How Old Are You

Well. It looks like the Earth has nearly made another rotation around the sun 23 years since I was born.

People keep asking me how old I’m turning this year. Which is fine except it always takes me a few seconds to answer them. I just don’t keep track.

Or maybe because I don’t feel like I’m 23. Obviously because Taylor Swift doesn’t have a song for 23 and so I’d much rather be 22.

Nah. It’s just. Same thing as last year I suppose. The pressure is on to have achieved a lot by this point in life. I’m still in Med school. Woop. People in my class are getting married, having kids, owning houses even.

I say Blech to all of that.

I can barely own my emotions. I can’t stand the company of people for more than a few of hours, and kids frighten me.

I just don’t think I’m mature.

Although now I think I’m not really expected to be. I kind of have one of those “plan” things for the next 2 years in terms of where I should work, etc. That, to me is a BIG achievement. But I am aware every plan is subject to change. I mean, I’m not so naïve as to think everything will work out how I want it to.

Ah. How mature of me.

I’m just a bit tired of life to be honest. I mentioned that it’s really hard to be in your 20s. I’m feeling it a lot these days. How I wish I could quit life and go live on Mars or something. I just cannot be bothered facing the day every day, waiting for something to happen, but it doesn’t. Watching friends move on to bigger and better things and accepting that I’ll see less and less of them soon, dealing with people who are these so called “colleagues” who have a whole different set of rules as to how to deal with them. Like no they’re not your friends. No, they don’t care about how your day is going. They just want you to do whatever it is they need, and they’ll say everything you want to hear to make that happen because they’re sizing you up too.

Blechhh

I’m just not cut out for the fakeness the workforce demands. That’s another big reason I don’t feel old enough to be a 23 year old.

I gotta have thick skin right? Gotta be used to how the world works and not let it affect me. But I just don’t think I can.

Anger is a big poison for me. I get angry at people quite easily. Angry at how they talk to each other and treat each other. Angry when they care so little about things like doing their job right. Angry when they’re so obviously fake.

And the worst part is, I see those opportunists around me who are all those things I mentioned above, but they know how to play the game and they put themselves ahead. Meanwhile, I get angry and probably get left behind. You gotta be that kind of person to get ahead apparently.

Err. This is probably something I’ll get over when I’m 30 right? 40? 65?

Oh God I do not want to have to deal with people for that long.

I bet I sound like a cynical 50 year old right now. Saying I hate people and wanting to live somewhere on my own. But it’s not all bad. Truly there are some awesome people in the world and life has some great aspects.

I’m just in a not so great stage of it I think.

As Ed Sheeran says: I’m well aware of certain things that will destroy a man like me. But with that said, give me one more.

Really liking that song.

Oh birthday plans! Didn’t talk about those! Probably because I don’t have any. I’m in another continent from the people I usually hang out with for my birthday. This year I’ll be at the rural hospital on my birthday, seeing patients. And then maybe I’ll get some cake or something. Or I’ll reward myself with a lot of sleep.

Living the wild life, Abracadabra

 

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Eraser

And ain’t nobody wanna see you down in the dumps. ‘Cause you’re living your dream and that sh*t should be fun

-Ed Sheeran

On The Spot

I’ve always wondered how I would react in a situation in the community where something happens that needs medical attention. I’d heard from some friends who had experienced such situations. 

They had either pretended they weren’t medical students or they had risen to the challenge somehow and at least made sure the person ended up in a hospital for further care.

I had my situation today. Far far away from home. 

On the way to the hosp on my elective in India, I saw two motorbikes fallen over and 3 people on the ground. One of them was a man who was already getting up and helping the two girls. One of the girls looked fine and she stood up with help. The other girl however, lay on her back, crying, clutching her left leg. 

At this point I stopped and thought I should do something to help. Scary thing that. Realising that you’re actually in a position that gives you the responsibility to stop and help. I felt hideously unprepared.

Anyway I approached the girl on the ground and my immediate thought was oh my goodness should I introduce myself as a doctor? Because I wasn’t one. But if I didn’t, they’d think I was just a bystander and not really cooperate. 

But I couldn’t stand there and have this internal conflict. I looked for any evidence of fracture or bleeding, etc in that leg. After going through the whole DRSABCD acronym that they’ve drilled into us. By this time a lot of ppl were on the scene and the girl was helped up and she could walk. Yay no fracture. Yay no bleeding. 

My expert advice was to take her to the nearest hospital. Something many others had already figured out. A TukTuk pulled up and the girl hobbled over into it. I tried to comfort her as best as I could and told her she didn’t have a fracture. But she needs to be in a hospital to assess her leg further. She was still in tears and didn’t want me pampering her knee at all. This is probably when the magic words “I’m a doctor” would have helped. 

But I couldn’t do it.

Okay I don’t know why. Yes because it’s the truth, but not saying so probably indicates a lack of confidence in my abilities. Because I’m nearly done. I should be able to handle things like this. I should be able to be a doctor. Nothing major is going to change when I get my degree soon. I’m essentially all done with my training. 

So I suppose I did have an element of lack of confidence.

It ultimately ended well because the girl was okay and I helped a bit I think. 

But if there is a next time, I gotta be more confident. Hopefully that’ll come when I’m put on the spot.

Off To Elective

Alrighty! I’m here in India!

Coimbatore, to be precise. A city in the southern part of India. Here I am to do my 8 weeks in a hospital in rural medicine and Emergency medicine.

So. Why’d I choose this place? Well it’s a developing country. It’s what uni recommends to do on your elective. Go to a developing country and learn about the health system there! That’s what I intended to do. I’ve also been to Coimbatore before, So I’m familiar with the city and the hospitals. I figured this would help me get into the system straight away without too many new place barriers. And I was sure I’d see so many different things.

So I got here. Met my supervisor who is a 70 year old woman, still practising medicine. Which for me was a big shock. Like sure I admire her drive and commitment to medicine even at this age but Gosh I would not want to keep my brain going for that long. 

Anyway she was really lovely. And unlike my selective last year (if you remember, where I found my supervisor was on a holiday and I never met him), she was on to planning my 8 weeks straight away. She took a genuine interest in my learning and said that because I’m the only student at this hospital, I can pretty much see whatever I want, and she would organise it for me. 

Major advantage, that. As opposed to going to a hospital somewhere where there are a lot of other students to compete with to see interesting things, I like being the only one given these opportunities. 

I also think I’ve picked a good hospital in terms of patients. While they all have different pathologies etc, they all speak English! Which was super impressive. I was fully prepared to have to take histories in Tamil (the language here), but it turns out that may not be as hard as I thought! So yay!

The plan for the next 8 weeks is quite varied. My supervisor is more keen than I am to get me to see as many things as possible. While my focus will be on rural medicine and ED, she also wants me to spend time with her in geriatrics, put me in neurology, nephrology, and anything else I want to experience. 

How neat is that!

I think it’s also good for my short attention span because I get tired of runs pretty quickly. 6 weeks can often be a very long time, as I’ve said lots of times before. Hopefully the variation in these 8 weeks will make that a lot easier!

So. First days are always first days like. Getting lost in hospital, making awkward conversations with the other doctors, smiling a lot without much reason, etc. But I do expect it to get easier. As most runs have.

Will keep updating! For now, I gotta go meet my supervisor! 

Good Intentions

When you decide to do something just because you thought it would be the right thing to do and you took certain things and people into account to do that thing, but it ends up blowing up in your face and you’re left feeling like you’ve done something wrong but you don’t know what..

Yeah. That kinda sucks.

But then I know I didn’t do it out of any bad intentions. I know I didn’t do it because I didn’t care about other things.

So I shouldn’t care right?

Well I mean. I have to care. But I suppose I shouldn’t feel yucky. Right? 

It’s no big deal. 

Right?

In The Deep End

Today was my 3rd ED shift. And it was the most challenging 7 hours of my life. 

Mostly because of just 1 patient. 

At the beginning of the shift, my consultant was called to resus to see a 15 year old boy who had come in with 5 days of headache but who had since become unconscious in the resus area. 

He had no other medical conditions. The whole team was working on making him regain consciousness. While differentials such as meningitis and seizures crossed everyone’s mind. 

The mother came in shortly afterwards frightened and distressed as she recounted how he had had only a headache for the last 5 days but today while she was at work, had called and said bizarre things before hanging up. She returned home to find him unsteady on his feet before collapsing to the ground. The mother also brought her 4 year old son with her. There was no father to be seen. 

The young boy regained some consciousness. He was responsive to speech and followed commands. Everyone became confident at this improvement. My consultant decided now would be a good time to CT scan his head for signs of infection or bleed. 

The boy was wheeled off and my consultant and I followed him. 

The CT scan showed a large tumour pressing on the boy’s brain. Causing the brain to be pushed to one side, likely resulting in this symptoms. He would have a large amount of pressure in his skull at that time. 

The consultant took the mother into a room to talk to her. I was present when he told her the news. 

She instantly burst into tears and wailed. Her precious, obedient, healthy boy was going to be taken from her? How could this happen? Will he be cured?

My consultant told her that he would contact the neurosurgeons who would tell her more about the next steps in management. 

She cried harder. She told us she had no one else. That the boy’s father was estranged from when he was 4 years old. That the boy was all she had. 

He younger son was oblivious to what was going on as he quietly played with some puzzles. 

Meanwhile we were again called to resus as the boy had lost consciousness again and was now showing signs of very high pressures in his skull. One of his pupils were dilated massively while the other was small. The neurosurgeons arrived to take him to theatre immediately and they began to put a tube down his throat as he was no longer breathing on his own. 

At this point, the consultant asked me to sit with the mother. And console her and prevent her from witnessing the placement of the tube. 

I was way out of my depth. The mother begged me to be with her son. She asked me whether she had given him some food that may have caused the tumour. Or whether a fall as a young child would have caused it. She told me she worked so hard and had saved money for a house for him in the future. How he had wanted to be a pilot when he was older and how she had arranged classes for him to learn more about this every week. 

She asked me if he could be cured. Or if he was going to die in ICU where he would be taken after the neurosurgeons performed an emergency operation to relieve the pressure in his brain. 

I comforted her as best as I could. Telling her she couldn’t have prevented any of this. That some things just happen. She asked me why God was taking her son away from her. I had no answer. She said she had been a bad mother. 

She eventually decided to call the boy’s father as he was taken to surgery. 

To complicate matters further, the father began yelling at the mother. Saying it was her fault he had gotten cancer. 

This carried on to the point where my consultant had to intervene to explain to him that it was no one’s fault. 

The boy’s father said his nephew also had brain tumour but he’s fine now. 

The mother, who was hurting in a big way, clearly fed up with the father’s accusations said that she was the best mum in the world for her son. And that if cancer ran in the father’s side of the family, he should have mentioned it earlier. 

It was all rather weird for me. 

But it was just

Quite confronting. 

I’ve never seen such a situation before. The reality of what happens if medicine isn’t good enough. And sometimes it just isn’t good enough to answer every question or solve every problem. And what that leaves behind is quite devastating. 

I couldn’t process everything for a while. My consultant asked if I needed a break to calm down. 

How did I react to this? I said I didn’t require a break. I just need to go see the next patient. 

I can’t say why I said that. I guess I needed to feel like even though it was obvious that not much could be done for that young boy, much could be done for other patients. And I needed to see that. And I needed to be part of that. To get over the disappointment and the grief that I had witnessed. 

It all just goes back to what Robert Frost had said:

“I can sum up everything I have learnt about life in 3 words:”

It Goes On…..

I guess I have to also be grateful for my life and my health. And the health of those closest to me. It shouldn’t ever be taken for granted

The Thing About Emergency Medicine

I’m on my 2 week ED rotation. 

Now, I love ED. Because it’s all diagnosis and planning. It’s really bringing those diagnostic skills and knowledge learnt in med school to practice.

But it’s a hard life being an ED consultant. Even as a consultant, Ie having the top job in that field, you still have to do shift work. And that’s exhausting.

Did you know that the world health organization listed shift work, particularly night shifts, as a cause of cancer? 

Blech. That’s not very appealing is it.

It’s an extremely difficult job they have. And you gotta be a certain kind of person to be an ED enthusiast too. Like as a student, it’s brilliant because you get to practice diagnosis and management unlike in any other specialty, but you also have to be okay with never hearing the end of a story.

People in ED see patients, and refer them after initial management. Then you don’t get to know what happens to them. This for me is extremely upsetting. xD I don’t like cliff hangers. I need closure. 

But ED is honestly so exciting. I am in fact doing my 8 week overseas elective with a heavy focus on ED. It’s going to be in India! Along with rural medicine, I will be in a hospital emergency department. Meanwhile everyone else in my class is taking this opportunity to travel the world, I’m hoping I’m sacrificing my travelling opportunity to learn heaps. 

What better place to do so than ED!

I’m leaving for my elective next week! More on this soon!

4 Weeks Later

Well, surgery is officially over. And I am exhausted. 

It didn’t really get better. I was still doing ward jobs all day and staying late even though not much was being achieved.

I feel like I haven’t used my brain at all these past 4 weeks. And that’s annoying.

So I am relieved it’s over. But I am concerned for my future years as a house officer when I have to do surgical rotations. My own house officer on this rotation was flustered 90% of the time, and complaining 98% of the time about her job. She would stay later than me and achieve pretty much nothing as well. No patients discharged, scans and tests ordered but not carried out, and an endless amount of paperwork to do.

She also said she hasn’t used her diagnostic skills in the whole time she has been on this rotation. Sigh. Not looking forward to this in the coming years.

However!

I will say that my registrar and my consultants are amazingly nice people. One of my consultants, while I didn’t manage to see him a lot, he was more than happy to talk to me whenever I approached him, even if he were in a great rush. He was happy to do my report and my reference (all 3 required references done! Woohoo now I can relax).

My other consultant also offered to do any assessments I required for me, and thanked me multiple times for my hard work. Though I’m trying to figure out what exactly that was.

And my registrar was the loveliest person in the world who never got tired of answering questions, teaching, making jokes and just being supportive. 

While the overall rotation was tiring and annoying, I am so grateful to the people on the team for making it bearable. 

Now. Onto ED. Time to turn my brain back on!! 

Translation Please?

Well this is something that has bothered me throughout med school. But today it was at such a frustrating level that I just have to talk about it on here.

Today an elderly couple had presented to hospital to be admitted. The wife was to have a major abdominal surgery the following day (Whipple’s procedure). They were a Chinese couple who had been living in New Zealand for many years now. Unfortunately, neither of them knew any English.

It took One hour for the house officer (who luckily spoke Mandarin) to explain the details of the woman’s procedure, translating for the surgeons. Another hour to get her to consent for a research project she had the opportunity to be a part of, and another full hour to admit her medically to the ward with the anaesthetics team.

Why?

Two words. Language Barrier.

The woman was so flustered by the end of the multiple consults that she requested to back out of the research project because she was uncomfortable and nervous that she didn’t understand a lot of the jargon even though it was translated.

She was quite anxious about her procedure and couldn’t follow many of the details described to her during the consent for the actual procedure itself.

By the end of it, both the patient and the doctors left with quite a yucky feeling. Neither completely satisfied that they had achieved full comprehension.

Medicine is so difficult. I can appreciate that fully as a medical student. But oh my goodness it must be even harder for general people to understand things.

And then throw in a communication obstacle in. What are we supposed to do here??

Immigrants are great. Moving to a new country is an awesome idea. But I wish people would do so with the intention of learning the language of that country. Fair enough if English isn’t taught or spoken in your country. Just like Spanish or French isn’t spoken in mine. But if I were moving to France, there is no way in heck I would do so without attempting to learn the language.

But in medicine, I’ve come across many patients who require interpreters. And from those experiences, I can tell you that they do not make the process any better at all. There’s always gaps. There’s always compromises being made and questions going unanswered. You just don’t get the full picture.

Fair enough if you are new to the country and you don’t know the language. But I take issue with the people who have lived in this country for decades, working, owning retail businesses, etc. etc, and yet saying they don’t speak any English.

I don’t understand it. Do they only ever talk to their own people? Do they stay at home forever? How does it work?

But I do know that when it comes that they become unwell unfortunately, they get sub-optimal care purely because the doctors can’t understand them or vice versa.

It’s just not fair. The doctors would also feel quite frustrated and helpless, not being able to provide the best care for patients like this. But there’s just no way around the barrier.

I just think that people need to take responsibility and ensure they are safe and can communicate in situations like this. Like it’s not just with doctors. In an emergency situation, how would such a person call for help? There are no interpreters in an emergency. They could be in danger.

And don’t get me started on interpreters. It’s just way too hard to be on the same page with them as well.

Gah. Just frustrating.

A language barrier is just dangerous. I just think people need to realise that. 

BRB: Being Grateful

Oh my goodness! One of the things I was stressing about worked out amazingly well!

And I just gotta take a minute to be so grateful! When things work out well, it’s so important to stop and be grateful to the universe and everyone involved.

Ahh so happy! ^^ And uber uber grateful to the universe!!