Heart of stone.

I read an article recently about a survey into bullying of doctors specialising in intensive care (ICU).  One third of those surveyed revealed bullying, probably the tip of the iceberg  That, however, is not what disturbed me the most.  What disturbed me the most was that when these results were presented to the college, some smug upstart stood up and said the results weren’t valid because they weren’t statistically significant.  Statistical significance means that if positive, it would be representative of an entire population relevant to what was being studied.  Except that when you’re measuring qualitative things, such as, people, not drug responses, statistical significance kind of doesn’t really matter – if even one person has been bullied, it’s not okay.  The fact that this didn’t even register with that person, is symptomatic of the strange cult medicine has become.

When you’re a medical student, you’re so excited.  You did medicine because you wanted to help people, because you wanted to be proud of what you do.  You can’t understand why people in the field seem a bit grumpy.  Sometimes your consultant teachers are really mean, sometimes they make you cry or feel stupid, sometimes they make your colleagues all laugh at you because they’re frightened too.  And it’s normal.  It’s all normal.  It’s hundreds of years of history and nobility normal.  But it’s okay because medical school is still kind of a cocoon where you have your friends and you go to the pub and you have a few and laugh at the mean consultant and feel better about it.  By final year, shit is getting real but it’s still mostly okay.  Some people are wigging out because they want to be neurosurgeons since forever and they’re worrying about their careers but most of us have held onto that idealism.

When you’re an intern it’s really really really hard.  You’re thrown into these giant hospitals with hundreds of people, and lists of jobs longer than the time given to do them.  When you complain that you don’t get to go home on time, you’re told to be more efficient.  When you ask for benchmarks or KPI’s so you can try to understand what is expected of you, there is nothing but silence.  You’re too afraid to complain that the working conditions are outside of your award, because you want a career.  If you’ve even read the award, because it’s never supplied to you when you get hired.  ‘Good’ interns power through all their jobs with a smile on their face and never complain.  ‘Bad’ interns complain, struggle to do all the jobs because they spend too long trying to care about their patients, suffer extreme anxiety to the point of paralysis and ultimately leave the hospital for greener pastures because they didn’t feel ‘good enough’.  Never mind they got the scores to get into medical school or got through medical school.  Bearing in mind these two examples are extremes, everyone falls between the two.

The ‘good’ registrar (the person who is on a training programme to become some kind of specialist) is direct, and ascerbic, and doesn’t take shit from anyone.  They frequently bark at interns who ring them to ask for advice, seem to know everything, see their patients with lightning efficiency and not too much caring (because that will get in the way of getting through their work), and their bosses think they are great because they handle the inpatients for them (bosses do clinics and have private patients too), the residents trying to get onto the specialty programme try to emulate them, and the interns are left in tears by them, but ultimately, if they stay, become them.

The consultants are a mixed breed but encourage the direct-speaking, highly knowledgeable and acerbic trainee who doesn’t display too much caring because they make their job easier.  Some consultants like to make sexist ‘jokes’ in front of their trainees (usually female) but always ‘just joking’, some don’t let gender get in the way and employ the time-honoured ritual of humiliation, generally at the bedside in front of the patient, some just outright tell you that you’re useless, and some will try and tell you that you’re terrible as a means of getting you to step up.  Ultimately every junior person at some point feels like they’re not up to the job over minor things (like forgetting to order a non-urgent test) or that they are personally responsible for the safety of their patients and no one else (not true, medicine is a system with multiple safety layers).

And when the most ‘successful’ role models, are the way they are, you become that way too.  I painfully remember at the end of residency, having a busy and stressful shift, and snapped about one of the patients.  I had reached the end of my rope, the end of constantly trying to perform, to clear my jobs, to be that good resident.  I can’t remember what I said, but it was something particularly insensitive and uncaring about a sick patient (fortunately to a nurse and not to their face).  The nurse in charge stopped in her tracks and said “hey, that’s not like you.  You used to be lovely and now you’ve changed”.  I was mortified.  I’d been so process driven, so goal oriented, so focussed on being like the registrars that I’d forgotten there were sick people around.

It had seeped into my personal life.  When your patients walk the line between life and death, when your actions can dictate the difference between that, your heart becomes hard.  Your tolerance for the banalities of everyday life drops and you become hard as a rock.  You see so much terrible shit on a day-to-day basis that it’s your normal.  You don’t even know it’s terrible anymore.  When you step out into the normal world again, you think people are too soft.  You pride yourself on saying things like ‘harden up’ and see it as a point of pride that nothing gets to you, you find schadenfreude in the soft hearted around you suffering because you’re not and there’s clearly something wrong with them and something right with you.

Except you are very wrong.  That heart of stone is made of layers upon layers of vicarious trauma, from the huge amounts of patients with horrible illnesses and stories you’re forced to churn through without ever even getting to say “I’m so sorry” to them, to the hardened hearts of all of your mentors saying things like “toughen up, it’s good for you”, or “you lot are soft, we saw twice as many patients in my day”.  It’s made of completely normalised bullying, of colleagues who lack the integrity to stick with you because their career is more important, because once you get there, once you’ve made it, you can go back to being you again.  But you can’t.  Once there, you have to keep yourself there.  And to keep yourself there, you have to be as hard as a stone.

Later when I was a more junior registrar, one of my patients pulled me aside and told me he couldn’t believe how badly we were bullied.  I asked him what on earth he was talking about, that my consultant was lovely.  The gentleman was agog with disbelief, pointed out how badly each one of us had been humiliated when he was teaching us by the bedside.  I laughed it off at the time and said ‘oh that’s just the way he teaches, we’re used to it’.  I hadn’t even felt humiliated by then.  Once upon a time I would have been in tears.

While I was in medical school I would sometimes go to drinks with my husbands corporate friends.  One of those friend’s Dad was a doctor, and I was musing aloud what I would become when I ‘grew up’, tossing around different ideas for specialities.  That guy at the time told me not to let what I chose harden me, because that was his Dad’s biggest regret.  I didn’t understand what he meant at the time.  I know now.  Doctors are unaware that they are bullied by their colleagues, and traumatised by the double whammy of seeing horrible things happen to people, and not having the time to properly care for them.  In other health areas, like psychology and social work, there are weekly or fortnightly supervision sessions where the trainee can debrief and reflect and work out how they can be better.  This concept is met with suspicion in the medical profession, everyone is always so afraid for their career, they don’t want to be seen as soft, they don’t want to admit mistakes.

I’ve had a few opportunities for ‘greatness’ over the years. Offers to train in lucrative specialties, take on prestigious research and I was so tempted.  But I could see the writing on the wall by the end of residency.  I was becoming what I never wanted to be, that doctor that didn’t care.  You are presented with a clear choice at some stage in medicine, and that’s to go with or against your values.  Maybe it’s not so clear for everyone.   So I took the less prestigious road, I prioritised time and my family over it.  It stings sometimes, a comment here, some dismissiveness there, but I don’t care anymore.  As a medical student, older male doctors used to tell me to do general practice because it was ‘good for women’ (i.e. it’s not as time-intensive as surgery and critical care) but really, they all should be.

Only certain specialties are like this.  Some are lovely.  All have elements while some are overt, and there is no secret which, it’s been in the media enough.  It’s going to take decades to change and that’s being generous.  There is too much bedrock in there, too much fossilised, entrenched attitude, too many hearts of stone running closed systems, believing any opinion that there is something wrong with what’s happening is simply political-correctness gone mad.  They will joke about it to their registrars, say things like “you don’t think like that do you?  You’re one of the good ones!”, and “oooh am I bullying you right now?” and the registrars and residents and interns will laugh because they have no other choice, they will internalise these messages as correct.  And they need these consultants because without their expertise, people will die that they could help save.  It’s a very complex, powerful, codependent relationship, further reinforced by the medical workforce units, responsible for rostering and employment, who behave as though 80-100 weeks are normal and that doctors are lazy or ungrateful if they suggest otherwise.  Of course, on paper, no one does 80-100 weeks.

This post doesn’t really even begin to pick apart what is happening, and what has been happening under the public’s noses for a very long time.  It’s a tragedy.  Everyone wants the caring doctor, but they rarely survive through residency these days.  It’s cooler to be a tough and hard-nosed sort that isn’t fazed by anything.  Everyone is much more comfortable with that, except of course, our patients.  And our families.  And our friends.  All the people who really matter.

So to all my colleagues reading this, trust your instincts.  If it doesn’t feel right then it’s not.  If you don’t feel like you, if you’re crying in the cupboard or telling a family member you think their problem is nothing, just know that you’re still in there and you’re not the one with the problem.  The system has the problem and it’s inflicting it on you.  What you choose to do with your values, is still up to you.

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A post for anyone sitting any exam in medicine.

I have a dear friend sitting a fellowship exam in a few months.  Said friend is brilliant – we’ve known each other since first year of medical school, and when she’s passed this exam, she’s qualified to be far richer than me.  Her specialty is so safety-critical (there are varying degrees of this depending on what field you choose), that it has an exam when you start training, and an exit-exam at the end.  And like all medical exams, they’re a curious mix of vague multiple choice exams, essay questions on things you know nothing about that you’ve never heard of in your day-to-day job, and face-to-face arrangements where you either stand in front of a bunch of serious looking guys who are all much bigger than you, answering questions on scientific obscurity, or, getting 6 minutes (in front of same bunch of guys), to examine someone and confidently make a diagnosis, usually obscure.  FUN right!

The BEST part, is that there is no real curriculum.  It’s not like university where, for the most part, if you show up to lectures and do your readings you’ll do alright, and if you’re really interested you’ll get HDs.  Or you do the easily-available past papers and your lecturers write questions based on the semester material.  There’s ‘the curriculum’ they provide you, which is really just a list of all medicine. (Hot tip; there are now over 7000 drugs you can prescribe, let alone all the diseases, genetic mutations, crazy new drugs, diagnostic procedures – I could go on!).  There’s also the part of you (especially when you’re a woman, occasionally one of your examiners might be a woman but that’s it), that just isn’t used to the idea of being a specialist doctor.  You think, ‘who, me?’  because ten minutes ago you were playing beer pong in a seedy bar in medical school thinking you were the coolest ever because you’d never been cool until that moment you played beer pong.  But specialists don’t play beer pong, they wear suits and have serious faces and Know Everything.  Their juniors are scared of them and scramble at the slightest hint they’re coming to make sure everything is ready and beat themselves up for a good week if they haven’t gotten to something, longer if the specialist gives them grief about it.  And you’re a junior for so long you don’t know what it is to be a boss.  Does anyone?

One minute you’re in medical school playing beer pong even though you don’t like beer, thinking you’re the coolest ever, hiding up the back of the lecture theatre with your friend hoping no one asks you a question while your friend does the crossword, or standing in the path lab being told about the special tubes in some machine when really you just want a nap – and suddenly you’re sitting fellowship exams?  About to become a boss??  Really?

And yet, here you are my friend.  Yes you, about to become a boss.  And here I am bursting with pride, watching you jump into that black hole of study.

Studying for these exams is like being blindfolded and tied up and straightjacketed and asked to swim in a straight line across a lake.  Nothing you do is every enough.  Everyone is better than you.  Everyone studies better than you, and magically is going to do better than you.  It is mandatory that you beat yourself up for not understanding statistical theory they offer whole degrees in.  If you’re a guy, you grow a long beard and it’s not movember, out of some strange time-marking ritual.  You can’t speak to anyone.  You don’t want to do anything but study but you can’t study because you’re exhausted from your 12 hour shifts that usually go much longer if you’re a caring doctor.  You walk outside and the light blinds your eyes and you see regular people doing regular things and they feel like aliens.  You do really badly on your practice exams.  So badly sometimes, you can’t even talk about it because if anyone found out The Truth, they would know that you don’t deserve this.  You don’t deserve to be a boss, what are you doing here?  You get 35% on a practice exam, how dare you even dream of it?  Most people would give up, surely?

Except you do deserve it.  And here you are.  Dressing up and showing up, in one way or another, at that study desk days in and days out.  Doing good some days, badly on others, not enough on some, too much on others.  Trying to find that balance that can’t be found.  Falling down that rabbit hole that has to be gone down for success.  Entertaining the idea, that subversive, dangerous idea that maybe you can.  Maybe, just maybe, all that learning and forgetting and learning and forgetting, and failing and succeeding is just exactly what you need.  On the day you’re going to see that question you failed a thousand times over and you’re going to remember the answer.  On the day you walk into that room and there are 5 guys in suits, maybe a token woman, you’re going to remember every single guy in a suit who gave you grief over the last 6 years and know that they can’t hurt you.

And because you’ve passed all of your exams with high marks so beautifully before (or maybe you didn’t but regardless, you still got here), you’ll know that you can do this because you’ve done it before.  You know that all those study sessions, the long ones, the short ones, the failed ones, the successful ones are all just coins in a bucket and you’ve filled the bucket up a thousand times over.  On the day, you’re going to walk in there and everything will just kick in, you wont be you anymore, you wont have control over what you say because your training will take over and the fancy, suit wearing specialist will take over and choose the best answers for their patient.  The safe answers, the caring answer, the non-experimental answers, the ethical answers.  And even if the roof caves in and the exam is cancelled you know you’re going to be okay and that the sun will keep rising whether you want it to or not, and all of your friends and family will be cheering on the other side, roof or no roof.

All of this is a process of shedding your skin and growing a new one.  It takes time, and it’s painful and it doesn’t necessarily go smoothly.

Here’s the best part though.  You’re not going to be that specialist.  You’re not going to be the one in the suit with the five other serious looking ones who gave you grief when you were an intern.  You’re going to be the one with the kind smile.  With the twinkle in their eye.  Who tells their intern not to sweat it if they didn’t follow up on something non-critical within 3 hours of being asked to do it.  You’re going to be the new breed, the next generation of specialist.  The dynamic, friendly and brilliant kind who are currently just sprinkled about like little oases of relief in a world of so much stress and anxiety.  That’s who you’re becoming right now.  Try it on.  You’ll probably find that it fits better than you ever imagined.

No matter where you are in medicine – first year, or pre-fellowship, this post is for you.  All the very best of luck.

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.

Soundtrack to 2016

I’ve been doing this on and off over the years.  Last year I didn’t because lullabies.  My entire Spotify top 50 was lullabies.  This year I’ve somewhat redeemed myself with a grab bag of good running tracks, New Order’s most recent effort (full of nostalgia), and random other things I’ve liked along the way – line it up to play at your Christmas party and enjoy the compliments you receive on your AMAZING taste.  Enjoy!

  1.  New Order – Restless
  2. David Bowie – Blackstar (listen to the whole song!)
  3. September – St Lucia (probably my favourite for the year)
  4. Get Home – Angus and Julia Stone
  5. New Order – Tutti Frutti
  6. Holy Ghost! – It Gets Dark
  7. Uptown Funk – Mark Ronson
  8. Pretty Pimpin’ – Kurt Vile
  9. My Delirium – Lady Hawke
  10.  Lofticries – Purity Ring
  11. Not This Time – The 2 Bears
  12. Maribo – Mystic Crock
  13. Mountain at my Gates – Foals
  14. This Old Love – Lior
  15. Warrior – Kimbra
  16. Hurricane – MSMR
  17. Pretty Girls – Britney Spears & Iggy Azalea
  18. Cigarettes (ft Hue Blanes) – Illy
  19. Down the Road – C2C
  20. From St Kilda to Kings Cross – Paul Kelly

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.

Pregnant on the wards – part 1: the practical.

I hadn’t thought about writing this so thankyou for the suggestion Shedidwhatnext.  First of all, and absolutely first of all, if you’re a pregnant medical registrar, or about-to-be medical registrar, congratulations!!  This is a good thing!  Babies are wonderful!

But that wasn’t your first thought, was it?  In spite of this happy news, your first thought was oh shit.  Oh shit, what have I done?   Now you’re wondering if you’ve thrown a nuclear weapon under your career, you’re wondering if your DPT is going to disown you, if you’re going to be that pregnant medical registrar who everyone whines about slacking off at work ‘just because they’re pregnant’ and mutter about ‘special treatment’.

I repeat, congratulations!  It’s still a good thing in spite of those scary thoughts.

Everything I am going to tell you is with the benefit of hindsight.  Take my advice or don’t take it (because advice is cheap), but know that I learned everything the hard way, and this is what I wish I had of done and known.  Here it is in list form because I struggle to think in any other way these days.

  1.  Being pregnant is a special state of existence.  I’m not being self-entitled, I’m not being earth-mothery, I am being practical.  Pregnancy is a unique, physiological condition that people cannot understand unless they have been there or unless they’ve had loved ones go through it.  The hormonal fluctuations, the fluid shifts are insane.  The fatigue is insane.  The sleep deprivation intense.  The mental fog from all those biochemical changes and the stress you’re under.  And then all sorts of other things can happen that we wont talk about because it may not.  The point is that you DESERVE special treatment because of it.  Those people who mutter words like ‘unfair’ and ‘special treatment’ are ignorant.  They might sound very certain, as ignorant people tend to do, but they’re not.  They’re not in your world so they don’t count.
  2. YOUR pregnancy is unique and there is no such thing as a perfect one.  It. does. not. exist.  So when you develop SPD, or the nausea doesn’t go away, or you get intercostal nerve pain and the muscles rip off your ribs because your kids head is off the chart thanks to Dad’s noggin (not bitter or anything;) ), don’t beat yourself up.  It’s okay, it will be over in a few months.
  3. Tell your DPT.  Especially if the exams are coming up.  Even if it’s before 12 weeks.  I made the mistake of not saying anything.  I was doing relief, I was on nights, I was sneaking Maxalon, I was finishing my round and going to my car and sleeping whenever I could.  I didn’t know you could write a letter to the college and they would give you special dispensation for a seat near the bathroom during the exam.  I wish I had of done this.  I will explain in my next post.  This is a personal decision and I understand if you don’t want to do it, because telling someone means untelling them so I leave it up to you, but I wish I had of.
  4. Join the AMA in your state.  Right now.  Especially if you’re at a hospital with a less-than-supportive medical workforce.  They are amazing.  Most doctors don’t know their rights.  Most are led to believe that speaking up about unfair working conditions will harm their career which is one of the last greatest myths in the job.  It wont hurt your career but it WILL hurt the career of the person trying to pull it off.  There are people in the AMA who have the power to make or break careers, and they’re there to protect your rights.  I have a few very good examples of the AMA stepping in with legal advice and representation and not only ridding the unfair request made on the pregnant/new parent, but actually improving the workplace for the better.  It’s expensive but it’s tax deductible.  I wish I had of.  I wish I hadn’t of worked those 7 nights in a row with 2 days off and then back to the day job at 32 weeks pregnant because the terrible SPD and migraines with vision loss wasn’t worth it.
  5. If you’re struggling, talk to your obstetrician about your work conditions.  They are very helpful and will write you a letter in support.  Mine offered to call my DPT and demand I not work in the conditions I was asked to.  Again, I wish I’d said yes.
  6. You need people on your team.  See points 4 and 5.  The AMA, your obstetrician, your family, and supportive colleagues.  The hospital is FULL of people who have kids who’ve been treated badly and will look out for you.
  7. Prepare to be pleasantly surprised.  Most people don’t think you’re lazy and getting special treatment.  Most people love a pregnant lady and want to help in any way they can.  Let them help.  Shoulders to cry on, cups of tea, interns who will go the extra mile for you, they’re all there.
  8. You don’t get to not drink water all day and not go to the bathroom all day anymore.  Yes we all do it when we’re not pregnant, but the placenta needs blood flow and so does your brain.  Please buy a giant water bottle and drink a lot of water.  Don’t faint at work.  Don’t deprive the placenta.  The placenta needs you.
  9. CALL IN SICK. CALL IN SICK.  CALL IN SICK.  CALL IN SICK.  Do I need to repeat myself?  You WILL thank me.  This job is not worth you or your babies health or life.  If you can’t do it you can’t do it so CALL IN SICK.  You have my permission.  Blame me.  This is what sick leave is FOR.
  10. There will come a point when you DO feel like that lazy registrar.  When you can hardly walk anymore, when you haven’t slept, when your back hurts.  If you need to go on maternity leave early, just go.  Better to leave a good impression than a bad one to people who just don’t bloody get it.  It’s not the end of the world if you don’t cover yourself in glory at work in the final trimester, most people are pretty understanding, and…
  11. When you come back to work for a visit while you’re on mat leave, with a tiny little baby (and make sure that you do), all of those people who made you cups of tea or let you cry on their shoulder, or who did a bit of extra work to give you a break and maybe even grumbled about it, will feel like they had a hand in that babies creation, and that will make them feel good, and suddenly all the mutterings about ‘special treatment’ will be replaced with a little bit of guilt.  The people who didn’t treat you right, who see the new mother with the little, entirely dependent on you human, will also treat the next new mother with a little more grace next time too.  Or a lot more grace if the hospital’s management has hauled them into a meeting after the AMA got involved and made them look like a despot 😉

So congratulations again!  And no, your career isn’t over – but don’t make any decisions until the baby is born.  Go on maternity leave, try to have a job to return to, but things may change for you.  I was always going to be that person who got a full time nanny and returned to work full time because career, but once she was born, it was like a new, incandescent universe opened up in my life and tossed out everything I’d ever thought about it.  Colleagues who’ve been super-maternal with plans of part time and/or staying at home, have found themselves putting the kidalid in full time daycare/nanny and returning to work full time, quite happily, for their own sanity.

There is no right answer, there is only the one that works for you and your family.  This is your new mantra, because everyone is going to have an opinion.  Take what works for you and unashamedly ditch the rest.  And congratulations again!