Burnout Sometimes Looks Like This

Okay kids, storytime.

This is a story of me realising how burntout I actually am in my job.

I didn’t think I was burning out. I was still fine to wake up every morning and go to work. And when I had weekends or days off after working weekends, I was usually unproductive and felt like I would be better off at work and being productive. I haven’t had any leave since last Christmas. I had a couple of weeks of leave planned and requested, but due to the wonderful COVID19 era, and lack of anywhere to go, and my working in the frontline during the pandemic, I cancelled all my leave requests.

I kept telling myself I’d be fine. My roster isn’t that bad. I get most weekends off and days off post weekends and sleep days post nights. And there wasn’t really anywhere else I wanted to be or could be. So it’s all fine. I’ll just keep chugging on.

Spoiler alert: Not a good move.

So on this fateful day, I was working in the medical ED (AMU) as usual when I received a call from the hospital’s discharge lounge. (It’s this area with a bunch of LayZboy chairs where patient’s who are waiting for discharge papers or rides home sit patiently). Basically people who are completely stable and need no further treatment/management go here.

So a nurse calls me up and says “Good morning, I have a patient from your team here for a blood transfusion. She needs to be admitted and blood charted please!”

My first response was a big HUH? I work in AMU. Yes I have an acute medicine “team” in AMU that admits patients with simple conditions like a viral illness, but they get discharged the next day. And we certainly don’t take elective admissions and we DEFINITELY don’t take patients in discharge lounge. Needless to say, I was super confused.

The nurse on the phone didn’t really clear things up for me. She said the patient was under my team. And she’s here and she needs admission. Over and over. Strike 1. In the end I said okay I’ll ask my registrar and come sort that out, and hung up.

I approached one of my registrars and asked him what was going on. He said that he and the other registrars had received an email from a medical consultant stating that a GP had called her saying a patient who was 8 weeks post partum was still experiencing PV bleeding and had a low haemoglobin and she needed to come in for a blood transfusion. The email also had the line “In retrospect I probably should have asked the GP to discuss with OBGYN, but given she only needs this, I’m sure we can handle it under general medicine” And of course, the house officers (like me), who actually DO the admissions, were conveniently left out of this email. So we had no idea about this patient. The other house officers were otherwise occupied so I guess it was up to me. My registrar also said it was up to me to sort out.

I didn’t know blood transfusions happened in the discharge lounge but the medical consultant had specifically asked for the patient to be admitted to the discharge lounge. It struck me as odd because that wasn’t a place unwell patients should be at all. They didn’t have a lot of equipment for medical managment there.

But I went anyway. I went to see the patient and made sure she was consented to receive blood products and was about to take some blood tests (nurses at my hospital are not certified to do blood tests and IV lines themselves. Even though nurses at the other 2 Auckland hospitals are) when I realised they didn’t have the right blood tubes for the blood bank. I asked the nurses and they had no idea what I was talking about. I huffed and had to walk all the way back to AMU to get the right tubes and returned to carry out the blood tests. The patient’s nurse and the head nurse stood in the room and hovered over me, watching. They seemed just as uncomfortable with this patient being in discharge lounge as I did. Only they didn’t really want to help me. I passed them the blood tubes I had collected and they just placed them on the table next to me instead of sending them off. Strike 2. I was sending the bloods off myself when the head nurse pushed a piece of paper under my nose and said “please chart the blood”. We were still standing in the patient’s room.

I looked at her. I was getting more confused. We have e-prescribing at our hospital. All patients admitted to Middlemore had to have an electronic prescription for their medications. I asked why I couldn’t chart it online. She said “She’s not in the system. It’s fine we can use a paper chart”. I felt super uneasy about this. And so I said “That’s a bit unsafe isn’t it? If she’s being admitted for this, she needs to have an electronic chart for the records.”

The head nurse just looked at me and said “Well she’s not in the system. You can just chart it on the paper”

Strike 3

In that moment, I got super annoyed. At the entire situation. But most of all, at the consultant that orchestrated this difficult scenario. So I said that out loud as well. “You know I’m really going to talk to Dr. A about this. Patients like this really shouldn’t be admitted to discharge lounge”.

The head nurse turned around and said “You can talk about this in the nurse’s station. Not in front of the patient okay?” And then she walked away. There was a steely note in her voice that made me raise my eyebrows. I immediately shut up. I begrudgingly wrote the prescription on the paper like she asked and took it back to the nurse’s station.

I was about to leave when the nurse, Ronita, asked to speak to me for a minute. She took me into the drug room and started talking fast, with a strain in her voice. Like she was trying hard not to cry. She told me that I was completely out of line and I cannot talk to her that way in front of the patient. She doesn’t usually have patients like this in her discharge lounge and she was doing it as a favour to Dr. A and the house officers aren’t doing Her a favour by charting medications so I shouldn’t be so entitled and she was going to file a complaint against me.

In that moment, I probably should have been appalled. I probably should have argued. I’m not sure. But I didn’t. Because I wasn’t sure what exactly was happening. I said the thing that was most obvious to me. That I didn’t mean what I said to put her down. I didn’t really understand how she made that connection but she had assumed I was hinting she was incompetent and discharge lounge was a crappy place for patients. I hadn’t meant that. I was frustrated that Dr. A had decided to place a patient there and stress out me and the nurses. I tried to explain that as best as I could to Ronita. I apologised for what I said and reassured her that she was doing a good job and this wasn’t a reflection on her. She seemed somewhat appeased and let me leave.

The situation with the patient continued, however. Ronita called me again in the next 10 minutes after I had returned to AMU to say that the patient had online prescription available and I could go ahead and do that. So I did as I was told. She then called back and said blood back refused to provide units of blood. I didn’t know what to do about that. The blood bank called me and said it was irresponsible of us as a medical team to just treat the patient with a blood transfusion when she had ongoing PV bleeding that was not addressed. She said she had called Dr. A and told her this, but Dr. A had told her to call the person who prescribed the units of blood. That would be me. The blood bank head nurse told me to assess the patient properly and call OBGYN. Again, I did as I was told. I took a gynae history from the patient, something I hadn’t done in years, and referred the patient to OBGYN. As I went back to tell the patient, Ronita reported she’s going to file a complaint against Dr. A for sending this patient to discharge lounge without calling OBGYN first. She seemed warmer towards me since I referred the patient over to the right service and out of her discharge lounge.

What a debacle.

Time for reflection. I guess this kinda shows my burnout because of the things going on in my head at the time. From the moment I received the first call from the nurse, I was annoyed. Annoyed that I was asked to do something that wasn’t my job, annoyed that I was left out of an email that would have helped a lot initially, and annoyed that it was in a place that I knew had very little resources for medical intervention. My entire walk over there I was thinking how dumb this was and why it had become my job.

When I got there and realised the proper equipment wasn’t there I got increasingly annoyed because the number of jobs just doubled. I was annoyed that the nurses weren’t helping me more and annoyed that none of this was planned out properly so that I could just do my thing and leave.

Loosely, all of the above translates to me being annoyed by kind of minor inconveniences. I should have known that the nurses there aren’t there to do stuff like this and they were just as annoyed with the situation as me. I should have expected this to be long and difficult. But I chose to be annoyed by it. And I said something to a nurse that was taken the wrong way.

Bottom line, I shouldn’t have said it. Even if it was Dr. A’s fault, it wasn’t my job to say that. It would only make a hard situation worse. It wasn’t going to help anyone. And the consequence was a nurse threatening to complain about my professionalism. Something I value a lot about in the image of myself as a doctor.

While trying to reassure Ronita, I realised how numb I was. I talked like an automaton doing confrontation de-escalation 101. Without really processing what I was saying. The word complaint definitely sent a wave of fear through me and I wanted to fix the situation before that happened, but in general I just said a bunch of things that I didn’t really feel strongly about.

And then I did something worse. I went back to AMU and started doing jobs. I admitted a patient and carried out a treadmill test and said nothing to anyone. I didn’t take a few minutes to reflect. The word “complaint” still bouncing around in my head as I was doing everything. After I finished sorting that patient out, I felt gross. I didn’t want to show my face in discharge lounge again. I saw some friends in the cafe at lunchtime and made a dramatic show of retelling the story of what happened that morning. I said it as though I was the victim in this situation. Being good friends, my audience joined in with my outrage and agreed that Dr. A and Ronita shouldn’t have put me through that.

But later on, when I was alone in my car driving home, I wept silently. I didn’t like the way I talked to Ronita. Both what I said initially, and when I was trying to fix it. I didn’t like the thoughts in my head about Dr. A. I didn’t like the way I told the story to my friends.

I realised my entire outlook was toxic from the get go. Every day I show up to work and do work, but I take things out on others in subtle ways like this. It isn’t always clear who I’m annoyed at but it’s likely to affect someone compeltely unrelated. And that’s because of my headspace. I think so much. Twice, three times when I see patients these days. I second guess every plan and every examination. I dismiss things as “useless” and “dumb”. I have no faith in what others tell me.

And it all starts with me.

Me not having a break from work, me not taking the time to appreciate the good things others do, and the way the system works. Me just not being wholly in the moment and appreciating it for what it is.

It’s a form of burnout. I didn’t even realise it was until I had brunch with a friend and she told me her usual personality of being loud and animated had dimmed in the last few months and nothing seemed to faze her. Good or bad. She said she felt apathetic about everything.

It takes something like this to realise that you need help and you need to make a change. I vowed to change. I made a simple effort. Very simple. Every time my work phone rang, I would take 10 seconds before answering it. I would literally breathe, clear my mind of everything, be aware of those 10 seconds, before I answered the phone. No matter what was happening. I would listen completely without interrupting whoever it was on the phone and I would keep my mind as open as possible while they talked.

I would then approach my RMO admin and ask for a few days off work. Just a few days. Not heaps of time. But enough to really feel like a break.

The leave hasn’t been approved yet, but the phone thing is working well so far!

I feel lighter. I feel more in control. The situations haven’t changed. There’s still a lot of questionable things I get called about, but I feel less intensely about them. I feel like I can manage them a bit better.

And in making this change, I’m slowing down my burnout process.

I felt a lot of anxiety when I got the roster for my next rotation starting in September. I aim to have some leave approved during that time.

It’s really important to realise the subtle features of burnout. It can be so variable for every person depending on their personality. You’ve just gotta keep reflecting and realise that it can always happen to you.

On that note, if you’ve read this far, thanks for doing so. Here’s a reward:

Silent treee

A calming photo of a sunset. Hope you’re all well!

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.

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.

The Graveyard Shift

Well I just finished my first week of night shifts.

It was a very long week. But that was quite an experience.

Middlemore hospital gets extremely busy over winter. More so than usual.

On medicine overnight, there are 2 house officers to run the entire medicine department of the hospital. This week, we had 3.

Usually 1 person stays downstairs and admits patients to hospital with the registrars, and 2 people stay upstairs managing ward calls from the 12 medical wards.

But this week, there were so many people waiting to be admitted at the start of the night shift, that 2 house officers needed to be downstairs, and 1 house officer managing 12 wards.

Take a wild guess which one I was.

Me and my 12 wards all 4 nights this week.

People having pain, fevers, sepsis, bleeding, crashing, and passing away. And little me being the first to deal with all of them.

My hospital has an online job posting system where nurses post up alerts/jobs about patients who are unwell and need to be reviewed.

On a good shift, this is limited to around 10-15 jobs.

Every night this week, I started on a shift where there were 40+ jobs across 12 wards, with constant phone calls about acutely unwell patients too.

I had a friend of mine (a 2nd year house officer) at a different hospital also rostered on nights this week. He was my cheerleader and support. Which really helped.

But my God was it tiring. The night house officer job is nice in some ways. Such that your main goal is to get people alive through the night before their primary medical team is able to see them.

But the difficult thing is that there are zero resources through the nights and it’s just you and a very busy registrar downstairs making all the decisions.

Meaning if there’s a patient who has been having nose bleeds for 6 hours straight despite several nose packs, your options are to continue trying the nose packs or call the ENT registrar on call at a different hospital who can barely offer any useful advice at all.

But I’ve got to say, I got all my patients through the week.

Last night in particular, I started off the shift with 51 jobs across 12 wards with several acutely unwell patients that the previous on call house officers were unable to clear.

Oh and there were 15 people downstairs waiting to be seen, meaning the registrars and both other house officers were stuck downstairs and no one was available to help me clear said 51 tasks.

I was running the entire medical hospital.

Quite proud to say that by 630am, I had cleared all 51 tasks, put in 8 IV lines,  successfully carried out 2 Abgs and kept all my patients alive.

My first night I couldn’t clear 46 tasks and hadn’t eaten or drank anything for the full 10 hour shift. I was close to tears from the exhaustion.

I also didn’t eat or drink anything on my last shift, but I cleared all my tasks.

Sleeping and reflecting afterwards, I felt strangely good.

The feeling was one of actually having accomplished something. And feeling that hey maybe I can handle some things on my own!

Night shifts are weird. I can see why they’re commonly called the graveyard shift.

But honestly, sleep is VERY important for life, people!

That’s Gen MedĀ 

First week of gen med done! And it was very refreshing.

Good news is that my team still exists as we have a consultant covering the missing one. And my registrar is quite nice, and I’m the only house officer on my team. So yay that worked out.

And it’s wonderfully busy! I barely have any time to think or worry about anything else! Going on a ward round takes up half the day, then doing jobs takes up the other half! With a couple of late finishes too! 

Needless to say, I’m enjoying myself so far.

But this was a short week. I only worked Monday, Thursday and Friday. Because incase you didn’t know, (and you’re not likely to because this isn’t big news like Lady Gaga and Bradley Cooper possibly being in love or Taylor Swift hinting at new music) the junior doctors of New Zealand are on strike! 

We are on strike for safer hours. Basically we work 12 day stretches (including weekends) without breaks and are demanding that we should not work any more than 10 days continuously at a time. Which I am totally behind. A lot of the other house officers are strong advocates and unionists so I hear a lot of noise from them.

I’m not a big unionist. I do support the cause, but I feel like sometimes people take it overboard in a “Us vs them” concept. And people complain about a lot of things that I don’t think ought to be complained about. There’s a lot of “they don’t care about us!!” Talk from a lot of the other house officers but I think I can atleast be grateful that I have a job. 

But anyway. I am part of the union and so I have been going on strike!

In the midst of that however, yay gen med is good so far. It’s been an interesting week. I got shot down by the radiologist when trying to discuss my first case (he basically said your patient is 90. She’s done with life, what’s this investigation going to change), ordered a blood test for the wrong patient (I’m sure I’ll be screwing up a lot of these little things) did atleast 10 discharge summaries in 2 days, and worked late. Not too bad for the first week

Hopefully things stay manageable.

On Gen Med I..

Wake up tired

Get to hospital way too early and tired

Go on 3 hour ward rounds getting progressively tired

Answer questions through the scrambled fog of tiredness in my brain and feel kinda good

Eat way too late and thus feel hungry and tired

Trudge up and down 5 floors of stairs to do ward jobs while still tired

Get home way too late to be motivated to study and do the things that need doing despite the tiredness

Fall asleep far too early 

And repeat.

Sighhhh. 

Future

So. Today was my oficial last day of this year at uni. We even had our orientation for the final year of med school. 

Man. Was it weird.

Because I’ll tell you why… Even though you didn’t ask.

For the first time in ages, all 244 of my classmates were in the same lecture theatre together. It was so packed that I couldn’t find a seat. And what was more, I still didn’t recognise all of them. It’s been 5 years and yet there are people in my year group that I do not know. And probably will never know. Because today was the last time we were all going to be in the same room together other than our graduation at the end of next year. Who knows what’ll happen by then. 

And my friends, well, the few med students I consider myself close-ish to, I wouldn’t be seeing as much of anymore. They are either at different hospitals altogether next year, or are on different rotations than me. Which means there’s very little time to meet up with them and discuss life. Today was the last day I would see them in a while. Of course, the ones I’m really close to, I would make an effort to keep in touch and catch up with. But then again, who knows what’ll happen.

What a melancholy thought.

And then, we had several lectures about the year after next year. First year house officers fresh out of medical school. Where are you going to go? What are you going to do??

This is where things got weird for me. By the middle of next year,  everyone has to apply to the hospitals they want to work at in their pgy1 year. Eugh. Too much pressure. Up until recently, I was an obsessive future planning person. I always had goals, lists, etc. But now, I don’t bother anymore. What’s the point of making plans that aren’t really going to work out? 

Well anyway. There are 20 hospitals across New Zealand that you may work at. Only 3 of them are in my home city of Auckland. So you’d think naturally, I’d want to pick one of them, right?

Well actually, no. 

I’ve been to all 3 hospitals in the last two years. And now. I want out.

I can’t really explain it. But events from the last 2 years have really made me think that I need to get out of Auckland. Auckland is home. It’s the only place in NZ that I feel attached to. And that is familiar. But the hospitals in Auckland have really made me want to forget all that other stuff and move on. 

I’m the kind of person that remembers things vividly. So a place where significant things took place, will always remind me of those things. It will invoke certain feelings. I’m not proud of that. I wish my mind wasn’t like that. But it is. 

Back in 4th year, I was in middlemore hospital. I’ve got to say that there isn’t a single part of that hospital that I have not cried or felt lonely in. Of course it may have been because it was a difficult year in general, but even so. I get the feeling it has this innate negative energy. 

This year I spent a lot of time at northshore hospital. I’ve never felt so scrutinised and judged so harshly in my life as I had been by people during my time at northshore. There are still people there I hope I never have to see again. 

And then there’s Auckland city hospital. I’ve not had any horrific experiences there as of yet. Which is why I’ve chosen to complete my final year at Auckland city hospital. But even so, it’s not a fantastic place to be. 

The environment you’re in can have a significant impact on your outlook and your mental well-being. Of course I am training to be a professional and I should learn to deal with such things and not run away from issues, but to be honest, no one should have to feel trapped in a place just because it’s in their job description. 

I also want to be by myself. If I continue to stay in Auckland, I will invariably be around the same people I have been around the past few years. And I just can’t tolerate working with people who once looked down on me or pitied me, etc. 

I know this may sound unbelievably childish, pathetic, etc. But I just think that everyone should have the chance to choose a comfortable environment to work in. Not that I think moving out of Auckland is going to solve all my problems and I’ll be happy etc. Because every place has its negativities. But atleast I know what it is I want to get away from. 

But hey. This is a whole year away. Who knows what’ll happen.

And here’s a picture of Mt. Taranaki. A mountain on the west coast of the North island. 

There’s no reason this picture is here other than to project feelings of calm as the rest of this post is pretty melancholy. And because I took it recently and I think it’s a nice photo. 

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 BribeĀ 

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.

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.