Tuesday, December 31, 2019

Goodbye, 2019

Welp. From the memes and pictures being shared around Facebook etc, it appears 2019 was a rough year for most of us. It's certainly felt longer than twelve months, though it is a little hard to believe it's the last day of December already -- time does this weird thing where it crawls and flies at the same time. But here we are, on the last day of the year, heaving a collective sigh of relief that it's finally over. And here I am hurriedly cobbling together my usual year end post before heading in to work for my long shift. What are you doing for NYE? Something much better, I hope.


There are a few things I want to write about. These topics have been divided into the good, the bad, and the ugly. Original, I know.

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The good

Moving to a bigger hospital and going into BPT (Basic Physician Training) have been the highlights of the year. I've done and learnt so much that just thinking of it all makes me exhausted. I've been able to work under and alongside some really great people, and from the not-so-great people I have learnt how not to do things both now and in the future. I think the key to learning in the clinical setting is to take everything in, and then sort through it all and keep the bits you feel are important or applicable. I do my best to be open...by which I mean have open eyes to observe, an open mind to take everything in, and open hands to do the tasks and jobs that come my way. In other career news, I finally came to terms with the fact that if I'm serious about getting into Oncology, I'll need to do more than just the exams and sit and hope and pray. I've recently started an audit on a topic I am genuinely interested in and curious about, and hope to finish sometime next year. If it gets published, I'll probably be posting it everywhere triumphantly, so watch this space! I'm pretty pleased with the progress I've made this year, and hope to continue on the same trajectory in 2020.


For my annual leave this year, I focused on seeing friends and family. Over the course of five weeks, I travelled to Perth, KL, Seremban, Singapore, Launceston, and Melbourne. None of these places was particularly exotic or anything, but the trip was special to me -- I got to attend a beautiful wedding, see extended family members I hadn't seen in years, and meet up with a whole bunch of uni friends. I also got a selfie with a quokka! It was a wonderful break, and I'm glad to have spent it the way I did.


The other good thing is that I bought a car! After years and years of bumming rides off people, I've finally got a ride of my own. It's a cute little Kia Picanto that I got for a great price after months of stalking new and used car prices. To be honest, where I live right now, I've been perfectly fine without a car -- the hospital is nearby, as is a variety of grocery stores, church, an Asian mart, the bank, everything you could ever want. Next year, though, I'll be working in regional Queensland for six months, so I'll need a car to get there and get around the place. So I have a car now! It's been so great driving to further away farmer's markets, not having to walk 25 minutes in the sun to get to church, picking packages up from the post office... Oh man. I finally have a car now, and it's the best.


The bad

If you didn't already know, moving to a new place where you knew barely anyone is hard. I'm very lucky to have known a couple people here, but because we're all doctors, our days off often don't align so we don't see each other that much. Making friends at work who stay friends outside of work is difficult -- you already see them for like ten hours a day when you're in the hospital, so you don't really feel like seeing them again on your days off. Also, at the end of the work day, everyone's so tired they just want to go home, so you don't hang out after work. It's very isolating, to tell you the truth. Oftentimes I've thought that if I were to just disappear off the face of the earth, the only party who would realise for perhaps several days would be work (not my most cheerful thought in 2019). Having a housemate was helpful, as well as keeping in contact with people elsewhere. Pro tip: Check in on your friends who have moved elsewhere for work. I've spoken to several people who have been in the same situation, and we all feel the same way: Making friends when you're working is hard!


Work itself occasionally got me down, particularly when it was extremely busy and/or emotionally taxing. It's hard to feel like/function as a human being when you're stretched so thin! I learnt to compartmentalise and deal with emotions at a more convenient time, particularly after crazy ward call shifts or Med Onc days (although telling someone they have months left to live and immediately moving on to the next patient is something I may never get used to).

The ugly

Probably the least important thing on here, but a big part of my year nonetheless. My skin has been the worst it's ever been this year. It all started with my thinking that perhaps I should use sunscreen every day, seeing as how the sun here seemed so strong. Which is all well and good, but I unfortunately hadn't realised you were meant to remove sunscreen with makeup remover or something oil-based! My skin got worse and worse and I didn't understand why, so I started watching lots of skincare stuff on YouTube, and it was there that I found out what I was doing wrong/fell down the rabbit hole. I've learnt so much stuff! I know about retinol, the difference between AHAs and BHAs, what AHAs and BHAs even are, how great niacinamide is, and why I'll probably never use a mineral sunscreen (the white cast). I also got sucked into the Korean skincare world, so I can reel off brand names and their specific lines, and talk about K-beauty ingredients that are all the rage like madecassoside and green tea and mugwort.


My skin is slowly, slowly recovering now that I'm taking better care of it. I won't go so far as to post my entire routine on here, but I think I'm using a good bunch of things and am pretty pleased with their effects. A few takeaways: Everyone should moisturise, expensive isn't necessarily better, and, for the love of all that is holy, remove your sunscreen with makeup remover or something oil-based and not just regular cleanser like what I did.

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2019 has certainly been a year of hardships and lessons learnt. Hopefully we've all grown and made progress in various aspects of our lives, and are on our way to becoming better people. Here's to a better twelve months, starting tomorrow! 2020, come at me!

Sunday, December 15, 2019

Small fish, big pond

I'm writing again because I'm stuck at home sick. This is the fifth time this year I've been off sick, it's a little ridiculous. Apparently this can happen when you move to a new place -- something to do with new bugs your immune system has never encountered or whatever. Apparently this can also happen when you do a Respiratory term (I was sick three times in ten weeks!), maybe due to the weird and wonderful bugs people come in with. Regardless, I am feverish and sore-throated and runny-nosed and headachey and achy in general (the arthralgia is real), so what better time to wax lyrical on my move from Launnie to Brisbane? It's probably the main culprit in the onslaught of illnesses that have afflicted me this year, anyway.


I'll be writing specifically about going from a relatively small hospital to a bigger one; I have the most to say about that, and it's probably what people want to know about the most. If it seems a little disjointed, I apologise in advance -- I'm fresh out of Panadol and don't feel well enough to crawl out to get some more, so this could get a little interesting. Here we go!


For the first couple months of working at the Princess Alexandra Hospital (PA), I was basically Kimmy Schmidt. There was lots of "Woah, you guys have that?" and "You guys do that here?!". Being only two years out of med school and from the Launceston General Hospital (LGH), everything was amazing and great and awesome. When I first heard about TAVIs, and that they were done at the PA, I almost lost it. It's quite embarrassing to think about, actually. Eventually, I started saying 'us' instead of 'you guys', and accepted that there were lots of complicated procedures I had never heard of before, and most of them were done at the PA. It gave me an undeserved sense of pride, almost -- "There's TAVIs and hepatic artery embolisations and freaking kidney transplants, and I may not know a great deal about them, but we do them all here!"


Of course, many procedures means many diseases and many sick patients. My first ward call shift was a Saturday Med Ward Call (MWC), and I was floundering. What I tell people is this: In a smaller hospital, the sick patients go to ICU and the really sick and complicated patients go to a bigger tertiary hospital. Here I was now in a bigger tertiary hospital, surrounded by really sick and complicated patients who weren't quite sick or complicated enough for a tertiary hospital ICU. And they were mine to handle for the shift. I got used to MWC shifts quickly enough, but then had to do Renal Ward Call (RWC) shifts, which are infamous for being the Worst Shifts Ever. The RWC resident looks after Onc, Haem, Cardio, Renal, Gastro, Infectious Diseases, and Endocrine patients -- ie. the sickest patients outside of ICU -- and the job is never done by an intern for this reason. It's an incredibly harrowing experience, with lots of sick patients, lots of phone calls to specialty on calls (which I never had to do at the LGH!), and lots and lots and lots of pages keeping your pager constantly abuzz. I'd done Medical and Surgical weekends and after hours shifts at the LGH, but they were nothing compared to these. Nothing!


In retrospect, I'd probably been a bit spoiled by the LGH. Rostering was generally pretty good, with not too many after hours or weekend shifts; people on rostering were careful to ensure we weren't working unsafe/illegal hours over the fortnight. I was fortunate enough to get rotations in line with my medically-inclined preferences after letting admin know I was intending to join the BPT pathway. Also, we were allowed to split the five weeks of annual leave we had into separate chunks throughout the year. Ah, the joys of working in a small hospital! This year was incredibly different, and a bit of a shock to the system. Annual leave was allocated in a five-week block which you weren't allowed to break up (mine was in March, not even two months after I'd started work). Overtime may or may not have been paid, depending on the rotation, and rostered hours were more than I'd ever worked at the LGH. I won't say much more on the topic, but my advice is this: It would be prudent to know your worker's rights and safe working hours/conditions per fortnight. In a bigger hospital, they want their shifts filled, and no one is going to look out for you or make sure your working hours are safe, particularly if your roster is being drawn up by more than one party. Look up the Medical Officers Award or similar and don't just ask around like I did -- people working there will probably be used to those working conditions, and tell you it was normal and to suck it up. Oh well. At least I got paid, I guess.


I probably sound like a huge downer right now, but you'll be pleasantly surprised to know that I'm actually really glad I came to the PA. The exposure has been great, and I feel like I've dealt with many more things than I would've at the LGH. I also really like the diverse patient population -- grumpy old Serbian men, tiny Vietnamese ladies, toothless Chinese uncles (cue me ducking my head embarrassedly when people ask if there's anyone around who can speak Chinese)... Interpreters play an important role in this hospital, and I'm very grateful for them! As a BPT trainee, I really like how there are several tutes a week organised by the Department of Medicine; they're aimed at trainees taking the upcoming written exam, but I attend when I can because I'm a nerd and like learning things. I feel like in your first few years out of uni in particular, the learning curve should be exponential, and for me it certainly has been. I want to be a sponge and take in all the teaching and exposure and experiences possible, because I have so much learning and growing to do! The PA has allowed me to do just that, and I am very grateful. It's been a hard but good year.


Next year I will be back in a smaller hospital that's only a little larger than the LGH. I'm glad to be starting my registrar year in a smaller place -- hopefully it'll be a little less stressful! I've heard good things about Toowoomba, and I'm quite excited for my six months there (even if they aren't electronic) (sigh). I am now quite sleepy and losing steam, so I'll end it here. If anyone has any questions about the small to big hospital transition, I'm happy to answer them. You know where to find me!

Sunday, October 20, 2019

Hello? Is this thing on?

So it's been pretty much forever since I last posted here...'forever' being about ten months, which is pretty much forever in terms of social media. So much has happened since then! I've moved to Brisbane, started working in a hospital several times the size of my old one, and found a new church. I've read a bunch of books, finished Zelda Breath of the Wild, and baked a bit. I've been lonely and heartbroken, but also thankful and very loved. It's been one heck of a year, and it's only October! Or already October, depending on how you look at it.

2019 started off a little rough, to tell you the truth. I came to Brisbane knowing only two people (technically three, but the third was leaving for Sydney), with six years' worth of stuff in boxes and bags. Adjusting to my new, ginormous hospital was no mean feat, the sometimes ridiculously complicated electronic chart system notwithstanding. My first rotation was in a building separate from the main hospital building, which meant I never saw anyone else, so opportunities to make friends were scarce. It took awhile to find a church I liked -- sixth time's the charm, apparently! All these things led to my feeling rather lonely and sad, which was really the main reason I hadn't been posting anything on here. I'm glad to say things have changed, though!

I suppose the biggest update is that I will be Med regging next year! For those unfamiliar with the terminology, this basically means I'll be promoted and have much more responsibility! Getting the job was fairly straightforward, but behind it lies quite a story. The standard CV and referee things were fairly unremarkable, but the interview...that was a wild ride.

Let me paint you a picture. It had been the most eventful/worst night shift I have ever done. Ever. I had to wait with this patient to bring them to have a scan of their head, because they were agitated and confused, and I was pretty sure they had a bleed in their brain. (They did. It was huge.) In the meantime, my colleagues were taking it in turns to perform CPR on another patient who had coded and unfortunately didn't make it. I got yelled at by a boss when I called them about another patient's ongoing intestinal haemorrhage. Having to drop everything and deal with extremely unwell/dying patients meant being incredibly behind on jobs and pages, so the rest of the time was spent playing catch-up. Morning came, and I had to deal with calls from bosses asking why I hadn't phoned them with so-and-so's scan reports like I'd been asked to. It was insane. I'm not sure I ate anything for the entire ten-hour shift. At the end of it all, I wanted to go home and cry and/or collapse, but no -- I had my job interview to go for.

I went home, attempted to rehydrate myself, and stuffed some food down my throat. I then did my best to make myself look presentable, and caught an Uber to the interview location. We spent 20 minutes stationary on the highway because a truck had managed to drive head-on into a divider; I sat fretting in the passenger seat as my driver happily chatted about West Africa, where he was from. As the minutes crawled by, I realised with a sinking feeling that I was officially late for my job interview. It all felt like a bad dream. The minute we stopped at the entrance of the Royal Brisbane, I jumped out, got directions from reception, and ran to the interview location. I'd missed out on reading time, but thankfully got a few minutes to look over the sheet of paper, as the interviewers were running a little behind. It wasn't very much time at all, and I told myself I'd have to wing it. So I did.

They were all clinical questions, but that's about all I can remember on what they asked. I remember shaking everyone's hands, having to listen closely to the questions (since I hadn't had much time to read them), and talking a lot. There was lots of nodding and ticks on papers. I honestly don't know what else happened -- everything still felt like a bad dream. I left the interview room reeling, ridiculously tired but also still pumped on adrenaline. I went home, showered, and collapsed into bed. I needed all the rest I could get, since I was going back for another night shift later that day.

I genuinely hadn't realised how awful that was until I started typing it all out now! It was probably worth it, in any case, because I got the job! For six months next year I'll be at a regional hospital, then I'll be back in Brisbane for the next twelve. I'm very excited to be Med regging next year, but also a little bit terrified. I'll be running codes! At night! Me! Maybe it will be a baptism by fire sort of situation, where you get an insane amount of things thrown at you but you emerge much cleverer, calmer, and wiser. I feel like that's just how you learn things in medicine in general, anyway.

Speaking of baptism by fire, I do want to write about my experience moving from a smaller regional hospital to a huge tertiary one. That's probably a whole blog post on its own, though, so I'll save that for another time. I suggest you don't hold your breath -- keep in mind this is my first blog post this year, in October. Maybe I'll get better at this now that I'm less sad. We shall see!

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!