Author Archives for jkhartsock

About jkhartsock

Jenny Hartsock is a physician who lives in Dayton, OH who is on her own journey to find good health. She writes about weight loss, vegetarian recipes, and being a physician. Follow her on instagram @doctorofacertainsize

My First Code Blue

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Stepping into a hospital for the first time as a clinical medical student is a strange dichotomy. There is still so much you have to learn before you will become a physician, but you are quickly thrust into life and death situations. One of my early rotations was in the emergency room. As a student you have no actual authority and must be closely monitored at all times. Many times you will just need to step back and observe and stay out of the active personnel’s way. 

In one of my early shifts, in the ER at our large downtown hospital, I found out what it’s really like to work in medicine. It was near the end of my shift when an ambulance brought in a man to the trauma bay. He was rolled in on the gurney with the EMT kneeling over him doing chest compressions. The ER staff swung into action. He was transferred from the gurney to the table and a swarm of a dozen personnel were in a flurry around the bed. One nurse was doing chest compressions while another was trying to place a peripheral IV line and several more were gathering medications and supplies. The ER resident and doctor were at the head of the bed intubating the patient in between the violent rhythmic jerking movements of his body with the chest compressions. Another resident was at the patients groin, trying to get a femoral IV line in place. The patient was a healthy man in his 50s who had collapsed suddenly at home while mowing the lawn. As sometimes occurs, his bowels has evacuated so the room smelled of feces initially and soon the scent of blood from an unsuccessful femoral line attempt commingled in the room. Occasionally the flurry of activity would pause as the team checked to see if any signs of life were present, looking for a pulse or signs of cardiac activity. The patient’s heart was in ventricular fibrillation so the attending doctor yelled “all clear” and a jolt of electricity shocked through the patient. His body jerked and then the staff resumed their compressions. 

Trying to revive someone is messy, physical work and the staff needed more help. I was called to the bedside to do chest compressions. Standing atop a small metal stool I concentrated solely on the strength and rhythm of my compressions. Activity continued all around in controlled chaos as medications were found and administered, the breathing tube was secure in place, and blood samples obtained to send to the lab. While securing the patient’s airway, the doctors had caused some trauma to the airway tissues, so blood was filling up the tube and bubbling out with each compression. The respiratory therapist suctioned to try and clear the bloody secretions and allow for air to move, blood was constantly splattered on the staff and the room. Time seems to slow down during a code blue. We each know how precious each single minute is, as with every passing one the brain is deprived of critical oxygen. This patient had been down for approximately 10 minutes before the ambulance had arrived to his home. By the time our ER team was working on him he had been without oxygenation and cardiac activity for 25 minutes. As time in a code goes on, it slows down even more. The rhythm of the team is established and everyone is perfectly in place doing their role. At a certain point the attending will call again for time. It had been over 45 minutes since the patient was found down in his yard. “Hold compressions and check for pulse” said the attending. Silence. No electrical activity of the heart, no pulse, no breathing. In those last seconds, silence overtakes the room. “Time of death 1746”. 

The doctors cleared quickly from the room, they had other patients they urgently needed to attend to. In the quiet the nurses went about removing the invasive medical equipment from the patient’s body and cleaning the body fluids and debris. They worked with a quick efficiency, but showed small compassionate gestures like closing the patients eyes and resting their hands on his forehead for a moment. I had stayed in the room and was helping to tidy up. As I was disposing of some used medical equipment, the attending physician was speaking to the family in a holding room next door. I could hear wailing seeping through the walls. The sounds grew louder, and when the nurses had finished making the body presentable, the patient’s family was led in. His wife and several children huddled around the body, overcome with grief. A nurse stood close by, keeping her arm on his wife, to steady her and offer support. Simultaneously as the family came into the room myself and the other unneeded staff members exited. The family, who had last seen the patient laying dead on the front lawn, were reunited to spend their last moments together in the ER bay. 

At this time, the end of my shift had come and gone. I quickly touched base with my attending and walked to the parking garage. I sat in my car. A wave came over me. I started sobbing in the garage. I had just witnessed my first patient die. I couldn’t forget the sound of the wife’s wailing screams. The violent physicality of the resuscitation attempt, with the forceful chest compressions, the invasive devices being inserted into the patient, the body fluids co-mingling in the room was traumatizing to witness. This patient had been a young, otherwise healthy father and husband, to know his life was gone in an instant and that his family would never see him alive again hit me like a truck as I sobbed in the garage. And then I did what everyone in medicine does, I went home and I came back the next day and did it all again.

The Pros and Cons of Needing Medication

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Part of the reason this year has been so deflating for me is the need to go back on medications. Last year, I was able to get off all my medications and be prescription-med free for over 8 months. With this year bringing the challenges of worse and worse migraines, anxiety, acute on chronic pain, and weight gain which had led me back to pre-diabetes, I am now on more medication than I have ever been. 💉💊👩🏻‍⚕️
On the one hand, these medications have helped me in many ways. Especially with my anxiety, I just could not function anymore on my own without the medications. Before I was in a state of 24/7 panic attacks, and the biggest change I’ve had on the meds is that I am able to be calmer and sleep better for the first time in my adult life. It doesn’t stop the worry or the racing thoughts, but it has helped them significantly, especially the physical symptoms associated with my anxiety.

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Why does it feel like such a failure to have to be on medications? I recommend and prescribe them for my patients every single day. I guess I’ve always had the attitude that I could overcome anything on my own. It’s humbling to know that it’s the true. For now these medications are necessary and are helping me to get my health back on track. In the end that’s what this has always been about. My quest to lose the weight and keep it off has never been about looking better, it’s always been about feeling better and being as healthy as possible. 💪🏻🏃🏻‍♀️👩🏻‍⚕️

#drjennygetsfit

Normalizing obesity and fat acceptance- is it a mistake?

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I cannot get behind fat acceptance, or better stated in medical lingo as “normalizing obesity”. As a physician and as someone who has been obese or morbidly obese my adult life, I know first hand what it’s like to hate my body and feel ashamed of it. I still do this very moment as I type this, that’s something I have to work on. Funny thing is, I am much more understanding of my obese patients than myself, and I think my own struggles make me more empathetic. There is a place in which you can encourage people to lose weight without being cruel and judgmental.
I would never tell myself or any patient to accept that their body is destined to be obese and to just make the best of it. Just as I would never tell a drug or alcohol abuser to give up on sobriety. Obesity in this country, at its core, is caused by addiction to foods- to processed sugary foods and to lifestyles that are less and less active and more sedentary. There’s a reason we are now using naltrexone to treat obesity just as we treat our heroin addicts- it curbs the cravings. We are still learning more about why some people are more susceptible to obesity, and I hope in years to come research will continue to shine more light on the subject. In the meantime the vast majority of us obese people need to find our version of the winning formula that works: less calories in, more calories out.
I think the bigger problem this article is alluding to is bias against obese patients. As I’ve said before, that’s a real thing and a huge problem. It makes me sad to see how obese people are treated in this country; we are treated the same way that we treat drug abusers, alcoholics, smokers, and the mentally ill. No one chooses these problems. But I hate myself for being obese, so I can understand why other people would hate me for it, too. As everyone has seen the last two years, with a healthy calorie-counting diet and daily exercise an obese person can transform to one of (nearly) normal and healthy weight. But I harbor a dark passenger inside me that triggers me to binge eat and eat to the point of sickness. Do I consider that to be a personal failing and sign of weakness? Yes, yes I do. That’s the bias I bring against myself. Are there genetic factors that predispose me to these behaviors, I’m sure there are. In the end I feel like it’s up to me, and to my patients, to overcome what genetic factors we may have. And the good news is that if diet and exercise alone don’t help enough, there are medications and surgery that can. I want myself and my patients to feel healthy, strong, and capable. Being fat doesn’t make me a worse person, but it does make me less capable of living a long, full, healthy, and active life. So I won’t sign off on fat acceptance; I won’t normalize obesity. I will keep doing everything in my power to help myself and every one of my patients live our best, healthiest lives.

The Pay Gap- a Rude Reminder of it’s Existence Courtesy of a Sexist Doc

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As we were all so rudely were reminded today, by the now infamous sexist Dr. Gary Tigges, a pay gap exists in medicine just like in all other fields. Looking back on the history of medicine, and of the world, it’s not hard to see how we got there.
Medicine, like any other scholarly pursuit, was dominated by men for several hundred years. Modern medicine, in the 21st century, saw the spread of medical schools and the numbers of licensed physicians increase dramatically. Women lagged behind men for decades and decades, until just the last few years. In the US, the majority of people entering medical school are now women. We will continue to outpace men in the coming years.
So why is there still a pay gap? Just like in other fields, the answer is complex. It starts with the fact that women historically have entered lower paying specialties like pediatrics, family practice, and psychiatry. Men have domineered the specialties that pay higher- namely any specialty where procedures and surgeries are performed. Women have faced discrimination getting into these surgical and more lucrative specialties for years, thus amplifying the pay gap, and are only now in the last 5-10 years breaking into them in record numbers.
Even when women get into the specialty of their choice, they still make on average 27% less than their male counterparts (source Doximity survey), which amounts to over $100,000 less per year. The usual reasons apply here: being punished for taking time off to have children, being seen as less dedicated to their jobs, having to call off due to childcare or family emergencies, women who negotiate for higher salaries are viewed as abrasive or demanding, etc.
So how can we end the gender pay gap in medicine?
1. Compensate non-surgical specialties with higher wages. Medicine has become a culture where “pay for procedures” has dominated for years. Let’s value traditional medicine by increasing pay for those who practice the bread and butter of patients’ care.
2. Salary transparency. Contracts for payment are so cloaked in mystery that we often don’t know how much our colleagues make. It is frowned upon to discuss salary, which only allows men to continue to earn more.
3. Encourage, don’t dissuade women from negotiating. Offer other benefits than salary- like flexible scheduling or extra vacation days to incentive women.
4. Don’t apologize for our success or undervalue our worth. Own your accomplishments! Get rid of “I’m sorry” syndrome of perpetually apologizing.
5. Finally make paid family leave a reality!!!!! It is a stain on our country that we have not enacted this in the year 2018.
6. Imbed affordable childcare into all our hospitals and doctors office. Childcare is often expensive and can be unreliable, let’s make it a no-brainer by having it available in the workplace.
And last- but most importantly- speak up and speak out! Don’t let your voice be silenced and use your vote to elect candidates who prioritize closing the wage gap!

What does it feel like to be fat?

When you are fat, what does it feel like? It mostly feels like you are nothing. Like you are invisible and disposable. People look right through you. They bump into you and don’t apologize. To them, you don’t exist, you don’t matter. Until the moment your fatness affects them, and then you do.
Seated next to me on the airplane? Yes, thank you, I see your constant fidgeting. I know my thigh is pressing against your leg. I am clenching my arms to my sides to try and give you more room, but I know I am invading your space. I saw you glare at me as I sat down and moved the seatbelt to its longest setting. I heard your sigh when I asked to get up and put my bag in the overhead. And guess what? You and all the other passengers saw me struggle to lift the heavy bag, but no one- no one- offered to help me. You dart out of your seat before the seatbelt sign was even off, like you were going to catch my fatness like a disease if you stay one second more next to me.
Watching me walk through the gym? You pretend to be in your bubble on the elliptical with your headphones, but don’t worry I see the disgusted look you shoot my way. I have been going for only ten minutes at a snail’s pace, but am drenched in sweat, it’s dripping all over everything. I get off the machine and wipe it down with the sanitizer. I see you waiting for it and I see you armed with your own paper towels and soap, ready to remove the filth of the fat girl’s sweat. Moving through the weight machines I may as well be a ghost, unless I am taking up valuable real estate at the machine you want. I heard you and your six-packed friends asking why I even bothered. I heard you.
Parked your beach blanket next to mine? I see you look at me and my husband. No we don’t have kids. It’s just us. I didn’t get fat gestating the next generation, I just am. I did this to myself. I picked a run of the mill one- piece; splurging on underwire so my boobs don’t hit my knees. I see you visibly wince as I rub lotion on my skin and walk to the water’s edge. You sit there smoking and throwing your beer cans on the sand, yet you think you are better than me solely based on my appearance. My fatness means I am a lazy, stupid, likely poor and uneducated person. You couldn’t care less, I mean nothing to you. If I told you I am a doctor, you would laugh in my face. It’s incomprehensible to you I am anything other than a fat, worthless woman.

A Snapshot Of Mental Health

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Treading Water

I think as we go through life we will all have different phases. Times when we are killing it and crushing life, moving forward at the speed of light. Times where everything is calm, relaxed and peaceful, and life is good and happy. And times when the wheels are coming off the bus and it’s all you can do to stay on the road.
I’ve certainly been through all those phases multiple times in my life. Just as my anxiety and panic have had their ups and downs through the years. I was always anxious even as a kid, I remember being afraid to sleep at night for years, hiding under my blankets until exhaustion would creep in and lull me to sleep. For many years my anxiety was not something that registered to me, it was just my normal state of being to worry constantly and be an insomniac, and I thought it was perfectly ordinary.
In college I had my first bout of life-altering anxiety and panic. I was then, as I am now, a highly functional, competitive, type A person who was always involved in 12 different things at once and making my way towards medical school. In the wake of my first real and terrible breakup, I became unwound. Beyond just the typical break-up blues, I was in constant state of anxiety. Then, as it had been now, I sought medical helps in multiple ways, and had many physical symptoms. I went to my college’s medical clinic and counselor and even to the ER with symptoms that in hind-sight were born of my anxiety disorder. This episode also led me to have a brief run of using diet pills that gave me dangerous tachy-arrhythmias. Luckily, my roommates and friends pulled me out of my own head and got me back on solid ground.
My second life-changing encounter with anxiety and panic happened in medical school. During my first two years of school I became more and more reclusive. I could not enter a classroom or have an encounter with my classmates or professors or take an exam without having a panic attack. I got to the point where I did not want to leave the house to get groceries, as I was terrified everyone I met was judging me and could see that I was falling apart. I went to the dean of the school and requested to take a year off. At that time, I did not know if I was ever going to go back to medicine. I worked as a research assistant for a year in a darling company in Yellow Springs, and slowly found my way back to myself and to living a regular life. I was able to become reinvigorated and upon returning to medical school, I found myself and my place again in the world.
My anxiety has continued in bursts and spurts, always there at some level since that time. In residency, terrible physical injury led to another prolonged episode of worsened anxiety, and depression. It is only because of the love of my life Rob that I have been able to come out of all these past episodes unscathed. He is my grounding force and my light, and he has never, ever wavered in his support of me.
I write about these past episodes now as a way of release. As a way to remind myself that I have been there before and come out the other side. As a way to acknowledge my own innate humanity and struggles. In taking time to reflect, I am able to get outside of myself temporarily and let myself know that there is a way out of this.
And that could not be more important. Because right now I feel as if I am treading water and only a second away from drowning. I feel as if my panic is not coming in “attacks” but is a constant force underneath my skin on the verge of tearing through. I have moments where I succumb to the panic and cry and scream until I cannot take even one more breath. So I need to remember that I am a person who has had this struggle before and come through it. I need to tell myself that it is going to be okay. I need it to be okay.

 

International Women’s Day

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In honor of International Women’s Day here’s to all the amazing, smart, kind, generous, beautiful, strong, dedicated ladies in the world! ❤️❤️
As I’ve gotten older I have become more strongly attached to being a woman. I grew up a tomboy and pretty oblivious to gender roles in society, thanks in large part to my family always making sure I knew I could excel at whatever I chose to do in life. Over time, I’ve seen blatant and subtle acts of sexism pepper my days. I’ve seen the vast differences in how women are treated based on their culture, religion, ethnicity. I’ve reflected back on my own life and how it has been shaped by my gender, even if I didn’t realize it… the opportunities I had, and the ones I didn’t.
I am grateful for my experience in the world as a woman. I’m grateful for my voice when so many women in the world are forced to be silent. I’m grateful to be able to stand up for myself and to speak out against gender disparity. I am grateful for my amazing husband, the center of my world, who is an awesome feminist and a true partner to me. I am grateful for all the many phenomenal women I know and how we celebrate and empower each other!

#internationalwomensday

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