Coping

3 weeks of gastroenterology down! 

Hugely annoying three weeks. Despite my first day being full of potential and exciting, things brought me down really quickly. 

I was at ADHB during my trainee intern year. Ie my final year of medical school. I had found that year fabulous and the hospital to be a really great place. But now that I’m back….. it’s really lack luster.

Adhb is woefully behind on technology such as electronic prescribing and blood test ordering. It’s behind on referrals processes and radiology liaisons. They even changed the IV cannula needles I remember using in my TI year. 

What has happened?

And worse, the heriarchy that Adhb is famous for, reared it’s ugly head.

Gastroenterology is my chosen speciality. I love working in gastro and seeing gastro patients and attending endoscopy lists. But the consultants in my department seem to not care very much for my existence. 

I made it a point to introduce myself to the consultants and greet them every morning. But beyond responding with a lukewarm “hi” they don’t say much else, and what’s more, the same consultants are super nice and conversational to the registrars. 

I don’t get it. I’m helpful too you know. I’m keen on gastro too you know.

Ugh.

Thankfully at least my registrars are nice to me and invest in my learning.

But it does bring me down. Also the job is not very busy at all. I feel like I’m back on psychiatry where there’s nothing to do. 

Sighhhhh

And then there’s this situation at home. Currently my family is planning a big move to Australia. That they want me to be a part of. They want me to quit my job here and find one there and start all over.

There are financial benefits and family benefits to doing this, but I don’t want to.

I’m aware that I sound incredibly selfish, but I feel like I should have some autonomy over where I work and where I want to live. And I don’t want to leave NZ yet. I know I probably will eventually, but I don’t want to right now. And they are taking it hard. And I’m demonized everyday.

Life’s not in one of its peaks at the moment. 
The other day a friend of mine who I hadn’t seen in years asked me about work and what it’s like to be a doctor. One of the things he asked me was; “do you often get stressed about work? How do you deal with that?”

And to be honest, I hadn’t really thought about it until he brought it up.

I actually have really bad coping mechanisms. 

I can’t remember if I ever had good coping mechanisms but I’m sure I don’t now. 

I told him, I cope by sleeping.

And that’s true. Every time things get really rough for me, I choose to go to sleep. (Yeah a real man of action, I am)

I don’t know why. But it’s an escape I suppose. The only time I don’t have to think or stress is when I’m physically unable to. And that’s when I sleep. 

Ofcourse that’s not really coping at all because when I wake up the problems haven’t magically gone away, but I guess in some ways I had a break from it and that gives me some strength to deal with it all again. 

I don’t know. 

I’m just hoping it all gets better. I just wish I knew what the right thing to do was.

Hectic Real Quick

I do apologise for my absence for the last two-ish weeks. Things got hectic real quick.

Let me outline it for you. Last I spoke, was about paediatrics. That’s over so yay! Made some good connections. I expressed my interest in pursuing gastroenterology as a specialty and one of the nice consultants took me on to do a project. Specifically,¬† a case report.

Good thing about a case report is that it’s likely to get published. Buuuut it’s not exactly a “research project” so I’ll probably have to do an actual project later on.

Yeah the requirement to join the gastroenterology program is to have done a research project in gastroeneterology. I’ve got time though. And a case report is still neat. So I’ve been working on that.

Straight after paediatrics, began Psychiatry. I am placed this year, not in Mason clinic, but in a community facility. Which is interesting enough. I do find psychiatry interesting, psychiatrists themselves are weird, as usual. One of my consultants is really nice, the other uses 3 different e-cigarettes constantly in a pattern I call, “chain-vaping”. I doubt it’s really much of a step up from actual cigarettes.

Anyway! Psychiatry this year is very stressful because I have a practical exam at the end of the rotation where I take a psychiatric history from an actor and present it according to the DSM 4. Good old DSM 4 with its pages and pages of criteria but still managing to make the conditions fluffy and not really any easier to distinguish between. Sigh. So I have been cramming as much A B C criteria for the diagnoses as possible. Not. Fun.

I was also given my rotations for my first house officer year in these past weeks. They will be as follows:

Psychiatry (oh my God when will it end)
Gen med (Good. Good learning, useful, mhmm)
Cardiology (Interesting, should be fun)
General Surgery (Not looking forward to. Lots of admin, but if I do it now, never have to do another surgical rotation again so yay!)

I didn’t really want this combination, but pretty much all the combinations were pretty lame and at least I don’t have to do any runs I really dislike like orthopaedics or geriatrics. So good stuff!

In other news, my mood has been quite low lately. No particular reason that I can mention. My right brain playing up maybe. But life seems a bit bleh these days.

I wonder if I have some watered down form of bipolar disorder. But where a person with bipolar disorder would have a mood pattern that looks a bit like this;

Sketch (1)

Mine, looks more like this:

Sketch (2)

Yes I’m a whiner at the moment. I don’t have bipolar disorder and frankly my problems are no where near that substantial. They have it hard. I’m just complaining about something that isn’t there. I should get over myself. I guess it’s just a first world thing.

So yes, that’s what has been keeping me busy lately. Blogging helps, as always. Hope everyone else has been doing great!

Spelling Woes

Today I found out that for the last 4 years of med school, I have been spelling the word “pruritus” wrong.

I had been spelling it as “pruritis”

No one had corrected me. In 4 years.

Today I was corrected by my gastroenterology supervisor via email as part of a research project questionnaire I had put together. There were 2 other consultants on this email chain.

“Please note the correct spelling of pruritus” he had said.

Eughhhhhh how embarrassing.

Why did I never know this. I’ve read textbooks. Somehow my mind has accepted the wrong spelling.

Gah. I suck at spelling. It’s so sad. So sad and embarrassing.

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.

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.

A Week In Melbourne

Greetings from Melbourne!

Apologies for not updating sooner but it’s been a challenging week for me on my first week of selective. And it’s been really full-on with highs and lows. That I shall now recount.

It’s my first week of living in an apartment with two flatmates. Both of whom are super organised but have been very nice and accommodating. It’s taking a while to get used to. When you live in an apartment you appreciate the value of hot water and electricity. You can’t have the heater on all day, you can’t take a shower for any longer than 15 minutes, you have to wait your turn to use the bathroom in general. You have to get used to the fact that everyone has a different sleep schedule and because you live in such close quarters someone is bound to be disturbed. One of my flatmates has crazy work hours and basically comes crashing in past midnight now and then. However, the following day, I crash around trying to make a cup of tea while he tries to sleep. And you’ve got to preserve electricity for when you need it.

That’ll be for the heaters.

Melbourne is 9 times colder than Auckland. It’s ridiculously windy and I haven’t seen sunlight in 5 days. And my apartment is lacking in insulation so things get extra chilly at night.

But otherwise, I’m super grateful for my little flat. My flatmates are great and I’m finding this new change quite endearing. Hopefully I’m a good flatmate too.

In terms of my selective, I’ve had an interesting week. The Alfred hospital is where I’m based and it’s pretty huge. But the medical school (as all medical schools seem to be), is completely useless.

I walked up to the clinical school on Monday, earlier than I was expected, and waited a full hour to be oriented. The selective coordinator I had been in contact with told me my “supervisor will come to collect me”. Instead, another doctor showed and took me through the basics of being in hospital. Avoid infections, wash your hands, patient confidentiality, don’t kill anyone, etc. After that he left me with the registrar on the gastroenterology team for a ward round.  After which, I still hadn’t met my supervisor. So I went down to his office, and he wasn’t at his desk. So I returned to the gastro department and asked my registrar where I could find him. A lady nearby said “oh he’s on leave for 3 weeks”

……..seriously? I have to have a pre-selective catch up, a midway catch up and an end of run catch up at which point my supervisor fills in my final report. I can’t do any of that if he’s away for 3 weeks!! And the most annoying thing was, I had told the lady I was in contact with all of this. So when I emailed her asking if she knew this, she said she had no idea and that I should ask my registrar who the “acting” director was and he/she would be my new supervisor. Eugh.

My registrar didn’t know who the acting director was. Double eugh. But she finally introduced me to a consultant who agreed to be my supervisor but could only meet me for 10 mins at the end of the week. Eugh eughh eughhhh.

So until then, I was stuck following the registrar around on ward rounds. It ended okay. I caught up with the other consultant, he was nice enough, gave me a project to do over the next 5 weeks, so that’s good.

But omg the ward rounds.

The ward rounds on gastroenterology are a minimum of 4 hours. I haven’t been on ward rounds since OBGYN. And those were pretty straight forward. All the women were either pregnant or had tummy pain. So I wasn’t used to the burning pain in my legs and feet as I trudged up to the 7th floor to see more patients after 2 hours and counting. But the horrific part wasn’t even the pain. It was the fact that everything about these ward rounds reminded me of my gen med rotation last year.

The rounds where you have no idea what the patient’s backgrounds were but you have to stand awkwardly in the room, turn the lights on, draw the curtains, and listen as your reg talks to the patient about their ongoing care. And they’re moving at a pace such that asking what this particular patient came in with would be the last thing they want to answer. The house officers are feverishly writing notes, so they’re no good either. So as the most junior person, you stand around and think about how you’re not learning anything.

But I am no longer a lowly 4th year student, traumatised and vulnerable, pushed around by superiors, and intimidated by everyone for no good reason. Crippled by the fear of appearing incompetent that I actually come across as less competent than I am. Yeah nah. That’s sooo last year. If I learnt anything from last year, it’s that you are the only person responsible for your learning. And that means ditch the ward round if you’re not learning anything. Find somewhere else to be. If your time is better spent studying, go for it. Better spent in clinic? Go there. Endoscopy? Hell yeah. Don’t force yourself to be in a situation where you’re not gaining anything just because you’re “expected” to be there. I showed up to all of 2 ward rounds this week. I went to clinic where the one-on-one time with consultants is the best to learn about gastro diseases. I went to endoscopy where I saw some pretty cool stuff, but left early when it was a couple of mild reflux oesophagitis cases being scoped. Time better spent reading up on IBD. Of course someone will always try to undercut you, like a consultant who decides you’d learn more about “acute management” on a ward round on the 4th day where the list hasn’t changed, than go to a liver clinic, but even then, don’t be upset. When I’m on that ward round, I do ask my registrar questions and I do persist in learning. And even if I don’t, in useless situations, even if you don’t learn how to practice medicine, you’ll definitely atleast learn how not to practice medicine, And even that, is good learning.

Taking responsibility for your own learning means that you can’t expect anyone else to care or take an interest etc. But it does give you the freedom to do the things to learn the most you can. And it means you don’t have to care too much about them either. Just make your learning work for you. I’ve been following this. And it felt good. I’m more excited to learn on gastro than I have been on previous runs.

But anyway. I shall make another post about the merits of Melbourne as a city. Not just hospital related stuff. Because this place is huuuge.

And in a big city, when you’re having a tough week, the best way to blow off some steam is go exploring at night in the rain and capture some pretty lights.

Melbourne state library

This is the Melbourne state library at night. Finally a picture with my canon. It’s been a while. Very good effect with the rain by the way. Even though I was freezing.