Looking Down

Today was my first experience as a house officer with hierarchy.

I have been newly trained in carrying out DC cardioversions. The procedure where a defibrillator machine is used to shock your heart from an irregular rhythm to a regular one. 

This is usually done under anaesthesia. 

This wasn’t my first DCCV procedure. Me and a PGY2 house officer walked into the theatre and waited for the patient to be put to sleep. The pgy2 has never carried out a DCCV before. The anaesthetist, a tall stranger walked up to us and immediately turned to the other house officer, looking expectantly for an introduction. 

I spoke up and introduced myself as the cardiology house officer who will be carrying out this procedure. The other house officer introduced herself. Instantly, the anaesthetist’s eyes narrowed. But it disappeared quickly and I wasn’t sure if I had seen it.

He said okay then went back to putting the patient to sleep. A few moments later, patient still not asleep, the anaesthetist turns to me and says “who do you call for help?” 

I told him I would call my registrar. He asked for their name. I gave it to him.

A few moments later he instructed a nurse to ask me to write my registrar’s name and phone number on the whiteboard in the theatre “just in case”

The temperature in the room dropped fast.

I did as I was asked.

The patient was finally asleep and I delivered a single shock to the patient’s heart. I then began analysing the rhythm. 

The anaesthetist quickly interrupted me and asked if I was happy. Well Mr. Anaesthetist, I was not in fact happy as the rhythm was still slightly irregular. I was just discussing this with the other house officer when he began taking monitors and oxygen masks away from the patient, and essentially packing up. 

I still thought the rhythm was irregular. I voiced that I wanted to deliver a second shock to the patient. The anaesthetist gave me a look and told me I should really call my registrar if I’m having “trouble”. Ie he was not going to start again and anaesthetise the patient.

I called my registrar and she said she would come up but agreed that the patient should have a second shock.

I told the anaesthetist this and he said “you shouldn’t shock her on this rhythm”. Funny how you’ve made that conclusion now instead of straight away. 

I was wondering what I should do when he said “if you’re having trouble you should really call your registrar to come and review this patient”

He then proceeded to leave. 
The patient did not end up getting a second shock. Luckily for her, her heart reverted back to a regular rhythm later on.

But I was annoyed.

Mostly with myself because I had just let another doctor make me feel small and incompetent when what I should have said was “this isn’t my first DCCV” and asserted what I know.

But I didn’t expect to run into this problem. As house officers you’re the bottom of the ladder, sure. But for someone to outright assume that I don’t know what I’m doing and make that very clear to me is just not on.

You hear a lot about hierarchy. And I’ve experienced it as a student. But this was my first experience as a house officer when I’m actually NOT incompetent at this particular procedure. 

If you look down at someone when you’re at the top of your game, forgetting that you were once at that level and still learning….. well then you haven’t learnt anything really. 

Learning point for me is to be more assertive when I know I’m not incompetent at something. And to not treat anyone else like that. 

Some people are just shocking. Would rather be in the dark ages. 

Can he just not, step on my gown. He needs to calm down.

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