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.

Inappropriateness, Cynicism, & Words..

People ask me why I’ve become so cynical and unhappy with everyone since being in hospital. I just don’t know what to tell them….

There was a phone call to the paediatrician asking to come perform a newborn examination on a baby born in a difficult circumstance. The young mother was unaware she was pregnant until 2 days prior and showed up to hospital just in time to give birth. In the early hours of the morning, she went to the bathroom and locked herself in for a long time. Eventually the nurses banged on the door to ask what had happened to the mother. Later still, she opened the door claiming she had already had the baby. The baby was found, still attached to the umbilical cord which had been wrapped around his neck, fully submerged upside down in the commode of the bathroom.

The baby was retrieved. He was alive and well. However, the mother left the hospital shortly. The baby was to be put up for adoption.

Hearing this story made me cringe. Sitting with the paediatrician as he received this call. It filled me with sadness. We hurried to the birthing suite to examine the baby. He was perfectly normal. Ticked all the boxes and was very healthy. It should have been a relief. But the midwives happened.

On arriving to the birthing suite, a group of midwives approached the paediatrician. “Oh you’re here to examine him?” one of them said. “We named him Louis!!”

I stared at her for a few seconds. As did my paediatrician.

“Do you get it?? ‘Loo-ey’!!” The look on her face was in absolute glee. As though she was extremely proud of herself for coming up with this.

The paediatrician gave her an expression that was an attempt to smile “Yes. I get it”

I have no idea what was going through this woman’s mind, but I soon realised it wasn’t just her. Another midwife added “Yeah. We would have named him ‘Little Sh*t’ but he’s just been so good and quiet!” They all laughed. My paediatrician was already walking past them to the baby. And I followed suit. I wasn’t sure it was safe for the midwives if I stood there any longer.

After the examination, we returned to the office to write a note, where, incredibly, the midwives were still at it.

“I hope the name Louis follows him through!”

“Yes. I really think it should! It’s perfect”

“Yeah. Whoever adopts him. We should let them know. It’s so sad he’s up for adoption.”

“Did you see him though? He’s quite black. Maybe that’s why the mother didn’t want him. She’s white. The father must have been black”

I raced out of the birthing suite with my paediatrician as quickly as I could.

Millions of thoughts resonated through my mind at the atrocity of the situation. But something came through loudest. “If you can’t say something nice, zip it”. “Grow up. Get a life. This is reality. Get used to it.” We all have to have thick skin by now. It means we have to not react to such situations. But I just wonder if the midwives knew how inappropriate the things they said were. Does being thick skinned mean that you are no longer aware of other peoples’ feelings? That you can just say whatever you want just because you have a mouth and freedom of speech?

Or maybe I’m just not used to it. Maybe I’m blowing it way out of proportion. But all I know is that if I was the baby, I would not appreciate hearing these women talk about me that way.

In a field where we’re constantly taught about being compassionate and being professional, I just don’t understand how this would come about. Maybe it’s a way people cope with difficult situations. Maybe the midwives were trying to make this setting a bit lighter. Or maybe they think that it’s enough to maintain professionalism and ‘appear’ compassionate in the patient’s presence.

I just don’t know. I’ve mentioned several times on here how important I think it is to think about what you say before you say it. In a world where we have no other way to know what someone is thinking other than what they have to say, and how much impact words being said can have, I hope so much every single day that I never say something that comes across as cringe-worthy as what I heard the midwives say.

And I hope the little baby goes to a good home where no one ever tells him this story.

Gen med..Generally.

As I’ve already said, I’ve just finished my first rotation at hospital. That being general medicine. I thought now would be a good time to reflect on the past 6 weeks from a medical perspective.

So, general med. I’m not too sure what it’s called in your part of the world. Internal medicine? Family medicine? Well in my little corner it’s called general medicine. Why am I dwelling on the name? Because I feel it needs defining. With every other branch of medicine, cardiology, neurology etc, it’s pretty self-explanatory what that branch entails. General medicine is a bit different. So. Can I define it? Uhh not really. Basically it seems like this. If you’ve got heart failure, you’re a cardiology candidate. But if you’ve got heart failure in addition to lung abscess, liver metastases, diabetes, kidney failure, fluid overload, peripheral neuropathy aaand urinary symptoms, you’ve just won a free ticket to the general medicine ward! Welcome aboard!

The whole place seemed very disorganised. Everybody seemed to have a million and one problems: The million problems likely to have accumulated over many years (which I’m sorry, you’re just going to have to live with) and that one extra problem you’ve just acquired that we will now attempt to cure or bring to a stable enough condition for you to live with. Eugh. During med school, we were taught that a lot of conditions have no cure, etc. and I was okay with that. But seeing it in practice, was quite difficult to digest. The doctors don’t really make problems go away, they just make sure your treatment is good enough for you to go home and live with your problems. Now I realise this may not be exclusive to general medicine, but it was pretty much all I saw on this ward.

Another thing is that because these patients have a million and one problems, generally they stick around for a while. Statistics say that the average number of days a person stays in hospital is 3 days. I can tell you that only a quarter of the patients I saw in 6 weeks stayed for 3 days or less. There are patients on my ward that came in before I started and are still to remain for a few more weeks after I’ve finished. At least one of their problems causes issues for them every day. Leaving doctors clueless. There is a lot of standing around and thinking in general medicine. I can’t imagine any other speciality doing so. If you’re an orthopaedic surgeon, there’s no two ways about it. The knee needs to be worked on, the knee gets worked on. In general medicine, each of your million problems have to be considered separately and together before any of your medications are changed. Whew. That’s a lot of brain work. I can’t tell you how many times my registrar or consultant stare off blankly into space. Their agile minds sifting through thousands of resources of information on all the illnesses said patient has, and how best to treat them. You can see the sheer concentration on their face as they work to solve the puzzle. It’s quite cool really. But sadly, the solutions are not always so exciting. It generally consists of some small change in their current medication which, to be fair, does make them better and stable enough to go home, but not actually cure them of anything. Sighh. I think I might be too idealistic.

Also, if you stay in hospital for too long, bad things start to happen. Patients become boomerangs. Mr Brown came in with exacerbation of his heart failure which was complicated by his diabetes, liver abscesses, kidney failure and new onset diabetic neuropathy. He remained in hospital for 4 weeks during which time many doctors worked to stabilise him. At the end of 4 weeks on Friday, he was well enough to go home. The doctors cheered and celebrated his farewell for it was a job well done. Monday morning of the following week, he registrar received a call. Mr Brown was to return. He appears to have developed hospital acquired pneumonia. facepalm

Luckily for Mr Brown however, the pneumonia in addition to his lung abscess and pleural effusions qualified him to be in the care of the respiratory overlords. Mr Brown was lucky. Poor Mrs Smith however, returned with a new macular popular rash after being treated for her adenovirus. She is doomed to stay on the general medicine ward until the cause of her rash can be isolated.

As I’ve mentioned, in general medicine we get whoever doesn’t qualify for specialist care. Sometimes this can be extremely frustrating because the requirement for specialist care seems to be a bit too specific. And patients that just miss out seem to get sub-optimal care under general medicine. Mrs. Jones has had a long-standing rheumatological condition called behcet’s disease. She presented with abdominal pain and diarrhoea and was admitted under general medicine. Upon investigation, a colonoscopy was done which revealed ulcers in her intestines characteristic of her behcet’s disease. She requires immediate treatment of ulcers and further management of flares of her behcet’s. Both of which cannot be provided under general medicine. However, the rheumatology overlords refused to accept her as she presented with gastrointestinal type symptoms. Gastroenterology refused her as she has an underlying rheumatological condition. But both were happy to offer advice on her care for the minions in general medicine to carry out. Meanwhile, Mrs. Jones was still in pain.unimpressed

Not. Cool. But I’ve learnt that in hospital, everyone plays hard ball. My consultant knew the game. After several angry calls to both specialists, you’ll be happy to learn that Mrs Jones was referred to gastroenterology and is receiving the care she requires.

success-kid-300x166General medicine for the win.

I could go on and on and it seems as though I have. But I will say this. What I love most about general medicine is the patient centred care. The holistic approach to treatment of the patient as a whole. It’s all about the patient. What did they want? Were they well enough to go home? Did they understand what was happening to them? Who else did they want to involve? Etc etc. I think this is something unique to general medicine. One of my lecturers at medschool who is a bigshot neurosurgeon taught us that the more a doctor goes into a speciality, the less they see the whole patient. “An orthopaedic surgeon would basically just see a knee walking through the door” He would say. “Remember to look at the patient as a real person and treat them”. I was really able to appreciate this in general medicine. I could see that this made the patient feel that much better and safe. And I loved it. It’s what I would expect as a patient and it’s what I want to offer. I think I would really enjoy working in general medicine. But of course, it’s too soon to tell. Starting next week is my speciality medicine rotation and I’ve been allocated the most specialist subject there is: Stroke! I will be spending the next 3 weeks thinking and learning only about patients with stroke. I’m not too sure what to expect. But I’ll keep you posted!

NOTE: All names of patients given are not real names.