Gastroenterology Review

This is probably a bit preemptive considering I’m only 4 weeks into this rotation in Melbourne. But this rotation has been different to the others I have had this year. So I think now would be a good time to talk about my thoughts on gastroenterology.

I had mentioned how it must have been fate that I got accepted into gastroenterology over radiology. I think that was definitely true. It’s been a good run thus far.

Well. Kinda. Here’s the thing. I’ve had consultants here in Melbourne that ignore me and don’t acknowledge my presence (like back home). I’ve had registrars and team members that don’t really teach and don’t really care where I am or what I’m doing (also like back home). Then I’ve had consultants who are absolutely lovely and who teach and take an interest in me and my learning (this is also like back home). So the run in itself has been the same as all other things I have experienced in the last couple of years.

But I’ve been excited to go to hospital. I’ve been excited to go to endoscopes, clinics, ward rounds and to do my own studying. I actually enjoy what doctors do on a daily basis in gastro. Gastroenterology is one of those specialisations which has a good balance between medical management and procedures. And that’s something which I think is great 

I find the pathophysiology interesting and exciting. I find the medical management of patients intriguing. And I find the procedural side of endoscopies challenging and satisfying. I haven’t bad this kind of experience on any other rotation so far. I can actually see myself becoming a gastroenterologist.

And I am so grateful for that.

Now this isn’t 100% obviously. I’ve got a long time to definitely decide. But I am so glad that atleast one run (funnily, the final run of the year) has piqued my interest and has allowed me to visualise what kind of medical professional I would like to be.

And within gastroenterology, there are sub specialties. Liver, IBD, Oncology, etc. I’m not too sure which one of these I’d like. But I find liver pathology more interesting than IBD. So maybe I will specialise in hepatology. But hard to say.

It’s just exciting to ponder these options. To have something to hang off these ideas and consider them seriously. I am so glad. After a lot of rotations where I found out what I don’t like, it’s been nice to have a run I really do like.

Future gastroenterologist Abracadabra? Perhaps!

 

In other news, Melbourne is a huuuge city. But it’s a lot like back home. I went to Great Ocean Road today which has these big rocks on the shoreline. Great roadtrip with my flatmates and I took some photos! The weather was basically not great and we were all freezing and wet, but it was a good day overall!

12 apostles 412 apostles 512 apostles 6

I Am Not A Fish

4 weeks into this gastroenterology rotation, I’ve found that it’s quite specialised again.

I’ve found this on many rotations before and I’ve mentioned it on here. I don’t know what it is about being in a particular department that suddenly means you are wearing horse blinders and can only focus on one part of the body.

As in, you are admitted under gastro so therefore for the time that you are here, you are nothing except your liver and bowels.

One of the other med students and I admitted a patient together. As part of admission we completed the standard history and examination. This patient was being admitted for bowel preparation before a routine colonoscopy. While examining him, I found that his pulse was abnormal. The other med student confirmed this and we were concerned that he may have an arrhythmia. When we reported this back to our intern as part of the admission notes and said that we would like to request an ECG, she gave us a very pained look.

“…Really?” She said. “I mean. He’s just here for a colonoscopy. His pulse doesn’t really matter.. You can request an ECG if you want, but it’s just an extra thing to do…”

We were both a bit disappointed by this. Yes it probably isn’t relevant for a colonoscopy. But if it’s a heart rhythm that could descend into VF at any time during the anaesthetic administration for the colonoscopy, I would imagine the anaesthetist would question why the patient made it this far without anybody picking up his irregular heart beat. The chances of this happening are very low of  course as we did request the ECG and he had a benign RBBB. But the chance exists and I would hate to be the one to fall in that percentage. I wondered why my intern didn’t feel the same way.

Then today, a patient who had an endoscopy for a bleeding ulcer was found by the gastroenterologist to have something pressing on her stomach externally. He had ordered a CT scan to find out what this was. My gastro team received the result and it appeared that the patient had multiple large cysts in her abdomen. There were multiple cysts in her liver, and some pressing on her stomach. My registrar was satisfied with this finding and was glad that we found what was pressing on her stomach. I asked him what would have caused the cysts. He told me he had “no idea”. “Some people just have cysts. We just don’t touch them. We just need to know what was pressing on the stomach”.

I just…. Eugh.

What if those cysts were hydatid? Caused by parasites? What if they become infected? Again, super low chance of this happening. And I appreciate that. But no referral, no plan to monitor further, nothing really.

Ie. Let’s just wait ’till it becomes a gastro problem that needs fixing.

What is this mentality? I’m seeing this in all parts of medical practice that I have experienced. And it really bothers me. I appreciate that once you’ve confined yourself to a specialty, your priorities are the problems that come to that specialty. But surely that doesn’t mean you have to intentionally ignore the patient’s other problems? They bang on and on about ‘holistic’ patient care in med school. I wonder how people interpret this. I am still a student so obviously I’m trained to think about every possible issue a patient presents with. But I’d like to believe I’m not just trained that way for the heck of it.

For me, if you’re the sort of doctor that says “they’re only here for a colonoscopy, don’t worry about their heart”, you’re just not providing good enough care for the patient. Like it’s just not multi-dimensional.

Okay I understand that people are busy. I understand that you cannot possibly be expected to fix every problem someone comes in with. It would be super stressful and will probably shift focus from the problem you’re supposed to fix, but it’s just the attitude. It’s just the way you’re doing your job. Why would you tell the medical students to be just as uncaring about these things?

It’s broken as Seth Godin would say. This sort of thing would come under the “I am not a fish category” Whereby the person who designed the water exit for a fish placed it one foot above the water level. The fish can’t even get up there. Why did they guy design it that way? Because he’s not a fish. He just did what his job description said: To build an exit.

Really interesting talk if you’re interested:

 

Anyway. Point of this is. I want to know which field of medicine I need to be in for doctors to not shrug off certain problems just because it’s not part of the body that they are assigned to. I wonder if there even is such a field.

Maybe I just have to try to maintain my student training mentality.

I don’t know.

Unfair

Stop picking on me.

I have not displayed any features or signs of being that which you accuse me of.

Cut it out.

Why me? When there are all these other people who do fit that category.

I’ve said and done nothing to that effect.

It’s not nice.

Go pick on someone else.

I am not apologising for something I did not do.

I am not going to be made to feel guilty for no reason.

Not anymore.

Not me.

Politics……..Zzzzz

One of the things that comes with being an adult is pretending to care about politics. No no. You HAVE to care about politics. Why? Because everyone else is going out of their way to make sure you do.

So. The NZ general election is coming up. Over the last 9 years, we’ve had the same ruling party making up the government. That being National. The opposition has always been Labour. Apparently one of them is left wing and the other is right (I forget to care about remembering which is which). They are the two main competitors. Then there are all these random small parties that everyone knows will have no say at all, but people end up voting for anyway. Some do so because they want to waste their vote because they couldn’t care less, while others are very gung-ho about their actual policies.. apparently.

I’ve only earned the right to vote since the last election. Up until then, I, like every other kid out there would consider politics to be just a lot of boring noise that adults make at parties that I would somehow go talk to about my friends as though I came up with an opinion all on my own. Let’s face it.

But since gaining the right to vote, I’ve found just how ridiculous people can be when it comes to politics.

Now. I don’t mean this in an offensive way. All these people are my friends and they truly have strong beliefs and I respect that immensely. But what I don’t respect, is their attempt to force these beliefs on others.

Literally all I heard in my first year of med school was how the current government and our prime minister at the time had failed the entire country and we’re all suffering immensely and we’re all going to die because of the apocalypse that the government started. (Obviously kidding, but they were saying a lot to that effect). It surprised me just how ferocious people could get about this. There were posts upon posts on FaceBook about how everyone should vote for The Green Party (which is supposed to be both an environmental and cannabis friendly party that really cares about the youth. Well this is what people try to convince me of).

What was worse was that each person somehow assumed that every other person was voting for the same party.  I am not kidding. A friend of mine openly asked me who I was voting for. I don’t usually like discussing this, but I told her anyway. She then replied in a horrified tone that she thought I was a supporter of her own party. I asked her why, and she said “Idk I just thought you were that person. Who supports ______”

What the heck.

How? I mean….How?

Other people just add me to their conversations assuming that I’m voting for their parties. “I mean, we’re all voting for Green cuz we care about NZ, but like can you believe how unreasonable National is being??” Without so much as asking me whether I had an opinion.

Though I must say, the easiest conversations to have with people are about politics. It’s easy because all I do in these situations is smile and agree with whatever they’re saying. I mean hey, they’ve already assumed I’m a supporter. Why bother arguing otherwise with someone who is such a strong believer that they rely on transference to gain party votes?

Like I just don’t get it. Why openly hate any one party? Are people actually naive enough to believe that a Single party can fix the entire country and make everyone absolutely happy? It’s as though history has taught us nothing. There’s no way ANY party is going to bring every singly policy they had promised to a letter.

Surely it’s just about the bigger issues. Why do people take these things so personally? And I mean they take it personally because when I ask people about their partys’ policies, they usually just end up going on about how lovely the party candidate is. Or how good a speaker they are compared to that useless prime minister. Eugh. I’m just getting a bit tired of hearing about people’s ferocious opinions.

Regardless of who gets elected, there will always be a group of people negatively affected and who are going to complain. At the same time, regardless of who gets elected, people are not going to wither away and die. Yes the government is important, but it’s still just made of people.

This is just my opinion though. Again, I’m not saying it’s not important to have your own views and beliefs and vote, because of course it is. I have mine. I went out of my way to make sure I was well informed about policies, etc. But I just wish people would be more aware that there are other views out there before posting on FaceBook about who they have voted for, and who YOU SHOULD vote for if you give a damn about your country at all and are not selfish and stuck up like the current government is.

Because that’s no longer support. That’s propaganda.

I want to make a move to make it socially unacceptable to discuss your political ‘opinions’.

But anyway. That’s my political rant. I usually wouldn’t care so much. But some people have been unnecessarily pushy this election and I cannot wait until it’s over. I’ve become indifferent to who is even going to win. I’m just tired of my news feed being filled with people trashing others.

Where is the love? (As the black-eyed peas would say)

Journal Club Bribe 

How do you get people to come to a 7:30am gastroenterology journal club?

Bribe them with a free all-you-can-eat breakfast from the hospital Cafe!

Nothing says motivation like free food.

Unfortunately for me though, the hot chocolate I ordered was way too sweet. And the Berry yoghurt was far too thick. And the thing in the middle, was too salty.

Still. Free food is definitely motivation for everyone.

Just Out

When your team consultant kicks you off the ward round because “students slow things down” and he wants to have a “working” ward round so he can go play golf afterwards, ditch the ward round, take a long weekend, get on a train to nowhere and see where you end up 



LOL jk. I googled how to get to these places. 

But the rest is true. 

Balance

Do you ever have points in your life where you think that things are going really well at the moment… And that’s suspicious and you’re expecting things to crash?

I never have these points.

My life somehow seems to always be a perfect, and immediate balance. Whenever something good happens, the very next day, if not the same day, something not so good happens. Probably something unrelated to the good thing, but still. It’s instantaneous. And it’s just painful irony most of the time.

I don’t know why. You’re probably thinking what a cynical pessimistic thing to think. And optimists will say that perhaps a good thing is happening after every bad thing.

But with the latency between the bad thing and the good thing, I can kind of tell which is happening first.

Something good has happened, and then the next day, something upsets me. In a big way. Makes me wonder how I am going to stuff up the good thing that happened.

I suppose another way to look at it is that it keeps me grounded. Never too overconfident with myself and never too down on myself. Well…. That’s not really true. I have long moments of down-ness. But it almost always seems that goodness is followed by down-ness. Not really the other way around.

Eugh. I don’t know.

That’s life I suppose. Meh. Must go with le flow.

Intuitive Sensitivity

I haven’t seen any huge differences in terms of medical practice between Melbourne, where I am at the moment, and Auckland my home town. But something I did notice was this thing I like to call Intuitive Sensitivity.

Basically, back home, when doctors see patients, they are super intuitive about recognising what the patient is feeling and what they need. So many times I have seen registrars, house officers, consultants, etc. jump up and move to the patient’s side to put an arm around them or offer them some tissues even before they start crying. They just know when it’s coming. I’ve marveled at this several times. I certainly don’t see it coming. But they do. And it’s pretty great to watch.

But since being in Melbourne, I’ve already met several patients with terminal or extremely disabling conditions who burst into tears on ward rounds or during clinical consultations. But I am yet to see even a single doctor step forward to comfort them. House officers, registrars and consultants alike, just let the patient cry. It just becomes really quiet in the room while the patient cries.

This bothers me quite a bit. I hate standing (or sitting) around watching a patient cry. Or anyone, for that matter. No matter how staunch or independent a person is, everyone but everyone could use a gesture of reassurance. A hug, some tissues, a kind word, etc. Anything could help. But you have got to acknowledge, surely. Not just watch them while they cry.

Of course this could be a cultural thing. Basically Kiwis have a reputation worldwide of being the “softies” in everything. So I suppose it’s not surprising that people cry or people have that innate sense to comfort. And this might not necessarily translate in other countries. But then again, I have seen some consultants back home who just plain ignore patients when they cry.

But either way, I would hate to just sit in a room with a bunch of doctors staring at me blankly while I cry. And so, I can’t watch that. But it’s super awkward for me because (and I’ve said this a million times already) I am the student.

I have no role there really. I can’t just jump in and comfort patients while consultants are around. How awkward would that be. Or if it isn’t even acceptable culturally, I’d be both awkward and culturally incompetent.

But there was one point that I just couldn’t stand to watch a woman cry any longer. There’s this clinic called ‘functional gut disorders’ clinic. And I have to say it’s the most depressing set up I have ever heard of. Basically we just see patients with functional gut disorders that are incurable and are super complex and debilitating and we just tell them to continue their current treatment. Patients just come in to cry about their conditions, basically. So you’d think the doctors at this clinic would be super intuitively sensitive and do a lot of reassuring. But nope. I sat through multiple consultations where the consultant was, incredibly, typing notes while a patient sobbed away. This woman had an extremely disabling functional gut disorder. She cried for a few minutes, stopped, then cried again. Unable to watch her anymore, I had a huge internal conflict about moving towards her to offer some comfort while also not annoying the consultant. In the end, as a compromise, when it looked like she was about to cry again, I picked up the tissue box near me and offered it to her.

She accepted it gratefully and thanked me. The consultant gave me a small surprised look but then smiled and said “thank you for doing that”.

Okay it wasn’t a big gesture, but it was the most I could manage. And I think it kind of helped the lady. Which probably means it’s not culturally unacceptable. But yeah, there were a few more patients after that and my consultant still let them cry. As do the other doctors. And I’m still the med student so I can’t do much. Sigh.

I just don’t know how you can be okay with watching someone cry. Or knowing someone is sad. It makes me feel yucky.

I suppose I am developing this intuitive sensitivity though. I just have to try make as many small gestures as I can.

That One Person 

You’ll meet all sorts of people where you work. There are people who act like you don’t exist, there are people who wear a permanent crown on their heads, there are people who pretend to be nice but aren’t really. And there are people who don’t even pretend. 

But every so often, you’ll meet someone who does care. Someone who actually takes an interest, makes you feel important and has an enthusiasm that is infectious. 

That one person will make all that other stuff unimportant. And they’ll actually make you enjoy what you’re doing. 

And I am so grateful.