At the movies... with Dr J

Got roped into seeing "The Devil wears Prada" with some other doctors recently.

At first I was ready to snooze, thinking it would be a chick flick that would hardly sustain my attention span. However I actually found myself staying awake till the very end.

Why?

Cos for some strange reason I identified with it. It resonated with my experience.

No, not cos I'm somehow fashionlably endowed or into girls magazines, but because the hierarchical competite world it portrayed reminded me of medicine.

I wont spoil the story too much, but it portrays an ordinary girl working for a fashion mag who ends up changing her personality to survive and in the end wonders if it's all worth it. In the end she decides it's not and throws her phone into a fountain in Paris and frees herself from the suffocation of her identity by her job.

I watched her scurry in front of her boss to grab things and make deadlines and saw my own ward work on the big screen. What Prof wants... Prof gets!

Time after time the girl on the screen missed important parts of her friend's and family's lives because she was stuck to her work and couldn't leave. I felt my own guilt at the times I've stood friends up for dinner (even this week) because of work.

I feel like sometimes work is turning me into someone I don't like. Someone I don't want to be.

Maybe I should throw that pager into the nearest fountain? Maybe I should reclaim 'me'.

Memories

Yesterday my mate M left on his medical school elective.

He's off to Kenya to go play jungle doctor and see the world.

As I took him (and his farewell entourage) to the airport, it brought back memories.

The airport holds do many memories for me.

Seeing my sister off with the family as she left for the US for 2 years.
Picking up my overseas uni friends when they return from holidays.
Nervously waving Sydney goodbye as I took my first trip overseas when I went on my elective to Taiwan.
Excitedly hugging MC this year when I saw her walk out of customs.
The shed tears at the departure gates when MC left with part of me going with her too.

It's been 2 years now since my elective and it still holds such fond memories in my heart (and always will). The wonder of seeing the 'novel'. The smell of Asia. The greenery of the tropics. The humidity and palpable vibrancy in the air. The buzz of speaking another language.

To be honest I learnt no medicine whatsoever during my 2 months in Taiwan. But I learnt an awful lot about life. I think going somewhere completely foreign and isolated was an awesome idea. You are forced to go out of your comfort zone and live life to the fullest.

As I saw M walk to catch his plane, I saw a flashback and knew that when he
returned, he would understand.

Good luck and safe travels M!

What is this thing called "Saturday"?

After a month of working 6 day weeks it was pleasantly relaxing to enjoy the day known as Saturday.

Why?

Because:

a) you can leave work at 5pm Friday knowing you have 63 hours of freedom till you need to come back to the wards.

b) you can stay out really late on Friday night without feeling guilty about having to get up the next day for work. It also means you can go out karaoking with your Asian friends and then tie one of them up with duct tape and dump him outside the door of a girl he likes with a texta scrawled address label on his forehead.

c) you can sleep for long periods (enough said)

d) you can go to the shops whilst they are still open and buy things with all the money you've earnt from the past month of 6 day weeks. Things like exercise bikes (for that spring time health kick you've decided to embark on) or smoothie blenders (for the health kick too) or just random DVDs you have been eyeing for a while.

e) you can enjoy Sunday with less pressure knowing that it's not your only day off for the week.

f) you're not spending the day dealing with old people's medications whilst your friends are outside enjoying creation.

Can't wait for the long weekend! Bring it on!

Men are from Saturn, Women are from Liverpool

Relationships.

They are so confusing in all their forms and yet they are fundamental for human existence.

We inflict so much pain through them, and yet become profoundly depressed in their absence.

Friday night I spent enjoying the relationships with friends from church at our annual ball. The theme was "Cluedo" and so guys and gals donned various coloured clothing and solved a murder mystery of epic proportions. However when the DJ's music remained techno for too long my mate and I rushed down to my car, pulled out a dusty CD from my glovebox and got him to crank on "Backstreet's Back". Worked a charm until my mates decided I should dance and I decided I shouldn't* What ensued next was a tangling of limbs and bar stools and helium ballons being sucked as I was dragged laughing non-stop onto the middle fo the floor and dropped.
It was great to just have some fun and muck around with my brothers and sisters without worrying about life.

Ended up staying out way too late but seeing as I had the 'easy' Saturday shift at work I figured I could always sleep a bit during my shift the next day. How wrong I was...
Rocked up to work bleary eyed only to find that one of the residents was sick and seeing as I had the cruisy shift I was dobbed in to do his job as well until they found someone else. So I ended up being overworked, running between theatre (open appendix and a trachie) the intern wards and the resident wards. By the end of the shift I felt so exhausted, both emotionally and physically. And all I wanted to do was come home to someone. To have someone in my life who would be there for me and tell me it was ok and someone to look forward to seeing.

But to be honest I find myself frustrated with the whole boy-girl relationship thing. Girls whinge about guys not being 'chivalrous enough' (whoops I forgot to open the door! Sorry J!) and never asking them out whilst guys shake their fists and lament how girls are fickle and looking for Mr Darcy who doesnt exist.

I think I've been scarred from past expereinces which have all been less than ideal and made me bitter/pessimistic about the whole process for the future. And yet why do I keep finding myself seeing nice girls as 'potentials'? If I'm so fed up then why am I so hungry?

"No man should marry until he has studied anatomy and dissected at least one woman." - Balzac

I realise that relationships are so vital to life. We are placed in many relationships. As a son, as a doctor, as a friend, as a flatmate, as a leader, as a learner.

I feel that work makes me value relationships more. Somehow the business and exhaustion of work needs people outside of work to fulfill it. One day I hope that'll be with some amazing woman** but it must not be exclusively there. Fulfillment of relationship is found in love. And that is found in God. But in this fallen world we just keep stuffing it up. And so I long for that perfect relationship. One that casts out all fear.

* I hate dancing. Not other people dancing. How they choose to express themselves is their own business but I personally refuse to dance because I am crap at it. Not in a 'aww-isn't-it-nice-that-the-guy-can't-dance-and-is-lamely-trying' way, but in a "get-this-moron-off-the-dance-floor' way.
** Latest OoA is Pharm girl #2 the new pharmicist on our ward who is of Asian extraction, extremely nice and all the other guys think she's good looking too. Finding myself wanting to 'review a patients medications' so much more often now. Hehe. (Don't worry .. definitely out of my league and prob not Christian)

The human side of medicine

"A young intern confronts his own demons as he cares for a demented patient and is forced to face his own father's mortality."

Sounds like the TV blurb for ER or Greys Anatomy right?

Well it's my life!

Been havign way too many 'warm and fuzzy' moments in the last few days.

I think it all began on the weekend when I was working overtime and got called to a 'code blue' on my usual ward. As I looked at my pager I recognised the bed number as one of my little old ladies and a wave of dread fell over me.

When I arrived there were already 7 other doctors cracking her ribs, jumping up and down on her tiny heart and trying to stab for those ever important ABGs. Turns out she became hypothermic and dropped her temp to 32 degrees and became bradycardic... a sign of shutdown.

We called the son to come urgently and ICU came and rammed a tube down her throat... she went into Vtach and 20 seconds later got zapped with those paddles. She came back... but only for a few hours.

As we met with the son, I felt so awful listening as my reg explained to him what was happening and discusses the Not for Resus orders with him. Although she was sick and frail and elderly, I still feel like maybe I could have done something more... maybe I could have got a peripheral line in for some fluids? Maybe I could have been more aggressive in hounding the reg to see her? Either way, she's now gone and as my reg said to me:

"You're not a real intern until you kill someone"*

Then today I had one elderly patient ask me to sit on his bed and talk with him about 'life'. he onyl had a mild cases of gallstones but was convinced he was about to shuffle off this mortal coil tomorrow. I felt really sad as I listened to him and heard him talk abotu how great his life used to be and how he had bought his own house and raised 3 sons who were now living their dreams and he was living his life now through them. And yet there was a sadness there as he talked and he said he wished he could end it all rather than live a life of disability. It made me think just how truly awful it must be to see society devalue and ignore you as you age, just because you no longer have any capitalist value to them. I'm going to miss him when he goes tomorrow.

Straight after that I got called to see a lady with breast cancer who had liver mets and was dying but came under us cos she had biliary obstruction. As I stabbed her she began to pour out HER life story too (I must have had this sign on my head saying "please tell me ALL your problems"). As I sat there listening to her battle with breast cancer at a young age, it brought back horrific memories of my own grandmothers death. My grandmother was diagnosed at 45 with breast cancer and had a protracted 12 year battle with a slow but steady decline. In fact, it was her death that inspired me to become a doctor in the first place. And seeing this young 40-something woman dying there in front of me I couldn't bear it any longer and had to leave before I lost it.

But I only just made it to the ward when I was asked to talk to the wife of one of our demented patients about his return home. It was obvious this was gonna be a long one, so we went into a nearby room and she poured out her agony till she could say no more (and she was of Mediterranean descent.. there was a LOT to say). Sitting there listening to her talk about feelings towards her dementing husband made me feel like I was talking to my mother. All the pain and suffering I saw in her eyes resonated with the anguish I see in my own Mum each day. Hearing her reactions and grief to her husband made me break. I just sat there with her and gave her the one thing that doctors don't have... time.

Amidst the incessant paging and ward rounds, between the cannulas and med charts, we lose track of what it means to be a human and what it means to go through an illness. And so today I spent some time just sitting with my patients and listening to them. Not offering them textbook answers to their problems but just sharing their pain and being there for them.

To be honest, I dont like it. It makes me vulnerable and it makes me human. And doctors aren't supposed to be human. Cos if they were then they would not be able to cope with what they do each day. And to love others is truly... definitively... human.

* I didn't 'kill' her for those of you who are non-medical readers. It refers to that feeling though when you feel responisble for their deaths even though you did all you could.

What a difference a reg makes...

Well the sun is shining and the light has fallen.

Came back to the wards this week to find that the gastro regs had swapped over and my old reg was now sticking cameras up bums whilst I had the smooth talking Indian reg who is renound for writing in large letters and signing his entry with only his first name (now THAT is cool!)

I wasn't sure if this would be a good thing at first. My few previous conversations with him had involved talks about whips and chains if the patient list was too large when he hit the wards. But these fears were soon allayed when he told me not to bring the notes to the patient's bedside to write in as HE would do this himself later.

That's right... I have a reg who insists on writing the progress notes himself.

I never thought such people existed but it's a welcome relief from spending hours postdating entries for the rest of the morning. And not only that, but he generates less consults, less CT scans, less crap for me to do and therefore instead of getting out at an average of 6:30pm... I'm now finishing my work by 3:30pm and looking for ways to kill time.

Also in the past few days I have only had 2 new patients whereas with the old reg I had an average of 4 per day.

Life at the moment is just a whole lot better.

Which is good because had I kept going at the current rate I was last week I would have ended up like this:
http://www.theage.com.au/articles/2006/09/12/1157826941987.html?from=top5

And as icing on the cake, we have a new ward pharmacist who is of Asian extraction and instantly turned me into a blubbering fool when she asked me about a patient's medications (one of the other interns is going to asses her single status for me... haha).

Enjoy the good times while they last!

The lighter side of life

So what does an intern do when he has a few spare moments?
Read the latest edition of the New England Journal of Medicine?
Peruse eBay for a new Littman Cardiology III stethescope?

No.

I do the following:

a) decide which new free phone to get. That's right, customer loyalty in Gen Y is at an all time low and so my phone company is offering a new phone to stay with them. So now the only decision is whether to get the Motorola V3x or the Sony Ericsson K601i?

















b) watch the latest movie trailers on Quicktime's website. Of notable interest is the new upcoming Teenage Mutant Ninja Turtle feature film. Long live my childhood! And there's even a sneak preview of Spiderman 3... is dark, is good!











c) roam YouTube for random video clips of long lost shows such as "Ren and Stimpy" with their classic song "The Royal Canadian Kilted Yaksmen" (to the tune of God Save the Queen)

Our country reeks of trees
Our yaks are really large
And they smell like rotting beef carcasses
And we have to clean up after them
We proudly wear women's clothing and searing sand blows up our skirts

And the buzzards they soar overhead
And poisonous snakes will devour us whole
Our bones will bleach in the sun
And we will probably go to hell
And that is our great reward
For being the-uh Ro-yal Canadian Kilted Yaksmen
And our saddle sores are the best.















d) order a whole bunch of Asian music and DVD dramas online to keep myself occupied.

A story of old...

Amidst the craziness of the past few weeks, I have been looking after an elderly patient Mr A.

Mr A is a Swedish ex-navy officer who presented to ED with symptoms of chronic liver disease due to alcoholism. Your typical drunk old guy with liver problems... or so I thought.

Turns out Mr A has been hitting the grog hard for the last 5 years after his wife died. She was the love of his life.

They initially met in the United States when he was posted in the navy there. She was married at the time and he was a dashing young sailor. They hit it off well but since she was married they parted as friends.

It wasn't till 20 years later when he was in Australia that they met again by chance. In that time her husband had died from cancer. He had never forgotten her though and took the chance to find happiness with her. They were soon married and lived together in Sydney until she was taken from him by emphysema.

Since then he has lost his will to live. He doesn't care if he wakes up each day. He sees no point in living without her. It's so sad.

Whilst my ward rounds are pressing, I still find myself drawn to spend a little bit of time each day just talking to Mr A. Just to be there and listen to him talk about the love he once had and be there for him. I see a sadness in his eyes that haunts me. There's no sparkle there. Just a void of loneliness.

Tomorrow we are going to ship him off to a nursing home. His bed will be filled quickly with another patient with vague abdominal pain. And he will be lost to a world that has nothing of value for him.

Amidst the indifference I have towards most of my pateints, this guy has stood out as the one excpetion that shows somewhere underneath all the pounding of internship there is astill some shred of humanity left in me. Some piece of connectedness to the shared common experience that we all have that makes us relate to each other.

And so although he leaves our dreary ward, his memory will be a temporary reminder to me, that people are humans first... and patients second.

Re-Employment

Last Friday had my first medcial job interview.

Basically had to reapply for my own job which was kinda weird seeing as all I'll be doing next year is the same as what I'm doing this year*

At first I wasn't that nervous as I expected that most people would get back in to The Zoo. However as the time drew closer for our date with destiny, people began to flip out. Interns began to gather in huddles to discuss rumours of selection criteria. Unofficial gossip from the JMO office began to strike fear in otherwise sane people. Panic set in and the fight or flight response cranked itself up.

When the day itself dawned, people started showing up for work dressed in suits and looking sharp. And one by one, interns started filing into the admin offices to face the firing squad.

The first few trickled back to the wards sounding mildly confident with the process, however this did little to allay the fears of those still to go. As the day progressed the tension eased slightly and at 2pm I put my suit jacket on, straightened my pink tie** and walke dup to the interview room. I bumped into the formerly fat/pregnant intern who was on maternity leave and we nervously made small talk about her baby whilst internally freaking out about our upcoming interrogation.

So finally they called my name and I walked up the long corridor to face my destiny.

"Welcome Dr J, please take a seat..."

Question 1 - Tell us 3 reasons why you believe you are the best candidate for the position.
I rattled off some rubbish about communication, organisational skills and clinical competence totally feeling self-conscious about 'selling myself'.

Question 2 - Clinical scenario about an unconscious guy on the ward.
Usual ABCs and as soon as I mentioned I'd do a blood sugar level they were happy to move on.

Question 3 - If you've had a really bad day at work, what do you do afterwards?
What the?? What a stupid question! "Well sir, I like to raid the nearest S8 cupbaord and steal some hard core drugs and then I go get high whilst on call" I mumbled something about having dinner with fellow colleagues to gather their input into how to deal with situations. Bah!

Overall I think I did well. Talking confidently in these kinda things and exams is something I've always had little trouble with. Only time will tell if this intern will be able to come back to the Zoo next year. Fingers crossed eh?

* With the minor exception that I will finally be able to write outside scripts and deal drugs to people who aren't in hospital.
** Pink ties are cool. Or at least the nurses keep telling me so. Hehe

Overwhelmed...

I hate medical terms.... I really really hate them.

The last two weeks have been a non-stop rollercoaster ride known as "Gastroenterology" which have left me ever so tempted to just pick up my bag, walk out the door of the Zoo and never return again. To be honest, any enthusiasm or noble aspirations I ever held about helping people are well and truly gone. I hate my job and I hate in particular doing medical terms.

Started last week with a huge patient list and a Korean reg who is known for his abruptness and comments such as "I'm a liver man... only bother to call me if the ALP has gone up by 5!".

Within 5 days I had 5 patients dischanrge themsleves against medical advice. Now so far I had only ever had 1 do that ALL YEAR, but in one week either my sheer exhaustion/incompetence or the crap-ness of this term made 5 people leave hospital while they were still sick and needing treatment.

Patient A staetd that he needed to leave to go and buy a house in Adelaide, then when about to walk out the dorr demanded a taxi voucher to get himself a few hundred metres home and when we refused called us 'lacking in compassion and lacking in brains.

Patient B came in witha multi-drug resistant HIV strain and had a UTI and rectal stranding on CT. Didn't take Einstein to work out that this was "what happens when you put things in places they don't belong" (to quote the Urology registrar). However the patient didn't like the smell of poo on the ward (it's a gastro ward for crying out loud!) and so walked out the door to take his chances without antibiotics.

Patient C had acute pancreatitis and kept ripping out his drip on a 6 hourly basis requiring me to keep stabbing him. He wanted to go off to pay some bills and when I said we advised against this he self-discharged and said he was oging to admit himself to St Elsewhere's where they have more compassion (don't let that door hit you on the way out buddy!)

Patient D had chronic abdo pain and kept wanting more and more painkillers yet everytime we saw her on the ward she was running around and chatting on the phone to her friends then would double over in pain the instant she saw us... who you kidding girly?

Patient E came under gastro becasue she had mastitis. That's right. Apparently tummy doctors are now the ones to treat infected breasts. So we were about to start some good ole IV fluclox when the patient's 'natural therapist' objected and even though we got senior advice from the 'lactation advisors' that this was an ok anti-bug to use, she still refused. And so we had a patient in hospital refusing treatment but still wanting to be admitted to the private hospital... why bother coming to hospital if you don't want our treatment?

I've concluded that gastro is the medical term you dump patients in when you can't find any 'real' pathology that a surgeon could chop out. We send half our patients home with no real diagnosis and I've consulted the 'chronic pain team' more in 1 week than I have all year so far.

Combine that with the fact that my reg is constantly scoping/never around and I'm totally losing the plot. I have no morale and feel sick each morning as I get up to get ready for work. I even had to walk out of the ward the other day to stop myself from breaking down. I even had the social worker run after me to check I wasn't about to jump off the building (although very tempting).

The med students look at me with pity and horror. The senior ones have stopped asking me for patients when they see the anger in my eyes. The junior ones I try to be nice to and spare them the horror of what's to come.

There's no sparkle in life right now. It's just day after day or crap (and this is what life will be like for the next 9.5 weeks)

The only thing keeping me sane right now is Coca-Cola, grace, the onset of spring and the weekend food outings with old uni buddies.