An Irritating First Day

Well it was my first day as a house officer. Orientation day 1. This whole week is orientation. Should be good. Should be exciting.

Today was a total bust.

And I need to vent on here.

So how did my morning start?

Early.

7:30am start was written on the timetable. I’ve been on break for the past 2 weeks so I was already having trouble waking up early. I planned to leave 45 minutes early to get to Middlemore hospital which is a 20 minute drive from my house. I had given myself twice the amount of time I would need. 

And it was useless. I’m not sure what it was as I have travelled on this motorway for a whole year the last time I was at Middlemore. But in 2 years, the development of traffic has been shocking. It took me and my friend who takes the same route, 1 hour to get there. Meaning, I left at 6:45am and got to the hospital at 7:45am. MEANING, I was late. On my first day of a new house officer year. 

Miracle of miracles atleast I didn’t miss much. Actually, I showed up and the introductory talk lasted all of 7 minutes before we were given a 1hr break. 

So what did I rush for? Nothing really. 

The 1hr break was for everyone to go get their access cards and parking cards sorted. I had done this a week ago because a lack of a parking card meant that I had to park in public parking for 10$ until I got the card. So I came in early to avoid that. While I was there, they also gave me my access card. So yay I was organised beforehand. 

But when everyone else got their access cards today, they were also given their meal cards. House officers get free food at the hospital with their meal card. Mine was missing. Why? Because I got my access card early and nobody told the department that issues meal cards this. Or some admin screw up to that effect.

The lady running the session said to me, when I approached her asking for my meal card: ” Oh so you thought you’d be so organised beforehand, but see now they didn’t give you your meal card. Which is the best part really” 

………

Why the heck would anyone think that’s funny? I don’t know you like that. Why would you rub it in?? 

So I was given vouchers for the week instead and told that “hopefully” I would get the card by the end of the week.

The rest of the day was quite slow. So many breaks interspersed with irrelevant talks and a walk around a hospital I was already familiar with.

It was nice to see my friends again, but there were also 54 other house officers in the room that I had to socialise with as they’re the people I’ll be spending a year with. And truth be told, that notion made me quite tired. I need to try be a more sociable person. I feel like I’ve lost that about me. I’m basically only comfortable around very very few people. And that’s not a useful way to be. 

Sigh.

Oh well. I guess in a way it’s a good thing that all these annoying things happened on the first day. Like a good omen for the rest of this year maybe. We’ll see. 

4 days left. I’ll need luck. 

Finally Graduated

Here hangs proudly my graduation regalia.

Looks a bit like a dementor does it not? 

Well it looked okay on me. Apparently in New Zealand, the colour of the Medicine degree is Hot pink!…. I’ll never understand fashion.

Anyway! My graduation ceremony was yesterday! After 6 years I sat in a 2 hour ceremony where my name was called and I was awarded my degree to say I am now a Doctor. 

It was a super long day. But it was great. Friends and family showed up. My friend from Wellington even flew up just for my ceremony! It was a great day. 

Lots of people to be grateful for. It’s been a long ride. But I got there in the end. And from Monday onwards, it’s on to work! Officially a house officer. 

I can’t wait! Hopefully I will be a good doctor. 

We all had to take an oath yesterday. One of the lines were “I promise to uphold the reputation of my profession”. Now other than the immediate Taylor Swift reference in my head, I realised I don’t really know what that promise means. What is the reputation of my profession? Have I been holding it up so far? I don’t actually know. Hopefully it becomes apparent when I start working. On to Monday!

My friend got me this cute graduation Kiwi doll! Yay for finally being done!

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! 😀

A view of Rangitoto from my ice cream celebration

Back To Paediatrics

Well a year and a half later, I have returned to the land of the children!  

A completely different hospital this time, thankfully. Because I had a less than great experience last year. 

But this year! I am allocated to the paediatric gastroenterology team! I was hoping my love for gastroenterology would balance out my fear/dislike of paediatrics.

And it does, to a certain extent. On my first day I learnt about 3 new conditions I hadn’t seen or heard of before which was super interesting. And my consultant is extremely nice, which makes things so much better.

But I’m still not feeling the paediatrics vibe. 

Beyond the fact that children scare me, I am not cut out for the people the grown-ups turn into around children.

I cannot handle or do baby talk.

Like just no. People don’t realise how ridiculous it sounds to others.

Sometimes I think even the kids judge some of the adults and their attempt to comfort them using baby talk.

You just end up saying things that make no sense. 

There was a crying baby on the ward round, so my house officer took off her brightly coloured lanyard with her nametag on it, and waved it in the baby’s face. (Which by the way I don’t approve of. There could be millions of germs on there) but then, the nurse in the room let out a dramatic gasp and said “see that?? You love a good nametag don’t you!!”

…???

What.

That doesn’t even make any sense. And it’s not something a kid would stop crying to.

And of course this kid didn’t stop crying. I mean it wasn’t going to be like “yes Sharon I do love a good nametag thanks. I’ll stop crying now”

I mean honestly. So unnecessary.

And the other day on ward rounds, a child was hiding behind the curtains in his room and the registrar was trying to examine him. My house officer out of nowhere looks at me with the most serious face and says “where’s Timmy??” (Not his real name). For a second I was confused if she was seriously asking me something.
But no. She was doing it for the child’s benefit. He of course ignored her. 

Oh God. I cannot do that. I talk to kids normally. And I do okay-ish with examinations. 

But yeah I don’t know. Definitely cannot be a paediatrician. 

Thankfully the rotation this year is only 4 weeks and I am currently on my 3rd week.

But seriously people. Stop with the baby talk. It’s not cool anymore. The babies are judging you big time. 

In The Middle Of Nowhere

Woah it’s been a whirlwind of an elective. And I’m sorry I’ve not been updating on here about my actual elective. Other things have been happening during this time that put my stress levels super high and got in the way of my blogging about nice things regarding my elective.

And now my elective is over! I’m leaving in 4 days for home! Super excited!

Time in India has been quite interesting! Had a really good time in the emergency department where the doctors let me do pretty much everything from being part of resuscitation, doing ABGs, (my first successful one made me so happy I felt like such a nerd), and I even successfully intubated a patient who couldn’t breathe.

Very neat. Lots of hands-on stuff is why I chose this elective. So that’s a good thing.

Most of the rest of the time though I was observing doctors and talking to patients. I saw some pretty neat signs like Janeway lesions which are super rare, Eisenmenger syndrome which I’d never heard about back home, and even heard the bruits of a bilateral arterial stenosis. Pretty cool stuff.

My rural hospital experience was pretty interesting too. Met a doctor who has single-handedly been running this clinic from 25 years. She is the lone medical officer there among about 15 nurses. She does literally everything. From seeing 40 patients a day, to delivering babies, to home visits, to colposcopies. Literally everything. Her knowledge was amazing. She basically knows more than any general practitioner I had seen back home in New Zealand. Not suggesting that they were incompetent or anything. But this doctor was just pretty extraordinary.

And then there were the patients. I could seriously appreciate what poor health literacy meant, in India. A woman had been given a prescription for her hyperthyroidism. She lived quite far away from the clinic and had lost her prescription. So she went to her local pharmacy and asked for “thyroid medication”. She was given thyroxine which is the treatment for an underactive thyroid that would worsen the condition for someone who had a hyperactive thyroid like this woman did. She had no idea of the difference. And of course it’s also the pharmacist’s fault for giving her that medication without a prescription, but still. She didn’t know the difference. And that had serious effects on her health before she was able to return to the clinic and the doctor had told her to stop the thyroxine and provide the correct prescription.

I also saw an elderly couple who both had complications from type 2 diabetes. But both of them, were beggars that lived at the local temple. The doctor at the clinic told me how difficult it is to offer diet and lifestyle advice to people like this. Because hey eat more fruits and vegetables doesn’t mean anything to someone who can’t control what they eat or if they eat at all.

Super intense stuff.

The rest of Coimbatore city was pretty quiet. Not much else happening. So I spent a lot of time writing my report for this whole elective. I did get some cool pics though! 

Coimbatore is bordered by mountains so mainly a lot of interesting flora and fauna!

I’m glad to be getting home after so long. My supervisor went on leave for the last week of my elective so I get an extra week of holiday before I get back to hospital in New Zealand. Should be fun!

So. The verdict.

Was my elective life changing? No. No it wasn’t.

Did I still learn a lot?

Yes. Yes I did.

On The Spot

I’ve always wondered how I would react in a situation in the community where something happens that needs medical attention. I’d heard from some friends who had experienced such situations. 

They had either pretended they weren’t medical students or they had risen to the challenge somehow and at least made sure the person ended up in a hospital for further care.

I had my situation today. Far far away from home. 

On the way to the hosp on my elective in India, I saw two motorbikes fallen over and 3 people on the ground. One of them was a man who was already getting up and helping the two girls. One of the girls looked fine and she stood up with help. The other girl however, lay on her back, crying, clutching her left leg. 

At this point I stopped and thought I should do something to help. Scary thing that. Realising that you’re actually in a position that gives you the responsibility to stop and help. I felt hideously unprepared.

Anyway I approached the girl on the ground and my immediate thought was oh my goodness should I introduce myself as a doctor? Because I wasn’t one. But if I didn’t, they’d think I was just a bystander and not really cooperate. 

But I couldn’t stand there and have this internal conflict. I looked for any evidence of fracture or bleeding, etc in that leg. After going through the whole DRSABCD acronym that they’ve drilled into us. By this time a lot of ppl were on the scene and the girl was helped up and she could walk. Yay no fracture. Yay no bleeding. 

My expert advice was to take her to the nearest hospital. Something many others had already figured out. A TukTuk pulled up and the girl hobbled over into it. I tried to comfort her as best as I could and told her she didn’t have a fracture. But she needs to be in a hospital to assess her leg further. She was still in tears and didn’t want me pampering her knee at all. This is probably when the magic words “I’m a doctor” would have helped. 

But I couldn’t do it.

Okay I don’t know why. Yes because it’s the truth, but not saying so probably indicates a lack of confidence in my abilities. Because I’m nearly done. I should be able to handle things like this. I should be able to be a doctor. Nothing major is going to change when I get my degree soon. I’m essentially all done with my training. 

So I suppose I did have an element of lack of confidence.

It ultimately ended well because the girl was okay and I helped a bit I think. 

But if there is a next time, I gotta be more confident. Hopefully that’ll come when I’m put on the spot.

Off To Elective

Alrighty! I’m here in India!

Coimbatore, to be precise. A city in the southern part of India. Here I am to do my 8 weeks in a hospital in rural medicine and Emergency medicine.

So. Why’d I choose this place? Well it’s a developing country. It’s what uni recommends to do on your elective. Go to a developing country and learn about the health system there! That’s what I intended to do. I’ve also been to Coimbatore before, So I’m familiar with the city and the hospitals. I figured this would help me get into the system straight away without too many new place barriers. And I was sure I’d see so many different things.

So I got here. Met my supervisor who is a 70 year old woman, still practising medicine. Which for me was a big shock. Like sure I admire her drive and commitment to medicine even at this age but Gosh I would not want to keep my brain going for that long. 

Anyway she was really lovely. And unlike my selective last year (if you remember, where I found my supervisor was on a holiday and I never met him), she was on to planning my 8 weeks straight away. She took a genuine interest in my learning and said that because I’m the only student at this hospital, I can pretty much see whatever I want, and she would organise it for me. 

Major advantage, that. As opposed to going to a hospital somewhere where there are a lot of other students to compete with to see interesting things, I like being the only one given these opportunities. 

I also think I’ve picked a good hospital in terms of patients. While they all have different pathologies etc, they all speak English! Which was super impressive. I was fully prepared to have to take histories in Tamil (the language here), but it turns out that may not be as hard as I thought! So yay!

The plan for the next 8 weeks is quite varied. My supervisor is more keen than I am to get me to see as many things as possible. While my focus will be on rural medicine and ED, she also wants me to spend time with her in geriatrics, put me in neurology, nephrology, and anything else I want to experience. 

How neat is that!

I think it’s also good for my short attention span because I get tired of runs pretty quickly. 6 weeks can often be a very long time, as I’ve said lots of times before. Hopefully the variation in these 8 weeks will make that a lot easier!

So. First days are always first days like. Getting lost in hospital, making awkward conversations with the other doctors, smiling a lot without much reason, etc. But I do expect it to get easier. As most runs have.

Will keep updating! For now, I gotta go meet my supervisor! 

In The Deep End

Today was my 3rd ED shift. And it was the most challenging 7 hours of my life. 

Mostly because of just 1 patient. 

At the beginning of the shift, my consultant was called to resus to see a 15 year old boy who had come in with 5 days of headache but who had since become unconscious in the resus area. 

He had no other medical conditions. The whole team was working on making him regain consciousness. While differentials such as meningitis and seizures crossed everyone’s mind. 

The mother came in shortly afterwards frightened and distressed as she recounted how he had had only a headache for the last 5 days but today while she was at work, had called and said bizarre things before hanging up. She returned home to find him unsteady on his feet before collapsing to the ground. The mother also brought her 4 year old son with her. There was no father to be seen. 

The young boy regained some consciousness. He was responsive to speech and followed commands. Everyone became confident at this improvement. My consultant decided now would be a good time to CT scan his head for signs of infection or bleed. 

The boy was wheeled off and my consultant and I followed him. 

The CT scan showed a large tumour pressing on the boy’s brain. Causing the brain to be pushed to one side, likely resulting in this symptoms. He would have a large amount of pressure in his skull at that time. 

The consultant took the mother into a room to talk to her. I was present when he told her the news. 

She instantly burst into tears and wailed. Her precious, obedient, healthy boy was going to be taken from her? How could this happen? Will he be cured?

My consultant told her that he would contact the neurosurgeons who would tell her more about the next steps in management. 

She cried harder. She told us she had no one else. That the boy’s father was estranged from when he was 4 years old. That the boy was all she had. 

He younger son was oblivious to what was going on as he quietly played with some puzzles. 

Meanwhile we were again called to resus as the boy had lost consciousness again and was now showing signs of very high pressures in his skull. One of his pupils were dilated massively while the other was small. The neurosurgeons arrived to take him to theatre immediately and they began to put a tube down his throat as he was no longer breathing on his own. 

At this point, the consultant asked me to sit with the mother. And console her and prevent her from witnessing the placement of the tube. 

I was way out of my depth. The mother begged me to be with her son. She asked me whether she had given him some food that may have caused the tumour. Or whether a fall as a young child would have caused it. She told me she worked so hard and had saved money for a house for him in the future. How he had wanted to be a pilot when he was older and how she had arranged classes for him to learn more about this every week. 

She asked me if he could be cured. Or if he was going to die in ICU where he would be taken after the neurosurgeons performed an emergency operation to relieve the pressure in his brain. 

I comforted her as best as I could. Telling her she couldn’t have prevented any of this. That some things just happen. She asked me why God was taking her son away from her. I had no answer. She said she had been a bad mother. 

She eventually decided to call the boy’s father as he was taken to surgery. 

To complicate matters further, the father began yelling at the mother. Saying it was her fault he had gotten cancer. 

This carried on to the point where my consultant had to intervene to explain to him that it was no one’s fault. 

The boy’s father said his nephew also had brain tumour but he’s fine now. 

The mother, who was hurting in a big way, clearly fed up with the father’s accusations said that she was the best mum in the world for her son. And that if cancer ran in the father’s side of the family, he should have mentioned it earlier. 

It was all rather weird for me. 

But it was just

Quite confronting. 

I’ve never seen such a situation before. The reality of what happens if medicine isn’t good enough. And sometimes it just isn’t good enough to answer every question or solve every problem. And what that leaves behind is quite devastating. 

I couldn’t process everything for a while. My consultant asked if I needed a break to calm down. 

How did I react to this? I said I didn’t require a break. I just need to go see the next patient. 

I can’t say why I said that. I guess I needed to feel like even though it was obvious that not much could be done for that young boy, much could be done for other patients. And I needed to see that. And I needed to be part of that. To get over the disappointment and the grief that I had witnessed. 

It all just goes back to what Robert Frost had said:

“I can sum up everything I have learnt about life in 3 words:”

It Goes On…..

I guess I have to also be grateful for my life and my health. And the health of those closest to me. It shouldn’t ever be taken for granted

The Thing About Emergency Medicine

I’m on my 2 week ED rotation. 

Now, I love ED. Because it’s all diagnosis and planning. It’s really bringing those diagnostic skills and knowledge learnt in med school to practice.

But it’s a hard life being an ED consultant. Even as a consultant, Ie having the top job in that field, you still have to do shift work. And that’s exhausting.

Did you know that the world health organization listed shift work, particularly night shifts, as a cause of cancer? 

Blech. That’s not very appealing is it.

It’s an extremely difficult job they have. And you gotta be a certain kind of person to be an ED enthusiast too. Like as a student, it’s brilliant because you get to practice diagnosis and management unlike in any other specialty, but you also have to be okay with never hearing the end of a story.

People in ED see patients, and refer them after initial management. Then you don’t get to know what happens to them. This for me is extremely upsetting. xD I don’t like cliff hangers. I need closure. 

But ED is honestly so exciting. I am in fact doing my 8 week overseas elective with a heavy focus on ED. It’s going to be in India! Along with rural medicine, I will be in a hospital emergency department. Meanwhile everyone else in my class is taking this opportunity to travel the world, I’m hoping I’m sacrificing my travelling opportunity to learn heaps. 

What better place to do so than ED!

I’m leaving for my elective next week! More on this soon!