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! 😉

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!

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!

Paediatric Medicine: End of Rotation 1

Hi friends 🙂

Today marked my last day of Rotation 1 – Paediatric Medicine, which I completed at a large tertiary hospital.

8 weeks on a variety of teams, soaking in as much as possible, in as little time as possible.

  • 2 weeks in General Paediatrics
  • 1.5 weeks in Emergency Department
  • 0.5 weeks in Neonatal Intensive Care Unit (NICU)
  • 1 week in General Surgery
  • 1 week in Gastroenterology
  • 1 week in Oncology
  • 1 week in Respirology

I definitely enjoyed some placements more than others, for a variety of reasons including: personal interest, consultants and senior staff more interested in teaching, and the learning opportunities provided.

For this rotation, we had a number of assessments, including 3 mini clinical examinations (mini-CEX, each worth 10%): neonatal (well-baby check), short case, and long case.

My well-baby check was performed an adorable newly born girl and her lovely parents. She was a little hungry and crying during my examination but was perfectly healthy.

My short case was a respiratory exam on a 1 year old girl who presented with noisy breathing. She was recovering from bronchiolitis and by chance also had a number of neurological findings with associated developmental delays.

And lastly, my long case was a young adolescent girl who presented with fevers on a background of complex mastoiditis leading to the severe complications of intracranial abscesses and venous sinus thrombosis. Incidentally, she had many features consistent with Cushing’s which led to additional discussion points.

The feedback I received from all 3 of my assessments were positive, so hopefully my grades will reflect that!

And today was the big day. A multiple choice exam of 75 questions worth 50% and 2 OSCE stations, each worth 10%.

The written exam was overall fair and very representative of our teachings this rotation.

The clinical exams each had 2 minutes perusal followed by 8 minutes of discussion:

  • Case #1: A 5 week old girl who came in with signs of sepsis.
  • Case #2: A 5 year old girl with acute exacerbation of asthma.

For each case, we had to discuss what additional information we would like on history and examination, what our differential diagnoses were, what investigations we wanted to perform, and how we’d like to manage the patient.

Those 10 minutes go by in the blink of an eye, and I always walk away thinking, “Should’ve said that, could’ve done that, forgot to ask about this, didn’t mention that.”

Only time will tell how I did this rotation! Hopefully hard work paid off.

In the meantime… I would love to catch up on my sleep. However, before I do that, I need to catch up on my blogging! Thanks for reading! 🙂

Random recent moments

As I mentioned in the last post, I haven’t done much in the last 3 weeks but there are a few things to share!

My dear friend Amanda gifted me with lovely chocolate covered sultanas by Melba’s and a bottle of Chenin Blanc (Coriole Vineyards), both presents from South Australia. The chocolates are rich, smooth and delicious and of the course, the wine was very tasty. She even wrote a really touching note… just because she’s an awesome friend and is always thinking of other people. 🙂

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Having some of the chocolates and salted cashews = winning snack.

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Craving for Korean food led us back to our usual spot – Madtongsan II for dinner on Oct 16!

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Oct 19 – Could not resist the great lunch specials at Wagaya. Went for my new favourite dish, tonkotsu ramen, so delicious! Even comes with dumplings and an amazing bowl of fried rice!

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For dessert, we chose to share the green tea cheese cake with green tea ice cream. Have been wanting to try this for a while but probably not worth getting again.

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Mike’s squishing me! Long but fun and extremely worthwhile days in hospital this rotation. But sooo tired when we finally get home, not much studying gets done.

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Yoni was in town from Nambour and staying with us Oct 19-20. We went to see Gravity which was good, although I was glad we didn’t see the 3D version because I think I would’ve gotten motion sickness. And we never go without food! My favourite wedges from Beastie Burgers and burritos from Guzman y Gomez, yummy picnic!

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I ordered a few BB Cream replacements recently, and look at all the amazing samples I received! All well known Korean brands too… can’t wait to try some of these out, especially the Ice Mask!

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Boiled quail eggs with some salt and pepper – delicious snack!

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How do you cut a pineapple? This is how I learned from my mom, least amount of pineapple wastage!

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Yummy! Honeydew melon with pineapple and lychee – can’t go wrong!

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Tried frozen yoghurt for the first time not too long ago – how delicious! Biscotti and coconut pandan flavour with fruits – yum!

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A new favourite in our house, basil & blueberry gin and tonic – try it! Very tasty 🙂

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Home made food update? Here are a few things!

Crispy oven baked sweet potato fries

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Creamy mushroom soup – delightful!

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More mango sticky rice with coconut cream, mmm

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Vegetarian pasta salad with Greek yoghurt based dressing

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Pear cupcakes with passionfruit icing for the students in my group

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Chocolate cupcakes with peanut butter icing and carrot cupcakes with cream cheese icing as thank you gifts for my med team.

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Mental Health: The End!

Yesterday marked the end of our fourth rotation, Mental Health – yay!

The past 8 weeks seemed to have gone by in the blink of an eye. We saw patients when they were admitted, learned their stories, followed their progress and said good bye when they left… a humbling and worthwhile learning opportunity.

Despite being laughed at by our registrar many times at our pathetic initial attempts of presenting a Mental Status Examination and formulation… in the end he said we did well and our evaluation backed that up.

Many thanks to our Registrar and the Consultants who took us under their wing and taught us throughout this past rotation. They are so knowledgeable and have so much experience to impart, couldn’t have done as well as we did without their guidance! And of course, to the wonderful staff at our hospital 🙂

On Thursday, we had our clinical exam where we were provided a vignette (clinical situation on paper) and 20 minutes perusal time. Then we had 20 minutes to present a summary, formulation, differential diagnoses and rationale, additional information needed and management plan to 2 consultants/examiners. I was SO nervous. But as soon as I sat down and started reading, I immediately calmed down – a case of an elderly patient in the hospital who developed delirium. Something I was familiar with and had prepared for, yes! I think that exam went well, but only time will tell what my 2 examiners thought!

Then we had our written exam yesterday, 50 multiple choice questions. As always, there were a handful of questions that left us thinking, “What was… what?” But in general, we left with a sense of security rather than panicked with the thought of, “Oh my god, I might’ve failed that,” racing through our minds.

So now, one week vacation!

Haven’t done anything… yet 😉 Hopefully it will be relaxing and full of nature! We have some plans but I’ll update as it happens!