What More Can I Do?

The well has run dry

The aerosal can has only got air left, no solution

The bar of soap has dissolved

The ice cubes have melted and have only diluted your lemonade

The cup of tea has become cold

But I’m not giving up. 

I can’t possibly give up. 

I don’t get tired of trying, I just get frustrated when I don’t know what more to do. 

But I’ll keep going.

Even if the stray thread has unravelled the entire sweater. 

Pointless Arguments

So today I was having a “discussion” with someone who had recently become a doctor, about a patient I saw in my GP clinic. This discussion quickly turned into an argument and that was not cool.

Basically, I saw a man who had metastatic melanoma and after undergoing chemotherapy he was declared to be palliative. He came into the clinic because he had felt some slight discomfort in his tummy last night and this morning he woke up and had a glass of water, felt the discomfort again, and vomited up everything from his dinner last night. He had some more water and vomited again. So he had 3 episodes of vomiting at 7 am. He then was no longer vomiting, his nausea had settled and he was able to have sips of water. He came into the clinic at 2:30pm. He hadn’t eaten since his vomiting episodes.

So anyway, I took a history and did an examination and my registrar and I decided that he had had a bout of food poisoning or was in the early stages of a viral illness. We sent him home with some anti-emetics.

I recounted this story to this person. Her immediate reaction was “did you give him some IV fluids?”. I was in a rural GP practice. There wasn’t really much opportunity to provide bags of IV fluid for someone like this patient.

But more importantly, when I examined him, I was looking for signs of dehydration. He had a blood pressure of 150/70 (which is high), he was passing urine, tissue turgor was good, his JVP was 3cm (which is normal), his capillary refill was less than 2 seconds. (Oh God sorry about this. I’ve just practiced writing all these examination findings up in notes that I’ve just spewed them on here)

Basically, He was not dehydrated. He had been having sips of water all day. I didn’t think he needed fluids.

This person I was talking to however, did. She said that I should have at the very least, given him dextrose. For “energy” apparently. I had never been taught that you could give someone dextrose for “energy” so I said I didn’t think it was indicated as he seemed quite well and was likely to go home and eat and drink normally. She started to get annoyed. She said that it didn’t matter whether it was indicated, and that if I thought about it “logically”, I would see that giving dextrose was the best choice. And that she was giving me advice to be a “better practitioner”. She went on to say that in other health systems they do give dextrose to these patients. I said that I have never been taught this and no one else suggested it at the time and he looked quite well. She said “Well you’re wrong. This is good advice”. And that I should follow it if I wanted to be a “good doctor”.

At this point I got quite annoyed.

I’m sure I’ve mentioned somewhere before that in medicine it is so hard to decide who is “right” and who is “wrong” regarding diagnosis and management of a patient. Everybody takes away something different from their learning and have been exposed to different things, and as such, they are all inclined to practice medicine differently. To say someone is “wrong” because they don’t do exactly what you would do in the same situation seems a bit silly. Of course, this is what always happens. There is no department in hospital you can go to without hearing the doctors there trashing other doctors and their care of patients. It’s just the way it works.

I’m just frustrated at the futility of it though. To get angry because you think yours is the Right way and someone else didn’t know that? When realistically, neither approach would have done much harm or benefit to the patient in that setting. As long as neither approach severely damages the patient in some way, there should be some grey area between this “right” and “wrong” thing. Shouldn’t there?

Why do people walk around thinking they’re way is the right way? Surely we’re all working to make people feel better.

Giving him IV dextrose would mean pricking him and making him sit around for an hour in a small GP practice when he was likely to go home and eat and drink something normally. This was my opinion. And my registrar, who had also seen this patient felt the same.

Her opinion was different. Which is fine. But for her to say that I was “wrong” and wasn’t a “good doctor” for not loading him with fluids, seemed a bit much to me. It seemed arrogant.

I guess this is how it’s going to be in this career. Everyone has their own “right” way. Even me I suppose. But I wouldn’t be calling someone else wrong or a bad practitioner unless they actually did something awful to a patient.

Well maybe I might. Someday.

But I hope not. Blech.

Need To Know Basis

If you’re anything like me, things that frustrate you to no end are when people say things like “ugh I’m upset” and then when you ask why, they say “doesn’t matter” or “too hard to explain” or they don’t reply or they change the subject abruptly. 

Excuse me how rude. 

First of all, if you’ve got a problem you would like to share, then for heaven’s sake share it! If you don’t want to, then don’t. Please do not come by and hint that you’re dying on the inside but don’t want to share the full story. Don’t hint it at all. Like ignorance is bliss. I was having a perfectly good day until someone says “I’m really upset” and then when I panic enough to drop whatever I’m doing and ask them what’s happening, they decide they don’t really want to talk about it anymore. 

That stuff messes with people you know. Decide whether you would like to talk about it. People like continuity. I do, anyway. I even try following up. I mean, I can appreciate if someone is too emotional, etc to discuss it right that instant. So I normally make the effort to remember who said what and try to follow up and make sure they’re okay. But nope. I get rewarded with a “too hard to explain”, or just plain change of subject. 

You know to be honest, I’d much rather appreciate a person saying “hey I’m upset and I thought I wanted to talk about it with you, but I changed my mind for these reasons so I won’t be talking about it. Nothing personal” or something to that effect. Because otherwise it’s like being left on the cliffhanger of game of thrones with an indefinite time period as to when the next season will be up.  (Or so people tell me. I wouldn’t know) 

It’s really not that hard. 

But anyway, I’ve learnt to cope using my technique of the need to know basis. As in, is going to kill me if I don’t ask about this or if I don’t know what’s happening? Probably not. Can I live with just hands off methods of interacting with them without bringing up these issues? Yes I think so. 

It’s just for my peace of mind really. I ruminate far too much on what people were Going to say, but didn’t. There’s just no point. I mean yes I get curious, and I try asking maybe once, but after that, I’d rather join this person in pretending that conversation never happened than putting myself through the trauma. Just gotta accept that’s what people do sometimes.  

Not So Rural GP

I have just completed my first week of my “rural GP” rotations. The quotation marks and the title should suggest what this post will be about.

My rotation is in a place called Warkworth. Warkworth is actually still in Auckland. The point of a rural placement is that I should be placed in some tiny rural town deep interior of the North island. But I’m actually in the northern most part of Auckland which is so unnecessarily big that a part of it is actually considered “rural”. Warkworth is an hour away from where I live. Even though it’s still in Auckland.

I mean of course Auckland is not as big as other cities, like Melbourne for instance. But I don’t think any part of Melbourne is considered “rural”. Whereas, Warkworth is. Isn’t that weird?

Anyway. I’m at Warkworth medical centre for the next 6 weeks. It was an absolute nightmare trying to find accommodation at this place. Luckily we live in the age on things like AirBnB and what not. So it should be easier finding accommodation right? 

Well, no.

There was another student at the same practice before me. And she was staying in an AirBnB quite close to the practice for 45$ a night that she recommended. So I thought I would check it out. I went to the owner’s house and the lady there took me downstairs, opened the stair closet, and there was a bed in it. 

Yep. Not kidding. No Windows, no space, literally a stair closet that this other student was paying 45$ a night for. And there wasn’t access to the kitchen either because this was someone’s house. I was very concerned. I could die in there. Someone could close the door and I could literally die. I was genuinely concerned for this other student who spent 6 weeks there. I wonder if she was hoping that if she stayed there long enough, she’d receive a letter from Hogwarts. 

Blech. But yeah that wasn’t going to work for me. And everywhere else was extremely expensive. I ended up finding a studio beach house about 10 minutes away from Warkworth. Yep 10 minutes away is basically another town. But anyway. It’s a bed, a kitchenette and a bathroom. Which was pretty new and pretty decent however, it’s 260$ a week to stay there. Eugh. Expensive. But decent I suppose. I decided to drive back home on Fridays so that’s good. 

But oh my God is it hot in the studio. It’s extremely hot in Warkworth in general but there is no air in the place I’m staying. I tried opening some windows and a bunch of bugs flew in so I spent an evening hiding in my bed scared that bugs would crawl into my ears. So I decided never to open the windows again and die of the heat instead. Blech. 

On the bright side, the actual rotation is great. The practice is pleasant and all the GPs I’ve worked with thus far, including my supervisor, have been really nice. So that’s really good. I saw some patients on my own aswell and they were really nice too. I guess 6 weeks won’t be too bad. 

It’s challenging though. In any one day I saw patients with illnesses from every single medical specialty. Cardiology, rheumatology, orthopedics, gastroenterology, psychiatry, etc etc. In hospital, you refer them to wherever they need to go in a heartbeat. But in general practice, you have to deal with it all. Which means you have to know it all. I do not. Yet. So I basically have to study everything again. 

And Warkworth is quite nice. It’s part of a region called Rodney and they’re famous for beaches and nature trails. So of course I had to go for a walk. And of course the most interesting thing for me is sunset.  

So here are some pictures from Warkworth

The Poison 

Do you know what the funny thing about anger is? It’s the most aggressive slow-killing poison in the world. 

Anger at someone else, grudges, revenge, negative thoughts, etc etc. Are all ingredients for the perfect poison. 

But the real funny part.. is that you can only use this poison to kill yourself. 

Someone upset you. Someone annoyed you. They hurt you, offended you and so on. You get angry. Your muscles all start contracting, your heart starts pumping like crazy, the adrenaline seeps through your body and brain causing every nerve to tense up in response and puts strain on your body and your mind. The Poison has entered. 

It leaves behind a trail. The memory you have of this incident. Every time you remember, it all starts again. You see someone or something and it just literally burns you up from the inside out. 

Meanwhile, the other person walks away. Completely healthy. Completely unaffected by all the detrimental effects going on in your body. Endorphins flowing freely through their system no problem. 

Isn’t that funny?

When someone makes you angry, don’t you want to hurt them in some way? Sure. But what do you end up doing? Just taking more of your slow poison. Again and again and again. 

You getting angry isn’t going to change them. It isn’t going to change what happened. It’s just going to stress you and your body out every time. 

Especially if you hold onto a trace of the poison somewhere in your memory. It’s pretty much an unlimited supply. 

It’s a slow and painful suicide. 

Yes I can appreciate it’s not exactly something you can control. But you can atleast try to stop taking the poison multiple times. It’s just not affecting anyone except you. And not in a good way. 

I don’t wanna die that way. It’s just not worth it. 

Hurdles Crossed 

Today was the last day of my first rotation of 2018! Never had I known Gen Med to be so tolerable as I had this year. Of course it may have had something to do with the fact that I am a final year medical student and as such I am a legitimate member of the team not just the awkward appendage that opens curtains and turns lights on as a 4th year student.

No more. I am needed. I am important! I am a Trainee Intern and I am second to the house officer.

It’s been really great actually. My house officer had been extremely helpful in teaching me how to be a house officer next year. I was doing jobs and learning the ways. My consultants were lovely and actually took an interest in me, making an effort to teach, etc. It was such a change to the experience in my 4th year.

But it’s been 6 weeks and it was time to end. I had my long case assessment which was entirely horrendous. Basically I had to take a history and do a focused examination on a patient with a long-term issue. These usually being medical issues like diabetes or heart failure or something along those lines. And these patients are supposed to know the drill and know quite a lot about their conditions. I however, got Mrs. Vague from Lost Town in Shadyville.

Me: So, what concerns you mainly about your health?

Patient: Well I had a fall 50 years ago. I hurt my back. And I haven’t been able to walk since.

Me: Oh I see. Could you tell me a little bit about that?

Patient: Well, I fell over and hurt my back. I had a surgery, and I haven’t been able to walk since.

Me: What surgery did you have?

Patient: A surgery on my back which took the pain away but left my legs feeling like lard. I couldn’t move them, couldn’t feel anything, and I had to have physiotherapy for 1 year.

Me: Oh so you’re able to walk now?

Patient: Yes I walk fine now. I don’t need supports or anything.

Me: Okay and how is the feeling in your legs now?

Patient: Oh much the same. They feel like lard. Like I can’t move them at all. And I have foot drop in both my legs. But I can walk fine. Everything is fine!

Horrendous. She kept talking in circles and I had no idea what her problem was. When I presented to the consultant, he told me that she actually had a failed spinal surgery where a few nerves were accidentally cut!! I never would have gotten that out of her. Meanwhile, the other students had garden variety patients with diabetes and atrial fibrillation.

I had this awful 10 minutes before presenting to the consultant where I was sure I had failed. Fortunately for me, both the examiner in the room, and the consultant I presented to recognised that I had a particularly difficult case and said I did well, and I passed!

Thank you Universe!

And then on my last day, my own consultant gave me a good report. She told me I had been a wonderful addition to the team and I would make a great doctor. Which was so nice to hear. It just gives you that boost of confidence. After two years of being unsure about everything, it made me feel good. That maybe I’m finally doing enough to come across as someone competent. Who does belong in medicine. But anyway, as I’ve mentioned before, I’m useless at receiving compliments still, so I just sort of smiled and said thank you. Hopefully she didn’t think I was being weird.

The Gen Med rotation and the long case are huge hurdles for this year. The long case is the major assessment 6th year students are expected to pass. I’m really grateful that I was able to get through it and feel competent doing so. 

But anyway. I’m properly exhausted now. Gen med is the most tiring rotation to be on. I’m moving on to rural GP starting Monday. So hopefully that’ll be a good change of pace and I can get some decent rest. Hopefully not famous last words. xD