Year Long Sacrifice

Reflecting back on the events of this year, I’m amazed at how fast time has gone.

First comes the moving back to the big city from a regional centre, then comes the job applications and interviews for general practice positions, and now finally, I have finished my paediatrics diploma in child health exam! Well, to be more precise I sat the exam on Friday, and only had time to write about it now. I’m such a bad blogger :p

No more needing to rush home to study paediatrics. No more weekends spent listening to online lectures. No more stress!

I was lucky to have been able to take an entire week out to study, which was really helpful. My work colleague jokingly told me off on the bus after the exam, saying how busy it got in obstetrics and gynaecology without me. She ended up having to do my postnatal checks in addition to hers. But, I had to do that for a week before, when one of the previous residents resigned as well. So in my defence, I can at least say I’ve done the work before.

But after all this, I feel like I need to start preparing for study for general practice… A life in medicine entails exams till you’re at least 30 years old.

Now, at least I can come home without need to worry about intense study at least. I can study at a somewhat more relaxed pace for general practice.


Signs of Impending Death

The title of this post may sound too medically based, since it seems to focus more on just the signs of death. But having a palliative care doctor assign me this topic to present at our next palliative ward round, I figured it would make for an interesting read.

I was 25 when I witnessed a patient who passed away in front of me. I was still an intern then, and was asked to see the patient in front of many family members. The patient had agonal breathing – periods of deep sighing breathing, followed by long pauses of silence. After a few minutes, the patient stopped breathing at all. Being fairly uncomfortable in such a situation, all I could do at the time was examine the patient, and inform the family that their loved one has passed away.

That was some 3 years ago. I have assessed many more deceased patients since then.

Having used an ebook database, I find out that some of the signs of impending death include:

  • Decreasing cardiac output: increased heart rate, hypotension, cyanosis, mottling, livedo reticularis
  • Renal failure: oliguria, anuria
  • Neurologic dysfunction: decreased level of consciousness, terminal delirium, hypo/hyperactivity
  • Reduced oral intake.

During our palliative ward round, we see a patient who seems to have signs of dying. It was an elderly man who presented due to what appears to be pneumonia. He was drifting in and out of consciousness. He had reduced oral intake. And he looked pale. The man ended up succumbing to his pneumonia, despite IV antibiotics we were giving. Realistically, he didn’t improve after 3 – 4 days of IV antibiotics, and so we had to explain to the 2 daughters that he wasn’t likely to pull through.

I remembered this man from a few weeks back. He was up and talking back then, cracking a few jokes even. I found it hard to believe that he was so well just a few weeks ago.

From what I’ve seen, disease does not discriminate against people. It attacks people of any age.

Looking at the World

Since having a medical education, it has made me look at people in ways that I never used to look at them. I’m more observant of people around me.

In medical school, the crucial thing we were taught, was to use our eyes. In our clinical examination classes, we were taught that a general order of examination of the patient was: observation, palpation, percussion, auscultation. Note how observation comes first and foremost before you touch them, and before you use your stethoscope.

And so we’re told that you can glimpse a lot of information about your patient just from watching them. A person who limps into your practice may indicate something like pain from the knee or hip (maybe from osteoarthritis), and an infant who is brought in in the mother’s arms with reduced responsiveness and alertness is probably quite sick.

When you’re observing people all the time, it only becomes natural that you apply it in public. In general, the major thing I glean from seeing people are whether they are well or sick. Then little other subtle things I may observe – things like gait, scars present (may indicate things like past knee replacements), and just other things in general like if they’re pale, have rashes or so.

In turn, I guess being able to apply it in public means that I’m constantly using the skill of observation, and hopefully it will aid in my further career development.

A Diploma in Child Health

Earlier this year, I heard about people enrolling in a diploma in child health. All it required was 6 months of clinical paediatrics contact, some online lectures, 2 case reports and 2 exams. Best thing of all: almost all of it can be done online (except of course the exams).

Of course, having heard about this information earlier this year, I was too lazy to look further into it. I’ll look it up later I kept telling myself. Of course, weeks would go by when I completely forget to look it up, and when I’m reminded about it either through work or a colleague, I put it off again.

It wasn’t only until a few days ago when I attended a paediatric emergency workshop. Following that workshop, I realized that my paediatrics knowledge wasn’t exactly the best and up to date. So after a day of looking up the actual diploma website, I decided to join. Well, actually, I looked all over the website, but could not find out how much it cost. So curious, I enrolled, and it was only after I got provisional enrolment that I got a cost back : $AUD 3000. Not too bad I guess, given the flexibility of the program, and the 111 lectures and materials I’d get access to as well.

Having gone through 3 lectures already, I already feel smarter with things like managing DKA, and meningitis in children. I think the money will be well worth it, and it would be a great investment into my professional development.

Which brings me to another fairly important point as well: professional development. In a way, it is the responsibilty, and duty of a practicing doctor to keep up to date with information. Those who fail to do so get left behind providing outdated and inefficient care to patients. Education is definitely essential to maintaining high quality of care, and even consultants shouldn’t be exempt from continuing to learn.

All fair and all, but the major gripe I have with Australia’s method of continuing education, is that costs need to be paid out of our own pockets (of course of which we can get tax deductions). And really, medical education does not come cheap. Workshops can cost thousands of dollars. In a way, I did wish that Australia was a bit like New Zealand in that the cost of education if you are in a training program is paid by the employer.

But I suppose, different countries have different systems, and you can’t have it all.