The Last Day Of 2020

So I thought about writing my annual year in review post. But I’m struggling to do so. Can Anyone really write a good summary post about 2020? Probably not. Mostly because it seems like the perils of 2020 are not yet over.

I usually say there’s always something to be grateful for every year. I guess that’s true. I mean, this year I thought was going to be awful for a bunch of other reasons. But as it turned out, that stuff was less awful and kind of turned out okay as collateral damage to the whole covid business.

Some things were broken beyond repair this year. But other things were built. Nobody has ever had an experience quite like this around the world. It was unique. It brought people together in a way while also ripping them apart. Lockdown was hard. Working through it in hospital for me was hard. But I imagine it would have been way harder for people at home.

For me personally, stuff happened this year that kind of broke who I thought I was. And the relationships I have with others. But there were also times that solidified who I am and certain relationships.

But I hadn’t achieved any personal goals this year. I had a few of them. I had visions to improve certain aspects of my life. But all is not lost. As always, when things don’t turn out the way you want them to, they inevitably turn out the way they’re meant to. And at the end of the day, that will be what was best for you and everyone. Even if it doesn’t seem that way at the time.

I believe that.

So. Going forward, I can’t really picture 2021 being loads better. Because as we all know, this covid thing hasn’t yet gone away. Of course there is the vaccine which gives lots of people hope. Myself included. But in the time that it takes for most of the world’s population to be vaccinated or immune, things will be rather different. Travel will take a long time to go back to how it was.

But we can surely hope it will be better in that everyone is prepared for these changes. And everyone, will go with the flow. As will I.

So on the last day of 2020, I decided to do my favourite thing – watch the sunset. May the setting sun on the last day of 2020 bode well for the sunrise of 2021

I Wish For Understanding

Don’t know how to start or talk about this. I just wish for understanding. I wish someone would understand me.

I wish I would be able to understand myself

I didn’t get the jobs my family wanted me to get. I am relieved by that which makes me guilty. It makes them sad. I don’t want to make them sad. But I don’t want to go along with their plans.

Some part of me wants a happy family. But I don’t want to give up what I have.

I’m averse to change. That’s wrong. But there are some things I yearn for.

I threw myself into my work. I find happiness in it. I find solace it. The little annoying things are part of what makes it.

I threw myself into work and career to escape the gaps in the rest of my life. Now I can’t give up what I have because it’s become too great a part of me.

I did the same for some people in my life. They’ve become too great a part in my life. I can’t give that up.

But they tell me they like me because I understand them. I make them feel good.

But it never occurs to anyone that I want to be understood too. That I want to feel good.

Nobody seems to get it.

My chest often feels heavy with too much emotion. Guilt, regret, fear, love, sadness, loneliness.

I imagine telling someone about my thoughts, but I keep hearing them feeling sorry for me. Not really understanding me.

But then I break down and actually try to tell someone but they often don’t have enough time to reply or are caught up in their own feelings. And I feel guilty for burdening them.

I want things I shouldn’t want. I do and say things as though I already have those things. But then I get angry when people don’t confine to the things I want or think I have. And that makes me angry. I’m punishing someone else for an idea I created in my own head. I’m trying to sabotage it myself.

I don’t know what I’m doing

I look at myself and I don’t know what I’m doing next. I don’t know what I’m doing now. I want to stop feeling this way but I don’t know what I have to do when virtually everything scares me.

I don’t understand.

I wish for understanding.

In My Head

People always talk about a utopia/dystopia whereby you could read other people’s minds or people would say exactly what they’re thinking to everyone every single moment of every day

People talk about this being ideal and not ideal for various different reasons

But lately I feel like the only thing worse than the scenario above is when I am genuinely trying to convey my feelings and the truth as best as I know how, and the people around me either don’t listen, don’t believe, or don’t want to understand.

You’d think the challenge would be trying to get someone to tell you what they’re feeling. Not having people not wanting to hear what you’re feeling.

Feel like I’m just another one of these clowns at an arcade. Being hit on the head, told to get back in my hole when I try to say something about my feelings

Pedantics and Quirks

I’ve got a lot of thoughts buzzing in my head today. Not all of them good. But somehow I got into thinking about weird quirks I have and things I’m pedantic about.

When someone says “Thanks” instead of “Thank you” to something quite significant and something that was actually quite thoughtful, it seems less than adequate. I have no idea what the singular form of “Thank” and the addition of “you” has, but it means more to me when some says thank you, rather than just Thanks.

I also sometimes have issue with people saying “no worries” (must be a NZ/Aus thing) instead of the conventional “you’re welcome” or “anytime!”. When I say a genuine thank you to show how grateful I am, “no worries” feels so impersonal and like it’s being brushed off.

But nothing bothers me more than “I’m sorry”. Nothing seems more pointless than these 2 words. I’m willing to bet 9/10 times someone has said this to me, they 100% did not mean it. And I can tell because their actions hardly ever show that they’re actually filled with any amount of “sorrow”. Maybe a new variation? “I feel much sorrow over what I have said/done”…. meh. Still not feeling it.

When people don’t thank you/show a gesture of a hand when you let them pass into your lane or give them way to cross. I don’t know. It’s like the trolley theory (look it up if you haven’t heard of it). Nobody is going to tell you off for not doing it, but whether you’re a good enough person to show gratitude for small gestures or not, can be worked out from something like this.

When people don’t reply. Not just being left on seen, etc. Everybody has a problem with that. I mean more when someone messages me and I reply in 0.1 seconds but then they take the next 24h to say “okay” or something equally insignificant. People don’t give enough credit for the demons in another person’s head.

Lack of empathy. Specifically, if you KNOW something would definitely bother you if it happened to you, why on EARTH do you think it’s acceptable to do it to someone else? Like why. Why.

WHY

Don’t know. Too late in the night for any of these thoughts to end anywhere constructive.

Feel free to disagree with any of the above. It’s all probably not any big deal at all. But these are my quirks and things I’m pedantic about.

The Burnout Ended

Finally my week off arrived! And let me tell you, it was a long time coming.

Prior to my week off I had a set of night shifts which were pretty awful and draining. Made me worry a bit for the coming years and whether I would even have the energy for night shifts. It’s just not natural. Eugh.

But something else that happened in the weeks leading up to my week off is that I was asked to step up to be a registrar 2months earlier than everyone else.

Our employers in Auckland, being as useless with admin as they usually are, realised much too late that they do not have enough medical registrars for the coming year and especially for the transition period in November. So their last-ditch attempt was to ask those of us who are going to be registrars in February, to start in December. I was one of them.

Initially the whole thing freaked me out because I was still in my burnout spell and I didn’t think I could tolerate more responsibility and a more difficult roster (being a registrar is nothing glamorous, let me tell you.) So I was super scared. Every one I talked to thought I was ready. Except me.

I didn’t quite know what I should do but I kept telling myself it’s the burnout talking. Because I knew I wanted to be a reg and I knew if I did it early, my senior regs who I know and who like me will still be around to support me before they move on to their next rotation. So that’s a bonus.

But on the other hand, it was more responsibility when others at my level were still House officers and I sure as hell won’t get the week of leave I had asked for around Christmas time and what if I screw up? How do I just step up early?

Well as someone who just recently read The Subtle Art of not giving a f*ck, I guess the answer to that question is, you just do it. If you haven’t read that book, I recommend it. Helped me through my burnout stages.

I guess the point is I knew I was gonna do this so I guess, just do it. (In the most non-Nike way possible).

There was no real point to being scared. I mean of course I have to be a bit scared and make sure I do a good job and not screw up, but there’s no point in being so scared that I go backwards from progress that I need to have.

So anyway, during my week off, I reflected, and agreed to go ahead and take the job starting in December. Only time will tell how thing shall turn out.

I went to Tauranga on my week off, a city in the East Coast of the North Island. Famous for the beaches and nature trails. Climbed up a mountain and took some pics as I do.

It’s been a good week off. Much needed, tried to be productive, reflective, get back into photography, reading, writing and being some version of happy.

And the weather was just gorgeous! Here are some pictures of the Tauranga coastline from Mt. Maunganui

What A Wonderful World..

I was talking to a friend I hadn’t spoken to in a while, today. She is a good friend when I need someone and I miss her every now and then. One of these people with whom you can just pick up where you left off.

Catching up on her life, she told me she had recently been feeling low. I asked her why and she told me that it was because she had met a guy through an app a few months ago. She had been very taken with him. They had talked for a month and been on a couple of dates and things seemed good.

But then one day….POOF

He became a ghost. Not a ghost like it would have been understood 5-10 years ago where he died and had some unfinished business and came back to haunt someone.

No, more like a ghost of these days where you’re just a prick that stopped replying, stopped interacting and kind of left things up in the air in terms of your relationship with someone. Virtually.

I made a similar post like this a couple of years ago. But Goddam. I just don’t get it these days.

I’m not that old, but I still remember a time when people would actually talk things out. If you’re angry, upset, not feeling it, have a CONVERSATION and have it out so both parties can have closure. Don’t leave one person hanging just because you don’t want to deal with the awkward conversation.

I’m a big fan of talking. I mean surely we didn’t evolve into beings with the ability to create a bunch of complex languages (or be given that ability by God, if that’s what you believe) to waste our lives with buttons like “block” “unfollow” or even tiny emojis that could literally mean a million different things.

And why on EARTH is it actually affecting us?

My friend is a lot like me. She was tired of things being up in the air so she actually contacted the guy and asked him what was happening, if he was okay, etc. He skirted around the whole thing, didn’t really engage and went back to ghosting. He also made some comment towards the end that she “shouldn’t take things so seriously”…………….. Tosser.

We live in a world now where wanting to communicate directly, is somehow vilified. We make jokes and memes about people not wanting to answer the phone and talk to each other and we call out people who want that directness from the people close to them.

If you call someone in the middle of a text conversation that’s going nowhere, that phone call is so unlikely to be answered. If you repeatedly text someone asking for a clear answer, you’re “dramatic”, “crazy” and “taking things too seriously”

Why can’t you be like everyone else and just move on once you’ve been ghosted or take the hint that the other person doesn’t want to talk?

We’re literally growing up and raising a generation of people that shy away from actual confrontation, from real committment and everything that comes with it. That means having difficult conversations, actually putting in time for each other. And just honest-to-goodness respect for another human being.

And it’s ludicrous that people actually do experience pain from “being left on seen” or “unfollowed” or “unmatched”. Why have we come to a time where virtual cutting out equals real life rejction?

No wonder mental health issues are on the rise. It is so easy these days to get away with not sharing your feelings or dealing with conflicts. All those bottled up feelings have to give at some point. And it’s so easy to turn it on someone else for not fitting that mould and calling them “extra” or “overthinking” or “mad” because you didn’t want to have that conversation.

Really. What a wonderful world.

Abdo Pain ?Cause ?Abdominal Migraine

Following on my theme of having a hard time and reflecting on it, I did a thing.

A few weeks ago I got myself admitted to hospital. The hospital I work at. During work hours.

I was just sitting in Medical ED. Just admitting a patient. It was nearly lunchtime.

I had a sudden onset pain in my tummy. It was kinda painful. Kinda gnawing. I figured I was hungry. As all good doctors do, I ignored in and carried on working.

A few minutes passed and the pain got worse. It made me stop what I was doing and move to the tea room to get a glass of water. I felt nauseated. Again, probably just hungry. I’ll just get a glass of water and go get something to eat.

I felt hot. The pain in my tummy worsening. The cafe was a few hundred metres away. I abruptly sat on the couch in the tea room.

A nurse saw me. And as all good nurses do, he began fussing. He said I looked unwell and I should go lie down in the clinic room.

Pain still bad and now finding it difficult to walk, I obliged. Went to the clinic room. Sat down, lay down, pain worsening. Felt restless. The phrase “writhing in pain” came to mind.

But I’m a girl of action. I called my RMO unit and said I can’t complete the rest of my shift because I’m unwell. They wished me all the best. I told myself I would go home.

Big whoops. Couldn’t walk. Pain very bad now. More nurses fussing. Friend who heard my distress on the phone came to see me and began fussing. To my horror they called in MY consultant to assess me. At this point I began vomiting.

He watched me writhe in pain. Suggested I go to ED.

ED saw me and pumped me with 12mg of IV morphine, the approximate recommended dose to flatten an elephant.

I was floating in and out of consciousness. Answered questions. Every time I woke, I was in pain. Pumped with morphine and knocked out. Tests done in my half conscious state.

About 4h later, I was completely pain-free. Asked for some food. I was discharged happily.

My discharge summary arrived in the mail today. Diagnosis: abdo pain ?cause ?abdominal Migraine

Loosely translated that means the pain in my tummy was in my head.

I told one of my friends this story some days after it all happened. He said “that sounds like some good old fashioned stress”

I laughed. Yeah some real “stress” that was.

Until I replayed everything that happened before that day.

I was stressed as heck. I walked into work that morning feeling the worst I ever had. The weekend that had just gone by was traumatic for me. I saw and experienced things that were so confronting to my image of myself that I didn’t know how to deal with it.

A friend and I were waiting for some important, life altering news that day this all happened. I was anxious and scared and sad and I didn’t want to be at work except I had to be at work.

We got good news. The pain had just come on when my friend said he received the good news. But that didn’t make the pain go away.

Maybe it was too late and all that pent up tension was already being released. I’m not sure.

But as quickly as the pain came on, 4h later and a bunch of plum normal investigations, it was gone. And I was left feeling embarrassed for causing all that fuss.

But it was all in my head. I don’t not appreciate the physical manifestations of psychological distress, and I’ve been nauseated and sick before because of depression. But I’ve never experienced anything quite like this.

I realised I have a lot of pent up emotion that’s not going anywhere any time soon.

Things are the most wrong they’ve ever been in my life. But they’re also the most not wrong they’ve ever been. And I don’t know what to do.

Focus on the good things? Yeah. Hope for a change? I guess so.

But ultimately I don’t know. And I don’t know how much more my mind and body can really take.

But I guess I’m in the business of finding out.

But this is a public service announcement. Abdominal migraines are a real thing. Even if it is all in your head.

Burnout Sometimes Looks Like This

Okay kids, storytime.

This is a story of me realising how burntout I actually am in my job.

I didn’t think I was burning out. I was still fine to wake up every morning and go to work. And when I had weekends or days off after working weekends, I was usually unproductive and felt like I would be better off at work and being productive. I haven’t had any leave since last Christmas. I had a couple of weeks of leave planned and requested, but due to the wonderful COVID19 era, and lack of anywhere to go, and my working in the frontline during the pandemic, I cancelled all my leave requests.

I kept telling myself I’d be fine. My roster isn’t that bad. I get most weekends off and days off post weekends and sleep days post nights. And there wasn’t really anywhere else I wanted to be or could be. So it’s all fine. I’ll just keep chugging on.

Spoiler alert: Not a good move.

So on this fateful day, I was working in the medical ED (AMU) as usual when I received a call from the hospital’s discharge lounge. (It’s this area with a bunch of LayZboy chairs where patient’s who are waiting for discharge papers or rides home sit patiently). Basically people who are completely stable and need no further treatment/management go here.

So a nurse calls me up and says “Good morning, I have a patient from your team here for a blood transfusion. She needs to be admitted and blood charted please!”

My first response was a big HUH? I work in AMU. Yes I have an acute medicine “team” in AMU that admits patients with simple conditions like a viral illness, but they get discharged the next day. And we certainly don’t take elective admissions and we DEFINITELY don’t take patients in discharge lounge. Needless to say, I was super confused.

The nurse on the phone didn’t really clear things up for me. She said the patient was under my team. And she’s here and she needs admission. Over and over. Strike 1. In the end I said okay I’ll ask my registrar and come sort that out, and hung up.

I approached one of my registrars and asked him what was going on. He said that he and the other registrars had received an email from a medical consultant stating that a GP had called her saying a patient who was 8 weeks post partum was still experiencing PV bleeding and had a low haemoglobin and she needed to come in for a blood transfusion. The email also had the line “In retrospect I probably should have asked the GP to discuss with OBGYN, but given she only needs this, I’m sure we can handle it under general medicine” And of course, the house officers (like me), who actually DO the admissions, were conveniently left out of this email. So we had no idea about this patient. The other house officers were otherwise occupied so I guess it was up to me. My registrar also said it was up to me to sort out.

I didn’t know blood transfusions happened in the discharge lounge but the medical consultant had specifically asked for the patient to be admitted to the discharge lounge. It struck me as odd because that wasn’t a place unwell patients should be at all. They didn’t have a lot of equipment for medical managment there.

But I went anyway. I went to see the patient and made sure she was consented to receive blood products and was about to take some blood tests (nurses at my hospital are not certified to do blood tests and IV lines themselves. Even though nurses at the other 2 Auckland hospitals are) when I realised they didn’t have the right blood tubes for the blood bank. I asked the nurses and they had no idea what I was talking about. I huffed and had to walk all the way back to AMU to get the right tubes and returned to carry out the blood tests. The patient’s nurse and the head nurse stood in the room and hovered over me, watching. They seemed just as uncomfortable with this patient being in discharge lounge as I did. Only they didn’t really want to help me. I passed them the blood tubes I had collected and they just placed them on the table next to me instead of sending them off. Strike 2. I was sending the bloods off myself when the head nurse pushed a piece of paper under my nose and said “please chart the blood”. We were still standing in the patient’s room.

I looked at her. I was getting more confused. We have e-prescribing at our hospital. All patients admitted to Middlemore had to have an electronic prescription for their medications. I asked why I couldn’t chart it online. She said “She’s not in the system. It’s fine we can use a paper chart”. I felt super uneasy about this. And so I said “That’s a bit unsafe isn’t it? If she’s being admitted for this, she needs to have an electronic chart for the records.”

The head nurse just looked at me and said “Well she’s not in the system. You can just chart it on the paper”

Strike 3

In that moment, I got super annoyed. At the entire situation. But most of all, at the consultant that orchestrated this difficult scenario. So I said that out loud as well. “You know I’m really going to talk to Dr. A about this. Patients like this really shouldn’t be admitted to discharge lounge”.

The head nurse turned around and said “You can talk about this in the nurse’s station. Not in front of the patient okay?” And then she walked away. There was a steely note in her voice that made me raise my eyebrows. I immediately shut up. I begrudgingly wrote the prescription on the paper like she asked and took it back to the nurse’s station.

I was about to leave when the nurse, Ronita, asked to speak to me for a minute. She took me into the drug room and started talking fast, with a strain in her voice. Like she was trying hard not to cry. She told me that I was completely out of line and I cannot talk to her that way in front of the patient. She doesn’t usually have patients like this in her discharge lounge and she was doing it as a favour to Dr. A and the house officers aren’t doing Her a favour by charting medications so I shouldn’t be so entitled and she was going to file a complaint against me.

In that moment, I probably should have been appalled. I probably should have argued. I’m not sure. But I didn’t. Because I wasn’t sure what exactly was happening. I said the thing that was most obvious to me. That I didn’t mean what I said to put her down. I didn’t really understand how she made that connection but she had assumed I was hinting she was incompetent and discharge lounge was a crappy place for patients. I hadn’t meant that. I was frustrated that Dr. A had decided to place a patient there and stress out me and the nurses. I tried to explain that as best as I could to Ronita. I apologised for what I said and reassured her that she was doing a good job and this wasn’t a reflection on her. She seemed somewhat appeased and let me leave.

The situation with the patient continued, however. Ronita called me again in the next 10 minutes after I had returned to AMU to say that the patient had online prescription available and I could go ahead and do that. So I did as I was told. She then called back and said blood back refused to provide units of blood. I didn’t know what to do about that. The blood bank called me and said it was irresponsible of us as a medical team to just treat the patient with a blood transfusion when she had ongoing PV bleeding that was not addressed. She said she had called Dr. A and told her this, but Dr. A had told her to call the person who prescribed the units of blood. That would be me. The blood bank head nurse told me to assess the patient properly and call OBGYN. Again, I did as I was told. I took a gynae history from the patient, something I hadn’t done in years, and referred the patient to OBGYN. As I went back to tell the patient, Ronita reported she’s going to file a complaint against Dr. A for sending this patient to discharge lounge without calling OBGYN first. She seemed warmer towards me since I referred the patient over to the right service and out of her discharge lounge.

What a debacle.

Time for reflection. I guess this kinda shows my burnout because of the things going on in my head at the time. From the moment I received the first call from the nurse, I was annoyed. Annoyed that I was asked to do something that wasn’t my job, annoyed that I was left out of an email that would have helped a lot initially, and annoyed that it was in a place that I knew had very little resources for medical intervention. My entire walk over there I was thinking how dumb this was and why it had become my job.

When I got there and realised the proper equipment wasn’t there I got increasingly annoyed because the number of jobs just doubled. I was annoyed that the nurses weren’t helping me more and annoyed that none of this was planned out properly so that I could just do my thing and leave.

Loosely, all of the above translates to me being annoyed by kind of minor inconveniences. I should have known that the nurses there aren’t there to do stuff like this and they were just as annoyed with the situation as me. I should have expected this to be long and difficult. But I chose to be annoyed by it. And I said something to a nurse that was taken the wrong way.

Bottom line, I shouldn’t have said it. Even if it was Dr. A’s fault, it wasn’t my job to say that. It would only make a hard situation worse. It wasn’t going to help anyone. And the consequence was a nurse threatening to complain about my professionalism. Something I value a lot about in the image of myself as a doctor.

While trying to reassure Ronita, I realised how numb I was. I talked like an automaton doing confrontation de-escalation 101. Without really processing what I was saying. The word complaint definitely sent a wave of fear through me and I wanted to fix the situation before that happened, but in general I just said a bunch of things that I didn’t really feel strongly about.

And then I did something worse. I went back to AMU and started doing jobs. I admitted a patient and carried out a treadmill test and said nothing to anyone. I didn’t take a few minutes to reflect. The word “complaint” still bouncing around in my head as I was doing everything. After I finished sorting that patient out, I felt gross. I didn’t want to show my face in discharge lounge again. I saw some friends in the cafe at lunchtime and made a dramatic show of retelling the story of what happened that morning. I said it as though I was the victim in this situation. Being good friends, my audience joined in with my outrage and agreed that Dr. A and Ronita shouldn’t have put me through that.

But later on, when I was alone in my car driving home, I wept silently. I didn’t like the way I talked to Ronita. Both what I said initially, and when I was trying to fix it. I didn’t like the thoughts in my head about Dr. A. I didn’t like the way I told the story to my friends.

I realised my entire outlook was toxic from the get go. Every day I show up to work and do work, but I take things out on others in subtle ways like this. It isn’t always clear who I’m annoyed at but it’s likely to affect someone compeltely unrelated. And that’s because of my headspace. I think so much. Twice, three times when I see patients these days. I second guess every plan and every examination. I dismiss things as “useless” and “dumb”. I have no faith in what others tell me.

And it all starts with me.

Me not having a break from work, me not taking the time to appreciate the good things others do, and the way the system works. Me just not being wholly in the moment and appreciating it for what it is.

It’s a form of burnout. I didn’t even realise it was until I had brunch with a friend and she told me her usual personality of being loud and animated had dimmed in the last few months and nothing seemed to faze her. Good or bad. She said she felt apathetic about everything.

It takes something like this to realise that you need help and you need to make a change. I vowed to change. I made a simple effort. Very simple. Every time my work phone rang, I would take 10 seconds before answering it. I would literally breathe, clear my mind of everything, be aware of those 10 seconds, before I answered the phone. No matter what was happening. I would listen completely without interrupting whoever it was on the phone and I would keep my mind as open as possible while they talked.

I would then approach my RMO admin and ask for a few days off work. Just a few days. Not heaps of time. But enough to really feel like a break.

The leave hasn’t been approved yet, but the phone thing is working well so far!

I feel lighter. I feel more in control. The situations haven’t changed. There’s still a lot of questionable things I get called about, but I feel less intensely about them. I feel like I can manage them a bit better.

And in making this change, I’m slowing down my burnout process.

I felt a lot of anxiety when I got the roster for my next rotation starting in September. I aim to have some leave approved during that time.

It’s really important to realise the subtle features of burnout. It can be so variable for every person depending on their personality. You’ve just gotta keep reflecting and realise that it can always happen to you.

On that note, if you’ve read this far, thanks for doing so. Here’s a reward:

Silent treee

A calming photo of a sunset. Hope you’re all well!