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!

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