Pocket of Air

But I couldn’t have done it, could I? My mind swirled with chaotic panic, as I desperately looked through the internet, looking for any bit of information that could alleviate my fears.

I punched in key terms “lethal” and “air embolism” on Google. Definitions and the pathogenesis of air embolism were explained on various sites. Still, they didn’t provide the answers that I desperately needed. I scrolled through pages of the search results, and then bam – there it was.

Air Embolism

Reading through the article, I was immensely relieved. The panic, and the chaos in my mind instantly subsided. This article was to keep me sane, for in it, it states that it takes about 200-300 mL of air injection to kill someone. Why am I so thankful for this piece of information?

It all starts back to earlier that day. Earlier that day, I had been in ED, practicing my cannulation skills on patients that needed a cannula. It had been perhaps a good 3-4 months ago since I had inserted a cannula, and I was really rusty in my skills. On one pretty stoic gentleman, I popped the tourniquet up, producing some bulging veins. This would be easy, and I inserted and successfully advanced a cannula. Removing the needle, the plastic part stayed behind, and blood slowly trickled out of the cannula. I was happy I was in a vein. With that in mind, I grabbed my saline syringe flush. Connecting it in to the cannula, I depressed the plunger. It didn’t budge. I tried harder, and it advanced a small bit. This is certainly strange I thought to myself. So I kept on going, and probably advanced about 1-2 mL of the saline flush in, and decided to give up. That’s when I noticed there were some pockets of air in my syringe.

I started to panic. Had I given this patient an air embolus? It certainly wouldn’t kill him would it? I prayed dearly that nothing would come of it. Too scared to tell anyone, I kept a close eye on him that morning at ED. Nothing happened to him, but I was scared for my life. Thoughts raced through my mind, coroner’s reports, news reports about the negligent medical student who gave an air embolus to a patient. Maybe I should quit medical school before they find out? Maybe nothing won’t occur. Maybe….  I need some reassurance.

Reading through the internet article, I was relieved that it would take 200-300 mL of air to kill someone. It was a close call, but I like to think that the air would be reabsorbed by the patient’s body. I sincerely hope nothing bad has happened to the gentleman.

And so, such was an extremely anxious and scary learning experience, coupled with my inexperience during my student years. Yes, I dread the many more days of similar experiences of close calls that are to come as a doctor….

How Can Anyone Survive In Surgery?

As a medical student, I had a terrifying surgical experience. The general surgery consultant grilled me and a bunch of other medical students rigorously, and expected us to know answers to some pretty tough questions. He was a terrifying man, who only slept for 4 hours every day (according to himself), and who backhandedly disguised a praise to his registrar with a nasty comment (“great presentation Dr X, this is the first time you sound like you know what you’re talking about”).

Perhaps another thing that terrified me, was going to theatre. The scrub nurse would tell me off for not scrubbing up properly, because I wasn’t sterile enough (any more sterile and I’d have been castrated ha!). It was my first time, and the nurse didn’t have to be so mean about it! Perhaps the most terrifying scrub experience, was at a rural location where I was needed to assist in a c-section, but was delayed for a very long time because of the scrub nurse needing me to get the scrub perfectly. The consultant was yelling off “come on, I need you here right now!”. I almost gave up under the pressure, but in the end, I scrubbed up, amidst a ton of pressure.

Fast forward to now, and I still feel terrified of surgery. The consultant gives the impression of friendliness, but I feel as if she’s just as deadly, and I feel she will explode some point in the future with rage, rage at us residents for not doing an extremely brilliant job. She has high expectations I feel, and her offhanded remarks at us at times reflect this. We are all doing our very best, and we can’t help it if everything is so disorganized and chaotic!

There are days where panic just sweeps over me because of the tasks I have to balance simultaneously. Consent, x-ray forms, sorting out a man who has passed about 20 mL in the past 2 hours, patient about to be discharged soon etc. It’s just the constant stream of tasks that we have to balance that is freaking me out now. I am afraid that I’m going to make a mistake because I cannot multitask. Afraid that my memory won’t serve me correctly, because it isn’t photographic in nature, and afraid that I will forget some urgent task to be done, because I would have had 2 or 3 of those I am trying to balance at the same time. And I am afraid that I will get a stomach perforation, because I am constantly having lunch or dinner 2 or 3 hours too late. Perhaps they’ll put me through an x-ray and find free gas under my diaphragm?

So, I am still getting my head around surgery. But I am freaking out here because of the consultant, and the tasks I have to balance. The registrars are too busy to help us residents, so we are left to deal with things ourselves, learning from trial and error. What a horrible way to learn from making mistakes. But what doesn’t kill you makes you stronger right?

Having Gone Through Hell…

If I were to use one word to describe my ED rotation, I would use the word “hell”. In saying this, I feel that I have learned an incredible amount of things from my ED rotation, but at the cost of my self esteem, and perhaps a little bit of my sanity.

It wasn’t the stress of seeing unfamiliar patient presentations that freaked me out the most, but rather in dealing with the senior doctors and the culture of degradation of junior doctors.

As junior doctors, we were thrown in the deep end. We were doing the same job that a registrar in ED would be doing, working up the patient, performing appropriate investigations, and making referrals. It was tough work.But this tough work I could cope with. It was even challenging, and something I learned a lot from. The thing I couldn’t cope with, were the staff. Not all were terrible, but I could say that a few were quite bad, with one particular man who seemed to be hated by everyone, including surgical registrars.This man yelled at me on the second day of work. I got yelled in front of almost all the other ED doctors for asking my senior doctor to describe an open fracture he had seen earlier that day, so that I could relay it back to the orthopaedic doctor. Words to the effect of “incompetent”, and “idiot” were used. That night, I couldn’t sleep, dreading the next day and fearing how it would turn out. It wasn’t until just a few days ago, that I found out other colleagues have cried at home from this very man yelling at them.

And so, for the next few weeks, I was mentally tortured by this very man who we had to run all our cases through. He would question my competence as a doctor, carefully pointing out my mistakes, and how I had forgotten to do things such as chart regular pain medications, hence why the patient is suffering excruciating pain.

On more days then not, I sat on the edge of my bed, thinking about the mistakes I made, and questioning myself whether I was competent or not. It was self abuse, and completely self defeating. I would dread the next day that I had to get up to go to work. Finishing work was the most relieving feeling ever, but on days that I was yelled at, or pointed out numerous mistakes, even that feeling of relief was taken away, to be replaced by frustration, anger and thoughts of worthlessness at the end of my shift.

To me, I felt worthless at my job. I wasn’t getting the support I needed, I never got the encouragement or acknowledgement that I was learning from my mistakes, or doing a better job than I was doing in the past. They didn’t take the time to explain my mistakes, and how I could avoid such mistakes next time, but they pointed out my mistakes, reinforcing the message that I was doing badly. In hindsight, I wasn’t doing badly, but I was doing something in which they held unrealistic expectations of  me as a junior doctor.

What doesn’t kill you only makes you stronger right? In that sense, I feel stronger having put up with such degradation, and the subjected self torture. The biggest lesson I learnt was in dealing with ***holes in medicine. Learning to deal with other people – it’s an important life skill, and it will surely help you to survive in this big bad world.

When My Registrar Irrigated a Urology Patient

There are some things in medicine that just stick with you for the rest of your life. It’s something that you won’t forget. Perhaps something so different to the normal routine of things seen, that it just jumps out at you.

For me, that was yesterday. Doing the urology ward rounds with my registrar, we came across a gentleman who had urinary retention secondary to haematuria and possible clots. This gentleman had a catheter, with bloody urine draining into the catheter bag. Just the thought of blood in urine ….. Gives me the creeps

Anyway, I stayed holding up the bag connector tubing while my registrar vigorously irrigated the catheter with water. Squirting water in and withdrawing water. The first few sucks yielded nothing. She pulled slightly on the syringe, but it was unyielding. “I’m going to go a bit rougher”. And with that, she gave a vigorous squirt of water, and a massive effort withdrawing the plunger, and pop! Clots, lots and lots of clots out into the syringe. Admidst cheers of the gentleman who cheered her on “oh yea, come on, you can do it! You got this Doctor!”

I contemplated how funny the situation was; a female registrar breaking up clots in a mans bladder, while the man cheered her on in an almost orgasmic tone.

With clots and blood dumped in a bucket, it was probably one of the most disgusting things I had seen during medicine, and I’ve seen and done lots of disgusting things (Bloody PR exam anyone?).

Anyway, it’s something that’s going to stick with me for a very very long time. Good dinner conversation too


Is it Sexual Harassment?

It certainly has been several days since I have updated this blog, and part of the reason has been because my mum came to visit me, so I spent a lot of time with her, and spent less on my blog.

Anyway, a few days ago, I think I might have been sexually assaulted. Ok, maybe that’s an overstatement, but the patient’s actions were certainly inappropriate, and if I were a female and it happened, I could probably claim sexual harrassment. 

So, I was looking after this friendly Italian man. He seemed quite nice, talked about watching Swan Lake, and commented on how I had the gait and grace of a ballet dancer.This should have alerted me at the beginning about something, but when you’re too busy focussed on the patient’s presenting complaints and illnesses, your mind focuses on the illness and the problems.

After chatting to one of the senior doctors about the presentation, the senior doctor saw the patient with me, and explained that everything was alright, that the patient likely had early stages of osteoarthritis of the knee. He was ok to go home. After explaining that, the patient thanked the senior doctor, and then thanked me, slapping me on the butt! Granted, he was lying down on bed, and I was standing beside him. I completely didn’t see that coming.

At such a point, I didn’t know how to react, but I just shrugged it off in a way. But it was a little disturbing to know I got sexually harassed. I’m a guy however so…… am I supposed to just shrug it off and just pretend that nothing happened? It hasn’t distressed me or anything, but I’m just curious as to what would have been an appropriate response to such an action? I mean, do I tell the man it’s inappropriate, or do I ignore it?

Because in society, it’s perceived that a guy doesn’t and can’t get sexually harassed right, because that just doesn’t happen to guys right?