"Struggling to be human"

Was wandering around the shops the other day when I stumbled across the first season of Grey's Anatomy on DVD. The blurb on the back caught my eye. It described the fresh aspiring interns as 'struggling to be human'.

Very insightful I thought.

Have been noticing that now having survived 6 months as a doctor I have definitely noticed some changes. The way I view the world has been modified to accomodate the all encompassing trade off known as 'internship'.

I find myself more 'blunted' in affect towards people's suffering. Maybe it's a coping mechanism to help one deal with the large volumes of sick and suffering. Maybe it's a laziness on my part to engage with the harsh realities of real human emotions. Maybe part of my humanity is being lost?

I also find myself more frustrated with the inefficiencies of people. Whereas last year I would have tolerated 'suboptimal' ways of doing things; now I cannot accept anything that slows me down. This isn't stemming from a desire to self-promote myself or put others down, but stems from a necessity to be continually striving for more ways to stream my workload in the face of ballooning patient loads. I find myself welling with rage at the nurses, gritting my teeth when slowed down by the black hole of radiology and tearing my hair out (metaphorically haha) when allied health staff put their 2 cents in.

I feel too tired to tolerate. Too exhausted to empathise. Too harassed to be humane.

Is this what medicine is all about? Replacing the human within with a machine that reacts to certain 'problems' and their solutions?

I feel like sometimes I personally cease to exist from Monday to Friday and only really resurrect myself on the weekends. The "Dr" part of Dr J consumes the "J" part of me and I really am just an employee.

What does it mean to be human?

The Intern Experiments?

It's guinea pig time!

In an attempt to save money and generally just be stingy, The Zoo admin are conducting their very own intern experiment (I should charge them for copyright!) by stuffing around with our timetables. There's a conspiracy theory going around (based on the top secret 'leaked' email ploy) that this is part of a capitalist AWA ploy to eventually move all interns onto a shift based system of work (rather than our 'day job' system) in order to stop having to pay us overtime and thereby saving the government a few thousand dollars per year.

The RMO's are not happy. They are jumping up and down and brining in the consultants to back us up. The admin are citing their 'financial crisis' (which always seems to have enough money to pay for irrelevant departments/positions whilst not being able to pay their doctors).

And so I beomce one of the test subjects by doing an entire week of evening shifts. In reality I don't mind too much. It means I can sleep in and do stuff during the day before coming to work refreshed for the evening. Been shopping and swimming and watching late night soccer in an attempt to get some normality into an otherwise boring week. It's kinda nice to do a week of overtime too because you don't have to order any consults and justify yourself to registrars who should realise by now that it's your boss ordering them and not you and therefore they do not need to lecture you at length about the innappropriateness of your consult. It's nice to not have to battle daily with the radiology department about those 'urgent' tests (once again demanded by the boss) and wrestle with the dragon lady in the film department to get those scans onto the ward (oh why can't we have online radiology like every other civilised hospital?)

This week all I have to do is maintain the status quo. No need to solve the riddle, just keep the patient alive till the morning and "do no harm". Spending lots of time in front of the big TV screen is not necessarily a bad thing either.

Let's just hope no one gets too sick*!

*last night was quite awful with 3 'off' patients all going downhill at once... thankfully they are all alive tonight still which means I can't have done too bad a job?

Mourning

Grief.

Sorrow.

The removal of pleasure.

Life is plagued with the onset of pain and troubles.

Sometimes they can come in the form of the ordinary. The little things like passive-aggressive nurses making one's day more difficult by demanding their will be done.

Sometimes it can come in the form of the personal tragedy. The bigger things like the father diagnosed with terminal degenerative illness and the changes that accompany a family coming to grips with such a diagnosis.

Sometimes it can come in the form of national surrender. The antithesis of the jingoism that characterises a colonial nation.

We lost the soccer. And it sucks.

To be honest I didn't highly rate our chances when we qualified late last year. I thought to get into the World Cup would be achievement enough for our fledgling patchwork team. But somehow they proved us wrong. Somehow they rallied together and pulled off some damn good soccer. And somehow they captured our hearts.

But last night we were heartbroken. A poor theatrical attempt by the despo Italians saw us packing our bags and switching off our TV sets. To be honest we played crap. We passed the ball too much and didn't have enough suprise in our attack. We gave them more than enough time to regather and form a wall in their box. But we didn't deserve to lose either. We held them at bay for 90 minutes only to have a crushing blow delivered on the siren.

Life just doesn't taste the same today. The gloss is a little less shiny and the mornings a little colder. The hopes have been curtailed and the wind taken out of our national sails.

Kinda like girls actually... you cautiously don't get too exicted because you don't like your chances anyway but then small little signs start to suprise you and your hope builds. You get sucked in to the 'match' and become a 'fan'. Only to have your dreams shattered by a decision that goes against you. And yet in another 4 years you'll get up, turn the TV on again and watch all over again. Hopefully the interval between nice girls wont be as sparse.

A good friend put it quite accuarately last week. "It'd be nice to have someone to wake up next to." Someone to be there when work is crap and you need to be remined of the good in life. Someone to lean on when your life starts falling apart. Someone to support during their times of difficulty. Just someone.

Another friend (who has been thru some suffering of their own) said to me that at times like these you really don't want people's sympathy. You get sick sometimes of repeated asking about how blah is going. You just want to be around your friends and enjoy the good things in life once more without being reminded of the bad.

Sometimes you need to be reminded to breathe.

Broken Hearts Part 1

Thus begins the stories of Dr J, relief intern.

It was a cold winter's morning in the cardiology ward when the new surgically primed intern Dr J waltzed onto the ward. Exuding a new found confidence he strolled up to the computer and began to print out his team list expecting a maximum of 20 patients.

A sense of complete panic and fearwashed over him as he saw a 2 (TWO) page list of 35 cardiology sickies under his care.

Crap!

To make matters worse his team was to be on call for Emergency for the next 2 days which would mean even MORE patients would be arriving.

He had no idea who the patients were, no idea about the laws of the Empire (ie how to order tests in the 'level 6 cardiology unit') no idea what the Echo results actually meant and no idea how to interpret complex ECGs.

And so began the start of an awful week that would involve hours of unrostered overtime in order to stop patients from getting sicker and a vague sense of life spinning out of control.

You always hear the bad stories of dodgy doctors who don't follow standard practice and we all shake our heads and go "tsk tsk". But this week the sheer volume and complexity of our patient load led both my reg and I to overlook some basic stuff. We got phone calls from pharmacy querying certain discharge meds and asking us to review certain decisions we'd made. And most of the time they were right in questioning us.

Argh! I felt so overwhelmed I wanted to go into a quiet room and take a time out.. but I couldn't. I was hungry and tired but just had to keep psuhing on until it was all done... and this had happened everyday this week.

Sigh.

Cardiology is full of people with broken hearts. Full of people who have stuffed arteries from too much McDonalds. Full of people who have valves that dont work properly. Full of people with pump failure.

One pt came straight off a plane in VTach and got a direct ambulance escort form the plane to ED where he was shocked with the pads.

Another we zapped on the ward back into normal rhythm after a run of rapid AF.

So many people complaining of chest pain that even I began to feel some 'central rushing chest pain' as I tried to sort them all out.

But today was gold! Pure gold!

Stuck in another boring round when the med students come rushing in with a nervous look on their faces.

"Um J and A.... we think Mrs X is pretty sick... can you come see her?"

We ran (I've never seen people run to code blues) and from outside her room I could hear the 'gurgle of death'*.

The reg took command (like a good team leader) and the nurses bustled about grabbing stuff. The med students looked overwhelmed and as the adrenaline kicked in I grabbed the cannuals and started running thru my training.

A - airway patent
B - Pt put on high flow Hudson mask oxygen
C -time for cannulas!

Now I hate cannulas at the best of times. But when it's an emergency I hate them even more. My reg asked me as the next most senior to secure IV access and I grabbed the nearest cannula and got ready. Everyone around watched me as I went to puncture the skin.

Somehow I got it first go (in a 99-yr old lady that's pretty good!) only to hear my reg say "Great now lets get another one in the other arm"

10 minutes later I had secured another IV line with a large bore and given her 160mg of IV frusemide and a shot of digoxin and taken an arterial blood gas all on my first attempt.

"Quick get me a cannula bung and slaine flush stat!"

Afterwards the nurses congratulated me and the med students looked in awe. I was in control, I had secured venous access and taken an ABG in an almost textbook fashion. I was on FIRE! I began to orate my advice to the students "Well you see it's all about the LMNOP of Acute Pulmonary Oedema, we gave her Lasix, we gave her Morphine**, we gave her a Nitrate patch, we gave her Oxygen and we Positioned her upright."

Today I felt like I'd saved someone's life.

In 2 weeks that lady will get a telegram from her Royal Majesty as she celebrates her 100th birthday... and I had a part in keeping her here for that.

It's a small consolation for the crappiness of the rest of life.

*When in acute pulmoary oedema, pt's can sound very morbid as they try to breath.
** the reg gave this, it's a controversial topic as it may suppress resp rate so don't take it as gospel

Viva Viagra!

After 11 weeks of strutting my stuff in the OT the time came to take off the blue clothes and don the stethescope once more.

It was an emotional farewell with my team as I filled the last discharge summaries and finally got my patient list down to 2 (thats right, I didnt get to enjoy the fruits of my labour!) and even got a peck on the cheek from a rather oldish nurse in the Urology department (Ewww!)

For our final team meeting we were graced with the presence of the Pfizer drug rep which can mean only 1 thing!

Free Viagra trinkets! Yay!

I had been waiting all term to score some cool Viagra stuff and they didn't disappoint. Got some of the high quality pens emblazoned with the big "V" symbol and they pulled out free 'erect' staplers. But the crowning jewel in their wares was the Viagra stamped dinner plates. Who needs fine china when one has a bright red dinner plate with a picture of a tiger in the middle and the drug name splashed all around the perimeter? I was ecstatic! I took two! Like seriously? Who is actually gonna own up to using a Viagra dinner plate? Haha

I had my end of term interview with the boss who wrote that I was "a pleasure to work with" (ie I didn't stuff up too badly) and managed to con my registrars into giving me references.

I sadly said farewell to the now-not-entirely-100%-evil and exited the Urology ward for the last time.

I'll miss the relative small patient load.

I'll miss the super-friendly surgical regs and their antics (I'm already finding myself becoming like one reg who was eternally frustrated with slow or annoying patients)

I'll miss the escapism of 'going to theatre' and avoiding my pages.

I'll miss having almost complete medical control over my surgical patients.

I wanna go back to Urology!!!! Argh!

The Grey Reality

Being a surgical intern has been pretty cool I must admit. You get to live the lifestyle idolised by people on TV dramas like ER. You get to wear the scrubs and strut like you're important.

Recently, when people ask what I do for a living, I tell them I'm a surgical intern and that I'm basically living out "Grey's Anatomy" except without all the complicated love stories.

And to be honest, that's what it feels like.

Day after day I get to wear my scrubs and interact with other doctors with personalities that put the TV shows to shame. The little idiosyncracies of the surgeons, the backstabbing of other interns trying to get onto surgical training programs (well maybe just one in particular).

I feel like I'm living my dreams. We have interesting and bizarre surgical cases on Urology which always make for interesting stories. I get to assist with operating when my reg's aren't too busy. I have enough time off to enjoy and relax with my newfound financial freedom.

I know people who are like Izzy and care too much, I know people like George who are the nice-guys-always-left-out and I know surgical nuts like Christina who'd sell their firstborn child to get onto surgical training programs.

I feel like I'm on TV! And it's great!

However, I forgot that on TV, they are called 'dramas' for a reason. In order to make it interesting to watch, the writers need to add some kind of tension or problem in order to sustain viewers interest.

In the case of Grey's Anatomy, there is the estranged relationship with McDreamy, but on the side lurks another subplot regarding Meredith's mother who has recently been diagnosed with dementia.

And this is the Grey Reality of my life.

Last Thursday my father was diagnosed with Picks Disease (frontotemporal dementia) and for once the novelty of living out the reality of a TV show was not so great.

My ideal lifestyle has now come crashing down in a heap and my plans for the future are all in disarray.

Basically my dad has about 5 years to live (give or take a few) during which time he will progressively deteriorate and need more and more care. Whereas he once provided for the family for so many years, now it is our time to provide for him.

Somehow we gotta sort out what to do, but to be honest, I dont KNOW what to do.

There IS no treatment, no surgery, no pills, no intervention to slow or halt disease progression (unlike Alzheimers).

As a doctor I feel really powerless and useless.

Reality sucks!

"Saubawls"

My registrar has a unique way of describing certain urological conditions.

One of his favourite 'diseases' is "Sore balls" (pronounced "SAU-Baw-LS") which is a syndrome mainly psychiatric in nature where young men present to EDs all around the city to whinge about their scotums.

Most are defiantly dismissed with oral Antibugs and referred back to the rock they crawled out from underneath.

But occasionally, just occasionally, we hit something more interesting.

Today got dragged down to the "Urology bed" in ED to see a young 30 yr old Saubawls Syndrome. Reg was gonna turf him out into the rain but realised this was the 2nd presentation in under a week for this condition.

I got the unenviable task of begging the ultrasound Nazi's to scan his scrote and chasing down the report.

Turned out it was not what we were expecting. Abnormal vascularity and random shape indicating a possible testicular tumour.

Now as bad as it sounds, something inside me got all excited when I heard the CT report.

Testicular tumours are rare but very curable. And to diagnose one as an intern (with registrar assistance) is very cool.

I hastily called my reg, blurted out the Ultrasound report and added on, "So can I send off a B-hCG and an AFP?"

My reg obviously impressed with my keeness to get stuck into tumour markers said "Of course! And lets do a CT too to look at lymph nodes"

Feeling very excited and telling any intern around I could find about my discovery, I then realised the poor dude with his busted balls had no idea what was going on.

You know on TV when the pt asks "Doctor, what's wrong with me?" and they give that vague non-specific answer that you know means bad news? Well today I know WHY they give that vague non-specific answer.

It's a fob off.

On the one hand you can't lie and say it's not more sinister when in reality theres a good chance it could be. But on the other hand, you don't want to get them worried and panicked when you haven't confirmed it yet.

So you fob it off. You say something like "Well we still aren't quite sure what it is so we need to do more tests to work out if it's an infection or something else".

You never specifiy what that something else is.

I kinda felt bad for being so excited about having 'interesting' pathology.

Maybe I really AM getting too into surgery... thankfully only 6 working days left!

Where's Wally? (stuck in ED!)

I'm very sorry.

It's been a long time between drinks and I must sincerely apologise for not writing earlier.

To quote my registrar: "We've been raped!" (metaphorically, referring to our team list exploding, not literally)

The last two weeks have been hell... exacerbated by the fact that yesterday was 6/6/6 which can only really mean badnesss all round.

Came back form my ADO-weekend off to find that my boss had been 'turfed' all these patients from the general surgeon Dr T (who-I-have-now-decided-is-a-big-pilonidal-sinus-aka-pain-in-the-bum-because-he-turfs-everyone) and that due to their having been 3 theatres running at once my list had exploded from an average of 3 per day to 14 per day.

So I found myself on the "Urology" team managing:

a) a 87 yr old Jewish man with chronic proven cholecystitis who came to ED complaining of abdo pain... ED clumsily rammed a catheter into his willy and caused it to bleed and so Dr T 'turfed' us this obvoious gall stone pt because he thought the haematuria was not due to the IDC but to some rare cause of painful haematuria. (Pt is now sitting on ward for almost 2 weeks awaiting Nursing Home and hitting on all the nurses cos he's too well to be in hospital)

b) a 77 yr old morbidly obese (read:180kg) lady who came to ED with rapid atrial fibriallation and chest pain on a background of diabetes and chronic leg ulcers. An obvious cardiology/geri's admission? No way! Because this patient had a cystoscopy 4 days prior, the med reg insisted that this was a UTI exacerbated problem and needed Urology admission even thoguh the MSU was negative, the white cells were normal and the patient was afebrile. (pt is now awaiting geri's transfer and hallucinating about cats and ants running around her room)

c) a 83 yr old male came in with a simple urosepsis but deconditions in the 25 hours (literally) it took for him to become afebrile. Now he 'cannot' walk and needs long term physio rehab after only 24 hours of a UTI. However because he once had a superbug infection 4 (that's F-O-U-R) years ago he needs a seperate room a the rehab hospital and so we cannot transfer him until that bed becomes available. (Pt now hitting week 3 of 'waiting')

All these non-urological pt's are really annoying the crap out of me. I don't mind looking after a pt if we can DO something about them. But these ones are not our territory... we can't do anything more for them. And yet the med teams refuse to take them.

The ED is full. We get daily reminders telling us to discharge any patients who are well (as if we like keeping them for fun?) on our pagers. And yet the bedblock is due to the fact that stupid people keep dumping us with their patients. Grrr!

I have relabelled bed 3 in the ED cubicles the "Urology bed" because we consistently have a new pt in that bed waiting for a ward bed because there is no room in the inn. I even know the nurses down there pretty well now cos I'm asking them to manage the pt when I'm not there!

It all came apart yesterday when ED asked my reg to take care of a patient. She suggested it could be a joint admission but that we would NOT be turfed and would NOT take primary care of them. Later that day the patient was admitted under us.
Reg goes to ED.
Reg screams (I kid you not!) at ED reg and ED reg gets all sooky and stroppy with my red faced, red haired reg who is about to kill someone.
ED reg calls 'other' Uro reg and pt ends up admitted under different boss but Dr J the long suffering Uro intern still has to deal with the pt.

Fini