Gen med..Generally.

As I’ve already said, I’ve just finished my first rotation at hospital. That being general medicine. I thought now would be a good time to reflect on the past 6 weeks from a medical perspective.

So, general med. I’m not too sure what it’s called in your part of the world. Internal medicine? Family medicine? Well in my little corner it’s called general medicine. Why am I dwelling on the name? Because I feel it needs defining. With every other branch of medicine, cardiology, neurology etc, it’s pretty self-explanatory what that branch entails. General medicine is a bit different. So. Can I define it? Uhh not really. Basically it seems like this. If you’ve got heart failure, you’re a cardiology candidate. But if you’ve got heart failure in addition to lung abscess, liver metastases, diabetes, kidney failure, fluid overload, peripheral neuropathy aaand urinary symptoms, you’ve just won a free ticket to the general medicine ward! Welcome aboard!

The whole place seemed very disorganised. Everybody seemed to have a million and one problems: The million problems likely to have accumulated over many years (which I’m sorry, you’re just going to have to live with) and that one extra problem you’ve just acquired that we will now attempt to cure or bring to a stable enough condition for you to live with. Eugh. During med school, we were taught that a lot of conditions have no cure, etc. and I was okay with that. But seeing it in practice, was quite difficult to digest. The doctors don’t really make problems go away, they just make sure your treatment is good enough for you to go home and live with your problems. Now I realise this may not be exclusive to general medicine, but it was pretty much all I saw on this ward.

Another thing is that because these patients have a million and one problems, generally they stick around for a while. Statistics say that the average number of days a person stays in hospital is 3 days. I can tell you that only a quarter of the patients I saw in 6 weeks stayed for 3 days or less. There are patients on my ward that came in before I started and are still to remain for a few more weeks after I’ve finished. At least one of their problems causes issues for them every day. Leaving doctors clueless. There is a lot of standing around and thinking in general medicine. I can’t imagine any other speciality doing so. If you’re an orthopaedic surgeon, there’s no two ways about it. The knee needs to be worked on, the knee gets worked on. In general medicine, each of your million problems have to be considered separately and together before any of your medications are changed. Whew. That’s a lot of brain work. I can’t tell you how many times my registrar or consultant stare off blankly into space. Their agile minds sifting through thousands of resources of information on all the illnesses said patient has, and how best to treat them. You can see the sheer concentration on their face as they work to solve the puzzle. It’s quite cool really. But sadly, the solutions are not always so exciting. It generally consists of some small change in their current medication which, to be fair, does make them better and stable enough to go home, but not actually cure them of anything. Sighh. I think I might be too idealistic.

Also, if you stay in hospital for too long, bad things start to happen. Patients become boomerangs. Mr Brown came in with exacerbation of his heart failure which was complicated by his diabetes, liver abscesses, kidney failure and new onset diabetic neuropathy. He remained in hospital for 4 weeks during which time many doctors worked to stabilise him. At the end of 4 weeks on Friday, he was well enough to go home. The doctors cheered and celebrated his farewell for it was a job well done. Monday morning of the following week, he registrar received a call. Mr Brown was to return. He appears to have developed hospital acquired pneumonia. facepalm

Luckily for Mr Brown however, the pneumonia in addition to his lung abscess and pleural effusions qualified him to be in the care of the respiratory overlords. Mr Brown was lucky. Poor Mrs Smith however, returned with a new macular popular rash after being treated for her adenovirus. She is doomed to stay on the general medicine ward until the cause of her rash can be isolated.

As I’ve mentioned, in general medicine we get whoever doesn’t qualify for specialist care. Sometimes this can be extremely frustrating because the requirement for specialist care seems to be a bit too specific. And patients that just miss out seem to get sub-optimal care under general medicine. Mrs. Jones has had a long-standing rheumatological condition called behcet’s disease. She presented with abdominal pain and diarrhoea and was admitted under general medicine. Upon investigation, a colonoscopy was done which revealed ulcers in her intestines characteristic of her behcet’s disease. She requires immediate treatment of ulcers and further management of flares of her behcet’s. Both of which cannot be provided under general medicine. However, the rheumatology overlords refused to accept her as she presented with gastrointestinal type symptoms. Gastroenterology refused her as she has an underlying rheumatological condition. But both were happy to offer advice on her care for the minions in general medicine to carry out. Meanwhile, Mrs. Jones was still in pain.unimpressed

Not. Cool. But I’ve learnt that in hospital, everyone plays hard ball. My consultant knew the game. After several angry calls to both specialists, you’ll be happy to learn that Mrs Jones was referred to gastroenterology and is receiving the care she requires.

success-kid-300x166General medicine for the win.

I could go on and on and it seems as though I have. But I will say this. What I love most about general medicine is the patient centred care. The holistic approach to treatment of the patient as a whole. It’s all about the patient. What did they want? Were they well enough to go home? Did they understand what was happening to them? Who else did they want to involve? Etc etc. I think this is something unique to general medicine. One of my lecturers at medschool who is a bigshot neurosurgeon taught us that the more a doctor goes into a speciality, the less they see the whole patient. “An orthopaedic surgeon would basically just see a knee walking through the door” He would say. “Remember to look at the patient as a real person and treat them”. I was really able to appreciate this in general medicine. I could see that this made the patient feel that much better and safe. And I loved it. It’s what I would expect as a patient and it’s what I want to offer. I think I would really enjoy working in general medicine. But of course, it’s too soon to tell. Starting next week is my speciality medicine rotation and I’ve been allocated the most specialist subject there is: Stroke! I will be spending the next 3 weeks thinking and learning only about patients with stroke. I’m not too sure what to expect. But I’ll keep you posted!

NOTE: All names of patients given are not real names.

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Bad Goodbyes

Today was the last day of my genmed run in hospital so I was trying to be extra nice to my stressed out registrar who has been amazing the whole time. I had this whole speech planned out in my head to thank her for all she’s done and how helpful she’s been, etc. But when the time came for me to leave and say goodbye, the words just fell out of my head. Eugh.

Our team had just finished rounding on the wards and my registrar had just finished talking to our consultant on the phone. I waited patiently. I had to go off to a lecture and then I was done for the day. So now was as good a time as ever to thank my registrar and say goodbye. My house officer was also there waiting for the registrar. He knew I was leaving and encouraged me to talk to her now. (He was new so I didn’t have much to say to him other than thanks for being helpful this week. Not particularly hard). Anyway, she hung up on our consultant and I tapped her on the shoulder. “Hey, I’ve got to go to lecture now and then I’ll probably leave”. She took a second to understand the implication of what I said and replied with a smile and “Oh” We then proceeded to have this awkward exchange of “Thanks so much for everything” and “Oh you’re welcome I hope you had fun”. And I was just gearing up to say everything else I have bullet-pointed in my mind, but was sadly interrupted by her phone ringing. We had to make it short because obviously whoever was calling was more important than my clumsy attempt at saying bye. My house officer noticed I was struggling and also noticed the phone complication so jumped in with “She’s trying to say her final goodbyes”. To which my registrar responded “No no we’ll see each other around don’t worry” I can’t really say if she was serious or not because though it’s true that I’ll probably see her somewhere in passing around the many wards, we probably won’t interact at all beyond a smile or wave and we definitely won’t discuss patients or general life. This made me sad. Which ofcourse made more words fall out of my head completely. But it ended with a full hug and thanks from both of us (not a very long one because the damn phone was still ringing). We broke apart, she answered her phone and I walked away. That was the end of the interaction.

Thinking about it now, I really wish I had been able to give her my thank you speech because I always feel like I never say enough to the people I am grateful to. But I stink at it. I’m no good with goodbyes. I hate them and I can never walk away from someone feeling like that there was proper closure. I envy people that can express themselves so easily with words and can tell people exactly how they’re feeling. No matter how much I plan things in my head, they never come out sounding how I wanted them to. Sighh. I hope that from the hug, she knew how grateful I am that she was my registrar, how helpful she’s been, how she didn’t make me feel stupid about not knowing things, how much she taught me in the short few weeks, and how much I value that.
Yeah I really should have just said all these things. Gah.

Why are goodbyes so hard?! Does anyone else have this problem? Maybe I’m just bad at them. Note to self: Keep everyone in my life. Do not create situations for awkward goodbyes. Or if such a situation should arise, write out cue cards. >__>

Little win

Following on my theme of little things that get you through the day, today I had a particularly satisfying win.

It’s almost the end of my first run at hospital and it’s customary for medical students to bake for their team at the end of every run as a thank you. So I agreed to do this also for my team. I don’t particularly pride myself on my baking skills so I played it safe and decided to make cupcakes. But I also had an assignment to finish that night so I was sort of multitasking. Which isn’t always a good thing with baking because it requires a lot of attention. Well for me anyway. Like I said, I’m not very experienced. Anyway I thought they turned out pretty well.

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So the next day I took them in and invited everyone in my team, even the old house officers and pharmacists who had rotated to a different team. Err it turned out that I overestimated how much my team would eat, and also some people couldn’t make it so I had a bunch of cupcakes left over. The members of my team that showed up said they were great which made me happy. But again, I had a lot of them left over. So I left the box of cupcakes on a table in the ward for everyone to enjoy and went off to do other things. When I returned later, the box was completely empty and someone had left a note under the box

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This made me extremely happy. I then proceeded to pack up the box and leave when 3 people came up and asked if I had baked the “amazing cupcakes!!” and thanked me repeatedly.

The whole thing made me feel really happy. Not only that the cupcakes were all gone but also that they were actually good enough for someone to leave a note and come up and tell me how much they enjoyed them. So to whoever left the note, I am extremely grateful. You made me smile.

Little win, got me through the day. 🙂

It’s been a while.

First of all, I apologise for my absence. The past 4 weeks flew by so fast, I haven’t really had time to do anything at all. Not that I think my absence has actually affected anyone. I guess I’m really apologising to myself because I promised I’d be good and stick to regular blogging. So far that hasn’t happened very well, but hey! I’m trying!

Anyway, the past few weeks have been my first in hospital. Hospital. Allow me to sum it up in one word: Huheughhooherrrhuuh?! Yeah that’s not a word but it does sum it up appropriately. So much changed in such a short time. When I was about to start in hospital, people warned me about the practical problems I would have like not being able to find my team, or not being able to move as part of the team, feeling left out, not knowing what to do, where to stand, etc etc. This left me a bit worried because it sounded a lot like first day of school which is usually not a lot of fun until you make friends and find your classes etc. Fortunately, this was not a problem for me. I was able to find my team and they immediately took me in and gave me things to do like scribing patient notes on ward rounds. Felt like an important part of the team!

However, something I really wished wouldn’t be a problem at hospital, surprisingly was. Mind-blanks. In the weeks before starting hospital I attempted to study a lot of things at once because I didn’t want to be that person that stares blankly when asked a question by their consultant. Plot twist – The only thing worse than not knowing something, is knowing something but not being able to say it. Picture this: Endocrinologist consultant asks you an endocrinology question about diabetes that you’ve read twice, written tests on, discussed with friends but you just can’t remember what the heck it was. You know you know it. So you start off with “Oh it’s….” Big mistake. Because you’ve implied you know what it is and so are expected to complete this sentence in the next 5 seconds. You then try to buy time with “uhhh…”  hoping you can recall it in time, but all you’re thinking is “omg I’m blanking, omg they’re waiting, omg this is the longest anyone has not said something!! Not good not good not good!!” And of course that makes you blank more, so in the end, you give up and say “I don’t know, sorry”. Which is then followed by them giving you the “well it’s okay” look with the answer you knew and you mentally killing yourself multiple times in your head. SIGH. I cannot quantify the number of times this happened in the first two weeks of my run. Not. Fun.
But the good news is, it was probably just nervousness, and it has gotten a bit easier to answer questions and there have been fewer mind blanks for me. Hopefully it gets easier.

And every day seems to be overloaded with information that I’m not really sure what to do with. They tell me I should study. But what? Everything?? Apparently, yes. I sort of try to come home and read up on things patients I’ve seen have but it never seems to go in one direction. I end up reading about a million things at once and none of it really sticks. I’m hoping this is just because I’m on my general medicine run and every patient has 50 different issues with them at once that make no sense and half of which the doctors decide to ignore because “mehh it doesn’t fit the diagnosis, let’s just leave it out.” I don’t know about you but this line freaks me out a bit. In my head I’m thinking but it’s a problem!! And we don’t know why it’s there!! Eugh. Maybe I just need to get used to it. Or at least I hope I can.

But the best part about hospital are the patients. What I enjoy most is interacting with patients and helping out with their treatment. Even if it’s the smallest things like asking them how they are or talking to them about their stay in hospital, etc. It’s surprising how much even I seem to affect their lives. I’ve been introduced as the med student and while the doctors and nurses etc. think I’m not that important, the patients seem to want to ask me how things are going and compliment me on the hard work I’m doing and that I’ll help so many people who will be eternally grateful. This seems to give me lots of joy. While I’ve not achieved the things they’ve said, it’s nice to know where it is I’m headed and what sort of things I’ll hear from people. Sounds overly corny right? Helping patients gives me joy!! But I realised it’s actually a bit selfish and self-centred. Makes me feel good that I’m needed. Or will be needed. And I guess I’m okay with that. Don’t judge me too much.

I guess I learnt that every day even though I feel lost and useless and like I don’t know anything, that stuff doesn’t really matter much. Maybe it’s not about being in control and being great at everything, maybe it’s about the little things that get you through the day. Like a compliment from a patient, or helping out a team member, or getting a patient’s veins on the first go for bloods, seeing a cool procedure, or even just having lunch with a friend. This stuff keeps me going. So I’m just gonna try go with le flow.

Many more things have happened and are happening but I won’t spew them all out at once in one blog because it’ll go on for 4 weeks and I have no intention of taking that time out of your lives. So this is all that shall be said for now and hopefully I’m a bit more regular in recounting future events and thoughts…. Hopefully.

I hope the last 4 weeks for all of you have been fabulous!