The Burnout Ended

Finally my week off arrived! And let me tell you, it was a long time coming.

Prior to my week off I had a set of night shifts which were pretty awful and draining. Made me worry a bit for the coming years and whether I would even have the energy for night shifts. It’s just not natural. Eugh.

But something else that happened in the weeks leading up to my week off is that I was asked to step up to be a registrar 2months earlier than everyone else.

Our employers in Auckland, being as useless with admin as they usually are, realised much too late that they do not have enough medical registrars for the coming year and especially for the transition period in November. So their last-ditch attempt was to ask those of us who are going to be registrars in February, to start in December. I was one of them.

Initially the whole thing freaked me out because I was still in my burnout spell and I didn’t think I could tolerate more responsibility and a more difficult roster (being a registrar is nothing glamorous, let me tell you.) So I was super scared. Every one I talked to thought I was ready. Except me.

I didn’t quite know what I should do but I kept telling myself it’s the burnout talking. Because I knew I wanted to be a reg and I knew if I did it early, my senior regs who I know and who like me will still be around to support me before they move on to their next rotation. So that’s a bonus.

But on the other hand, it was more responsibility when others at my level were still House officers and I sure as hell won’t get the week of leave I had asked for around Christmas time and what if I screw up? How do I just step up early?

Well as someone who just recently read The Subtle Art of not giving a f*ck, I guess the answer to that question is, you just do it. If you haven’t read that book, I recommend it. Helped me through my burnout stages.

I guess the point is I knew I was gonna do this so I guess, just do it. (In the most non-Nike way possible).

There was no real point to being scared. I mean of course I have to be a bit scared and make sure I do a good job and not screw up, but there’s no point in being so scared that I go backwards from progress that I need to have.

So anyway, during my week off, I reflected, and agreed to go ahead and take the job starting in December. Only time will tell how thing shall turn out.

I went to Tauranga on my week off, a city in the East Coast of the North Island. Famous for the beaches and nature trails. Climbed up a mountain and took some pics as I do.

It’s been a good week off. Much needed, tried to be productive, reflective, get back into photography, reading, writing and being some version of happy.

And the weather was just gorgeous! Here are some pictures of the Tauranga coastline from Mt. Maunganui

Abdo Pain ?Cause ?Abdominal Migraine

Following on my theme of having a hard time and reflecting on it, I did a thing.

A few weeks ago I got myself admitted to hospital. The hospital I work at. During work hours.

I was just sitting in Medical ED. Just admitting a patient. It was nearly lunchtime.

I had a sudden onset pain in my tummy. It was kinda painful. Kinda gnawing. I figured I was hungry. As all good doctors do, I ignored in and carried on working.

A few minutes passed and the pain got worse. It made me stop what I was doing and move to the tea room to get a glass of water. I felt nauseated. Again, probably just hungry. I’ll just get a glass of water and go get something to eat.

I felt hot. The pain in my tummy worsening. The cafe was a few hundred metres away. I abruptly sat on the couch in the tea room.

A nurse saw me. And as all good nurses do, he began fussing. He said I looked unwell and I should go lie down in the clinic room.

Pain still bad and now finding it difficult to walk, I obliged. Went to the clinic room. Sat down, lay down, pain worsening. Felt restless. The phrase “writhing in pain” came to mind.

But I’m a girl of action. I called my RMO unit and said I can’t complete the rest of my shift because I’m unwell. They wished me all the best. I told myself I would go home.

Big whoops. Couldn’t walk. Pain very bad now. More nurses fussing. Friend who heard my distress on the phone came to see me and began fussing. To my horror they called in MY consultant to assess me. At this point I began vomiting.

He watched me writhe in pain. Suggested I go to ED.

ED saw me and pumped me with 12mg of IV morphine, the approximate recommended dose to flatten an elephant.

I was floating in and out of consciousness. Answered questions. Every time I woke, I was in pain. Pumped with morphine and knocked out. Tests done in my half conscious state.

About 4h later, I was completely pain-free. Asked for some food. I was discharged happily.

My discharge summary arrived in the mail today. Diagnosis: abdo pain ?cause ?abdominal Migraine

Loosely translated that means the pain in my tummy was in my head.

I told one of my friends this story some days after it all happened. He said “that sounds like some good old fashioned stress”

I laughed. Yeah some real “stress” that was.

Until I replayed everything that happened before that day.

I was stressed as heck. I walked into work that morning feeling the worst I ever had. The weekend that had just gone by was traumatic for me. I saw and experienced things that were so confronting to my image of myself that I didn’t know how to deal with it.

A friend and I were waiting for some important, life altering news that day this all happened. I was anxious and scared and sad and I didn’t want to be at work except I had to be at work.

We got good news. The pain had just come on when my friend said he received the good news. But that didn’t make the pain go away.

Maybe it was too late and all that pent up tension was already being released. I’m not sure.

But as quickly as the pain came on, 4h later and a bunch of plum normal investigations, it was gone. And I was left feeling embarrassed for causing all that fuss.

But it was all in my head. I don’t not appreciate the physical manifestations of psychological distress, and I’ve been nauseated and sick before because of depression. But I’ve never experienced anything quite like this.

I realised I have a lot of pent up emotion that’s not going anywhere any time soon.

Things are the most wrong they’ve ever been in my life. But they’re also the most not wrong they’ve ever been. And I don’t know what to do.

Focus on the good things? Yeah. Hope for a change? I guess so.

But ultimately I don’t know. And I don’t know how much more my mind and body can really take.

But I guess I’m in the business of finding out.

But this is a public service announcement. Abdominal migraines are a real thing. Even if it is all in your head.

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!

End Of PGY1

On the 20th of November, was my last day at Middlemore Hospital and my last day as a first year house officer.

I cannot believe it’s gone by so fast. To hear from my friends who are just graduating medical school that I’ve been doing this for a year now, is just bizarre.

How do I feel? Well, unsure. But ready to move on I suppose.

I guess now I have that goal in mind to keep progressing and moving up until I’m consultant. Starting Monday, I’ll be doing gastroenterology as a house officer in Auckland City hospital.

I need to join the College of Physicians sometime before the end of the year. I need to study for my exam which will be in a couple of years. I need to plan to step up as registrar at the end of next year.

Gosh.

I don’t know if I am prepared. I’m trying to reflect on my skills and what I’ve learned during my first year. The honest truth is, I’m not sure. I’ve not killed anyone, thank God for that. I’ve picked up a few unwell patients and helped look after them. I’ve made good friends (like actual friends, not just “colleagues”. Who knew?) I’ve met some pretty awesome registrars and consultants who I’ve learnt a lot from.

So I guess it’s been a good year overall.

I just hope it has prepared me in some respect for what is to come.

In the wake of finishing my first year as house officer, I had another quick getaway trip.

This time to Queenstown in the South Island of New Zealand. Everyone always hypes up the south island. As though it’s completely different to the north. I’ve got to say, it’s not really all that different. The landscape is beautiful, no doubt. But not breathtaking.

But I took some decent photos.

The mood of these photos is what I shall project onwards from Monday.

Lake wanaka sceneMilford sound 2Milford sound waterfallPSX_20191122_141654PSX_20191122_195246Queenstown skylineThat Wanaka Tree

 

General Surgery Week 1

meme

 

Oh God. Okay so I just finished my first week of general surgery.

That was NOT fun. My word of the week was “chaos”.

Day 1 faced with 30 patients, all of them unwell and complicated.

General surgical ward rounds are like normal ward rounds on steroids. Everyone just gets a hi and a bye. The consultant and registrar walks in, greets them, says a two-word plan to no one in particular, and walk out. Me and my friend, the house officers desperately scrambling to write notes, check bloods, ask questions and just try to orient ourselves in the chaos.

What bothered me most was the lack of medical knowledge of the senior staff on my team. One of the patients had a blood potassium level of 2.2 (normal range 3.5-5.2).

Just coming off cardiology, this was a major alarm bell for me. I told my registrar I would give the patient IV potassium and orals, as well as do an ECG and repeat blood tests that afternoon to ensure it was increasing.

My registrar replied “you don’t need to repeat the bloods in the afternoon. Just repeat them the next day. Don’t worry about orals. Just give IV. ECG not a priority”

My cardiology soul was screaming on the inside. Every medical registrar I told this story to, screamed in unison that I should NOT listen to my registrar.

And I didn’t. I repeated the bloods in the afternoon and found it was NOT in fact increasing very much following 2 bags of IV potassium. I had to hose this patient down with orals and IV fluids overnight until it normalised 2 days later.

The registrars couldn’t care less.

And that really annoyed me. Coming from such a supportive environment on medicine, it was hard to work with people who can only perform miracles in a theatre. And outside of it, do very little for the patient.

This isn’t to say they’re useless or bad doctors. I have mad respect for surgeons. But their medical knowledge is just shocking. And all the house officers have just started being doctors. I felt more concerned and nervous every night this week than I had in the last 9 months, wondering if I had made the right decision for patients in my care.

I also do not know all 40 of my patients (yep it increased by day 3 to an even bigger number) simply because I don’t have the time I had on medicine to learn about their history and provide the care they need. When I have to refer to other specialties, I am ashamed that I don’t know the information they need to be able to help me and my patient. But I simply don’t have the time to look through one patient’s notes while the other 39 also need my attention.

This was a shocking glimpse of what the next 12 weeks will be like.

But the bright side is that I have friends who are immensely helpful. When me and my friend were drowning in work, a bunch of the other less busy house officers took on some of our jobs and that really helped. Without them, we would have finished later than a long day finish.

Complaining to a bunch of the other house officers who also came off medical runs, really helps. We’re all holding and helping each other out. And that is super important.

But I’m also becoming quite unhealthy in this last week. Starting at 0630 means no time for breakfast. Rounding until 1230 means late lunch and leaving super late means starving until dinner around 2030. I have felt weak and washed out this whole week too.

I really must remember to take care of myself.

Hoping the next 12 weeks go by really quickly

We’re A Team

Nearly done with my rotation on cardiology.

I have to say this has been my most favourite rotation so far. The hours have been long but the consultants have been fabulous and the work has been so interesting.

But the best part of this rotation is my amazing registrar.

Dr. Bradley is the most senior registrar at my hospital at the moment. He is currently the Chief resident.  9 years of experience on him, he is hilariously sarcastic, the best at being a cardiology registrar, and the most supportive colleague I have EVER had.

Without word of a lie, every other registrar I’ve seen or worked with has left me to finish the jobs and gone home at the end of the day in EVERY rotation I’ve ever had. And this hasn’t really bothered me much. Until the bar was raised.

Even if it’s 6:30pm and we’re tired and barely chugging through, and I’ve told him he should go home, Dr. Bradley says “We’re a team! I’m not leaving you behind!” and proceeds to stay there and wait until I’ve finished any remaining jobs and helps me with anything that needs doing.

The amount of difference that makes to the work experience is amazing. It made me want to work harder and be more efficient. Made coming to work that much better.

He even invests a lot in my learning. Teaching me how to do DC cardioversions, Treadmill tests and ward cardiology reviews by myself (reviewing patients referred by other teams to cardiology. This is usually a registrar job) and present to our consultants. He stands next to me and backs me up if the consultant asks something I don’t know. If any consultant or anyone at all tries to undermine me, he tells them I’m a future cardiology registrar and I can handle anything.

Having a senior colleague like that is so important. All of my previous registrars have been good and reasonable enough to work with. But none of them have really given me the responsibilities and support and trust that Dr. Bradley has. He makes my role seem very important to the team, even though I’m just a first year house officer and the bottom of the ladder compared to him and the rest of the team.

That’s what I will miss most about cardiology and why I’m so sad to move on to general surgery.

But I am so incredibly grateful to have met Dr. Bradley and have a role model that I aspire to be when I become a registrar.

A Stupid, Dumb, Bad Bad Week

I just finished a 10-day stretch at work and this has been the worst week I’ve had thus far in cardiology. 

I’m sure wherever you’re working you’ve dealt with people who micromanage. We all know someone like that. 

This week I had a consultant who was so pedantic, he micromanaged me all the way to misery.

New consultant, fairly young electrophysiology cardiologist in a permanent blue suit. 

He started off by telling me I have to show up an hour early and write up all the patient’s weights and blood tests before the ward round, but ends up checking them himself on the actual ward round.

He asks me to write long elaborate notes for him but then casts his eyes over them and says “do you mind if I rewrite that?”

He spends a lot of time sorting out his personal life in the middle of the ward round.

He tells me I HAVE to get something done TODAY but won’t let me leave the ward round briefly to organise said thing that HAS to be done TODAY, even though he has a registrar with him perfectly capable of taking over my tasks while I sort things out.

“Don’t split from the round” he says, “just do it when you get back afterwards”. Oh but here’s the catch, when we “get back afterwards” it’s 3pm and there’s no time to do any of the jobs because the consultant just spent 6h doing his ward round that he showed up late for.

Then after I had worked my hardest to organise the thing TODAY, he calls me up to say he’s already organised it and I just need to coordinate with some minor part of the operation to make sure it’s done. Why was I asked to do something you were able to do yourself??

Ugh.

It didn’t help that my usual registrar, (who I will talk about in a different post) was away this week. And the reliever had never done cardiology and hence had no idea what was going on.

He means well. He’s overall a nice person I suppose. But man, people who micromanage need to be aware of what they’re doing. And how unnecessary it is. 

It would’ve been fine if somehow we were more efficient, but we weren’t. I was staying way late to complete all my tasks and ward round was going on for ages

No other consultant had been like this. They had all let me do my job and we had been done with everything on time. 

Ugh. 

Well I’m glad this week is over.

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.

High Mountains And Deep Rivers

1 Week of Cardio done. 

Cardio is interesting. Patients with way crazy conditions, some quite unwell, some where there’s just not much you can do. 

It’s been quite busy for me. Not quite finishing on time. But hey the day goes by quickly.

I had a lovely registrar this week. And it was actually his final week as a cardiology registrar. He was nice and included me in discussions and even helped out with a lot of the jobs. 

Today, on his last day. Though we had only been working together for 3 days, he told me that I’ve been a great House officer and he wanted to give me this.

He said he had been saving this book to give to someone who was really good. To use and help them study. He said he wanted me to have it for being so great this week. 

Then I found out that the charge nurse on my general medicine ward last rotation, had nominated me for House officer of the month. 

I didn’t win of course. But it was nice to be nominated.

From my low point last week where I thought I was just the worst House officer in the world having nearly killed someone with my prescribing blunder, this was quite the opposite feeling.

It was nice to feel good about the things I do. And be grateful for people who seem to appreciate me. 

It really is having the highest mountains and having the deepest rivers.

You can have it all but life keeps moving…. 

No Excuse

Today I got an email from a registrar whose patient I reviewed over my night shifts.

I had reviewed this man who had had a stroke and whose level of consciousness was fluctuating, making his swallow unsafe. The registrar who admitted him, had prescribed oral medications for him.

The nurse had called me to change his medications to IV. specifically, his anti-seizure medications.

I changed all his medications to IV, including his beta blockers and calcium channel blockers. These are very sensitive heart medications that slow your heart down when it’s going too fast or beating irregularly.

The registrar emailed me to tell me that these medications are never prescribed IV unless there are very specific indications or a patient is in intensive care. I had prescribed them on a ward overnight.

She informed me that thankfully, the patient hadn’t received these medications because the pharmacy does not dispense them overnight. She said that she would never prescribe those medications because the doses aren’t the same in oral as they are in IV and they could have caused a massive slowing of the heart and basically would have been fatal to the patient.

She told me not to stress about it as the patient is fine, but it’s just something to be aware of in the future.

I can’t quite explain how scary this was for me.

When I was changing his medications to IV, I hadn’t known those medications were available IV. When I saw that they were, I thought to myself, huh. That’s interesting.

But it didn’t occur to me to look up whether they could be used IV in a patient who had oral medications. What I should have done was withhold those oral medications until the patient could be reviewed the next day.

I nearly killed someone.

If the patient had received those medications, he would surely have had a massive bradycardia that wouldn’t have been easy to reverse.

I have no excuse other than I didn’t know. Which in my head translates to a level of incompetence.

I should know.

I can’t still be operating at a level where I don’t know what I don’t know. And that apparently nearly hurt someone.

I actually did cry when I read that email.

I probably should take the “well that’s how you learn” approach. It turned out fine. But I don’t think I’d ever be able to forget just how bad it could have been. Just how vulnerable someone is to the consequences of my actions.

I know I’ll be double, triple checking everything I prescribe from now on. And there’s just no excuse for getting something like this wrong.

None at all