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

 

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!

My Life Is Average 

So today I was mulling around thinking about the current state of my life. Basically kind of bored.

I just finished a 10 day working stretch including weekend and then slept for 11 hours straight.

I woke up and it was hard to get into a mode where I don’t think about work.

You know people bang on and on about “work-life balance” like it’s some magical equation that’ll make your life perfect. I bet all of them would agree that I don’t have such a “balance”

Mostly because people think that this “balance” is either being able to have babies and being a working mom (if you’re a woman), or being involved in some kind of group activity like sports or tree planting club or something.

I basically stay home and browse the internet and talk to my friends. I’m not part of any club and I’m not particularly athletically inclined. I’m sure most of these balance people will say that’s not good enough.

I kind of disagree. I think work-life balance is more about being able to give your best at work and outside of it. And let me tell you, I am giving 100% to being lazy right now.

But also it’s that point in my life where there are no big goals and nothing much to work towards.

Like I spent a lot of effort and time working towards becoming a doctor and it’s like, well now what?

So that’s what work-life balance is kind of a question mark for me. Now what do I do with my life?

A friend of mine said it may seem a bit messy but if you sum it up, it doesn’t sound that bad. He proceeded to say “I’ve got a good job I’m about to be promoted in, I’m engaged and planning a trip to Japan this year”

I had to laugh.

Mostly because that actually sounded great and my summary wouldn’t sound as good.

“I’m a doctor, working in Middlemore hospital… and uhh….”

Yeah I don’t know. It required much more thought after that initial sentence. Like yes I’m a doctor, and that’s pretty good I suppose. I’ve just started, I’ve got my whole career ahead of me, working towards becoming a gastro consultant etc.

What else do I do? I’ve got my blog. I’ve got my writing. I like taking photos, I like playing the guitar.

But I’m not exactly fantastic at any of these things. I’m basically average.

I’d like to be someone who does a lot of things. But I don’t know what.

Oh well. Today I at least made a point to play guitar, write, and take photos.

Macro shot of my bamboo plant/tree thing!

I’m going to get back into taking photos I think. Macro today. But hopefully will get back into going places and taking landscape photos. After all, the season is perfect for some soft, pastel photography.

That’s Gen Med 

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.

First Quarter Done 

And with that, psychiatry is over!!!!

Will I lament it’s loss? Naaaah

Well I will miss the people. The other house officers and my team, and having my own desk.

But I will NOT miss the department, the nurses, the fact that I have to look after geriatric patients I know nothing about, after hours. Just a big NO. 

Did I learn a lot? I’m not entirely sure to be very honest. I can’t say what skills I’ve gained in psychiatry other than developing an absolute “I don’t give a sh*t” attitude to certain things that aren’t even “problems” but someone else decides to make it a problem and they decide to make it YOUR problem. Which I will no longer stand for.

Having not much to do is really not my thing, I realised. Well I sort of knew that already, but now I’m certain. I need to stay busy. It just makes the day go so much faster.

I’m off to general medicine next! I am very excited. It should be very busy in comparison. 

But as usual, when I least expect it, my bad luck streak reared its ugly head. 

I was supposed to be on a team with another House officer. It was supposed to be a very busy team. On Friday, the last day of psych and the Friday before I start on gen med, I find out that the other house officer has been moved to another team and I heard that my team is going to be dissolved due to a lack of consultants.

Oh, and no one told me this.

I found out because the other house officer approached his new team and asked for a handover, meanwhile I was thinking we were still on the same team. Admin had called him about this, and not me.

Why?

Because that’s admin.

I freaked out and went to them and asked what would happen to me. They said the team is not going to be dissolved “yet”, and I am still on that team. But it is true that there are no available consultants for that team currently and this is likely to create several “changes” to the team structure. None of which I have been informed of yet. 

The lady I spoke to said “don’t stress. The other house officer has been moved but you’re still with this team. If there are any changes, we will let you know”. 

“Don’t stress” she says, even though had to approach her myself and ask about this or else would have shown up on Monday and been utterly lost as to why the other house officer on my team is no longer on my team and why my team has no consultants.

Thanks a lot, lady.

So I kind of don’t know what’s happening on Monday. The house officer currently on this team I will be going to said he would give me a good handover and there are patients on the team currently and there is a registrar. This is good.

But he also said he heard the team might be dissolved. This means I could be moved to another team sometime during this rotation.

Blech. 

I really must find out why I’m suddenly having these bizarre things happening to me.

On the bright side, ironically, every one I told this story to, basically said “well hey think of it as a blessing. You won’t need to deal with the other house officer anymore!” 

This is true I suppose. I will either have a team of my own which will be great.

But it could also be not great in that the team is slowly dissolved and I have to be moved to a different team. 

Which may not be terrible depending on the team. But with the way things are going for me currently, I would not be surprised if things go terribly.

What do I do? 

Gotta just keep swimming I suppose. 

We’ll see what happens Monday. 

Summertime Feels 

Summertime is really the best time to go out and reflect in places. 

Chances of coming by a view that is absolutely stunning, while on a walk, are much higher in summer than in winter. 

Unless you live somewhere where it snows and you like going on mid winter walks in a winter wonderland of course!

But anyway. Today I was due some reflection and mindfulness, as I’m 2 weeks off from finishing my first rotation as a house officer. 

I haven’t talked much about what my job actually entails. I deal with all the medicine for psychiatry patients. Often, most of them are perfectly healthy. But occasionally I get someone who is very comorbid so I have to order tests, make sure they happen, talk to a bunch of different departments, trying to piece together their management. And because of where the psych unit is placed at my hospital, people are very reluctant to come over there and do things for patients. And getting potentially aggressive and high AWOL risk patients to different parts of the hospital is also challenging. So getting things done is hard.

On my long days I also cover geriatric wards. Where every patient is liable to crash, the nurses are super nervous and the house officers during the day dump whatever they are unable to do while they’re there, on the psych house officers. 

But I’ve made it this far. And I’m going on to general medicine next. Which is going to be a massive change in pace which I would welcome, but also will be a huge challenge as I feel I haven’t done much medicine in these three months to prepare me for what general medicine will bring.

Lots of emotional highs and lows this rotation. Being told by someone that I lack motivation, that I lack common sense, that nobody would take me seriously, that I’m not trying hard enough to be involved, coupled together with my own insecurities, fears, the feeling of being frustrated that I can’t do more with my life, and the sickening realisation everyday that I know that I will never get what I want….

It brings me down.

But I’ve been chugging along. 

All of the stuff above is just noise I hear in my head everyday. 

But when I’m on a walk and see the omnipresent sea, the gentle lull of waves going back and forth on the shore, sounds of people and birds and boats going about doing their thing, the sun setting and creating the most beautiful set of colours as a backdrop to the city line and the ocean, my eyes and the rest of my senses are pleased. A wonderful stillness and peace comes upon me and drowns the noise out. Just for a little while. Making me feel that I’m part of something much bigger in the universe.

Of course those moments pass and reality and the noise comes back, but I’ll try holding onto that feeling of peace just like in the photo. 

A Moment Of Silence For Humanity

https://timesofindia.indiatimes.com/city/madurai/pregnant-woman-turns-hiv-positive-after-blood-transfusion/articleshow/67244584.cms
Recently saw this in the news. It’s from the state in India where I spent my elective. Basically, a pregnant woman was transfused blood for anaemia. She then tested positive for HIV. She was tested because the man who had donated his blood underwent an HIV test at a government hospital as part of a job application.

He had donated his blood twice in the last 2 years. He was HIV positive both times.

3 people at the blood bank in the government hospital are under suspicion for negligence. Because both times he had donated blood, no one had alerted him to the fact that he was positive for HIV. He would never have found out he had this disease without being tested himself. And the woman who was transfused his blood would never have found out she had received HIV positive blood unless the donor had approached the hospital to have himself tested for a completely different reason.

The pregnant woman was all over the news. Because she was pregnant and she was transfused HIV positive blood. She is currently undergoing counselling and antiretroviral therapy for her unborn child.

The donor, was not mentioned at all on the news anywhere.

Except for today.

When it was mentioned that he had committed suicide.

Things like this makes me lose faith in humanity.

The discussion about this that followed in my house was one about stigma. I was extremely shocked that the man had killed himself. My sister said that he would’ve had no other choice. He wouldn’t get that job he did the test for, he would be shunned and ridiculed the rest of his life because nobody knows how he acquired the disease.

This sickened me.

Stigma about health problems always make me really angry. It’s as though people think humans request the universe for a particular medical condition and enjoy having it and/or spreading it.

The pregnant woman in this case had someone to blame. She could blame the donor for giving her the disease. But how did the donor acquire HIV? Everyone would assume promiscuity. If this were the case, I’d think he would have found out he had the condition sooner. But the point is, he could have acquired it accidentally just like this. From a transfusion or some other blood  contact.

If anyone is to blame, it would be the blood bank that didn’t inform him he had the condition. He was being a good person, donating blood for those who need it, and he had never known he was donating contaminated blood. He had found out that on his own.

Did he deserve to die?

What bothered me was that my sister was right. People do attach a whole lot of stigma to certain medical conditions. And it is so unnecessary. Nobody wished to live with a medical condition. And nobody feels good about it. To shun things and people who have conditions like HIV or a mental illness or anything they don’t have control over, is in my opinion, a crime.

The man could have also received the same antiretroviral therapy the pregnant woman was receiving. But he didn’t have the chance to. He was a young man. Everyone probably blamed him for donating blood. His own family may have shunned him for having HIV. He had no choice but to end his life.

I think that’s a sad day for all of humanity. For all the progress we have in the world today, people still shun others for things they don’t have any control over. And this is far too high a price to pay.

Stigma like this makes people hide illnesses they have, makes them isolate themselves in society, it even makes them refrain from receiving the treatment they require. Fear of being labelled as a “patient” of a certain condition stops people from receiving life-saving interventions. Even improvement in quality of life is vital. And they miss out. Because everyone in society would look at them differently.

Pushing someone to the edge where they feel so lost and lonely for something they didn’t even do, is a crime committed by everyone involved.

The little things people judge others for makes me lose a lot of faith in the world. I hope one day all of this ends. And no more lives are lost to small minds.

A moment of silence for the man, and all of humanity.

 

My Oath

My first week of orientation to hospital ended. It was a long week let me tell you. Full of as many ups and downs as I can remember every year being. And more joyous times with people. 

I found that I can be extremely introverted when I’m not comfortable with the people I am around. But because now I’m an adult, I need to suck it up and do my job. Why must I be the only person who can’t be fake nice to their co-workers? It’s an important skill. 

Anyway it got me thinking. At my graduation, I took the medical oath. It was a lot of generic stuff about caring for patients and making sure I make good decisions, etc. 

But I need to take an oath of my own. Something relevant to me. Something I must strive to follow no matter what happens this first year of my being a doctor. And so I will write it on here so I may revisit it to make sure I’m keeping to my oath.

I promise to work hard and give my best without expecting rewards

I promise to hold myself high and trust that I am capable of doing what needs to be done.

I will not let anyone intimidate me into doubting my abilities or knowledge.

I promise to be self aware of my strengths and weaknesses and work on them accordingly. 

I will always take full responsibility for my actions and decisions. I will never blame anyone else for my choices.

I promise to realise when I need help and make sure I seek the right help.

I promise to remember that nothing and no one is worth stressing about, to the point where my mental health and happiness is affected.

I promise to remember that I am here because medicine is my passion and I am good enough to be here.

I will also remember that I have other interests and talents outside of medicine that I must strive to maintain those interests.

I promise to always think of the bigger picture. Not just parts of it. It includes everyone and all their perspectives. 

I promise to uphold my dignity and the dignity of patients and people I deal with.

I will ensure I remain happy. 

And I will strive to ensure my reputation is one I create. 



Here’s to being a functioning doctor and adult in my first year and beyond.