Lessons Learned

2012 has been a big year. Undoubtedly a lot of things have happened in the world and to every one of us. Personally, I have survived most of intern year, my first ever bank loan, a relationship breakup, and the Apocalypse.

I now know what an intern does. An intern does everything. Writes all the notes on ward rounds, examines the patients, requests pathology and imaging, takes the bloods, places cannulae, chases up on results, placates the senior doctors, looks after the medical students, arranges family meetings, attends family meetings, writes medication charts, writes discharge summaries, arranges patient transfers, makes referrals, answers phones, and sometimes makes coffee runs.

I have learnt not to panic when nurses approach with a question.

I have learnt the importance of filling out a time-sheet.

I have learned that doctors can get loans very easily.
"So, is it Miss, Mrs, Ms ... ?"
"... Doctor"
"I'll put that right through"

I have learnt how much fun it is to own a sports car.

 
I have learnt that sometimes you need to stop investing in bad relationships.

And the world does not necessarily end when you run out of calendars.

Grandmother

My grandmother: a portrait in landscape

A Heart

My window loves me

Christmas 2012

Christmas Candles

Midday Naps

Too many puddings

More food

Gaudy Decorations

We missed out on the Christmas crackers, but after several breakfast cocktails my grandmother was hilarious. Good times.

Merry Christmas 2012

Ah, Christmas. A day to spend time with family, eat rich food, drink too much wine and listen to drunk grandma laugh uproariously at the Christmas cracker jokes. A day to wear silly hats, drape tinsel over the entire house, and take midday naps. For those unlucky enough to work, a day to make extra money. A time to watch terrible Christmas-themed movies and not feel bad about enjoying them. A day to play cheesy Christmas music whilst pretending not to enjoy it. A time to hang gaudy ornaments all over a tree that has somehow made its way into the house. A day to give gifts to the people you love, and also to the person you got at the work Kris Kringle. A day to relax, to reflect, and to enjoy life.

Merry Christmas.

Beach Trip

It hasn't been a year for beach trips. The town I'm working in is notoriously cold, it rains all the time, and it's a fair distance from the beach.

But a few weekends ago Sprite and I finally tired of sitting inside the cold house, and ventured out into the cold outdoors.

We went to the beach.

It was just as I'd expected. It was a 30 minute drive away, it was deserted, it was windy, and it was cold.

It was wonderful.

Teacup Chihuahua

So, my sister bought a teacup chihuahua. I never thought it would happen to our family. We have outdoor dogs that chase mice and bark at intruders, not handbag-sized dogs that sleep under the covers.

She called it 'Tetley', as in Tetley tea, teacup, teacup chihuahua ... yeah. Anyway, now she has turned into a crazy dog lady.


And, unlike most of the other animals we've had, this strange little dog loves my sister above all other things in this world.


But my sister is obsessed.



"Look at my dog, look at her sleeping, look how she's eating, look she's watching the TV, look at her run ..."


I cannot have a sensible conversation with her now that the dog is around.

"Take a picture of Tetley! Take a picture of Tetley sleeping! Take a picture, she's eating! Take a picture of Tetley sitting on the rocking horse! Take a picture of Tetley dressed up as Santa, sitting on the rocking horse!"

Merry Christmas.

New Guy

Meet the new guy!

It has come as a bit of a surprise - meeting him certainly wasn't something I'd planned for, or expected.

He's certainly not my usual type.

His pedigree is a bit of a mystery - nobody I know has met his parents, or any of his brothers or sisters. Come to think of it, I don't even know if he has any brothers or sisters.

I have no idea what he plans to do with his life, but I hear unofficially he is showing some promise as an athlete.

I only just met him today, but well ... I think we would be cute together.



Help me with a name?

The new guy

One is enough

"And did you get any of the chocolates I brought in last time?" asks a returning patient.

I don't remember, but I tell her I had one, thanks.

She looks me up and down and says, "one is probably enough. I like your figure the way it is"

Joke's on you, lady. I probably had two.

Phones

She came in with a GP letter, "please see this patient with a view to hospital admission and IV fluids". Sure. She looked too well for a hospital admission, but she'd had gastro for two days and a recent collapse, so I'd run a bag of fluids.

I explained as much to the patient and she looked up from her phone and replied, "good luck".

Why?

"Last time they had 28 tries at putting a cannula in, and they had to get the anaesthetist in and even he had trouble. I have really difficult veins".

Nice, thanks. I palpated a vein - felt ok.

"My veins are all shot on that arm, they're no good, he destroyed them" the patient informed me, before turning away to text on her phone.

And in went the cannula first try.

"That didn't even hurt!" she exclaimed, "Aren't phones amazing!"

Sigh

Full Sentences

"WHAT THE F-K IS WRONG WITH YOU I NEED TO BE ADMITTED THIS HOSPITAL HAS GONE TO SH-T CAN'T YOU SEE I'M SICK AND I CAN'T BREATHE ARE YOU EVEN A DOCTOR GET ME A REAL DOCTOR!"

I nod, thoughtfully, and make a mental note ...

"Able to yell in full sentences with no demonstrable shortness of breath. Does not require admission"

Not even puffed.

Emergency

So, I work in the Emergency Department now. I'd like to try and make it sound exciting and glamorous, as if we do nothing but save lives and look awesome in scrubs. I'd really like to do that.

And sometimes people come in who are genuinely ill, or injured, and we all get excited and work fast to patch them up and stabilise them. Nothing is more exciting than chest plain and bleeding wounds.

But I can't help but think that most people should have asked their Mum for advice first. Maybe before waiting for hours to see a doctor in the emergency department. Before I have to tell them to take paracetamol for their very mild headache, or to do nothing in particular for that small bruise on their leg. Before I have to spend hours filling out all the paperwork.

And let's be honest, nobody looks good in scrubs.

Old Tricks

Turned up to start work

But I was four hours early

So I went shopping

.

Team Spirit

The medical registrar called me at midday on my day off.

Did they need my superb discharge summary-writing skills so badly I had to forsake my leisure time and return to work?

No.

The medical students had brought cake and I was invited to join the team for tea break.

When I arrived, they had already made me a cup of tea and we all sat down to enjoy the cake. It felt so great to be part of such a tight-knit team ... and then we realised that nobody had invited the SMO who was busy taking bloods on the ward. Oops.

Disappointment

Disappointment: giving up part of the afternoon to attend a stroke management session, then finding out it's a drug rep giving a half-hour spiel about Alteplase.

A drug rep who didn't bring sandwiches.

Fish Oil?

Our ward pharmacist is good. 

I would never have guessed 'fish oil'.

The Wisdom of Admin

Friday was a big day on medical ward. Dr K's team had 12 new overnight admissions, in addition to the 20-ish patients already on the ward. He'd been up all night taking calls and required frequent caffeination. We had to break the news of cancer diagnosis to three different patients. Nobody was well enough to go home, everybody needed new medication charts / cannulae / blood transfusion consents / imaging done and it was all urgent. But we got there in the end.

Then mid-afternoon we realised that Dr K wouldn't be there over the weekend, and the SMO on weekend duty wouldn't know any of the patients either, because he'd had Friday off.

Dr H, the locum who was covering the weekend, asked if I'd stay on if required. Sure. I had other plans but it made sense - I was the only one who knew the patients, and some of them were in a bad way. I'd work the weekend.

But admin looked at their computers, coughed, and said no.

Dr K, the permanent and eminent physician, marched off to request the same.

Admin looked at their computers and offered a wonderful compromise: no, they wouldn't roster the intern who knew all the patients. They dragged a surgical intern, kicking and screaming, to medical ward where he spent all of Saturday begrudging his luck. Then on Sunday they replaced him with a different unwilling victim.

I hope my patients are ok.

Instant Tea

What counts as "tea" has long been matter for contention. Tea purists will insist that only beverages brewed from the leaves of the tea plant deserve the name "tea", whereas some free thinkers believe they can add any old leaves to hot water and say they have a cup of tea. Camomile tea, mint tea, stinging nettle tea.

But I think even they would meet their match in the medical break room ...

Salt and pepper tea, anyone?

Catheter

I put in my first urinary catheter today. Hey, I'm a late starter.

I was trying to arrange transfer for a dialysis patient who I've come to know well. Speaking with the physician on the phone, I was on top of things - I knew his vitals, knew his blood results, knew all of his medications. Hell, I even knew what kind of car he drove (not that they asked).

And then the physician threw me with one question.

"Is he making urine?"

I heard him tell the nurse that he passes urine, so I answer "yes".

"How much?"

He doesn't pee in a bottle near the bed. He doesn't have a catheter. He goes to the bathroom all by himself. It isn't measured.

He's a dialysis patient, so I hazard, "minimal amounts?"

"Then why is he on dialysis if he's still producing urine?!"

"Because ... the renal physicians started him on dialysis?"

And then he tells me the patient will need a urinary catheter before he's transferred. I quickly set up and tell the patient what's happening. I do all the right things - sterile technique, clean the 'area', lignocaine gel, catheter. It's all straightforward.

Except there's no trickle or gush of urine through the catheter. The bladder is empty.

I feel bad for the patient who's now got a catheter in his willy for no good reason. I've just made a fool of myself, but that's nothing new. But then I see it - a tiny little blob of urine sitting in the catheter. If that's not "minimal amounts", I don't know what is.

Liar

Consultant, presenting a new patient in multidisciplinary meeting: "This is a 79-year-old gentleman who normally lives at home with some supports"

Nurse: "Actually he's in a high-care nursing home"

Consultant: "OH GOD, WHERE DID I LEARN TO LIE LIKE THIS?!"

.

Medical Intern: A Day In The Life

Not a typical day so far, but an accurate recount of today:

0745: arrive first, print out patient lists and start writing some discharge scripts
0750: make self coffee and sit down to check patient list
0755: put hand in coffee mug and spill coffee all over paperwork
0800: sit down for multidisciplinary meeting and rip side of dress so the pocket is now just a gap
0800 - 0845: muddle through meeting and present the few patients that you can remember from yesterday's ward round, because you've had a few days off and forgotten everybody else.
0845: learn that your consultant has clinic all day and you'll be running ward round. It's ok, you have a final-year student to help you
0845-1600: ward round, interspersed with nurses harassing you to discharge random patients because of bed pressure, and patients discharging themselves of their own accord
1600: dismiss student because you feel bad making them stay late on a Friday
1600-1700: frantic last-minute paperwork that needs to be finished in business hours
See ex with blonde medical student
Call it a day and leave hospital.
1706-1707: drive home (because you're a rural intern)
1708-1715: search for running shoes
1716-1720: go for a run, get puffed, go home
1721-1750: set up Wii Boxing and work out frustration in a more sheltered setting
1751: call from nurse asking you to urgently come back to work and do a discharge summary for a patient who is transferring to a city hospital RIGHT NOW. And you haven't done it yet because you spent the whole day pretending to be a consultant
1752: back at work doing the discharge summary (ok you showered first). Fax to city hospital
1755: learn that the patient dropped his BP at the airport and Flying Docs aren't happy to put him on the plane. He's coming back to the hospital.
(Cry a little on the inside)
1800: pizza with the nurses
1830: patient back on ward. Spend next few hours trying to fix everything - on phone with consultant and Flying Docs, and in discussion with ED staff who will cover the ward overnight. Learn that patient's blood pressure is back to normal and he is walking around all by himself. Learn that patient will not be retrieved tonight and will probably lose his bed in city hospital.
(Cry a little on the inside)
2100: Night nurse comes in and asks, "what, did you sh*t your bed and can't go home?"
2101: Go home

This is why we get paid the big bucks random amounts of pay and never see our payslips.

Hello? Is it me you're looking for?

Phone call from the locum pharmacist:

"Can I speak with Dr S please?"

Me: "Yep, that's me!"

"Thank you"

...

(pause)

...

Me: "Um, that's me"

"What?"

"That. Is. Me."

"Ohhhhh.

New Stamp

I was pretty devastated when the surgical interns told me I'd missed Journal Club today - I'd been counting on those free sandwiches for my lunch.

As I trudged back to the medical ward, the pharmacist intercepted me in the hallway. I braced myself for the worst - the pharmacists usually only chase me to point out my mistakes. But not today - today she gave me a brand new stamp with my name and provider number on it!

Now skipping back to the office, I opened up the stamp ... and promptly got ink all over my hands. Never mind. There's a hand bason in the nurses' station. And that's where I learnt two valuable lessons:


1. That ink is so permanent it pretty much gets into your genes
2. If you turn the tap off too far, it turns back on again and wets the front of your clothes

By the time I made it back to the office I was so glum that the RMO gave me a cupcake and sent me to do a mini-mental on our sweetly demented old patient.

He got 15/30, the cupcake was delicious, and the day got better.

Beautiful

He looked me up and down and said, "what a beautiful girl. Much too good for this job!"

I'm going to ignore the fact that he's 80 and we are working him up for acute confusional state, and take that compliment.

Why, thank you, delirious old man.

Cake

I told the nurse team leader that I'd like to leave on time today so that I could go home and make cakes.

"Ooh!" she said, "For us?"

"Yeah" I replied, a little glumly, "tomorrow is my last day"

"Oh good!" she exclaimed

Then after a long pause ... "Bad! Bad. But ... cake!"

.

"Conference"

Some intern colleagues and I just got back from a week-long medical conference in Wanaka, New Zealand. It was brilliant ... and not just because the speakers were all engaging and well-informed and the topics relevant and interesting. They were. But let's be honest - the focus was really on the extra-curricular.

The organisers purposefully made it like this. Lectures were held from 7-9am and then 5.30-7.30pm every day, leaving, as you can see, a significant number of daylight hours to be filled. Conveniently, we just so happened to be situated near some spectacular ski fields. One of our lecturers, a senior Emergency consultant, was late to give his presentation one day because he'd been heli-skiing in the afternoon. Of course everybody understood. Check out the view!

One of my colleagues, after assuring me that he had been skiing before and was quite good, is yet to forgive me for taking him down a 'black' (expert) slope. In my defence the signposting was quite poor and neither of us knew for sure that it was a black slope until it was too late.

My other colleague had never even seen snow before. After hours of discussion we convinced him to try skiing instead of snowboarding ... he tried skiing for a day, then went snowboarding. He probably would have enjoyed it all a lot more had he not developed pneumonia during the week.

There was also plenty to do for those not keen on snow ...

Fudge selection at the Remarkable Sweet Shop in Queenstown

Lake Wanaka (the conference venue had a spectacular view of the lake)

Some of the lovely classic cars at the Warbirds and Wheels Museum. There were also classic war-planes but they didn't fit into my picture!

The incredibly frustrating 3D maze at Puzzling World, Wanaka. It wasn't too bad until we needed to find our way out.

I will definitely be trying to get back there next year!

Pub Bingo

I'm getting to be a homebody now that I've started work. No late nights, no going out drinking, no dancing all night. I'm too old for that now.

But last night, together with some of my fellow interns and our medical students, I went out to experience a local club that has been voted "the second-worst nightclub in Australia". Pretty big claim, so that was something we really had to experience for ourselves.

To be honest, after all the injuries we've seen come through the hospital, and all the wild stories, the club itself was a bit of a let-down. Reasonably clean, with a big bar and tolerable music ... I've certainly been in worse clubs, but then we were only there until 3am so maybe it got wild later.

It was certainly a good place for pub bingo though. The following card would have been filled up by midnight ...

Pub bingo. Good game.

The body bag

I like working weekends on the surgical ward. There are no elective surgeries, so we don’t have many new patients. Most of the surgical patients from the week have been discharged by Saturday, but if not I get to send them home over the weekend. We don’t order many tests, or make many referrals, or really ... do anything much.

But yesterday the weekend shift delivered my creepiest moment in medicine so far. My consultant asked me to be the second doctor to verify a death on a palliative patient who’d passed away that morning. For patients who wish to be cremated, two separate doctors have to verify the death instead of the usual one.

I can usually handle deaths. I’ve verified deaths, been involved in failed resuscitations and dissected cadavers, so I thought I’d be ok.

Not this time. I made my way into the darkened room ... didn’t think to turn the light on ... and drew back the curtain to reveal, there where our patient lay just an hour before, a blue body bag. I hadn’t been expecting the body bag. I had to stand there for a minute working up the courage to unzip the bag and examine the body. 

I shouldn’t have given myself time to think about it.

Because when you stand there staring at it, you start to think that there could be worse options than finding a dead body inside. What if ... what if the patient isn’t dead? What if you unzip the bag and the patient opens his eyes and looks at you? Gasps for air? Grabs your arm? What if there isn’t a body at all? What if??

Next time I will ask a nurse to come and hold my hand.

On Uniforms

"Are you the only one who wears all black, are you?" - little old lady in hospital.

"Well ... I'm a doctor and we don't have uniforms. We just wear what we want"

"Oh, you just do as you wish, do you? That must be nice" - little old lady

Knock knock

Woke up at 5am this morning to somebody knocking on the front door.

Boyfriend opens the door, looks around - and there is nobody there.

Suddenly, there is the patter of small animal-feet, and a small shape darts in through the door.

My dog Sprite.

Sprite has, at some stage during the night, climbed out of her box on the back verandah, moved the bricks that block the gate, and escaped from the backyard. I only hope she didn't do too much in between escaping and knocking on the front door.

She really needs her own key.

Note to self

Just because it's the last day of rotation, doesn't mean it's Friday. Calling a vascular surgeon to make a referral and apologising for calling so late on a Friday doesn't make you seem considerate. You will seem disoriented and even saying clever things like "progressive carotid stenosis" and "possible need for endarterectomy" won't save the situation. You will get to fax your referral and wait in line just like everybody else.

Livatone Shots

Me, "Your liver function tests are a bit off. That's mostly because of your drinking"

Patient, "So you think I should take some of those Livatone shots then?"

Me, "No. I think you should cut back on your drinking"

PS I've been Googling Livatone shots, report to follow

Clinic Art

Some recent artwork from GP consulting:

Normal bowel (above) and diverticulitis (below)

Me, by my patient Brianna (4years)

This one is anyone's guess. Brianna wouldn't tell me. Possibly a diagram of the digestive system. Possibly a complicated break-in plan for the medical clinic. Or maybe I've got it upside down and it's an elephant fishing.

The more things change ...

I am quite enjoying my GP placement. Last week when I had an external assessor sit in for half a day and "inconspicuously" watch me consult, he said I was "pretty good for a first-term intern". And, safe in the knowledge that my terms this year are strictly laid out and non-negotiable, my supervisor recently asked if I'd like to stay for the whole year. Very encouraging.

And today I spent the afternoon with a Wiggles bandaid on my finger after cutting my finger opening a tin of Milo at lunch time. Then I had to leave a consult partway through because the patient couldn't take me seriously until I'd rid myself of my hiccups.

The more things change, the more they stay the same.

This is not a ghost town

A couple of shots from the town where I'm placed ...

... yeah that's my mailbox.

First Day

There aren't many occasions when you can use the excuse "but it's my first day!"

Today was my first day working as an actual doctor and getting paid to do doctoring. Although I'm contracted at a large regional hospital, my first rotation is in a smaller town at a GP clinic. In fact, the same GP clinic where I spent all of 2010. So I'm not new. The doctors all know me, the nurses know me, the reception and admin staff know me. I know how to use the computers and how to set up the right printer. Still, one of the practice partners spent several hours going through all that with me this morning.

After that I had an hour for lunch, and then when I came back they gave me a laptop and sent me home for the day.

Try as I might, I just couldn't throw in the "it's my first day!" excuse.

Oh well.