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!

Part Of Me

I’ve had a rough year. And it’s only July.

Understatement of the century of course. Everyone is having a really tough year.

I’m sure nobody’s plans are working out and a lot of people have worries and concerns and stresses that they can’t really see an end to.

And yeah me too. I won’t bore you with my COVID era sorrows though. I’m sure you have your own.

But in the face of adversity, especially one that seems long and relentless, I feel it’s important at some point to stop for a second and reflect.

I reflected on myself in the face of adversity. I realised that I’ve spent so much time being low and stressed that I’ve forgotten the parts of myself that are important to me.

I think it’s always important to think about the things that make up who you are. And hold onto that.

For instance, I’m usually an avid reader. I LOVE reading. My happy place is literally me and my kindle lost in some corner of the world facing much greater adversities than my current ones and ultimately coming out stronger.

But in the last few months my reading has been woefully low. And forget about studying. I just sit and stare blankly at something for hours on end waiting for something to happen.

I don’t want to lose this part of me. There’s nothing quite like the experience of starting a new book and devouring it and learning something new. In every single book. Each book is a fantastic experience.

Another part of me I had forgotten recently is my imagination. I’ve always felt blessed when I think about my imagination. Growing up I loved thinking up stories and scenarios and events that were weird and wonderful. Castles and dragons, going to Jupiter, seeing the things around me and imagining it to be so much more than it is always brought me great joy. As I grew up I imagined other things, where I would live, what I wanted to see, even how it would be at my best friend’s wedding.

I found during these tough times my thoughts are rarely abstract. They’re stunted and box-like. More robotic like here is another problem today. May as well dwell over how to solve it with what I have. Rather than imagining bigger and better things than this particular inconvenience.

My imagination is the source of my creativity. I can’t lose that. It’s a big part of what makes me, me. I tried to imagine good things. Bright and colourful. They’re quieter than before. As though there was a screen between me and my imagination.

And then there’s music. These days I just listen to music on the way to and from work. And that’s more to keep me awake rather than for my enjoyment. But with the arrival of the new Taylor Swift album, I realised how much I had missed listening to music and actually enjoying what I was listening to and singing along. That’s super important to me.

Passion for work. Since COVID, my work has become so mechanical. The daily frustrations have become twice as annoying and work is extra exhausting. A useless call from a nurse causes a physical reaction in me and brings me down. I barely notice the things I used to. Like how important it is when a patient thanks you for what you’ve done for them or learning something new from a patient’s condition. The other day I fought all day long for a patient to get a scan she needed. And when she finally did, my diagnosis was correct and she received the treatment she needed, and I learnt something new about her condition and the scan she had. I felt satisfied that day. It reminded me why I love what I do so much. I need to hold on to my passion.

Photography. Since being in lockdown, I’ve struggled to take my camera out and capture the world around me. But when I did, I realised how important photography is to me. Especially macro photography, and seeing the little things and making them look amazing.

But perhaps the most important part of me that I don’t wish to lose is being able to appreciate small things and find joy in them. Like a sunset, like watching a TV show from my childhood. Like helping a stranger with something or a stranger helping me with something. Like being able to tell my friends and family how much I love them, doing something to make them smile. Like a perfectly made cup of tea. Like a good conversation. A good joke.

Like a good hug at the right place at the right time when it was really needed.

Life is full of these little moments that can be so significant. They are the ones that you have to hang on to in times of adversity. That’s who I am as a person. Someone who focuses on the little things that make something or someone so amazing to me. 

These things are a part of me. And these are the things I need to remember. That will help me get through it all.

lavender with bee

Here’s a macro shot of a bee doing what it does best when I finally got my camera out. Little things with significance. 

Pride

The world is a very different place now. I’ve not pondered my existence quite as much as I have in the last few weeks.

It’s hard being a single 20 something. Everyone looks at you wondering why you’re not with someone. Some people even ask callously.

And if they don’t, they start assuming. If you’re not with someone by now…. is something else going on? Are you batting for another team? Are you even in the game?

Sometimes I see people who are so comfortable with who they are and I envy them. What must it be like to be totally aware of who you are and know exactly what you want?

I know they didn’t get there easily. Something would have given them that ability. But it still must be so liberating. To know what you want, and have the freedom to be who you are and want who you want and actually get that. 

I’ve been told I’m not the “girliest girl”. Among the guys I’m just one of the guys. Among the girls I’m just one of the girls. I’m comfortable, see everyone as a friend and hardly ever speak about what I want. 

But I do wonder how people see me. It happens on days when I am self-conscious about my appearance. People don’t give me a second glance. No matter how I change what I look like or how I walk and talk. I feel plain. Do people ever wonder about me? Probably not. Too often I’ve had the feeling that the person I’m talking to looks straight through me at someone else. 

When you see two people together, Any two people – girls and girls, boys and boys and everything in between, it’s just nice. They are just so lucky. It gives me a hope for the world. And I want that for everyone. Even if I don’t have it for myself. Not that I even know what I really want for myself.  

But I’m grateful the world is full of colours. Just like a rainbow. Just gotta have pride in who you are.

Filter

It’s hard, it’s rough but it’s soft enough

It’s ripped at every edge but smoothed together

It’s loud and extensive with a silence at its core

It’s sweet with a bite and sour with a glaze

It’ll take up every moment of every day but it’ll pass you in a flash

It’ll be warm as sunshine but still chill your bones

It’ll illuminate everything but still cast a shadow

It makes no sense at all but hits you differently

It’s shattered into a million pieces, yet somehow put together.

Treacherous Heart

How dare you.

You’re a real snake, you know that?

Why is it that you bleed and hurt for so long but then flutter as soon as you hear from him?

He’s not the one looking after you. Keeping you safe, trying to make you happy.

Can you for once just have some pride and ego? Can you stop hurting me and heal for a second?

Can you not be so fickle? Can you just be brave enough to face it and see it through?

Stop threatening to break every single time but then miraculously recover when you get the slightest bit of hope even when you know it’ll be short-lived and it won’t last.

Just stop. I can’t keep up.

Everything else is screaming No but you whisper Yes. Sure and true until I comply. And I always comply.

I want to stop.

Lost Love

Today is a sad day.

After 10 years, I had to say goodbye to my dearest Nissan March.

A few days ago on my way home from work, I was rear-ended by a large 4-wheel-drive from behind while I was stopped at a traffic light.

The entire boot of my car was smashed in.

Today my insurance company told me my car had to be written off. And that today was the last time I would ever see my car.

 

I couldn’t explain my feelings at this time.

 

My car was small and efficient. It was cute and orange in colour. It had been through a lot in the last 10 years. I had taken it all over New Zealand pretty much. Other cars had scoffed at it. But my car would drive hundreds of kilometres without a flinch. It had taken many grazes, bumps and crashes. It had survived all this time. And this time wasn’t even my fault.

It has barely been 2 weeks since I last got it WOF checked, serviced and registration renewed. My car passed all of the above. Sturdy and protected me from many events.

Everyone loved my little car. My friends used to identify my presence by seeing my car parked on the road. “The orange car landmark” they used to say,

I had spent hours alone in my car. Singing, laughing, talking and crying. My car was a quiet comfort for all of these things. It took everything I threw at it. Except this.

 

It hurt to say goodbye to my car. It was heartbreaking.

It truly is the end of an era.Nissan_March_K12_001