High Mountains And Deep Rivers

1 Week of Cardio done. 

Cardio is interesting. Patients with way crazy conditions, some quite unwell, some where there’s just not much you can do. 

It’s been quite busy for me. Not quite finishing on time. But hey the day goes by quickly.

I had a lovely registrar this week. And it was actually his final week as a cardiology registrar. He was nice and included me in discussions and even helped out with a lot of the jobs. 

Today, on his last day. Though we had only been working together for 3 days, he told me that I’ve been a great House officer and he wanted to give me this.

He said he had been saving this book to give to someone who was really good. To use and help them study. He said he wanted me to have it for being so great this week. 

Then I found out that the charge nurse on my general medicine ward last rotation, had nominated me for House officer of the month. 

I didn’t win of course. But it was nice to be nominated.

From my low point last week where I thought I was just the worst House officer in the world having nearly killed someone with my prescribing blunder, this was quite the opposite feeling.

It was nice to feel good about the things I do. And be grateful for people who seem to appreciate me. 

It really is having the highest mountains and having the deepest rivers.

You can have it all but life keeps moving…. 

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No Excuse

Today I got an email from a registrar whose patient I reviewed over my night shifts.

I had reviewed this man who had had a stroke and whose level of consciousness was fluctuating, making his swallow unsafe. The registrar who admitted him, had prescribed oral medications for him.

The nurse had called me to change his medications to IV. specifically, his anti-seizure medications.

I changed all his medications to IV, including his beta blockers and calcium channel blockers. These are very sensitive heart medications that slow your heart down when it’s going too fast or beating irregularly.

The registrar emailed me to tell me that these medications are never prescribed IV unless there are very specific indications or a patient is in intensive care. I had prescribed them on a ward overnight.

She informed me that thankfully, the patient hadn’t received these medications because the pharmacy does not dispense them overnight. She said that she would never prescribe those medications because the doses aren’t the same in oral as they are in IV and they could have caused a massive slowing of the heart and basically would have been fatal to the patient.

She told me not to stress about it as the patient is fine, but it’s just something to be aware of in the future.

I can’t quite explain how scary this was for me.

When I was changing his medications to IV, I hadn’t known those medications were available IV. When I saw that they were, I thought to myself, huh. That’s interesting.

But it didn’t occur to me to look up whether they could be used IV in a patient who had oral medications. What I should have done was withhold those oral medications until the patient could be reviewed the next day.

I nearly killed someone.

If the patient had received those medications, he would surely have had a massive bradycardia that wouldn’t have been easy to reverse.

I have no excuse other than I didn’t know. Which in my head translates to a level of incompetence.

I should know.

I can’t still be operating at a level where I don’t know what I don’t know. And that apparently nearly hurt someone.

I actually did cry when I read that email.

I probably should take the “well that’s how you learn” approach. It turned out fine. But I don’t think I’d ever be able to forget just how bad it could have been. Just how vulnerable someone is to the consequences of my actions.

I know I’ll be double, triple checking everything I prescribe from now on. And there’s just no excuse for getting something like this wrong.

None at all

 

The Graveyard Shift

Well I just finished my first week of night shifts.

It was a very long week. But that was quite an experience.

Middlemore hospital gets extremely busy over winter. More so than usual.

On medicine overnight, there are 2 house officers to run the entire medicine department of the hospital. This week, we had 3.

Usually 1 person stays downstairs and admits patients to hospital with the registrars, and 2 people stay upstairs managing ward calls from the 12 medical wards.

But this week, there were so many people waiting to be admitted at the start of the night shift, that 2 house officers needed to be downstairs, and 1 house officer managing 12 wards.

Take a wild guess which one I was.

Me and my 12 wards all 4 nights this week.

People having pain, fevers, sepsis, bleeding, crashing, and passing away. And little me being the first to deal with all of them.

My hospital has an online job posting system where nurses post up alerts/jobs about patients who are unwell and need to be reviewed.

On a good shift, this is limited to around 10-15 jobs.

Every night this week, I started on a shift where there were 40+ jobs across 12 wards, with constant phone calls about acutely unwell patients too.

I had a friend of mine (a 2nd year house officer) at a different hospital also rostered on nights this week. He was my cheerleader and support. Which really helped.

But my God was it tiring. The night house officer job is nice in some ways. Such that your main goal is to get people alive through the night before their primary medical team is able to see them.

But the difficult thing is that there are zero resources through the nights and it’s just you and a very busy registrar downstairs making all the decisions.

Meaning if there’s a patient who has been having nose bleeds for 6 hours straight despite several nose packs, your options are to continue trying the nose packs or call the ENT registrar on call at a different hospital who can barely offer any useful advice at all.

But I’ve got to say, I got all my patients through the week.

Last night in particular, I started off the shift with 51 jobs across 12 wards with several acutely unwell patients that the previous on call house officers were unable to clear.

Oh and there were 15 people downstairs waiting to be seen, meaning the registrars and both other house officers were stuck downstairs and no one was available to help me clear said 51 tasks.

I was running the entire medical hospital.

Quite proud to say that by 630am, I had cleared all 51 tasks, put in 8 IV lines,  successfully carried out 2 Abgs and kept all my patients alive.

My first night I couldn’t clear 46 tasks and hadn’t eaten or drank anything for the full 10 hour shift. I was close to tears from the exhaustion.

I also didn’t eat or drink anything on my last shift, but I cleared all my tasks.

Sleeping and reflecting afterwards, I felt strangely good.

The feeling was one of actually having accomplished something. And feeling that hey maybe I can handle some things on my own!

Night shifts are weird. I can see why they’re commonly called the graveyard shift.

But honestly, sleep is VERY important for life, people!

Gen Med Is Over

Today was the end of my general medicine house officer rotation! 

Stayed late to seal the deal ofcourse.

And I even did some therapeutic baking to finish it off.

Poifect chocolate cupcakes. Well I learnt quite a bit of medicine I suppose. And I was busy. 

But my consultant told me I did a great job this rotation and my medical student said I’ve been very helpful and the nurses on my ward gave me this 

And told me they really loved having me on the ward.

So I suppose even though there are good days and bad days and Fridays and days I want to rip my head off, I still seem to be something right and people seem to appreciate it.

It feels good.

Onto my first few night shifts next week! 

So it goes…

Avoidance Coping

When things go wrong, they all seem to go wrong at once.

Usually if it’s something I can influence or change or make better, I put myself out there and do my best to change it.

But if it’s something I can’t change but still affects me, 

I cope very poorly.

I have avoidance coping issues.

I tune out the issue and the people involved. I shut down all my emotions and thoughts pertaining to that issue. I pick up something to distract myself and run with it intently. 

But it’s just no good when those issues involve people close to you.

It means I’m grieving in a completely self-centred way. I don’t open myself to discussion about the issues or try to actively adapt to it. 

I literally stick my head in the sand until the thing passes on it’s own. Because I tell myself everything passes.

I’ve identified the cowardice inside me. 

But when things are this messy, I can’t really even work on it. 

So I’ll continue to keep my head below the sand. And face the consequences for it. 

In My Lifetime

So.

It’s getting to be that time of year again for me! My birthday is coming up. I shall in 2 weeks be 24 years old!

Can you believe it. nearly a quarter of a century on Earth. Born out of no where onto this planet and survived 24 years.

I was thinking the other day about what was significant for me in these years. Or significant for the world, rather.

A lot of significant things have happened in my lifetime that has shaped me and my view of the world. My parents used to tell me that in their lifetime, there were a lot of new things. TVs, computers, phones, cameras, etc.

But there have been new things in my lifetime too. And to add, I have seen things die down in my lifetime also.

  1. The invention of smart phones. Quite recent in my lifetime. But still. Very big. I even remember when the smart phones were still in the pipelines, and the first smart device was an iPod touch. Does anyone remember those? It was the first device on which you could surf the internet, download “apps” to play games and connect with others. Huge! Then came the iPhone and Android.

    But these things kind of came without any big hoopla about them. Now, it’s an everyday item. For everyone. Even children.

    I’m sure in the future, paediatricians will add milestones for babies such as “can handle small electronic device such as phone or tablet” and “can use index finger to open apps on a mobile device” Probably as young as 6 months! Wouldn’t that be something.

  2. Internet/mobile banking. This was something that came up during my lifetime. No longer did my parents need to “go down to the bank” to carry out tasks such as opening a new account, applying for a card, taking out loans, etc. Again, pretty big.
  3. E-readers. Invented in my time. My beloved kindle. Can carry thousands of books at once. Your own personal library. Access to so many books at the touch of a screen. You didn’t need to go down to a library or book store to see the most popular books and decide to buy them. Kindle will suggest the most popular books for you, and give you a free sample to try before you buy! Very cool.
  4. Social networking. When I was very young, there was MSN messenger and Yahoo! messenger. As I grew up, there was bebo, MySpace, and then finally, the pinnacle of it all, Facebook. Then of course there was Twitter and Instagram, etc. But the idea of social networking grew massively in my lifetime. Globalisation was a concept they taught relentlessly in social science at high school. And it really was that. Not only was the world’s newest products, businesses and ideas available to everyone, so are people! The growth of “influencers” on the internet has been exponential in my opinion. You can literally say anything and thousands of people will hear it! People follow strangers and become fans just by watching videos on YouTube or following posts on Instagram. It’s pretty amazing.
  5. Dating apps. While blind dates and online dating websites were there when I was younger, I hear the word Tinder wayyyy more these days. Again, I’m not too sure when it became so popular, but I definitely know it wasn’t this big a few years ago. And that’s pretty amazing too. I guess it falls in the social networking category, but it’s just so weird to me that you don’t have to make calls or go to a social event to meet new people any more. You have to put up a profile and a blurb about yourself (which by the way I’m not even sure would be true for most people. You’ve got to either talk yourself up too much or too little) and a picture, and boom! You find someone who actually wants to spend a whole evening with you! Who would’ve thought! And it honestly works for a lot of people! I have a feeling this will be one of those things my parents will tell stories about in a few years. “Back in my day, we had to go out and meet people. Not meet them on a phone.”
  6. Wireless connectivity. Wi-Fi. I was a dial-up kid. Now, my house has fibre optic powered internet. While I used to wait 5 minutes for my computer to make those weird screechy noises before the Yahoo webpage would even come up, these days I complain that my 1080p movie is not loading fast enough on my big screen TV. It’s so bizarre to think about that. My internet would constantly conk out when I was younger. Not that it mattered much then, given I didn’t use the internet as much as I do now. Now, even moving buses have Wi-Fi because it’s so hard to go a few minutes without being connected to the world.
  7. Cameras. When I was younger, you still had to take your film roll to a photo shop to have the photos developed from photo negatives. Now there are people that don’t understand any part of that sentence. Now there are phones that let you take incredibly zoomed up pictures of the Moon. Now there are phones that have 5 rear cameras. There are DSLR cameras that you can share photos from directly using Wi-Fi. Taking photos and editing them and capturing something stunning and having the photos available instantly has never been easier!
  8. Movies and TV shows and music. When I was younger, you had to go see a movie in the theatres or watch a show on TV no matter what time it aired at. Or go to your nearest video store and get a tape or CD. Now things like Netflix has changed all that. While people still go to cinemas to watch movies, you can still watch new movies online and stream them to your TV

    I also used to be of the time when if an artist released new music, you had to wait in line outside your nearest store to buy the CD, get back home and play it on your stereo, then tell all your friends about it the next day. But these days, you can pre-download songs on your phone, you can take them with you wherever you go, artists tease new music online, everyone experiences it instantly on the go and everyone knows about how good it is straight away. Again, Huge.

  9. Electric cars. This is still up and coming. But Tesla, and Nissan leaf and other fully electric cars! I am still waiting for the day that petrol becomes obsolete. Because I’ve got to say, prices of fuel are just not helping anybody. I am 100% behind this cause.

 

I’m sure I could keep going. The advances in the world just in the last 24 years have been numerous. The rate at which things are changes is quite staggering. And I’ve been alive for all of this.

But some things still haven’t changed. Like listening to the radio, using a microwave oven, using a refrigerator, etc.

And not only in technology.

People still have so much appreciation for the world and it’s people. I guess the idea is still to bring everyone closer together and experience everything around the world. And there’s still so much appreciation for history. Just take a trip to Rome or Paris or Greece and you can see how people marvel at old architecture and things.

I guess if this much has changed in just 24 years, I’m in for a lot more surprises over the rest of my lifetime. That’s a lot to think about it.

But for now, I guess I’ll just try to muddle through the current things in my life and be grateful for what I have on my birthday.

🙂

Less Is More

“Don’t be around people who make you think any less of yourself than you are”

Well the thing about that is, nobody ever tells you how much to think of yourself

Silent Beauty

So today I took my camera out again

There’s something very pleasing about shells I find. 

One of the many wonders of nature for me, are shells. Just the intricate shapes that are formed simply by withstanding the push and pull and the deep currents of the sea. 

It reminded me of a silly poem I wrote on my first day in 7th grade. The teacher was trying to get us to be creative, or she was just trying to get some quiet on the first day. By making us write poems about the beach.

I wrote about shells.

I can’t remember what I wrote exactly but I think it went something like this.

 Shells. 

Lying there softly and perfectly placed on a bed of hundreds of grains of sand

Telling a story of the sea 

 Some, a home to the magnificent creatures of the sea smaller than your nail

In all different shapes and sizes and patterns, 

Silent Beauty,

Shells.

..Oh dear. Quite amateur. Ugh it doesn’t even rhyme.

But I remember my teacher particularly liked the “silent beauty” description of shells. 

So do I. When I took these photos today, on a quiet beach while these shells were just lying their minding their own business, but calling me to them and prompting me to take a picture.

Silent beauty indeed.