Tuesday, January 1, 2019

Goodbye, 2018

I hadn't realised we'd reached December 31st already. All day I'd been writing the date in ward round notes, but only realised late this afternoon that it's the last day of 2018. And so, with only an hour of 2018 to go, I shall attempt to summarise the year as comprehensively and eloquently as I can.


To be frank, it's been an awful year. 2018 has brought a lot of loss - deaths, heartbreak, and everything else. My grandmother died after a bout of pneumonia that had necessitated ICU admission; she'd kept wanting to go home, and managed to do so before breathing her last. A primary school friend (who had been my age) died of metastatic cancer, which he'd told only a few about. I learnt that people are essentially self-serving beings, and will hurt you for their gain when push comes to shove, no matter how much they love you. Many bad things happened this year, and I almost can't believe I came out the other side intact.


When I say it's been a bad year, people automatically assume it's because of work. This is ironic, because for a long time, work was the only thing keeping me going. Sure, internship has been difficult, but I've loved pretty much every bit of it. I've learnt, done, and experienced so much, and it's amazing to see how far I've come compared to when I first started out. Internship has cemented my belief that medicine really is for me - it's something I love and am good at and can see myself doing for the rest of my days. I have also reaffirmed my love for Medicine (ie Not Surgery) over the past year, and am excited to begin Basic Physician Training (BPT) next year! Work has been hard but good, and I am so thankful to be doing something I love every day.


Of course, many good things have happened over the year as well. I saw Ed Sheeran in Melbourne in March, and he was absolutely incredible (how is one man, a guitar, and a loop pedal enough to captivate an entire stadium full of people?!). Over the Easter break in April, I went to Brisbane for the first time and loved it...and ended up getting a Brisbane job offer later in the year! My sister graduated with a dentistry degree in November, and I went home to attend her convocation; we're all very proud, and I know she will make an excellent dentist. Christmas was spent with friends in Hobart, and our gracious hostess with the mostest/Masterchef extrordinaire cooked up a seafood feast fit for pescatarian kings. There has been much to be thankful for in 2018.


Since signing my contract with Queensland Health, I've been doing my best to make the most of my time in Tassie. This year I've done more walks/climbs than I have in all my six years here - Cataract Gorge, Tamar Island wetlands, Quamby Bluff, St Patrick's Head, Narawntapu National Park, and Mount Wellington. I also went to see the tulips at Table Cape, stopping at Anver's on the way there (yum) and Van Diemen's ice creamery on the way back (double yum). Several Hobart visits were made this year as well, each one involving good food and even better company. In Launceston, we've had a fair few dinners, potlucks, and even a steamboat/hotpot session, spending time together before we all go our separate ways. I'm trying to meet up with as many people as I can before leaving; it's extremely exhausting for this introvert, but I know it'll be worth it.


All in all, it's been a rollercoaster of a year. 2019 will see me in Queensland, working at a much bigger hospital and starting BPT. I know hardly anyone in Queensland, but like to think I'm a fairly nice person, so I should make friends relatively quickly. It's scary, but also really exciting, and I can't wait.


Bye, 2018. You've been terrible. Please never return.


Hello, 2019! Bring on the fresh start!

Thursday, December 20, 2018

To the new interns

Congratulations! After many gruelling years of study, you've obtained your MBBS and are now a real live doctor! It's an accomplishment to be proud of, and I hope you and your loved ones celebrated accordingly at your graduation. Right now you're probably enjoying your uni-free, work-free days; maybe you're even in the midst of a family holiday. All too soon, though, you'll be making your way into the hospital, perhaps a little nervously. It will be time to step into the role you've worked so hard to earn - time to be a doctor.


For the first few weeks or so, being called 'doctor' will feel incredibly strange. And why wouldn't it? Just a couple of months ago you were a mere medical student, and you're now somehow a doctor despite being the exact same person as you were back then. Don't worry, doctor - you'll get used to it. Everyone desensitises eventually. After a while, you realise that your title only matters in the sense that the nurses need you to document something, you're the one who writes in the drug charts, the patients and/or their families want to speak to you. You grow to accept that these tasks are yours, because you are the doctor...and somewhere along the line embrace the title that you initially struggled to accept.


Of course, with great title comes great responsibility (Stan Lee just rolled in his grave). Probably every intern's worst nightmare is killing a patient, and I'm sure we've all heard the cautionary tales/urban legends regarding this. The prospect of now being able to prescribe medications and perform simple procedures unsupervised can be slightly terrifying. To be honest, I believe this fear is good - it makes us check and double check, and keeps us accountable for our actions. To those who find their fear excessive and difficult to deal with, here are the wise words of a Med reg to her new intern: "It's actually quite hard to kill a patient". Realistically, the chances of you killing a patient when you're working with a team are lower than you think. You're just the intern, so you mostly just carry out the consultant's plans. Anything you're unsure of, you run by the registrar. Nurses and pharmacists will be your saving grace many a time by quietly pointing out an incorrect dose that you've charted in the drug chart. There are almost always safety nets against human error, and there is always help available. Don't be afraid to seek it out!


When you can, try to help out your fellow interns as well. The first few months of internship is tough for everybody, and just checking to see if someone's eaten or if they need a coffee could mean a lot to them. Many people forget to eat; some tell themselves they don't need to, which is worse! My first after hours Med shift was particularly nightmarish - the calls kept coming, the jobs list was endless, and one patient deteriorated for no discernible (to me, anyway) reason and ended up in ICU. I was stressed out of my mind and hadn't eaten in nine hours. While sorting out the pre-ICU patient, the Med reg took me aside for a stern word. I needed to eat, they said. The hospital wouldn't fall apart if I took fifteen minutes to sit down and eat. If anything bad happened, the nurses would call a MET or a code. Also, if I didn't start taking care of myself now, how was I going to survive later on in my career? They wanted me to go eat, now, and send them a picture of my dinner so they knew I'd done as they said. It was all I could do not to bawl in front of them, I was so touched. A little act of kindness really does go a long way. Check in on others if you can - it might mean more than you know.


Speaking of crying, you will probably do that at some point during your internship. If you're someone who's prone to tears, you're going to cry a significant amount this year. How much, you ask? Well, try to guess how much you're going to cry over the next twelve months; multiply that by five and that'll be the rough figure. As a doctor, you're going to witness or be involved in many difficult situations - death, aggression, resuscitation, grieving families, breaking bad news. It will be hard, and sometimes extremely emotionally taxing. After a particularly bad day, try to do something for yourself, something nice that's just for you. Have a nice dinner. Go on a long walk or drive. Watch a movie. If you want, find someone to talk to and get things off your chest (fellow interns are great for this, since you're all in the same boat). Take care of yourself, particularly when the going gets rough. Remember, you took an oath!


Internship can be hard, but it can be wonderful. At the end of the first rotation, you'll look back and marvel at how far you've come; at the end of the year, you'll be amazed by how much you've grown as a person and as a doctor. The learning curve is scarily steep, but exciting in its promise of exponential growth. There is so much to learn, so much to explore, so much to do - you are a ball of pure potential, unmarred and unjaded, ready for what the next twelve months will bring. I hope you will find your internship rewarding and fulfilling, and learn and grow incredible amounts. Be brave, be humble, and be compassionate. You will do great.


Go forth and doctor!

Thursday, November 29, 2018

Home is where the hargow is

Just kidding, I actually prefer siumai.


I've been back in Malaysia for two weeks now, and it's been wonderful. The weather's been pretty good, I've been eating better (or worse, depending on how you look at it) than ever, and no work means having the time for far more regular exercise. Sleep comes easy, and I awake well-rested, revelling in the fact that I can get out of bed whenever I want. Mentally, I'm better than I've been in a very long time - I feel calm and happy and relaxed and rejuvenated. It's amazing what a holiday can do for you!


Spending time with family and friends this visit has been incredibly valuable. This year I've been a little bit 'out of sight, out of mind' - it can be hard to think of things other than what you're directly faced with when you're faced with so much. This resulted in minimal contact with anyone back home. Talking and reconnecting with people reminded me that there are so many here whom I love and who love me, and neither geographical location nor (in)frequency of contact will change that. It was quite heartening, to say the least, and I am very thankful.


The other special thing about this visit is the fact that I visited all four grandparents. My grandmother passed while I was away, and I didn't manage to go back for her funeral. I made it a point to visit her grave to pay my respects when I came back. She had been buried beside her husband, my grandfather, so I was able to visit them both at the same time. We hadn't been able to communicate much due to the language barrier, but Ah Neh always made sure we were well-fed and watered, and somehow (she had so many grandchildren!) always remembered to give me an extra birthday angpow every Chinese New Year as my birthday usually fell around the same time. I had a hard time equating the plot of land before me to my grandparents, so I looked around for a bit. The cemetery was a lovely place, well-kept and peaceful and green. A respectful sort of quiet covered the area - it gave no sense of creepiness or unease. I was glad that everyone there had such a beautiful final resting place. It was a nice place to be.


On perhaps a less morbid note, I've been doing a lot of eating. I've missed noodles a lot, I realised. Why do people like rice so much? Rice is just rice. When it comes to noodles, though, you've got dozens of different types, and they all taste different! There's bihun, mee, loh shi fun, mee pok, egg noodles, kuey tiao, laksa noodles, mee sua, ramen noodles, pan mee noodles/strips, tang hoon... There are just oodles of noodles, and I love them all so much. My favourite is probably chilli pan mee, and I managed to visit my go-to place, Super Kitchen in SS2, twice this trip. Also, I've decided that my go-to place for dim sum is Jin Xuan in DJ and my banana leaf rice go-to is probably Sri Paandi near Samad. The latter is where I had Indian apom for the first time, and it blew my mind how something so simple could be so delicious. Maybe it was the sweet, watery santan dipping sauce.


I've also had lots of local fruit! Twice now I've gorged myself on duku langsat, which I'd sorely missed. I've also had longan, jambu air, papaya, pineapple, and mango, all of which were delicious. It's true that I'm going back to Australia where a variety of fruits are in season, but I'm going to miss the fruit here. Few things compare to biting into a jambu air straight from the fridge on a hot day.


I leave on Thursday night, and will be starting night shifts the day after I land. (You can see why I find leaving to be incredibly unappealing.) Still, I can't complain - it's been a really great two weeks, and I'm probably as refreshed and recharged as I'm going to get. I am grateful for the time I've had here, and will try to focus on that rather than my reluctance to leave...which is quite great, to be honest, but I'll do my best to be positive. Hopefully.


Thanks for an excellent two weeks, Malaysia! I will miss you and your food quite dearly. See you again in 2019!

Sunday, October 7, 2018

Emergency!

Hello, blog! The time has come again for me to wax lyrical about how quickly the past three months have gone.


This time might be particularly interesting because I have been smitten with what is probably the worst case of pharyngitis in the world, so I am writing from within a weird fever dream-like fog. I have had several fever dreams in the past few days; they were very strange but also very real. I left several messages unanswered for a few hours as a result because it was hard to tell what was real and what wasn't, and I didn't want to be texting someone based on a strange dream I'd had that involved them. Text responsibly, friends!


Anyway, the past three months have not been an easy three months for a number of reasons, none of which I wish to write about. What I do wish to write about is my time on ED, which has actually been pretty great. It was a rotation that had received glowing feedback from most interns before me, so I was quite keen to start. Also, I was glad that we had a pretty good group of interns on the rotation, as it would make for easier shift-swapping and far more enjoyable shifts. It was looking to be a good rotation!


My aim on ED was to see as wide a variety of presentations as possible, as well as to get some procedural skills in. Looking back, I can pretty confidently say I managed to do both these things. I've seen Paeds, O&G, Psych, Gen Surg, all manner of Med, and even Ophthal cases! Trauma, both exciting and unexciting, was a common presentation; I even got to do some suturing, which I was super excited about. The bosses were wonderfully encouraging, talking a few of us through cardioversions and maintaining the airway during these, and letting us take over as they supervised. Towards the end of the rotation, I managed several Cat 2s (which I'd been terrified of doing at the start of the rotation), and was involved in a few resus cases. I think it's the resus cases that I really want to talk about.


It's a well-known fact that every doctor in the hospital sort of hates ED. They're an easy target, really. The jack-of-all-trades ED doctor wouldn't be the best at managing a complex patient before referring them on to the relevant specialty, which is often a cause of disdain from other doctors. There's also the fact that these referrals are being made in the first place, which means more work for the accepting team, and nobody likes being handed more work. People start to see ED as nothing more than a glorified triaging service, which is unfortunate, because they don't see what goes on apart from these referrals. And there is a lot that goes on apart from these referrals.


The most impressive thing has to be resus, or resuscitation. The first time I watched a cardiac arrest resus, I was awestruck, and the feeling has stayed with me since. Good resus cases are a sort of organised chaos, and things run like a well-oiled machine. People are assigned tasks, others stand back until something else needs to be done, and the team leader watches over everything and gives the orders. Airway. Breathing. Circulation. Disability. Exposure. Correct things that need to be corrected. Is the rhythm shockable or non-shockable? Then to rule out the 4Hs and 4Ts - the BSL's been done, so someone run a gas and someone else grab the ultrasound machine to check for tamponade. It's so quick and concise and systematic, and there's an electricity in the air like nothing else I've ever felt. Resus is amazing.


If you think about it, isn't that really what ED is for? Actual emergencies? And if ED handles these things and handles them well, I'd say they were doing a pretty good job. (I don't know. Maybe I'm young and naive and biased, and will change my mind once I become a jaded Med reg. We'll see.)


Of course, while resus is the bread and butter of ED, it is hardly the most common patient presentation. You would think that you'd see many emergent cases in the Emergency Department, but that was very often not the case. Ambulances get called for a variety of non-urgent things, which really gets my goat. One time I had to take deep breaths and calm myself before seeing a patient who had effectively called an ambulance for five hours of diarrhoea. They brought him in because he had a complex medical history which included some bowel problems. It came to light, however, that the reason he had been having diarrhoea was because he had been taking an unreasonable number of laxatives.


Never, ever assume patient intelligence. Ever.


The other thing I learned while on ED is that people like putting things up their butts. We had two such cases while I was there (both sex toys, I think), and the x-rays caused quite a bit of excitement on the floor. The unfortunate ED doctor who took the first case accidentally switched the toy on while attempting to manually remove it; they then gave up and rang the surgeons. It was hilarious, and can you imagine the documentation?! You won't get this anywhere other than ED!


It's been a really good rotation with a really good team, and I'm quite sad to leave. The only thing I didn't enjoy about it was the shift work, but then my next rotation consists of shift work too (boo). I will miss the complete lack of pretentiousness, not having to think about what to wear, the wide variety of patient presentations, the 2am food trolley, and the engaging bosses. Thanks for a great term, ED! Tomorrow, I begin shift work on a medical ward. After three months of scrubs, I can't seem to remember what work-appropriate clinical attire means anymore...but I'm sure I'll figure it out. Come at me, AMU. Last rotation, let's go!

Friday, July 13, 2018

No scrubs

I don't actually know what that line in the song means, but I thought it a fitting title for a post on finishing Surg.




Surgery has never been particularly appealing to me. I find anatomy tedious, have zero visual-spatial intelligence, and detest 30-seconds-per-patient ward rounds. Sure, Surg had been great as a student - I learned a lot and had no responsibilities. Also, I was only there for six weeks or something. The idea of living the #surglyfe for three whole months as an intern struck fear in my heart, to tell you the truth. I mentally prepared myself for long hours in a rotation that I cared little for, and bade the sun farewell (you're in the hospital well before the sun rises, and only head home after it's set).


There were some positives, though. I had been assigned to Breast and Endocrine, which meant I wouldn't have to be overly invested in patients' bowel habits/stool consistency (sorry, Colorectal). Breast and thyroid surgeries are generally pretty neat and quick, so no standing in theatre for hours on end assisting with complicated bowel resections or Roux-en-Ys. Also, thyroid and parathyroid surgeries meant at least some degree of medical learning, which this medically-inclined intern was grateful for. I'd been talking to a locum Psych reg (originally a Med reg) about starting Surg, and he said it wouldn't be so bad since interns dealt with patients' medical problems on the ward anyway. It had been a random, brief conversation with someone I might not ever meet again, but this was something I held on to throughout my time on Surg.


As the only non-surgically-inclined person on the team, I did my best to take care of the medical side of things. My biggest triumph was figuring out the cause of a pre-op patient's newly-diagnosed AKI after trawling through their drug chart, bloods, records, and taking a history. I would look through patients' histories and read up on the weird and wonderful diseases I encountered, just to get some medical learning in. Pre-op was great in terms of examination -- I learnt to listen for the prolonged expiratory phase in patients with known COPD, and got to examine Grave's patients with exophthalmos and good-going thyroid bruits. I also picked up a loud systolic murmur in a toddler, who went on to have a paediatric echo to look for structural abnormalities in their heart. And all that was just the non-surgical learning!


In terms of Surg itself, I also learnt heaps. A large part of being a Surg intern is managing electrolytes -- potassium and magnesium are the main concerns, but you're also worried about calcium when you're on Breast and Endocrine. Isaac was constantly writing up minibags, and I soon started calling him the electrolyte king. The other thing you get pretty good at is prescribing analgesia. Initially, whatever your boss says is gold and you just chart that, but then you occasionally overhear anaesthetics raging about charting (or not charting) a particular med, so you take that into account and slowly begin to formulate your own approach to analgesia. My two main takeaways: Long-acting analgesia should not be used for acute pain, and tramadol is the one thing that can definitely be used with a PCA. In addition to all that, I got to help out in theatre a bunch, and once did a close-to-perfect subcuticular stitch closure of a breast lump excision wound. It was beautiful and incredibly satisfying, and that was probably my proudest moment on Surg.


My favourite part of Surg, however, was the people. We had a great bunch of regs this term, and also a great bunch of interns. The doctors' office was always abuzz with activity -- paper rounds, general chatter, and everyone teasing/bullying Sarah. (Things got a bit confusing at times with two Sarahs and sometimes two Rachels, but we got over it.) The office was a narrow, stuffy, usually overcrowded room, but I already miss the good times we had in there. Like when an unnamed individual nearly gave himself a concussion. Or when the same unnamed individual somehow mysteriously ended up having his face plastered over the screen of every computer in the room. Or hilariously awkward Shoot Shag Marry sessions. Or 'superstitiously' planning but not planning basketball sessions. Or asking each other why they were still there and why they hadn't gone home yet. Or commiserating with each other because we were both still there and both hadn't gone home yet. Ah, the memories!


Of course, I'll miss my team as well. Isaac and I genuinely worked so well together -- it got to the point where if one of us was scribing and our phone rang, the other would silently reach for the phone to answer it, no prompting required. Jobs were completed quickly and efficiently, which meant we got to spend time in theatre. Our reg was an excellent leader, and I was constantly admiring his patient rapport. Also, thanks to him, we almost never had to come in before 7am, which is a huge blessing in the world of a Surg intern! The big bosses were an absolute pleasure to work for, and continuously showered us with surgical teaching and homemade food. It was such a fantastic team, and I will miss it very much. This is possibly the last Surg rotation I will ever do (woo!), and I'm thankful to have had such a great experience.


I've just started on ED, and found it to be a stark difference from Surg. Far less walking, for one, and also far more snacking in an attempt to stay awake (thanks, shift work). This does not bode well for my weight. However, I will theoretically have more time for gym, so hopefully this will help offset the extra food intake. My first day on the floor was kind of insane; so insane, in fact, that it actually made the news. I've just finished my second day, which went far better. All the bosses have been really lovely and supportive, and I've decided that ED nurses are my favourite nurses in the whole hospital. It's looking to be a good rotation, and I'm looking forward to the rest of it.


It's sort of ironic that I've titled this post 'No scrubs' as a farewell to Surg, but we actually wear scrubs in ED as well. But whatever. I thought it was clever, so I'm running with it.


NO, I DON'T WANT NO SCRUBS
(Bye, Surg!)