Things I have learnt about myself so far.

I had a conversation with my flatmate whilst on nights which went, in part, as follows:

"How was your night?"
"It was okay. One went to ICU. The one from ICU last night died after I started my shift."
"Oh no, that's terrible!"
"Yeah, sadly we couldn't fix him."

This gave me pause for thought - to me, it was just a casual conversation about work, but to my flatmate, it was really a big deal that someone had died. Which of course, made me wonder - have I stopped caring about the people I meet and look after?

When I first started freaking out about "being a doctor" in my final years of medical school, I was more worried that I would be too emotional and burn out caring about everyone. This was probably true right at the start, but wallowing in guilt whenever something bad happened and having existential crises whenever a patient died thankfully resolved itself in the first 6 months of work.

The reason that this man dying didn't make me go "oh, that's horrible" the day after I'd watched him go from "a guy with constipation" to "probably a perforation", was because there was nothing we could do to make him well again. Thus, the "best" outcome was that he was kept as pain-free and undistressed as possible at the end of his life. I honestly think I did the best that I could for this man in the set of fairly crap circumstances he was thrown - and because of this, I don't feel upset because he died. It was still sudden, and unexpected, and a crappy set of things for him to have happen - but I don't feel the need to mourn him or break down in tears because of it, because at the end of the day, we did the best we could with what we had.

So - I haven't had some big lightbulb moment or extreme revelation. I don't think I've stopped caring. Instead, I think that I've just gradually come around to appreciating the positives of being alive, the things that I can do, and the way that you can make a difference, even if you can't always change things to how you want them to be.

You should read this.

One of my friends has started a series of blog posts about her JRA, which can be found here.

Part 1

Part 2

Having had the privilege of knowing her for a number of years and talking to her a fair amount about her arthritis and the associated frustrations that come with it (side note: not everyone is your patient, but having friends who take meds that require a special authority number means that you will invariably talk to them about why they're on it) I'm incredibly impressed that she's started writing about her own journey and made the effort to share with others. 

I'm usually skeptical about "promoting awareness", mainly because that goal is used indiscriminately of the actual issue at hand and possible solution(s) to the issue(s) we are "promoting awareness" about, but given that she's had to deal with crap like being flat out told she was lying about having arthritis and pain for pity/attention, I think awareness is the right goal in this case. Plus, there are conditions that are far easier to lie about that don't involve having to take methotrexate or prednisone.

Gratuitous cat pictures

So I don't actually live with Nala any more, but I do go visit her from time to time - here are some of the highlights from my last visit.

Demon kitty eyes. Look at that winter coat fluff! :3

Kitty cuddles (under duress) also paws.

Like me, she's not a huge fan of hoppy beers.

Playing with the chair and a bit of paper. Also, dat tail.

And of course the cutest photo for last.

...I totally miss living with her.

Continuity of care/the privilege of being there

Recently I experienced something that made me feel very privileged; I got to be there for someone.

Sounds weird, right? Like... that's what we do. We're there when people are sick, as they get better, as they come in and leave hospital - we're there, in the hospital. But with this lady's journey I was there for all the key turning points, from the moment she arrived on my ward until the moment that she unfortunately did not leave hospital. I was there to watch her recover from her initial injury, and there when she got more unwell. I watched her recover from the second setback, and told her off for not telling the nurses when she was in pain. I was the doctor who reviewed her and panicked and kept the registrar busy for 3 hours the Sunday she had a heart attack. I was there when we told her family that we couldn't fix her, with all our technology and fancy drugs and medical treatments. I was there two Saturdays later, two hours after her daughter returned from overseas, certifying her deceased. 

In the hospital, we usually don't see all of our patients all of the time. They get sick; they get better. They get reviewed, they get fixed by the nurses and their own determination, or you come into work the next morning and they aren't on the list. But for this once, I managed to be there, and it honestly felt like a honour.

Sh*t doctors say and medical pop quiz

-"Lungs are good, air's going in and out"
-"There's a whole lot of noises in the chest."
-"Abdomen distended. Likely usual for patient and secondary to excess abdominal adipose."
-"I'm just going to have a poke around here"
-"I'm just going to have a feel"
-"This won't hurt me a bit"

A medical registrar walks into the Emergency Department with a feeling of impending doom.
Is this registrar:
a) going to see a patient
b) starting on nights
c) on the way to work
d) having a pulmonary embolism
e) having a dissecting aortic aneurysm
f) realising how long they've been at the hospital today
g) about to have a panic attack
h) 1 month out from exams
i) about to have a seizure

House officers say the darndest things

(So do consultants, but I'm not quite sure that I should quote them here.)

These are not my finest moments at all, but somehow I'm still employed despite these pearls of wisdom.

"Ooh, he has bones!" - reviewing images of a tagged white blood cell scan
"It's because his brain is like polkadots on his MRI." - describing multiple previous infarctions and extensive small vessel disease in an attempt to explain why I wanted OT to do a cognitive assessment.
"This patient's breath sounds are gurgly" - to my registrar
"There's a fluffy bit over there" - pointing out ?right lower zone consolidation on an x-ray
"Sorry I couldn't find a torch, the med student didn't have one" - also to my registrar
"They look squishable and there's no arrows, he must be fine" - describing images showing venous compression on leg USS to rule out a DVT.
"Oh crap, I'm calling the registrar." - said far too often on evenings. I love the registrars.

Breaking bad news.

I survived my first week of doctoring!

(just)

I can manage day work fine, as there are two house surgeons on the team and the other one (not me) is boss at lines and things, but evenings. Holy. Crap. I pretty much flailed around uselessly and left the night float to clean up (at least that's what it felt like) and hoped I didn't poison anyone. And I certified my first dead person, which was the easiest task all evening.

I'm pretty sure this is okay to upload to the interwebs, since the public can see it when I'm in the hospital anyway and it's about the best ID photo I've ever had.

Ketoprofen, klacid, and K+

I finished my elective in Singapore today, so rather than bore (or amaze you) with all the things that I saw/did/hid from I am going to highlight some of the main differences I found between the system here and the system in NZ. And post some pictures of pretty but unrelated clothing.

Alexandra Hospital photos and an oooooops....

Pathway up to the hospital. It's been drizzly the last few days so we haven't had quite as many patients.

Beautiful grounds and gardens...you can just see the front of the hospital through the trees

The hospital has some artwork on the walls. Some of them have fuzzy flocked patterns on them.

So, this used to be a treadmill test. Then it got knocked off the table and into the shredder...
 By some freak coincidence, it was at exactly the correct angle to get stuck in the shredder. And the shredder was on. And working. Here is the end result.

House officer's worst nightmare...

Protip: it is not advised to put original copies of patient documents in shredders, especially when the one and only copy of the consent form is attached.