the optic nerve simply because of its location in the brain. These changes lead to symptoms like nausea, vomiting, balance issues, hormone imbalances, and problems with vision. Craniopharyngiomas rarely metastasize, which is why they are usually designated as benign.

With this new information, the next step in figuring out what was going on was to get a CT scan of the patient’s head to make sure the tumor was completely gone. We also had some imaging of his abdomen done in case we could find anything there that might be causing his nausea and vomiting. When the results came back, it was my job to tell my patient what we found. I sat down next to his bed, and he looked at me already knowing what I was going to say. He started to tear up before I started talking. The reason he’d been so sick is because his brain tumor that was resected less than six months ago had come back. I also told him that we found a new lesion in his liver. I explained that he still had a number of options. There’s surgery, chemotherapy, and radiation. The lesion in his liver might be nothing at all. You try to stay positive in situations like these, but it’s very difficult not to focus on the negative, and it’s more difficult to maintain your composure with a tearful patient.

I like working in the emergency department because, most of the time, you’re able to see a problem, fix it, and send your patient on his or her way. Unfortunately, sometimes all you can do is give them a little more information than they had coming in and refer them to someone who might be able to help.

That night, I went home and unwound much like I usually do. Video games help me relax by taking me somewhere completely fantastical and so out of touch with reality that I forget what went on at work. I played one of my favorite franchises, Assassin’s Creed. It’s a historical science fiction series about a war between the order of Assassins and the Knights Templar. The games are set in various time periods and locales ranging from the Crusades in Jerusalem to Renaissance Italy and 14th century Constantinople. As an assassin, you are tasked with ridding your cities of the oppressive Templar regimes by any means necessary.

Typically, the games reward you for stealth and strategy more than wanton destruction. But that’s not how I played that night. That night, I was brazen with my attacks. I cut paths of murder and destruction from one end of the city to the other with no goal or objective, no in-game reward to reap. It was cathartic.

Video games get a lot of flack for their consequence-free destruction or violence – and in many cases, rightfully so. Without the proper maturity, the desensitization they cause can be dangerous. Sometimes, though, it’s precisely this desensitization that I play for. When the horrible things that happen on a daily basis in medicine can be blocked out, even momentarily, it makes the impact, the care, and the life of even a single patient that much more important. That’s why I play.

******

People often ask me why I play so many video games. Granted, I used to play much more than I do now, but I still turn on my DS or PSP for at least a few minutes each night before I go to sleep. Growing up, I used video games as my escape. If life was getting stressful or if I just wanted to procrastinate for a little while, I’d pop in a Zelda game and suddenly be a million miles away in Hyrule, swinging a sword or playing an ocarina.

But video games are more than escapism. During the most tumultuous times of my life, video games have been therapy. When I feel like I have no control over the things that matter most, video games offer a place where I can feel helpful. Useful. Needed. I’m saving a princess from captivity, a species from annihilation, or world from destruction. The helplessness I felt before is gone and I feel empowered to do something good. Even if that good is for fictional characters, it resonates. When I’m done playing, the feeling of empowerment stays, even if only for a week. A few days. A moment. It builds confidence. It battles depression. It inspires.

Sony just launched a new ad campaign called LongLivePlay. The video below sums up the feeling I’ve tried to convey here. It’s more effective if you’re familiar with the characters, but it gets the point across either way.