DHAL: June 11-18, 2014

Hello friends!

Look at that, I didn’t even get through one month of DHAL and I already failed at daily blogging, oops!

The reason I haven’t been blogging is because I have been on shift in the Emergency Department and in the Intensive Care Unit (ICU) for the past 7 days straight and I’m so tired when I get home – with laziness and studying distracting me. I still have a couple more days to go before I can finally have the weekend off. My days are averaging 10-11 hours, which is quite tiring for a number of reasons:

  • You’re not getting paid.
  • You need to be alert and learning at all time, so it can be very mentally exhausting.
  • It’s constantly a different environment with new staff, protocols, and procedures to become familiar with.
  • You still have to go home and study or read up every night to at least look slightly competent.

With that being said, there have been a number of highlights and lowlights this past week.

Highlights:

  • Enjoying and finishing my 4 week stint in the Emergency Department. I quite liked the variety of presentations – from mild to serious and seeing how they are assessed and managed. Had a good time working alongside the doctors (especially the interns), nurses, and physios. Felt appreciated for my work and had a good performance assessment by a senior doctor at the end.
  • I finally had suturing experience! An elder man had a large wooden post fall on his hand which gave him a number of lacerations that needed to be sutured. My only prior experience was in theatre while the patient was still asleep, not awake and watching me. I’m happy to say that unlike before, I sutured with a steady hand, with proper technique and approval by my seniors. Patient was also happy with my handiwork – yay! Confidence restored, I thought I was going to have to live with a hand tremor exacerbated under pressure for the rest of my life.
  • And related to previous post, where it used to be nerve wracking to have someone scrutinize me while doing procedures, either someone junior observing to learn or someone senior watching to make sure everything went well – I am now quite comfortable performing underneath someone’s gaze. Phew!
  • Did my own plaster casts, on real patients! I know, it’s silly that I’m halfway through the end of my last year of medical school and only getting this experience now. Unfortunately, as international students, we do not get the opportunity to go on a rural rotation, which is where you get a lot of hands on experience. With that being said, I’m trying to make the most of all opportunities I come across.
  • This week, I am the only student in ICU when normally there are 2-3. Initially, I was a little intimidated to be the only student, especially in such a different medical setting without a colleague, but now I definitely feel privileged. I now have scheduled one-on-one teaching time with great consultants, who never make you feel stupid for not knowing all the answers. I was invited to stick with one team throughout the week and follow the same patients so I get the opportunity to learn how patients are managed in ICU – as opposed to being with a different unit every day. I’m also getting opportunities to see and participate in procedures and tasks I haven’t in the past, like maxillary antral lavage, bedside bronchoscopy, and transport of critically ill patients. It’s cliche, but I really am finding everything interesting. My days in ICU pass by quickly as there are a number of scheduled activities every day including: morning handover rounds, one-on-one teaching, radiology meeting, afternoon teaching rounds, etc. I always feel welcomed to ask questions, which is a good facilitator to learning as well. Only 2 more days!

Lowlights:

  • I am SO tired! Would’ve been nice not working for 9 days straight, but I guess that’s what the real world will be like when I’m working.
  • Not eating well. I’ve been averaging 1-1.5 meals a day, which isn’t healthy but I’m trying to change that.
  • The sickest patients are in ICU… and it’s hard to see them not get better. For example, we are caring for a young woman who had pneumococcal meningitis and developed sepsis following a microvascular decompression surgery for trigeminal neuralgia. She now has partial locked in syndrome – paralyzed from the mouth down, intubated and ventilated and could only communicate by blinking her eyes. After a couple of weeks (when I first met her), she began to develop fevers with an unknown focus, despite adequate coverage with antibiotics. All possible tests and scans have been performed with no cause for her fevers found. In addition, she has a rash that was getting worse before our eyes and right before the end of my shift today, she took a turn for the worse and became completely unresponsive – GCS 3. It’s not easy dealing with an unwell patient, but even harder when we don’t know how to help a deteriorating patient.
  • June 15 was Father’s Day, always a difficult day when my dad is no longer with us in person…