Lessons From Medical School

I write this post on my last day at Auckland hospital. My last day of medical school. 6 years later… The most significant period of my life to date, has ended. It’s a real milestone. How do I feel…?

Meh.

It actually doesn’t feel particularly big or important. Because in 2 weeks, I’m back in hospital doing similar things to what I was doing this year, but getting paid for it, and not having the luxury of leaving work early, ever.

But I guess it is a big deal. 6 years of work I put in. It all feels a bit surreal. I definitely do not feel like a doctor yet. I doubt I will until I have my first ward call or unwell patient that I (hopefully) manage properly.

But then what does today mean? I think I should take this opportunity to look back and think about what I’ve learnt from medical school.

My 1st year – biomed. My pre-med year was a pretty significant year for me. I was straight out of highschool and working harder than I ever had in my school days to achieve a single goal – entrance into medical school. Once achieved, I had felt amazing about myself. I thought, hey I guess I do have the potential to do well in things if I work hard enough. During this year, I had made sure I had zero distractions.

My 2nd and 3rd year: Not working so hard on academia itself. Trying to learn what medicine was all about and where I fit in and what my skills were. Several times cut down by other students and taking several hits to my self-esteem. I learnt that theory was something I had major issues with. My knowledge needed to grow.

My 4th year: People in the workplace, people I know, people I didn’t know, people, people, people. I found I was quite naive. So very naive. Hospital hits you hard. But I didn’t realise until much later that my expectations of myself were not the expectations others had of me, and what level I was supposed to be functioning at. That made things way harder. I expected too much of myself. And crashed down. I also found that you cannot make friends wherever you go. Especially not at university or work. There will be people who you meet who will be nice, but they don’t know you. They’ve come along too late in your life to really understand what you’re all about. Don’t get too comfortable. It’s not a good idea. And with work, they are not your friends regardless of what you do. They are smiling and asking about your weekend because they need to work together with you in the most tolerable way possible. Do not think any more of it. It’ll only disappoint you.

My 5th year: Began to focus back on myself. Less on others. More reflecting, more skill developing, I found certain types of people and certain parts of medicine and the hospital do not agree with me. Accepting that I don’t know everything in medicine, and I never will. Even if I’ve revised it several times, and will not retain everything forever. I just have to keep revising and reminding myself of the knowledge I have and learn more at every opportunity. People tried cutting me down then too. But self focus and reflection is a powerful thing. Your skills are your skills and no one else’s. You’ve got yours that WILL work for you. I promise. My strengths, and my discovery of the love I have for gastroenterology. I also found I have great empathy towards patients apparently.

My 6th and final year: Things started to make more sense. More comfortable around the hospital and interacting with consultants. The confidence that comes with being needed and having a role. Not only being aware of strengths and weaknesses, but being able to use them to get things done as well as knowing what to do to fill the gaps. Plans needing to be made, looking ahead. Still many disappointments and nothing is certain, but accepting that and going with it anyway, is still pretty good.

Further lessons:
1. Never let anyone know that they get to you.
2. You could do your absolute best in everything, but still come up short and have bad things happen. Accept it.
3. Do not try to please everyone. No point. Doesn’t work. Regardless of what you do, people will still not understand you or trust your efforts.
4. Trust you. As you’re all you’ve got.

So looking at this, I guess medical school has been a significant part in teaching me about myself and how I should move forward.

Oh of course I also learnt medicine itself. xD But that’s more of an ongoing learning forever. I have to accept that.

And that’s my reflection over the last 6 years. It’s a brief one of course. More happened in these last few years than I can write about in one blog.

And many more to come when I start working in 2 weeks. There’s also my graduation next week which I will update on.

So for the last time, here is my med school. A student for 6 years and never again. I spent a little while sitting in front of it and reminiscing on this day. I’m on to bigger, better and older things!

Snapchat-1608802880

 

Home Stretch

Oh boy Oh boy Oh boy

So today I had my final practical exam of medical school! In psychiatry!

Happy to say I got a “solid distinction” in the examiner’s words. They even asked me if I would consider a career in psychiatry! Hahaha I wouldn’t, but it’s good to know I’ll probably be a good psychiatry house officer when I start working in November!

I celebrated this victory with Ice cream and a walk on the beach.

And that’s what this post is about! With the ending of my final practical exam, I now only have 4 weeks of medical school left for the rest of my life!! :O

My final rotation starting on Monday will be Obstetrics and Gynaecology. Back to the land where there’s far too much oestrogen in the air. 

But I’m not bothered! There aren’t any major assessments as part of this rotation.

I do have my final exam of medical school, the progress test, towards the end of October. But I am so over these after 6 years, I’m happy to just pass.

So, I’m literally on the home stretch now. 4 weeks to finish medical school, 2 weeks vacation, then graduation!

AND THEN,

Worklife begins.

I’m just going to leave those words hanging there for a bit.

I can say I am already looking forward to starting to work. Actually, I’m looking forward to the next few years of working. Getting to where I need to go. Not that I know where that is, but I do feel it’s time to start looking that way.

Medical school has been a huge part of my life in many ways. So many things had changed where when I first got in, I thought the hard part of life was over. And everything was sorted. I can at least say I’m no longer so naive.

But yes. Let’s get the next 4 weeks done and just keep swimming! đŸ˜€

A view of Rangitoto from my ice cream celebration

4 Weeks Later

Well, surgery is officially over. And I am exhausted. 

It didn’t really get better. I was still doing ward jobs all day and staying late even though not much was being achieved.

I feel like I haven’t used my brain at all these past 4 weeks. And that’s annoying.

So I am relieved it’s over. But I am concerned for my future years as a house officer when I have to do surgical rotations. My own house officer on this rotation was flustered 90% of the time, and complaining 98% of the time about her job. She would stay later than me and achieve pretty much nothing as well. No patients discharged, scans and tests ordered but not carried out, and an endless amount of paperwork to do.

She also said she hasn’t used her diagnostic skills in the whole time she has been on this rotation. Sigh. Not looking forward to this in the coming years.

However!

I will say that my registrar and my consultants are amazingly nice people. One of my consultants, while I didn’t manage to see him a lot, he was more than happy to talk to me whenever I approached him, even if he were in a great rush. He was happy to do my report and my reference (all 3 required references done! Woohoo now I can relax).

My other consultant also offered to do any assessments I required for me, and thanked me multiple times for my hard work. Though I’m trying to figure out what exactly that was.

And my registrar was the loveliest person in the world who never got tired of answering questions, teaching, making jokes and just being supportive. 

While the overall rotation was tiring and annoying, I am so grateful to the people on the team for making it bearable. 

Now. Onto ED. Time to turn my brain back on!! 

Hurdles Crossed 

Today was the last day of my first rotation of 2018! Never had I known Gen Med to be so tolerable as I had this year. Of course it may have had something to do with the fact that I am a final year medical student and as such I am a legitimate member of the team not just the awkward appendage that opens curtains and turns lights on as a 4th year student.

No more. I am needed. I am important! I am a Trainee Intern and I am second to the house officer.

It’s been really great actually. My house officer had been extremely helpful in teaching me how to be a house officer next year. I was doing jobs and learning the ways. My consultants were lovely and actually took an interest in me, making an effort to teach, etc. It was such a change to the experience in my 4th year.

But it’s been 6 weeks and it was time to end. I had my long case assessment which was entirely horrendous. Basically I had to take a history and do a focused examination on a patient with a long-term issue. These usually being medical issues like diabetes or heart failure or something along those lines. And these patients are supposed to know the drill and know quite a lot about their conditions. I however, got Mrs. Vague from Lost Town in Shadyville.

Me: So, what concerns you mainly about your health?

Patient: Well I had a fall 50 years ago. I hurt my back. And I haven’t been able to walk since.

Me: Oh I see. Could you tell me a little bit about that?

Patient: Well, I fell over and hurt my back. I had a surgery, and I haven’t been able to walk since.

Me: What surgery did you have?

Patient: A surgery on my back which took the pain away but left my legs feeling like lard. I couldn’t move them, couldn’t feel anything, and I had to have physiotherapy for 1 year.

Me: Oh so you’re able to walk now?

Patient: Yes I walk fine now. I don’t need supports or anything.

Me: Okay and how is the feeling in your legs now?

Patient: Oh much the same. They feel like lard. Like I can’t move them at all. And I have foot drop in both my legs. But I can walk fine. Everything is fine!

Horrendous. She kept talking in circles and I had no idea what her problem was. When I presented to the consultant, he told me that she actually had a failed spinal surgery where a few nerves were accidentally cut!! I never would have gotten that out of her. Meanwhile, the other students had garden variety patients with diabetes and atrial fibrillation.

I had this awful 10 minutes before presenting to the consultant where I was sure I had failed. Fortunately for me, both the examiner in the room, and the consultant I presented to recognised that I had a particularly difficult case and said I did well, and I passed!

Thank you Universe!

And then on my last day, my own consultant gave me a good report. She told me I had been a wonderful addition to the team and I would make a great doctor. Which was so nice to hear. It just gives you that boost of confidence. After two years of being unsure about everything, it made me feel good. That maybe I’m finally doing enough to come across as someone competent. Who does belong in medicine. But anyway, as I’ve mentioned before, I’m useless at receiving compliments still, so I just sort of smiled and said thank you. Hopefully she didn’t think I was being weird.

The Gen Med rotation and the long case are huge hurdles for this year. The long case is the major assessment 6th year students are expected to pass. I’m really grateful that I was able to get through it and feel competent doing so. 

But anyway. I’m properly exhausted now. Gen med is the most tiring rotation to be on. I’m moving on to rural GP starting Monday. So hopefully that’ll be a good change of pace and I can get some decent rest. Hopefully not famous last words. xD

 

Worthwhile

Today I was on my long shift and feeling the blues as usual when I was asked to see a patient as part of gen med review. 

She was a lovely elderly woman who had come in for some obstructive jaundice 

As I began to examine her, she looked at me and said 

“You have healing hands. I can feel it.” 

She then turned to her relative in the room and said 

“She’s the most gentle doctor I’ve seen you know”

And as I was leaving, she asked me when she would see me again.

Sometimes I wonder if I’m really helping anyone. When I’m tired, I wonder if I’m good enough to do the things doctors do. Sometimes I feel like maybe I’d be suited better somewhere else.

But when I interact with patients like this lovely woman, and they tell me the smallest things make a difference for them, I am so incredibly grateful for me and being in a position to impact someone in that way. It makes me strive to be better. It makes me appreciate my apparent skill of treating people in a way that makes them feel comfortable. 

I am so grateful to have met that woman and to have made her feel that way. It made me smile. It makes other things seem less significant. 

I’m glad.

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. 

Admin Nightmares

Nothing says back to uni like a big admin stuff up.

I just cannot stand the admin people in universities. Medical universities in particular. They are the most frustrating people in the world.

Yesterday was my first day back at hospital. I showed up and had a little orientation meeting with one of the consultants, during which I and other gen med students were handed a pack of information about our run. Including the team we would be attached to.

I was assigned to the Black gen med team ( at Auckland hospital, the team names are colours. But even so, black shouldn’t really be a colour associated with healthcare. I don’t think they thought this through very much)

Anyway! I trotted up to the ward and asked the nurse where I could find the Black team (The first fail was that there were no contact details or names for any members of the Black team provided in my “information pack”).

The nurse looked at me and said “which one? We have 3 black teams”. I stared back in horror. My “pack” did not specify which black team, nor did it mention there was more than one. Useless. I told the nurse I didn’t know. She was kind enough to call the Black team that was currently on the ward to look after me.

The consultant asked me who I was meant to be with. I said I didn’t know. He then proceeded to call the consultant I had met with this morning to see if he would know. He apparently said that it  should have been printed as part of my “information pack”.

Oh for God’s sake.

After standing there awkwardly for a bit, the Black team consultant said he would take me on. And I spent the last two days with this team.

Today, I received an email from “admin” specifying that I should be attached to a registrar of another black team.

And this wasn’t just me. The other students also joined whoever was present at the time of their arrival to their respective wards and we were all collectively pissed off by this late email asking us to switch teams.

It cannot be that hard to have the tiniest bit of communication between the so-called “admin” department that are supposed to run the whole show, and the clinical teams. Like what is the problem?

And it’s not just my university. Admin people worldwide are crap at replying to emails, answering phone calls, and just generally getting things done that they are supposed to do.

I mean it’s not like anyone is asking them to move heaven and earth. We’re only asking what is part of their job description. Surely this isn’t mission impossible.

All the students on Gen med decided to ignore this admin person’s jumping team suggestion and to remain with our own chosen teams. It seemed so much less messy.

That’s how you do good administration to be honest.

Blech.

Well that’s my rant for the day. I shall talk about Gen med itself later on!

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.

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.

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.