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!!