Second Sick Day Off, After Weekend Cover

I usually don’t take sick days off unless I really need them, but today seems to be one of those days that I have decided to call in sick. It is the second time I have called in sick in these last 1.5 years of work. I feel a little guilty however, since I’m not like actually dying, and could probably still go to work even though I would be extremely worn out and inefficient.

I suppose I was actually sick yesterday too, but decided to go into work anyway. Being a public holiday yesterday, and with two and a half pay, how could I not go into work? I wasn’t really that sick yesterday morning though, but late afternoon, I started sneezing and had terrible joint pains. Come the end of the day, and I was exhausted.

Being a public holiday, there were only 4 medical doctors on; the day consultant, an admitting registrar, the ward registrar, and the ward RMO (resident medical officer). My job was to see mostly well patients on the ward, while also getting called for ward jobs and reviews of patients that may need some attention on the ward by nurses. In total, I saw about 16 patients, did 4 cannulations, did two urgent discharge summaries, and attended to several other odd jobs like rewriting medication charts and the like.

I just churned through the list, and took my time to just have a chat with patients to identify any issues, and just a basic exam; all patients I saw got a chest, heart and abdominal examination. Mind you, many of these patients were actually well and didn’t have many issues, but needed some monitoring and review for things like bloods, hence that’s why even a lowly RMO could see these patients.

My shift started around 8 am, and ended at 8:30 pm, but I had pretty much seen all the patients by about 6pm, and then had to do other odd jobs that I had prioritized as last priority (which included rewrite of medical chart, and certifying a dead person). Certifying the dead person was actually quite spooky in a sense. The patient was in a body bag when I turned up, and had been dead for over 2 hours. On unzipping the body bag, and throwing the cover back, I came face to face with a ghastly pale and yellow face, with eyes closed. He felt cold to touch. On opening his eyes, I thought I could see the eye lens. HIs pupils were dilated, yet I could make out a slight shimmer, as if it was the lens of his eyes.

On finishing all jobs, I met the night RMO, and handed over just 3 easy jobs – essentially to chase bloods. I quickly headed off to one of my favourite restaurants (they close at 9pm), and got myself some Mexican food, and finished it at home. Switching the TV on, a movie was on; Freddy vs Jason. I watch for about half an hour, thinking to myself how ridiculous the movie was, with villains magically materializing from dreams. There’s nothing better to watch, so I just watch a bit more, and make my way to bed after a well deserved day (of working 12 hours).

Now I’m just looking forward to my upcoming pay check 🙂

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Examining the Deceased Person

Two weeks into my medicine rotation, and I’m really starting to enjoy it. It’s a refreshing change from the mundane stuff I was doing in orthopaedics anyway.

Finding out that I would start medicine as the night ward call RMO on the last week of orthopaedics made me a tad bit apprehensive though. My apprehension was unfounded however, as the nights had seemed to be going well. I’ve got a very friendly and reliable registrar, and the tasks I’m asked to deal with are manageable at my current level of knowledge.

Perhaps one of the amusing things I’ve done so far, had been examining a deceased person. Prior to this, in the one and a half years of working, I’ve only come across one deceased person as an intern. And that wasn’t the greatest experience. But that’s another story for another day.

Anyway, I got phoned by one of the nurses asking me to confirm the death of one of the patients.It was an expected death with the daughter present there. I made my way to the ward, and carefully read the patient’s history. I looked at my watch. 12:40 am. As I got to the patient’s room, it was illuminated by a very dim light, throwing sharp menancing shadows over the patient’s face. Her lips were sunken in, and she had an open mouth, with eyes closed. Protruding cheek bones, and a pale face alerted me to the fact this woman would have been very frail and in poor health prior to presentation.

I introduce myself to the daughter, and explain that I’m going to be examining her mother. I call out the patient’s name, and start giving some tactile stimulation over the sternum. No response. I feel her radial pulse. No pulse. I try the carotid pulses. No pulse. I listen over her chest for breath sounds and heart sounds. Neither of those are present after 30 seconds of auscultation. Finally, I open her eyes to find big dilated pupils that don’t react to a torch light. The eyes looked out, almost as if they were made of glass. I contemplated doing the “rag doll eyes” test, but given the way the patient’s head was angled, and how the daughter was there, I decided against it. I calmly turn around to the daughter and say “I’m sorry to inform you, but your mother has died.” I glance at my watch; 1.04 am. The daughter sobs quietly. I ask her if there is anything I can offer her for the time being, like a cup of water. She politely declines.

I walk out of the room to document my findings. I am surprised that I wasn’t freaked out this time by a deceased person. I know I shouldn’t be saying this, but it felt different in a way (in my mind, kind of cool), seeing and examining someone who’s life ceases to exist. I felt detached in a way examining the patient. I felt emotionless, felt like I was just going about doing my job. I think what helped was that I hadn’t been involved in this patient’s care. Perhaps that’s why I didn’t feel so emotional. But then, I’m not so sure how I am supposed to feel after something so sad like this. Was I supposed to feel this detached, or was I supposed to feel at least a little something about a person passing away?

I’m certain that there are many more deaths I’ll be asked to confirm. So far, I have confirmed 3 deaths, which for my stage of training is probably considered quite low (thanks to me being in a more regional hospital with less patients). I am lucky so far in that the deaths of all the patients I have had to confirm have been expected deaths. I fear the unexpected death, and having to explain and answer difficult questions they may have, as well as dealing with reactions of family members like anger and denial. I hope I’ll have the experience and skills to deal with that in the future.

Back to the Surgical Wards

I’m back on that horrible horrible surgical ward, the ward of bad memories from last year. The constant buzzing in the ward of bells and alarms is all too obvious. I see some familiar haunting faces. Faces that give me a nauseating feeling of disgust.

It’s a good thing that those haunting faces are on the other side of the surgical ward. I’m looking directly back at those past surgical consultants that gave me such a hard time last year, from the desk of the orthopaedics team.

For the mean time, I’ll be looking after bones, joints and wounds, as opposed to botched up colon resections, dehisced surgical wounds, and bladder to abdomen fistula-from-bad-surgery (all of which I really did encounter during my surgical time last year) thank you very much.

Our orthopaedics patients are few in number (sometimes only 5-6 on the ward), generally quite well post op (joint replacements – what can go wrong?), and have far fewer comorbidities. Our team is fairly large too (3 residents vs 4 for surgery, but much fewer patients, and way less clinics).

Some of my registrars still suck, with one even being a registrar from last year. He assigns some of the most time wasting tasks for me, at one time, phoning me up and slowly dictating all the patient details to me so that I could write up a theatre booking form. It was painstakingly slow, dictating the patient’s name, and at times, missing a few letters so that I’d ask him to repeat again. Makes me question the registrar’s judgement in that firstly, it would be much quicker for him to fill the damn form out himself, and secondly, he’s not only wasting his time, but also the resident’s time, therefore wasting two people’s time.

Some things in orthopaedics remain the same as surgery however. The mad frantic rush in the morning ward rounds as we jump from patient to patient, and the unclear plans for VTE prophylaxis, as each consultant likes different VTE prophylaxis use. On the other hand, a lot has changed too. There are way fewer MET calls on our side, or constant requests to review unwell patients, and way less phone calls from other staff hurrying us to get certain jobs done.

Yeap, I enjoy orthopaedics way more than surgery. I’m just thinking how much it sucks for the surgical residents now, but I can empathise with them at least. Been there, done that.

My Chinese Put to Use

I learned mandarin out of interest, and till now, I’ve still felt that my Mandarin is still extremely limited.

Words in my vocabulary were probably limited to basic things like “我很 高兴认识你” (I’m pleased to meet you) and “你的电话号码是什么?” (what is your telephone number?)

I never expected to conduct an entire medical history in Chinese!

I tried to ask questions in English, which were met with a blank stare. “You speak Mandarin?” she asked me.

I knew I couldn’t avoid it. So, I replied reluctantly “我的中文不太好” (My Chinese isn’t that great.)

In the end, it was a great learning experience, and a chance to test my Chinese out. The patient understood my mandarin to a large extent, and I was able to tease out the main reason for her presentation; namely, that she had numbness and tingling of her right arm, secondary to repetitive manual labour as part of her farming work.

Performing the Tinel’s test and Phalen’s test helped me to confirm the likely diagnosis of carpal tunnel syndrome, which I couldn’t translate in Chinese, but for which the use of my $2 Chinese dictionary saved me a ton of effort.

I learnt a new word that day “麻痹“ (numbness). And that patient taught me that my mandarin is better than I thought it was. 2.5 years of mandarin, and I could conduct a basic medical interview. Now, that made me very happy 🙂

Things I Learned in My Surgical Term

I have avoided writing about my surgical term until now (re: I have been too lazy lately to post much to my blog). It was a time of stress, a time of dread just thinking about work, and a whole lot of hard work with very little appreciation of the efforts put in at work.

Here are 5 of the things I learned about surgery during my rotation:

1. The consultant will blame you for things not going smoothly (read: the consultants are control freaks)

One particular patient seen during the ward round, was only being kept in because of his rising LFTs following a cholecystectomy. If his LFTs were fine, he could go home. The consultant decided to blast me vigorously about my lack of proactiveness in not asking the 6am phlebotomy blood rounds to have taken bloods from this patient so that we could discharge them during the ward round. The only problem: there are no 6 am phlebotomy ward rounds, only the 8 am rounds, and by the time they get to the surgical ward, it’s not till at least 9 am. Conclusion: my consultant is a control freak, and terribly clueless about the hospital schedules.

2. Hard work goes largely unappreciated. It’s all about results at the end of the day.

Despite us interns constantly working 2 hours overtime each day, some of us were told that we treated our jobs like a “9-4” job. We were also slagged for how little discharge summaries we were doing (since we were way too busy with lion’s share of ward work), yet the registrars got more discharge summaries done (the overnight registrar usually has a bunch of time to do them).

3. A met call on surgery doesn’t get you any senior staff – you’re pretty much on your own

My first met call ever was in surgery, after a patient’s legs gave way. Only 3 nurses and another intern attended the met call. Registrars and consultants were no where in sight. Fortunately the incident was fairly minor with only some torn skin (ouch).

4. The sickest patients should be looked after by the least experienced (interns)

Surgical patients are some of the sickest patients in the hospital. Most are elderly, with several comorbidities, and who have gone through some extreme surgery starting with “radical” and ending with -ectomy (ie a major major operation). Subsequently, nurses would constantly be asking interns to review patient A or patient B because of fevers, reduced urine output, high blood pressure etc. Being interns of course, we had hardly any experience with these patients, yet were expected to deal with them. Registrars were no where in sight again (see 3).

5. It’s teach yourself surgery.

Not once did any registrar sit down to properly explain about why we are managing patient A with such a management plan. We had to figure everything out ourselves by reading, and by experience. Asking questions were met with raised eyebrows and judgemental questioning of  “shouldn’t you have learned that in medical school already?”. The worse thing: registrars claiming how much you learnt at the end of the rotation due to their excellent teaching.

So there you go. A list of 5 things that surgery taught me. May I never have to repeat that again.

Experience Comes With Time

It’s always been said that experience comes with time. That’s something you can’t rush, as it takes exposure and learning from mistakes before things become ingrained into one’s repertoire of knowledge and skills.

And so, that’s what I’ve realized the beginning of this year. That I have definitely gained a year’s experience of being a doctor.

It’s strange in that going through my rotations, I always felt in a way that I wasn’t making much progress. I’d get familiar with a rotation, start to get comfortable, and then bam! It’s time to move onto the next rotation, where I am completely unfamiliar with the environment, and the jobs that I’m supposed to do. And it’s from the fact that I’m always moved to new units and wards that keeps making me feel like I have made no progress at all.

It hasn’t only been till the beginning of this year, where I am currently in Emergency rotation again that I can actually feel the progress I have made from last year. Taking a history is much smoother, as I am familiar with certain presentations and know what questions to ask, what differential diagnoses to consider and what relevant investigations to order.

What also surprises me, is how my just seems much more organized with things. Last year, I relied on a clip board and paper, scrawling almost everything the patient told me. This year, I still bring a clipboard and paper, but find that I spend more time listening to the patient, and only note things down that I will forget like a list of medications, or a list of their past medical history. I’ve always been in awe of the doctors that could take a history without a pen or paper, and recall nearly everything about the patient history. I thought they possessed some super human memory capabilities, something that I was lacking in. But I feel a step closer to that now 🙂

Another thing that happened last night, was when the consultant told me I did a “good job” at the end of my shift. I had never been told that last year, but being told that last night really made my day. It was something I never would have expected, not the least in the Emergency Department anyway.

Taking from all this, the past year has definitely given me some experience. I’ve learned from mistakes, I’ve become familiar with common presentations, I’ve gained some experience. And now I can see why most consultants have grey hair. It’s taken them a lot of time and experience to get to their position, and it isn’t something that can be had overnight.

Deja Vu

Wow, it has certainly been too long since I wrote in my blog. Christmas came and went, as did new years, yet I hadn’t written a thing in my blogs.

These past few weeks have been both relaxing and busy. On my medical rotation, the consultant was busy admitting a lot of patients, so I was kept busy. Ridiculous hours ensued, with me leaving on most days around 6-7 pm. It didn’t matter; I felt I learned a bit, and the work wasn’t very stressful, so I felt ok with it.

Today felt like I was coming back from a long break. I had a total of 6 days off work, before going back into ED. And what deja vu I got. I felt like I was repeating things from 4 months ago – same environment, same senior ED doctors. Except now I was writing JHO at the end of my name. Yeap, it’s officially the first day that I’m no longer an intern anymore. I’m a fully registered doctor. But I’m scared. Scared that I still don’t know enough about medicine. Scared of the night shifts that I will be doing in about a weeks time, where there will only be me, another resident and a PHO managing all the patients from 10pm until the next morning. I don’t feel ready. I don’t feel ready at all to be managing a large patient work load.

The other deja vu feeling, was walking into the kitchen area and toilets. Reminiscing the feeling of feeling extremely lost close to 6 months ago. Lost in the work I was doing (because I had no clue what I was doing) and feeling lost personally (due to breakup with girlfriend). Walking into the toilets gave me a momentary feeling of feeling lost again, and I realized how lost I felt half a year ago. Dread would fill me up at work, and I couldn’t help but feel despair on some days, and hopelessness. The only hope I held out, was that the pain of heart break would be temporary, and the suffering of the nature of my work would soon be ending as well. They were tough times I remember.

I still don’t know how tough round 2 of ED will be, but I feel more confident in myself. Perhaps it’s the experience in the past year?

My aim for this year, would be to write more regularly in this blog (at least twice per week). It will give me relief from the stresses of work, let me speak my mind, and let me see things from a new perspective.

I guess it helps that on ED, at least I get to go home on time 🙂

Hitting the Books Again

A lot has happened in the last few weeks. I’ve been too busy trying to sort through work related issues to have had any meaningful time to myself to blog and to relax. It’s only this past week that I have had a taste of working in a more relaxed and less chaotic environment.

And with this more relaxed and less chaotic environment, I’m actually wanting to do more study, and wanting to hit the books. I actually feel like I can start to sit down, and learn a few things from what I encounter at the hospital. My previous rotations were way too draining for me to get into a good mood for reading.

I’m spending more time with my Oxford Handbook of Clinical Medicine, and the small Harrison’s book. They give me great information about general medicine. Reading in itself to learn about the information feels much more different than as a student however. As a student, I was reading because I had to for exams. Now, I’m reading because I want to. It’s a way for myself to expand my mind about things related to medical.

I get up early in the morning, and I start to read. I think I might incorporate some meditation before starting the books. Meditating early in the morning is just tranquil… It will help me to get in the zone. So, I usually wake up around 5-5:30 am, do some reading, breakfast and preparing for tonight’s dinner, and then 7:40 am, head off to work. It means I can get at least an hour or so of reading every day.

With my new tablet, perhaps I can create some flash cards to reinforce the stuff that I have read up on? And perhaps I could read the PDF files I have on my new tablet as well. I’ve never felt more motivated to read about medicine than before, and I attribute this to work stress. When you feel stressed at work, you come home and don’t want to study, because you don’t want to be confronted by more work related stuff. I guess it’s kind of like chefs who come home, and don’t cook dinner, because they’ve been cooking all day.

Well, reading up on medicine will hopefully give me some much needed knowledge about things, since I feel that my previous rotation taught me nothing much, except how to handle chaos, and how to survive against ruthless consultants. More about that on another day…..

Drinks with Registrars

It’s funny when I went for drinks with my registrars. When alcohol is involved, they say all sorts of funny things. Things that were not quite appropriate, given our professional relationship.

The talk involved things more than just about medicine. It started off about the bizarre and funny cases that they saw during their time at work, and then it went on to gossip about other colleagues, things like how much one colleague in particular always waffled on, giving very little clinical details in their presentations. And then another gossip about another colleague who got a needle stick injury.

This later evolved into talks about the dating scene, relationship statuses, and how they had done one night stands and all!

Then they talked to me, about how I was still young, and should enjoy life as much as I can, how I should also go find someone else for a one night stand!

I enjoyed seeing how my registrars were so open and inappropriate in what they were talking about. That’s what alcohol does I guess. Me – I hadn’t had a drop of alcohol that night (I don’t drink). But it’s interesting to see what alcohol does to people – namely, they lose inhibitions, they talk about inappropriate things. And my registrar was so professional at work, a bit serious at times too.

I’ll never forget about that time my registrars talked to me about one night stands….

That Bastard!

Meeting up with a colleague for dinner a few nights ago, I was reminded of how smooth life can be at times. Here I was, little worries (since it was after work) and chilling at dinner with a friend.

My friend looks at me with a serious expression on her face.

“I’ve got something to tell you, but please don’t tell anyone else.”

“Yea, sure” I reply casually.

“You know X, one of our colleagues from the Emergency Department? She has resigned due to the pressure put on her by one of the consultants. She’s now got depression. I saw her at the supermarket the other day, and she looked like a lost soul”

I looked at her with a bewildered expression. I remembered that colleague. She was nice and friendly, although I had only spoken to her like 3 or 4 times. I thought back to my interactions with that particular consultant, and reeled with disgust. He often put the junior staff down, and humiliated them in front of other doctors. I hated presenting cases to him, because he would constantly interrupt my flow of thought, and point out my mistakes. He was rude and disrespectful.

I felt sad too for my colleague who was now suffering depression from such a horrible human being. I couldn’t imagine what suffering she must have put up with, the tortures of putting up with such a man.

My friend and I both sat in silence for a while.

We both hoped karma would come back and get this man for his horrible actions. I don’t know what else to do to help. I felt wronged by this man, and I’m sure several junior doctors have suffered immensely from him as well. But I don’t know what to do. The environment in ED is just toxic, and days have come and gone where I question my abilities, I question why I am still doing medicine.

Are there things we are just supposed to put up with such as these? I’m going to be dealing with this man again probably next year. If I report him early and he loses his job, I won’t have to see him again next year.

I don’t know what to do.