Life

Looking at life.

I was reflecting on my very long time online last night, made possible by a random sequence of events in the mid-1990s.  Those days are very long gone, as is the Internet as it was back then, it hasn’t really been archived and these days it feels a lot smaller, and a lot more corporate.  Gone are the days of it’s existence largely as a scientific information-sharing service, largely populated by enthusiastic geeks.

I thought back to my old blogs (also long gone) and how so much of what I wrote about was the day to day life of a twentysomething uni student, all the music I liked, and hobbies and random things.  It’s so easy when you’re a doctor to live that role when you get home from work, but of course, if you let that happen, when retirement comes, you might as well scoop out your soul and leave a shell of yourself.

So here is my proof that I do things other than medicine.  I do things.  Like, go to the aquarium with my daughter who has a natural affinity with penguins.  And they with her.

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I also work on my home, which we are not into a year of owning and like to bemoan how poor we are.  Like gardening.  Attempting gardening.  See the dead grass?  It died in a very neat line along the length of the fence.  If you look over the fence, the neighbours have done some gardening of their own.  Just saying.  This is an orange tree.  I hope.

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You may not know that I am a Swarovski addict.  I don’t care what anyone says about it.  It is sparkly and stays sparkly.

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I am also a big fan of high tea with friends.  I like to work my way through high tea venues in cities.  Where else can you legitimately drink champagne and eat cakes without anyone getting judgy?  This one had an all you can eat chocolate bar after the scones and whatnot.  It sounded good in theory.  It is a double edged sword laced with delicious poison.

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Meanwhile I continue to drown in college requirements and oddly sexist comments about part time doctors but what can you do?  Work finishes, and the cake awaits you on weekends.

 

Guts and glory.

I’m doing an outreach rotation at the moment.  It involves venturing into the community, leaving the bubble of the hospital, and assessing people to see if they need to go to hospital.  The idea is that if we can treat them in the community, we can prevent a hospital admission.  Hospital admissions are expensive, and for the group of patients I now work for, usually detrimental too.

Except that when you’re in a hospital you have everything.  You have a lab at your disposal, imaging, on-the-spot specialist opinions if urgently required, you’re surrounded by experts.  Out in the community it’s me.  Me and my stethoscope and doctors bag that has antibiotics, diuretics, and a script pad.  If I’m lucky a nurse will come out with me – the nurses I work with are for more experienced than I, they’ve been doing this gig for decades and before that, working in intensive care or emergency.

When I see my patients, I have to ask myself, what is the best for them?  Is it a hospital admission?  Is it prevention of a hospital admission?  Is that safe?  If I don’t send them to hospital, will they survive their ailment?  If I do send them to hospital, was it the wrong call?  Have I created illness for them, have I wasted thousands of dollars?

Last week I saw an elderly woman* who was delirious.  She’d had some blood tests a couple of weeks back which were helpful for me, but had been well in between.  Delirium is a hard one because my patient can’t tell me what’s wrong.  My patient didn’t have any pain (that much you can more-or-less elicit) and she had a catheter for her urine, the contents of which at a glance, was clear.  I gave her some juice and she vomited it immediately.  I examined her in a limted way – she couldn’t follow a single command and I couldn’t find any signs of infection or much else for that matter.  No medication change.  For all I knew it could be a non-medical reason, sometimes simply a change in staff, a change in bedroom, can cause a delirium in our older patients.  She was dehydrated.  The nurse offered to hang some fluids and I agreed and asked her to collect some bloods and sat down to write my notes.  I wasn’t keen to send her to hospital, surely I could figure this out, institute treatment, and keep her out of hospital.  But something was bugging me.  It was her colour.  People can take on a different tinge depending on what is wrong with them.  There is the yellow of jaundice, the flushed of infection, the mottled of sepsis, the pale of anaemia.  The greyish-yellow of uraemia (from kidney failure).

A million years ago I did a term as a renal (kidney) registrar.  It was easily the hardest term of my life, the level of responsibility given to me, given my junior level.  I wont go into details here.  But while it broke me, it made me, it taught me about guts.  My consultant at the time was a kind genius.  He would walk through the emergency department, and collect patients.  They would be admitted under other services but because he’d worked there for twenty years, he knew the whole community and wanted to look after them.  The other registrars would joke about never letting him go to the emergency department or you’d have the biggest round list in the world!

My genius boss, who knew everything and who loved people, used his gut a lot.  When faced with a problem he didn’t know the answer to, he would stand there for what seemed like an age, hand on his chin, and then eventually say “I think we should try this…” He never got it wrong.  It was wonderful to watch the 40 odd years of experience he had at work.  He never really articulated why he chose that and I’m not sure he could, it was just the weight of that experience influencing his gut.  I’ve always found this hard.  Especially in the exams.  There’s so much noise in your mind as you go through.  If you choose this, what about that?  What would others choose?  If you get it wrong does it prove you are as stupid as you suspect you are?  If you fail, what does it mean?  Does it mean you’re a terrible doctor, does it mean everyone will look down on you?  Isn’t that the right answer as well?  The answer is lost somewhere in all of that.

When the patient is in front of you, it’s even harder.  It’s none one of 5 options anymore, it’s 50.  My patient could have had a stroke.  She was delirious, she couldn’t swallow properly.  If I didn’t send her to hospital, was I missing a stroke?  I didn’t think it was a stroke, but it could be.  How would I know?  I sat there staring at my notes for a really long time.  I had no blood tests.  I had my examination findings, my history.  I had that strange colour.

The nurse returned.  I took a deep breath.
“I’m sending her to hospital.”
The nurse blinked in surprise, a little bemused.
“I think she’s uraemic” I blurt out, “I’m not a hundred percent sure, but if we send the bloods and wait for the results, and I’m right, she’s not getting into the hospital until 9pm and no one senior is going to see her for a while.”
“Your choice doc”.  It may seem a benign statement, but my wonderful, experienced nurse who knows far more than me, isn’t arguing.  And if they’re not arguing, you’re probably right.  But still, if I’m wrong, then I’ve put a lady through a lot of unnecessary and painful intervention, and cost thousands of dollars to a very stretched system.  There are so many points at which I could second guess myself.  So many wrong calls.  This could be a completely wrong call.  It would be so easy to talk myself out of it, go with inertia.

We organise an ambulance.  I ring the emergency department consultant.  They are never pleased to hear from me but we keep it polite because we both get it.  The nurse and I run the bloods back to the hospital ahead of the ambulance to expedite the patient through the department.  I call the patient’s next of kin and explain, they are accepting.  And then I move onto another patient and try to put it out of my mind.

Later in the day when I’ve returned to the office, the nurse claps a hand of my shoulder.
“Nice call doc – good to see you trusted your gut”.  She thrusts a printout of the blood test and brain CT in my hand and there it is.  Severe kidney failure, no (obvious) stroke, right call made, correct treatment and admission commenced on arrival.

When I was more junior, the glory would have been in making the right diagnosis.  There is no glory in this for me now, because it’s a horrible situation for the patient.  I’m glad that things were done correctly, but the glory is in the trust I afforded my own judgment.  It’s easy to make decisions when you have a lot of information available.  Out here, in the far reaches of the medical galaxy, it’s so different, you have so little at your disposal.  So my post tonight is a little bit of a pat on the back for me because you don’t often feel successful in this gig so that when you do, you’ve got to take a moment to enjoy it.

But as always, I have a point to make.  Exam sitters, when you take that exam on Monday, trust your gut.  When you have that moment when you think “I think it’s this but I’m not sure why”, no matter how faint that moment is, and no matter how much your mind tries to convince you it could be the other 4 options for so many other reasons (especially if you have an arts degree), hold that moment.  Trust your gut.  I get that you’re junior, that that muscle is as yet underdeveloped but it’s in there.  Your answer is in there.  The exams are the beginning of you finding your voice as a physician.  Don’t worry about failing.  This is the safest place to fail.  You wont harm anyone.  You wont have to tell anyone their loved one is dying.  You wont have to say to a patient “I made a mistake…”.  Your pride might get wounded if you do, but I don’t need to tell you that is nothing in the face of a medical error.

When you have that moment when your mind freezes, when you panic, when something screams at you “I don’t know!”, you know what?  It’s okay that you don’t know.  Half the time you really don’t.  Answer C, put a star next to it, move on and calm back to it later.  Or take a time out – stop, close your eyes, take 5 really deep breaths in and out, open your eyes, and keep moving, come back to it later.  The answer might come to you in a little while and if it does, wonderful, if it doesn’t, keep your answer at C.

You can’t harm anyone taking this test.  Your family is safe and unharmed, the people you love are okay.  You are okay.  This is all that matters.  This test is not who you are.  It’s a hurdle, sometimes you clear them, sometimes you crash into them and if you crash, you set it back up and you try again.  And the best part is that this is not a patient.  Even if you’re wrong, you’re not wrong, because you can’t hurt anyone doing this test.  On Monday, start trusting your gut.  It’s an ill-defined thing and it’s scary but ultimately, it’s worth it.

Good luck to all the candidates sitting the FRACP Part 1 Written Exam on Monday!

*patient information heavily de-identified and changed for this piece.

Goodbye 2016.

Sometimes you have years that have so much change in them that personal growth is minimal and everything feels insensible.  That was my 2016.  Interstate move, four new hospitals, new hospital system, buying a house, another move, a new daycare – I’ll be honest and say I drowned in it somewhat.  Sometimes you look around you and wonder how other people do it.  Tidy houses, tidy children, stability everywhere.  And then you realise that most people live in the same place for most of their lives, sometimes even the same suburb.  For the last 10 years we have moved and moved and moved and moved.  Never mind that in medicine for the first 5-10 years of your career you change job every 3 months.  You can go crazy trying to be the person who lives a life of no change, or you can raise your tolerance to mess and hope that other people raise their tolerance for your temporary scattiness and disorganisation.

I’ve been late to lodge forms for so many things this year, bills, training stuff, other vagaries of life and I’ve also been very lucky in that for the most part, people have been more patient than exasperated with me, and that in spite of this, my current network gave me a job for next year.  Sometimes you want to scream at people “I swear this isn’t me!  The form is in a box somewhere but I’ve moved so much that it’s not in the box it was in, it’s in another box which has the wrong label crossed out and the right one written on it and…” and so on.  No one has an attention span that long so I just apologise profusely and say I’ll get onto it and inevitably do.  I mean I just posted my work contract a month and a half late.

Don’t even get me started on keeping a house tidy!  A house!  Aren’t I lucky!  I have my own house and a patch of grass and honestly, this makes me feel like a king.  Watch The Castle if you haven’t already.  But I’ve lived in apartments for ten years.  Houses are big.  And drafty.  And you can’t just leave the window open and go out, and you have to worry about homes security because there aren’t 3 locked doors and a building manager between you and the outside world anymore.  And I seem to get one room tidy but the others get all messed up in the interim.  And you have to sweep.  You know, just like your parents did.  There’s a driveway and it needs to be swept.  And mowing the grass!  Anyway, all this little, new things that houses require on top of all that change, I’m afraid I’m not very good at that either.  I get one ball in the air and all the others are shattering on the ground – that’s been my 2016, but at the same time I feel so lucky and grateful for it all.

If there’s one thing I’ve learned from going through those exams, is that you have to be shit before you can be good.  All those people, living in the same places, doing the same things forever – they’ve had years to become that way.  Years to develop systems of living, and it does take years.  The exam also taught me that it’s okay to be a beginner and what it really really taught me is that it simply does not matter what people think of the way you do things, nor is there a ‘right’ way.  The best way is the ‘get it done’ way, whatever that looks like.  I’m afraid I’m not great at that either because oh, there’s just so many things to get done all of the time, and that’s just the ones you know about it.  Inevitably there turns out to be ones you don’t know about as well.

Anyway, 2016 has been a very very very hard year for me, but not an awful year.  No one I loved died (Carrie Fisher, David Bowie, and Prince notwithstanding!), my family is healthy, and we got our castle.  I stopped making resolutions a long time ago and have instead come up with themes to try and live by and improve on, and the theme for 2017 is ‘stay ahead’, which is kind of a testament to being more organised.  2017!!  Can you believe it?  We’re almost a decade into the 21st century.  There’s been modern science fiction movies made about times BEFORE now.

At any rate, I wish all of you lovely readers a wonderful 2017.  I can’t name a single person who hasn’t had a hard year, and this is the nature of things from time to time.  And to end my post, here are some photos of my structurally unstable 2016 gingerbread house I made for Christmas, and the Pinterest fruit salad I made that is held together by toothpicks, a large carrot, and half an apple.  Enjoy!

See how the side is bowing?

See how the side is bowing?

Funny story (not).  The whole thing slid apart when I put it together and the roof collapsed so the whole thing had to be fixed with skewers and terrifying amounts of royal icing.

Funny story (not). The whole thing slid apart when I put it together and the roof collapsed so the whole thing had to be fixed with skewers and terrifying amounts of royal icing.

How good is Pinterest?  It taught me how to make this!

How good is Pinterest? It taught me how to make this!

Here's a photo of some more gingerbread I made.  It's lemon icing and some FF-inspired gingerbread glamour.

Here’s a photo of some more gingerbread I made. It’s lemon icing and some FF-inspired gingerbread glamour.  The recipe is from the Barossa Vallery Cookery Book circa 1912 with a 16th century German gingerbread recipe renamed to ‘honey biscuits’ because everyone hated the Germans then and were very awful to German immigrants.  Sound familiar?

This is a platter that I wrapped after watching this video on Japanese gift wrapping. I modified the technique because it’s a circle (and it’s not as easy as it looks) but this technique is LIFE CHANGING.

Goodbye Christmas.  I got this decoration-organizer from Aldi in the spirit of my new years resolution.

Goodbye Christmas. I got this decoration-organizer from Aldi in the spirit of my new years resolution.

Goodbye Carrie.  You were the first female superhero I ever knew.  Your Leia was magnificent.  And no one but you could have done The Blues Brothers.  I'm sure when you got up there, John Belushi was wall 'well what took ya so long?

Goodbye Carrie. You were the first female superhero I ever knew. Your Leia was magnificent. And no one but you could have done The Blues Brothers. I’m sure when you got up there, John Belushi was all ‘well what took ya so long?”

Goodbye 2016, it’s been real.

Winners of 2016

Time for my favourite products of 2016!  There are some ones from last year but a bunch of new ones too, in case you need ideas for last minute presents and yourself.  I’m not affiliated with any of these companies in any way, I just like to shop.

 

1. Apple Cider Vinegar

This has changed my life.  I read an article about the need for our scalp to be PH balanced and how most products are too acidic, leaving the hair cuticle open and how using products and heat to force it shut is really bad for it.  Long story short, I have fine, dry hair, that loves to create it’s own halo of frizz.  A tablespoon of this in 500ml in water (2 tbsp for long hair) after I’ve washed out my shampoo and left on for 2 minutes then rinsed out has done amazing amazing things – no more frizz, lots of movement.  Just use once a week.  I usually have some sort of semi in my hair and it doesn’t hurt it.  No idea if it works on blonde.

2. Benefit Benetint

I know, it’s been done to death, but I’m still doing it.  The colour is perfect.

3.  IOPE Cushion foundation

IOPE Cushion foundation

This amazingly magical product has consigned my expensive Chanel foundation to the back of my drawer – it transforms you from haggard mother of energetic non-sleeping two year old into a magnificent airbrushed Disney character who has never worked or slept a day in her life.  Every year the Koreans impress me with their commitment to reinventing makeup.  Sadly after only a year, they discontinued my shade, necessitating the biggest buyup of foundation I’ve ever done.  You can buy all of the other shades from Strawberrynet or Yesstyle and Reddit has a good colour matching spreadsheet here.

4.  MECCA Lip Deluscious

Nothing says sharp, chic, and on my game like pulling out an attractive pot of lip gloss, a sharp-looking lipbrush and applying it mid sentence – at the nurses station.  It smells like marshmallows and has a faint moonstone-like shimmer with superior moisturising abilities.  I’ve been in love with it ever since my sharp, chic and on-her-game friend pulled it out with a sharp-looking lipbrush over cocktails at a hip restaurant.

5.  Benebalm

This one makes the list again this year because I’m still on the same one, it’s that good.

 

6.  O&M No Knott detangling spray

When you have very fine and dry hair that likes to exist in a permanent state of frizz, you also find that there is not a product on this earth that will get rid of the frizz without making your hair look lank.  Even the lightest anti-frizz stuff makes it look terrible.  Shine oils make it look dull.  Enter this amazing spray.  After I shampoo and use apple cider vinegar, I towel dry and spray it with this stuff.  No conditioner because it also weighs it down.  My hair then air dries into amazing bouncy non-frizzness.  It also smells like a beautiful garden full of dancing fairies and highly attractive other sorts.

7.  Tangle-teezer

You will find me in my grave, buried with his magical invention that has ridded me of the pain associated with brushing my dry knotty hair.

 

8.  Seea surf suits

If you live in perpetual fear of the sun burning holes in you and at the bare minimum, giving you melanoma, or you just don’t like bikinis because you feel like you’re wearing your underwear in public, give these a go.  They’re beautiful.  I love mine.

9.  Meditation Oasis

Mary Maddux voice has been honed from years and years of running meditation classes, since before it was cool and before it had an evidence base.  There’s an app or you can listen to the podcasts on their website for free, all guided meditations on many topics, all magic.  And necessary at the Game of Thrones style onslaught that is Christmas these days.

10.  Sonos & Spotify

My husband told me about these when they first came out and being the awesome cool wife that I am, went straight out and got him one for his birthday.  I had no idea what it was and I’m pretty sure Sonos hadn’t counted on someone like me getting to know one of these things.  It’s a speaker but it connects wirelessly so you can play music from your phone, tablet, or computer and the sound will come out of the speaker without it having to be connected to an MP3 or CD player.  Even better it works with Spotify (an all you can eat music subscription library) so it’s almost any music you want, any time you want.  Which, when you’re a new parent, is lullabies.  Endless lullabies.  I don’t think Sonos really thought about that but the ability to call up lullabies on demand, at any hour of the day when you can barely spell your own name, is golden.  Also Michael Buble Christmas carols.   One day I’ll expand it so I can do music in the kitchen and the backyard, but even with just one speaker this setup is worth it’s weight.

I’d love to see everyone else’s lists, and I hope you enjoyed this one!

Pregnant on the wards: Part 2 – the personal.

I write this with a heavy heart.  No dot points, a bit all over the place, but that is how these things go.  If you’ve ever experienced pregnancy or loved one loss, don’t read this.  You don’t need to.  You know it all already and you should live your life and not relive your losses.

A few years ago I became a medical registrar.  In my state, you become a registrar 3 years out of medical school.  In some other states, that third year is a quasi resident-registrar year in which some jobs you’re a reg and in others you’re still doing discharge summaries.  But in my state, you’re sent to a regional or rural site to ‘break you in’.  Three weeks after being a paper-pushing resident, I was the medical registrar for the hospital at night.  All medical admissions had to be seen by me.  All sick patients on the wards, seen by me.  And in a curiosity I think specific to my network, there was no week off after nights.  You would show up to your 8-5 day job, on Monday, work until Thursday, then on Friday, try to sleep during the day, and start nights.  You then did 7 12 hour nights, finish the following Friday, have two days off, then return to your 8-5 day job.  2 days off in 3 weeks, to give you an idea of the workload.

In medicine, as a resident or registrar, you don’t sit.  When the boss rounds, you always offer them the chair when there is a chair (not often).  You don’t have your own desk or phone, there are desks and phones but they’re usually shared between you, the nurses, the physios, the occupational therapists, the pharmacist, the social workers and everyone else who needs it.  Of course it depends on how well funded your hospital is, sometimes the doctors might get a cupboard with a lone computer in it but it’s rare.  You don’t sit, you stand and walk and stand and walk.  Sometimes when you’re tired you perch on the end of the patient’s bed.  As an intern your feet hurt all the time but it goes away eventually.  You see your patients, you come up with a list of things that needs to be done for them (a management plan), always with the goal of getting them home safely.  The list includes tests you need to do to confirm your suspected diagnosis and any new ones that usually come up, other services who need to see the patient who need to be called, and starting/stopping/adjusting medications.  You do this for everyone.  You admit patients, by writing up their history, examination, and a management plan.  Am I procrastinating telling my story enough?

My husband and I had been trying for a baby for the last six months of residency but nothing had happened and we decided to take a break.  I was starting a new job in a new hospital, and besides, it’s not like we’d be living together anyway – he had a job in the city and I had to work a couple of hours drive away, and frequently on weekends.  The new job hit me like a ton of bricks.  At first it was alright, I had a supportive group of consultants, but I was a fish well out of water.  And then, I rotated.  You rotate every 3 months in your early years.  Every 3 months, new job.  New bosses, new juniors, new allied health, new systems, new patients, new fridge to put your lunch in.  It’s exciting and intermittently dizzying.  I rotated into the hardest job I’ve ever had in medicine.  3 months out residency and suddenly I was on-call, every 3 weeks for one week.

On-call in this job meant, that from 8am Wednesday to 8am Wednesday, anyone, from the 4 hospitals in the area, laboratories, GP’s, and sometimes patients, could call me.  They would call me about sick inpatients and sick outpatients and did I want them admitted, they would call me to come in and see people they were worried about, the labs would call me about patients with terrifying lab results who weren’t my patients but were known to our service, resulting in me scrambling to figure out who the hell they were and where I could find them in a very large geographical area.  This was in addition to my day-job, where I had 30 patients, and 20 consults daily, which I usually managed to finish at 8pm on a good day.  The calls would come at dinner time, 2am, 3am, 5am, any time really and at any of those times, I had to go into the hospital if required.  Even if I had been in the hospital for a couple of hours since 2am, I had to be there at 8am, ready to go.  On the Saturday and Sunday, I would round on any patients under the service who were sick, and any consults that were sick, and any new consults.  On the following Wednesday, I would turn off my phone at night with relief.

It’s really boring to complain about how busy your job is, especially in this job.  Everyone has a more hardcore story than you.  Some wear it as a badge of honour ‘if you’re not working your guts out, you’re not working’ sort of mentality.  That’s medicine.  I didn’t write all that to complain about it – that term freaking made me, but I wanted to set the scene.

A couple of weeks into that term, I discovered I was about 5 weeks pregnant.  We’d stopped trying trying but weren’t actively not trying.  And what should have been happy news filled me with terror.  For some reason, the medical workforce had put me on my own in a dodgy flat in a dodgy part of town.  I had no idea how I was going to do this job and be pregnant.  No one I knew had kids.  My family were all interstate.  I’d worked so hard to get a coveted job in this network, and now I was letting them down.  How dare I?  They didn’t have to hire me but they did, when it was so competitive.  Would they think I didn’t take the job seriously?

At the same time, I was being bullied by a more senior colleague.  I can’t go into detail because it ended blowing up to something far greater than myself and I was told by administration I was not allowed to disclose any of it.  To anyone.  Not even my supervisors.  I wouldn’t talk about it here anyway as it’s far too identifying but needless to say, this dragged me down into the deepest of holes, pregnancy aside.  Adding first trimester fatigue, hormonal changes, nausea into that mix, along with the on-call, was a recipe for disaster.  I started withdrawing.  I didn’t see it at the time, but I stopped going online as much, talking to my friends and family as much.  I’d go home and turn on the TV and pretend none of this was happening, alone in that dodgy little apartment.  I swallowed Maxalon, showed up to work, did those hours, put up with the bullying, didn’t go to the bathroom, didn’t drink any water, and pretended everything was completely normal.

Two weeks later, my aunty died.  She was a driving force in my life, a second mother when my own had to work, being a single parent.  Her acerbic brand of humour, rampant feminism, and menthol cigarettes touched my life in more ways than I could ever count.  She was only in her late fifties and the cigarettes had given her lung cancer.  She’d gone into hospital for something unrelated and died suddenly of a cancer complication.  Nothing is ever really sudden in stage 4 cancer, but it wasn’t the slower deterioration I was used to.  I flew interstate to her funeral which was a mistake, as much as I loved her.  I finished my on-call, drove the two hours back to the city, got on a plane, went to the funeral, flew back the next morning and drove the two hours straight to work from the airport.  I was exhausted and it was a stupid thing to do.  She would have been horrified..  And I kept going on at work.  Getting bullied.  Being pregnant and telling no one, sick to my guts, so fatigued I could hardly see, withdrawing from everyone.

And then I started bleeding.

There is nothing in the world like that moment in the early pregnancy assessment clinic, when they send you to the ultrasound and you look up at the screen and see that little, unmoving circle.  I was 11.5 weeks when it happened.  You don’t need to hear the sonographer say ‘no heartbeat’, you can see it.  Everything just stops and zooms right onto that awful, little moment, in that tiny little room.  I stopped.  My mind stopped.  My husband’s head was in his hands.

Afterwards I disappeared into a hole.  I don’t have a lot of words to describe that time.  For the rest of the year I was a zombie.  I stopped talking to everyone, I couldn’t speak, I couldn’t compute.  I’m incredibly lucky I have the most incredible friends in the world who didn’t let me drown.  Even when I didn’t speak, they didn’t let go.  Flowers arrived.  A little gift here, a kind word there.  These were the protective threads that without even knowing, I held onto, that carried me through.  I hard deleted my Facebook account which is surprisingly difficult, (it’s not the same as closing it!), and just turned off the Internet.  I didn’t want the conversations of normal life, of the flow of life, when mine had stopped.  I showed up to work.  I suffered through that fucking term.  It didn’t matter anymore how hard I was working because there was nothing left to lose.  My hair fell out.  My husband and I entered a strange place, that place where you lose your innocence about pregnancy, where you lose the ideal that to be successful you work your guts out.  Something broke in us both.  I can barely remember the rest of that year.  I remember trying to study for the exam but staring at the wall. By the time the written exam had rolled around, the damage was done.  I failed it by 4 points.

I will never know if that miscarriage was due to all of those incredible stressors.  1 in 4 pregnancies end in miscarriage, and someone told me at the time that it’s exceptionally hard when it’s the first pregnancy that is lost.  In hindsight though, knowing what I know now, I would never, ever, have let the job run me down like that, as a pregnant woman.  All of the lessons I wrote about in Part 1 were learned in that black hole of a year and oh, if I had my time again! So if you’re reading this, don’t despair, go back and read Part 1 because it really can be okay if you prioritise yourself and your baby above everything including the job.  It’s a hard change to make, especially in medicine, where you are the last priority, but you just have to do it.  I lost so much that year, and it has taken me years to rebuild.

And so I don’t leave you feeling sad, here is the epilogue to that story.  On the day I found out I had failed the exam, between my tears I also was lucky enough to be telling people I was 12 weeks pregnant, scan confirmed.  And everyone in my network was elated for me (a pleasant surprise!) And although there were more lessons to be learned (like, do not let your employer put you on those shitty set of nights where you get 2 days off in 3 weeks, in the last trimester), it was nothing like the year before.  And when my daughter was finally born, my whole world opened up again and because of what had happened, she was more adored and loved than any baby on this planet and always will be.  I sailed through the written exam on the next go, 25 points clear of the pass mark, and then passed the clinical first-go too (which is a whole other excruciating story).  Because in the end, this too shall pass, and it really really did.

If you’re reading this, and have guessed who I am through this somewhat identifying story, please respect my anonymity.  I write this because I hope I can help others in that hole, who are in a unique situation, but I cannot continue to write without the safety of that anonymity.  Thankyou for reading.

Put your thing down, flip it, and reverse it.

It’s been a long time once again since I’ve blogged, and it’s been longer still since I’ve had the time to really think about what I want to write.  The past five or so years, from day one of internship has been insane.  So many milestones crammed into such a short space of time, peppered with happiness and tragedy.  Now, finally, I’ve come screeching to a near-halt.  A slow drift.

I went part time.  We bought a house.  We moved into the house and now I find myself a regular Bunnings visitor.  I leave work on time because the daycare charges by the minute if I’m not there but more importantly, the guilt kills me.  I suppose that’s what the men at the top mean when they say things like ‘woman can’t focus on their work once they have children’.  What they mean is that ‘women can’t prioritise me 100% anymore”, but I digress.

When you’re used to insane hours, when you’re neck deep in the cult of public hospital medicine, you don’t see it for what it is.  You think there’s something wrong with the people who leave on time.  Something wrong with the people who pick the ‘softer’ specialties.  They don’t have what it takes, they have must have pissed someone off.  The whole idea of crafting your work around your life is nonsensical.  It can’t be done.

In August last year I had a phone call.  The person at the other end of the phone wanted to hire me.  They were interstate, and they wanted to hire me.  My bosses had given glowing references.  My resume was sharp, if noncommittal.  I was reserved on the phone.  I’d been burned by too many heads of departments droning on about competitive it was, how I should ‘throw my hat into the ring’ (a term you hear not infrequently, year after year), how I was competing with the best of the best, and oh my goodness, you want to, job share?!.  Then the usual backtracking over how they support job-sharing but they’ve never done it before and how would it work, how would I make it work, how would I do all the work for them.  I was tired.  I was more tired than I’d been in my life.  I couldn’t blaze any more paths.

The person at the end of the phone sensed my reticence.  They could tell I’d long lost interest in prestige, or dollars, or any of the other pots of gold that the medicine rainbow allegedly offered.  Sensing this, they said magical words I’d never heard uttered in medicine.  Their passion, they told me, was supporting parents with young children through training.  They rattled off a list of things they did and did not want horribly sleep deprived parents doing, and how they had medical workforce on board with this, and that they would arrange my shifts however I wanted.  I was shocked.  I’d never heard of this in medicine before.  Even GP training, that oasis of family-friendliness that calls us all, is suffering from corporate-owned interests impeding on that.  And there it was.  I told the person on the other end of the phone that if they were serious, then I was serious, and I’d be on a plane immediately if they wanted me to be.

Here I am.  Part time, with my roster well controlled and not overloaded.  Surrounded by supportive consultants.  In my own home that I own.  I planted daisies and pelargonium today.  My mother was horrified that I didn’t just get a cutting of the latter, that I’d paid actual money for it, but I pointed out I’d not seen that particular shade of rose-tinted fuchsia in anyones front yard, and that I could grow this one up and take cuttings of it anyway.  The daisies are my toddlers favourite.

The more I tread into that misty territory no one in medicine believes is real, the more I realise that the whole culture of medicine, the whole break-em-down-and-build-em up mentality, the whole, you-must-work-at-150%-all-of-the-time-and-families-have-to-work-around-us schtick, is nothing more than entrenched ideology at it’s finest.  At the same time, I was forged in those fires.  My references, the amazing feedback I’m getting, was built in that culture and I can’t help but respect it.  But at some point, something should give.  6 years out, I get to rest now.  Some people don’t, they push on through that fire, develop skills I could never dream to for so many reasons and they have my admiration.

And as I find my way in this new land, I find myself finally loving my work, my patients, and my colleagues.  As the burnout lifts, I emerge, finally myself in a field where your identity so often evaporates into the thousands of hours spent learning through fire.

In the words of my favourite blogger, we are through the looking glass people.

Kate.

Dr Kate Granger MBE

Dear Kate,

I’ve never met you but my heart is broken.  I was a resident when I first discovered #hellomynameis and I remember reading your story and thinking how amazing you were, how suffering the blow of such a terrible diagnosis and at the same time, using your experience made something positive out of it.  I loved how much you loved medicine.  Your knowledge, the passion you had equally for the science and humanity of it; I remember thinking at the time, will I ever love this job that much?  I was burnt out and overworked by a giant, thousand bed hospital that had gobbled me up and chewed me into millions of tiny pieces.  I loved how you loved life, music, food, how you enjoyed all of it, in spite of it.  I followed you through time, all these years, to today.

When I became a registrar I had no idea what I wanted to do.  I figured a year of it wouldn’t hurt for experience sake and back then, I was so lost and confused by the brutality of the job.  And my first year of registrarship was a further baptism of fire that I wouldn’t wish on anyone.  Multiple personal tragedies, workplace bullying, and discovering what ‘clinical governance’ really means, more being gobbled up by the system, and int that year, being so lost I couldn’t speak anymore.  I kept following you, reading your tweets, feeling the dread that came with each infection, cheering for you when you got home.  Your love of life, of your marriage, your work, helped anchor me, helped me remember what was important in life.

Right at the end of that hard time, I did my first geriatric medicine term and like you, fell in love.  Suddenly I understood it.  It was all the best bits of medicine (for me), wound up messily with the culmination of human experience.  It was medicine, it was families, it was psychology, logistics, pain and suffering, healing, quality over quantity.  And finally, with a new purpose, that horrible year faded into memory, I got my exams and sailed happily into that world where I am now without one single regret.  And throughout that whole, torrid, journey, you were there on your own incandescent, heartbreaking, amazing, world-changing path.

I’m so sorry.  I’m sorry about Christmas.  I’m sorry Chris and God, so sorry about Charlie.  I’m sorry about the baking and the music and the little ones.  I’m so so goddamned sorry that your patients don’t get you as their doctor because you are who they need.  I’m sorry that thousands of people are championing your cause because I damned well know that if the cancer never happened there wouldn’t need to be the cause.  I want to wind back time for you, make the diagnosis never happen because you deserved your family and your career and all the cakes and Pimm’s and other nice, bright things in life. And you took all of that sorrow and turned it into magnificence, the highest form of functioning.

At the beginning of the year at my hospital in Sydney, the nurses had set up a table at the entrance and took photos of us in a picture frame adorned with the words ‘Hello My Name Is’.  We had name badges and wristbands and I wore them until they fell apart.  I’d been introducing myself properly ever since learning of you, not always perfect with it, but so much better than the at-times patriarchal way I’d been trained.  And these days it’s ingrained and it’s perfect because Kate, for you, I’ve practiced and practiced and practiced.  And early on I’ve been that scared resident that couldn’t look their cancer patient in the eye and since you, not any more, and since having my own interns and residents, I’ve trained them too and I know they’ll train all the others.

I love my job now Kate.  I appreciate the little things so much more.  I’ve learned so much from you and Chris, more than just introducing myself properly (and how sad we needed a campaign to teach us this), and forever more, for you, I will introduce myself, I will love my job, I will always try to look on the bright side of life and work with the hand I’ve been dealt.

The last thing I wanted to say, because I’m not sure you ever did, not publicly anyway because you’re a lady, was this.

Dear cancer,

Fuck you.

All of my love,
Another Kate.

Dr Kate Granger MBE and consultant geriatrician, passed away last night at the age of 34 from a rare type of cancer.  She was given less than two years to live at diagnosis, and in the five years that followed, sparked a worldwide campaign to have healthcare workers introduce themselves to patients, and treat them with the respect and kindness that they all deserve.  The #hellomynameis campaign has been adopted by hospitals and health facilities all over the world, and Kate and her wonderful husband Chris have raised over 250,000 pounds for the Yorkshire Cancer centre in Leeds.  Kate wrote two books in this time because she was clearly a spectacular overachiever, you can find them here.  She will be sorely missed by healthcare workers all over the world.