Night Ward Call

March 28 – May 1, 2016

5 weeks… 5 gruesome weeks of night shifts, being the only junior doctor covering nearly the entire hospital including: general medicine, general surgery, orthopaedics, cardiology, sub-acute geriatric evaluation, pallative care + oncology.

Let’s just say it was a lonesome time working mostly by yourself! Never another soul in the staff lounge when  you do have a few minutes to relax.

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There were many significant moments for me, including unexpected deterioration and deaths of patients, attending my first full-on resus (CPR, advanced life support – patient didn’t make it), managing many acutely unwell patients, etc!

One of the more fun moments – being approached by a nurse, “I don’t know what’s happening with this patient, but there’s all this blood on the floor after she’s gone to the toilet!”

My immediate reaction, “What?! What do you mean you don’t know?!” This was also right in the middle of reassessing a lady for a potential MET call. So the shift coordinatory (nurse in change) and I ran down to the other side of the ward to check on this other lady and was greeted by this wonderful sight:

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Don’t worry guys, she was fine! She just had a huge infected intra-abdominal abscess that was awaiting surgery when it finally exploded! She was actually feeling well with some of the pressure relieved!

So many memories from my 5 weeks on night ward call – it was definitely busy and sometimes incredibly stressful. But my medicine has definitely improved and I was happy for the experience.

Not to mention, I lost weight working nights and looked my best (ever) for our wedding! 😉

Moments of November 2015

November 07, 2015

Surprisingly a good handful of colleagues who also enjoy board games!

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November 12, 2015

A Christmas parade in the summer! We have never seen such a thing so took advantage of the evening off. Michael and I had dinner at Nando’s (always have to remind myself never to go there again… just don’t see the appeal!) right by the road the parade was passing through.

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Those poor possibly confused kids – we saw over 5 Santas in that parade! 😛

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Certainly nowhere near the extravagance of Christmas parades we are used to but still heartwarming to see all the participants in their vehicles and the families lining the streets to cheer and support!

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November 13, 2015

A farewell tea for one of our favourites – Dr Jama! A long term locum who was moving on to work in Brisbane – everyone was sad to see him go! He was the first supervisor I worked under as an intern and certainly one of the best first experiences as a junior doctor!

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Michael also had the chance to work with him, I think we are both on the same page! Sad to see him go!

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Lucky for us, since November, Dr Jama has since come back to work again as a medical specialist locum – hooray for us!

Oh, the Irony

When I first started working as a doctor in January of this year, I prepared myself mentally, emotionally and physically to be yelled at, and berated by my senior colleagues.

Haha, I know, that sounds horrible! Of course, I didn’t expect it to happen all the time, but after hearing some nasty horror stories, I would rather anticipate it than be taken by surprise. With that being said, I’m happy to say I’m approaching the end of my 8th month of employment and that still has not happened.

However, I have been yelled at. It was loud, terrifying, awkward, and made me feel like I had done something terribly wrong.

It happened during my first weekend shift at the beginning of the year. I was on Medicine, working ward call. I had just finished ward rounds with the consultant and met up with my colleague to see what other jobs needed to be completed. She asked if I could check in on a patient that she was just notified had gone into complete heart block. A precarious situation, I immediately went to see the patient. On the way, I was stopped by the nurse and given his latest ECG – he was back in 2nd degree heart block, no longer complete heart block.

The curtains around the patient’s bed were drawn and there were visitors behind the curtain. I could hear talking but could not make out what was being said. The health of the patient above all else, I excused myself and entered behind the curtain. I said hello, introduced myself to the patient and his 3 visitors, including his wife. I explained we had received a call from cardiology that his heart had gone into an abnormal rhythm and wanted to make sure that he wasn’t experiencing any symptoms of shortness of breath or chest pain. After a brief talk and examination, I was happy that the patient was clinically stable and apologised for the interruption. I told the patient that I would now go familiarise myself with his chart and have a chat with the senior and let him know if there was anything else that needed to be done. The patient and his wife said thank you and I excused myself.

As I reached the hallway, I heard a very angry, “Excuse me!” I turned around to have one of the patient’s visitors towering over me, 15cm from my face, who proceeded to yell at me at the top of his lungs, “Do you know how rude it is to interrupt a minister in the middle of praying?! How dare you! You should be ashamed of yourself!” Before I could apologise (again) for interrupting and explain that it was necessary for the safety of the patient, he stalked off.

I was shaking. Not because I was hurt, but because I was furious. How is it possible that an adult cannot treat another adult with respect and communicate more calmly?

Being yelled at, for the first time in my (short) career, by a Christian minister – OH THE IRONY. He who should practice what he preaches.

A few minutes later, I returned to see the patient, his family, and more importantly, the minister. Despite the fact that I stood by my actions, I wanted to apologise again if they felt I was rude. The minister was not there and the patient and his wife looked mortified. Both she and her husband apologised profusely for the minister’s behaviour. They said it was appalling and that they were so embarrassed. They agreed with my actions and thanked me for putting the patient first. I thanked them for their understanding.

And that, is the story of my first experience being yelled at as a doctor.

Intern year so far

Intern year has really been incredible so far.

Unfortunately, where writing and blogging used to come so easily to me, I now find it immensely difficult to sit down and make time for it, particularly on my days off! As a result, I have not been able to keep the promise to myself to blog regularly but I hope to share more of my work experience today 🙂

It seems like ages ago, but when Michael and I came back from our 5 week holiday in Canada (March 27), we completed our next 10 week rotation – Michael on Surgery and I on Medicine. In hindsight, second rotation passed by in a blink of an eye. I have always, and continue to absolutely love general medicine. The complexities of patient presentations, the intricacies of patient care, and the teamwork required with Allied Health to ensure patients are at their optimal level of function before going home. A great experience with wonderful teaching and support from all seniors.

Then, both Michael and I moved on to spend 10 weeks in Gladstone, 1hr20min away by car from Rockhampton, where Michael completed his rotation in Medicine and I in Emergency Medicine.

Now that, was an experience. Unfortunately, the ED was constantly understaffed with numerous new faces that came and went as locums. However, as a result, I gained a lot of independence and experience. It took a few days, but I got into my own groove and for once, felt comfortable handling anything thrown my way.

Here are some points I took away after 10 weeks of Emergency Medicine:

  • Recognizing a sick patient is sometimes difficult, but shouldn’t be. If the little details don’t fit a proper bigger picture, something is wrong. Trust your intuition. Never hesitate to present your concerns and get a second opinion, you will be surprised how often you are right.
  • I can totally handle paediatric patients – they are so much more trusting of you than I used to believe. You can easily win them over and make them feel at ease, even in hospital. That stethoscope they don’t want you touching them with? Let them listen to their own heart and suddenly the room is full of giggles. And always have a lower threshold for concern when dealing with paediatric patients.
  • Lots of patients will come in for abdominal and/or chest pains. And sometimes, you just don’t find a cause for their symptoms and have to send them away. I’ve been pleasantly surprised to learn that patients will rarely be upset if you cannot give them the answers they’re seeking. The key is attentiveness and good communication. Listen to their concerns, investigate appropriately, rule out the dangerous causes, good pain relief, follow up plan, and safety netting are key elements.
  • Finally got some proper suturing experience! Thank you patients who don’t shy away from letting a junior doctor stick them with needles.
  • Presenting patients and making referrals used to take a lot more time and thought. Now it is almost second nature as I was constantly seeing and presenting patients to seniors in ED.
  • People break a lot of bones. Some people are huge wimps when it comes to pain, others are so stoic you may not even think they had a fracture. Kids are almost always excited to have broken a bone because it means they can get a cast!
  • So many young men come into ED post electric shocks at work.
  • If a patient who rarely comes in hospital presents to Emergency 4 times in the last month, and each time sent back home, something is not right. Be their advocate. Whether it’s a medical condition that needs more investigations or a home situation that needs more support – something needs to change or they will continue coming into hospital.
  • Keep a log of patients you see! Record procedures you’ve done, interesting patients you’ve treated, those you want to follow up. Future case presentations, continuity of care, and personal interest are only some reasons to keep a good record!
  • Working at a small, understaffed hospital unfortunately has its disadvantages: No formal teaching and less opportunity to participate in “real emergency medicine.” I did not get the opportunity to participate in proper resus or trauma situations. As a result, I’m sure I will be terrified and at a disadvantage when the situation arises in the future.
  • Never be scared to say “I don’t know” and never shy away from asking questions. That is how you learn! Seniors would rather hear you don’t know and teach you, rather than hearing your pathetic attempt at pretending you know more than you actually do.
  • I don’t see myself doing Emergency Medicine as a career, but it is certainly an experience every doctor should have in their arsenal to be a better physician. As someone who wants to do GP, there was one observation I made: some of the terrible referrals from GPs in the community. Note to self: Keep that in mind on “How not to refer!”

And this past week? We started our 4th rotation, back in Rockhampton, yay! I have moved on to General Surgery (less enthusiastic “yay”) and Michael is in ED.

So far, I’ve survived! I’m back to feeling like a pen with legs, but I think the work load will pick up soon. Luckily, all the seniors have been more than pleasant and I haven’t been yelled at – always a bonus 😉 I have no inclinations of being a surgeon, however, as a GP, it would be good to have surgical skills for minor procedures under my belt. I have made that known to the surgical team and they are keeping me in mind, which I really appreciate! Day 2 and I was called down to clinic just to do a punch biopsy because of my interest in GP. I’m looking forward to the next 2 months on surgery, will keep you updated!

What’s it like being a doctor?

How’s your job? Do you like it? Are the hours crazy? Are the nurses nice? Are the surgeons mean?

Just some of the repeated questions I’ve received from family and friends since starting work as a medical intern. 😉

I was on the General Medicine ward for my first 5 weeks. Then we went on our annual 5 week holiday (which I’ll definitely tell you more about later) and now I’m currently week 8/10 of another Gen Med rotation. Where has the time gone?!

First day on the job… I knew absolutely nothing and no one, it was fantastic. (Not). I spent every day imitating a sponge as best as I could. Trying really hard not to look too much like a fool while absorbing everything I was seeing around me. Trying to remember patients and their issues, staff members’ names and their roles, which forms to fill and how, where to find equipment and leave specimens, etc.

It was exhausting. For the entirety of my first week, I got home, ate dinner and immediately fell asleep.

However, like many other tasks in life, I gained familiarity and through that, confidence. With time and experience, I’ve even built some competence! 😉 These days, not only do I leave work on time, I also don’t take work home with me AND I can stay up for hours after having dinner!

Some of you may have heard the saying, “Interns are just pens with legs.” The reality is, there is some truth in most medical stereotypes. I mean, we do have to…

  • Make sure the patient list is up to date
  • Write the chart notes during ward rounds and patient reviews
  • Fill out request forms, such as pathology, imaging, referrals, etc
  • Complete the discharge summaries

So yes, a lot of writing is involved. But can you imagine if this pen ran out of ink?

Who would keep people up to date with patient notes? How would patients get their required tests? How would GPs and other doctors know what happened to their patient and what follow up was required?

As the ones who spend the most time on the ward, and through the above roles, we often end up spending a lot of time with patients and their families. We are the first point of contact for nursing staff in caring for patients. We help to clarify questions and provide more information. We listen to and acknowledge concerns, even if only to provide a joke and share a smile. Not to say the senior doctors don’t do all the above and more, it’s still a rewarding experience for us junior doctors.

So yes, we are at the bottom of the totem pole. Some days you feel it, but most days you’re definitely an essential part of the team.

Orientation Week

January 12-16, 2015

Looking back, our one week orientation in preparation for our new job as medical interns went by in a blur. Was it useful? I sure thought so at the time. But when you have so much information being thrown at you with the expectation that you will remember everything – sometimes it feels like pouring water over a duck’s head… nothing sticks.

Important aspects I remember:

  • A chance to meet our colleagues, the other new interns – at social events as well as part of orientation. It’s nice to start a new job as (at least) acquaintances rather than strangers. Also a good idea to socialise when you’ve just relocated to a new city 😉
  • Meeting the staff of the Medical Education Unit (MEU) – they look after us and make sure we are alive and well… and still do!
  • Cultural Practice Program – an introduction to the culture and practices of those who identify as Aboriginal or Torres Straight Islander. Amazingly, I have never received such a talk through out medical school. Even simple knowledge like how their family hierarchy works can make a difference in the care of those patients.
  • Listening to a panel of 2014 interns sharing their tips – interesting at the time… but honestly can’t remember everything everyone said.
  • Skills rotation – refreshing our suturing, cannulation skills, etc.
  • Spending time with the previous interns on the ward we are rostered to. Good to get handover and tips. Would’ve been even better to spend more time with them getting hands on experience prior to starting our first shift.

Everything else… can’t say I remember much of it now. Not to say I didn’t find it useful at the time, but we really had to learn most aspects of our jobs on the go. Listening about how to do paperwork or order tests is never the same as going through the process of doing it yourself.

Then it was pretty much ‘hit the ground running’ on our first shift. Exhausting because you are so unfamiliar with everyone and everything. But by the end of first week, everyone gets the hang of things.

Do we become smarter? Knowledge-wise? …Maybe. Administratively? Most definitely!

People joke that medical interns are ‘pens with legs’ … sometimes, I don’t disagree! 😛

Joking aside, my first few months working as a doctor has been great. Impossible to sum it up in a single blog post but I hope to share stories in the future!

Graduation presents

December 21, 2014

After lunch at Wagaya, our families came back to our house to visit – a first time for my family from Perth!

In addition, our families took that opportunity to give us amazing, generous, graduation gifts – thank you so very much!

My mom gave us our gifts from my grandparents first – as they are the oldest and couldn’t attend in person – thank you Ong Ba Ngoai! We will put the money towards our future and wedding planning!

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I received a nice watch and card from Ong Ba Ba

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Thank you to Ong Ba Ut for their generous gifts – we will put it towards our relocation and setting up a new life in Rockhampton!

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A very special gift to Michael from his parents, a laminated card that his mom has kept safely for many years

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My mom is the best, as always!

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With the best card 😛

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She gave us each a Pilot retractable fountain pen

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Michael also got a beautiful dark purple DKNY tie from my mom, and I received 2 Pandora beads – thank you mom!

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Thank you to Di Loan for your lottery tickets! We were really hoping to win, but alas!

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Also a very special thank you to Ong Ba Hai (Ong Ba Ut’s best friends) and Nghiem for sending me cards and gifts!

Some family photos

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I also want to share the graduation gifts from Michael’s family! We received them on December 11, 2014, during our beach getaway at Noosa with his family 🙂

Aunt Patsy and Uncle Dan gave us a generous gift to treat ourselves out to a celebratory graduation dinner – thank you! It was really too bad that our graduation date was changed to a week later this year compared to previous years. Unfortunately, they couldn’t attend but I’m sure they had a great time on their cruise!

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Uncle Rick and Aunt Wendy gave us the cutest Christmas ornaments. They definitely went on our tree and will be on our tree every year!

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Uncle Jim and Aunt Brenda gave us the novel “Breathless” written by Dr Todd – a thoracic surgeon who performed many of Canada’s early lung transplant operations.

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Thank you so much to everyone for all your love, gifts, and kind words! Treasured forever!