medicine

How to be a good intern.

I feel like I’m qualified to make this post now, having run the full gamut of medical interns from so-barely-there-I-don’t-your-name to here-take-my-job-you-awesome-machine.  When I was an intern I really really wanted to be that star intern that was just basically awesome in every domain that everyone raved about.  The only problem was that I had no idea how to achieve it, or really even how to define it.  I was pretty good, sometimes great, but never the full package the perfectionist in me wanted to be.  And Googling it was NOT helpful unless you’re an American intern where you’re actually expected to know stuff.  As an Australian medical intern, you’re expected to do more and know less.  Only you don’t know how to do more because you know less.  It’s a tough year, and I wanted to write my list on how to be a good intern.  As usual, a big chunk of it is tongue-in-cheek and not be taken seriously, but could be, and if you did that would be AWESOME.

How to be a good THE BEST intern.

  1. Your registrar needs coffee whenever you think of coffee.
  2. Don’t bake.  I bake.  I have to bake.  It’s procrastibaketion for exams.  If you bake then what will I do?  You can however, bring coffee.  All the coffee.  You may also bring chocolate.
  3. If you could have my patient list and all the blood & imaging results written out on them and a photocopy for yourself done before I get to work, then you’re a little bit awesome and a little bit frightening in equal measure.
  4. Telling the nurse/NUM/physio/OT/social worker our plan right after we’ve made the plan shoots you to the top of the list for star intern.  Bonus points if I see it.  Full winning points if the boss sees it.
  5. When I come to work and find new patients on our list and you say “yeah I’ve read the plans they wrote down in Emergency and I’ve done the plans” then I will hug you.  And again, full winning points if the boss is there when you say it.
  6. Say “I haven’t done that yet, I’ll get right on it” when I ask if x has been done, rather than “I dunno…”
  7. Your gut instinct is key.  If I or my boss or anyone asks you to do something you don’t feel comfortable with, whether that reason is real or just a lack of knowledge on your part, saying “I don’t feel comfortable” is actually really appreciated.  The swiss cheese model of error lines up when this doesn’t happen.
  8. Be cheerful.  Yes the job stinks some days.  Yes you get asked to do stupid administrative things or call for consults when you think it’s pointless.  There is actually a point I promise.  It takes years to see that point.  If I have to pull out the “if this were your mother…” argument, you are not heading towards a good evaluation.  A friendly attitude is everything and remember, the boss often has 30 years of experience.  You have months.
  9. Hurry me up.  Tell me to go faster.  Tell me to finish the round so I can study.  When the round is done, get my mobile number, kick me out and tell me to go study and call me while I’m studying with any questions you like.  Please don’t ask me to sit next to you to keep you company while you do all your jobs and check everyone’s results.
  10. Did I mention coffee?  Now is a good time for coffee.  Feel free to suggest it.
  11. If the ward clerk loves you then I know you’re good. Ditto the NUM, and the nurse named Dazzle whose been there for 30 years.
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Reasons why I am late sometimes.

I was on Facebook the other day and watching a bunch of people complain about their doctor being late.  I started wondering about all the things that made me late to see patients so I thought I’d write them down in the hope it would make everyone in the SMH comments section hate doctors a bit less.  Possibly more if they see this but hopefully not

Reasons why doctors I am late sometimes.

  1.  I have lots and lots of patients.  This one seems obvious but in a hospital you can never see a new patient quickly.  It comes back to bite you if you do.  And most of the patients in hospital are of an older vintage and can’t be expected to remember the bits of their medical history I want them to remember so I have to ring their GP, their other hospitals, and their kids and their neighbours to piece together enough of a history that helps me understand why they’ve come to the emergency department unconscious, and what of their medical history is likely to slow them down getting home.
  2. Figuring out what medication my patients are on.  I know this should be in 1 but it deserves it’s whole own category.  Working this out is a bit like India Jones with those Roman numerals in The Last Crusade sometimes.  The amount of medications that some people are on and who has changed them and when is mind boggling.
  3. I am hiding in the toilet from the boss that was really mean to me a year ago and I don’t want him to see me and be mean to me again and I have to text my intern and find out if he’s gone even though he probably has no idea who I am but he might.
  4. I need a coffee and have in fact slowed to a standstill while my panicked intern runs downstairs and comes back and puts a coffee in my hand so I can drink it and we can keep moving.  Also I’m not allowed to drink my coffee on the ward/in front of you so I have to finish it before I keep moving or hide it in convenient places where it can’t hurt anyone.
  5. I am eating lunch.  We get half an hour for lunch.  I take 9 minutes exactly with an extra 2 minutes staring into space/groaning about having to stand up again.  It still counts as a delay because I could be seeing patients in that time.
  6. I already came to see you but you were asleep/getting a test/told me to piss off.  I always come back!
  7. I am chasing a delirious person.  This a common and unseen job of hospital doctors/nurses/cleaners/security/random hallway guy.  Delirious people have no idea where they are or how they got there so it’s only natural they would try to leave, and only natural they would get very upset, nay violent, when it is suggested to them that they can’t leave.  Chasing a delirious person means walking after them, but not too close, trying to join them in whatever delirious place they’re in and trying to reason with them into returning to that strange bed with the strange other people in the other 3 beds in the room because it’s good for their health.  No, I wouldn’t believe me either.
  8. Ranting at the ward clerk because my patient keeps calling me nurse.  I have been seeing them daily, every day, for two weeks and introducing myself as their doctor and it. does. not. compute.  So then I inevitably rant at the sympathetic ward clerk about #everydaysexism before my intern comes out and tells me the orthopaedic surgeon is here to have a chat about our patient and ask which guy he is in the group over there.  Naturally, it’s a woman.  This rant always makes me late but it needs to be had.
  9. I am hungry and my blood sugar is -5 and there are no patient biscuits in the cupboard so I have to go upstairs to the vending machine and eat something delicious but disgusting so I can make the words English good.
  10. I am blogging.  Haha just kidding, I wish.  Hospitals have the strictest firewalls ever.  They even block reputable medical websites.  But curiously not Youtube.

Delayed gratification.

After you pass your specialty exams and that initial “I’m so elated I can literally not feel pain or heat or cold or anything other than epic joy” feeling wears off, you inevitably go through the stages of post-examhood.  There’s the part where you promise yourself you’re always going to have this amazing level of knowledge and spout facts to anyone who’ll listen – your boss, your intern, the ward clerk, the nice coffee lady and sometimes the endlessly giving patient fridge.  Then there’s the part where you make up for all the time lost not-exercising, so you sign up to a gym and start working out maniacally as if there’s some way you can cram all that lost time into a week.  Then you overhaul your hair, your makeup, start wearing nice dresses and heels to work to prove to everyone you were only just a thrown-together massive slob while you were going through exams.  You stuff your fridge full of healthy stuff and start banging on about how much energy you have now that you exercise and eat well and brush your hair…

And then you crash.  You crash so hard you can barely drag yourself to work, your clothes look like you’ve been travelling for weeks, and your hair, it just can’t be spoken about.  That awesome amazing flawless human that you became for oh, about a week evaporates and you start lurking in the corners, hoping no one will notice how terrible you look and feel only you don’t know why because you should be feeling great right?  You’re through!  Through all the exams forever!  So you keep schlepping to work hoping that whatever this is, hormones?, not enough food? wears off only it doesn’t.  It doesn’t because for two years you haven’t stopped.  Exams are over but the job where you don’t sit down and walk all day and people fight over getting to sit in a chair (actually it’s a polite “no you sit in the chair!” type of argument) and some days it’s sad story after sad story, or worse, death after death, and those 15 hour weekend shifts are still there.  They are still there and you haven’t stopped.  And suddenly you’ve called in sick, feeling horribly guilty at the scared tone in your interns voice despite all your reassurances that the bosses wont eat them if they call them, with horrible bronchitis.

And then you do what any sane rational person feeling completely out of control does.  You spend way too much money online. “Bras? I haven’t bought any how long? CLICK! Ooh Philosophy does a peppermint body wash? I need body wash!  CLICK! ” and suddenly you’re stacking coupon codes and having a big box of Benefit products with more free samples than there is product coming your way.  Then you go and do all these pop psychology quizzes about what makes you feel out of control and then you think that if you just ate better then you wouldn’t get sick so much, so back onto overhauling your diet it is and suddenly your grocery cart is full of raw cacao, which as far as I can tell is a higher calorie version of cocoa, chia seeds, and Medjool dates because in some way, these must be superior since all the raw/Paleo/wholefoods people use them in everything.

No matter how many times you sit an exam in medicine, this happens every single time.  You cannot prepare for it, and you forget about it every single time.  The worst or best part, I can’t tell, is that it feels great.  And then you crash from that and get your credit card bill.  Mainly it’s that the whole wide world, that you’ve been denying yourself for two years is suddenly wide open and you want it all.  Now.  And at once.  This is probably why doctors wind up in the media doing stupid stuff sometimes.  That juggernaut of delayed gratification gets us in the end.

And while I’m procrastinating…

Did I really not post since last September? Let me catch you up on the last year:

  • I started physician training.  (For those not familiar with the system, when you finish your internship and residency, you often then thinking about the pathway you want to do: surgery/physician training/obstetrics/general practice/anaesthetics and so on.  Physician training is what you do to become a medical specialist something, don’t ask me what yet!)
  • I spent six months at The Regional Hospital From Hell.  It wasn’t all that bad, but it was really really hard.  Like, you pick up the phone 24 hours a day for 7 days a week, every three weeks, for four hospitals spanning a large country region.  And you deal with questions like, chopper or ambulance?  And you keep your cool when people call you at 3am for a medical issue not even remotely related to your specialty because they don’t want to wake up the right person who is known to not keep their cool and figure since you’re so junior, you’ll just say yes.  You come into work for all seven of those days too.  The sleep deprivation was a bitch.  As was seeing my husband once a week (when I wasn’t on call).
  • Lots of my hair fell out from the stress and I discovered a bald patch! I have the best hairdresser ever though, and it all grew back.
  • I made some new friends in my new network, and started working at my new home hospital which is great! I found a lovely study group…now to just err, study (more).
  • I stopped being vegan because it was too hard, I realised that the population examined in Forks Over Knives (i.e. I’m not an overweight type 2 diabetic who required bypass surgery) and there’s some great evidence for The Mediterranean Diet.  So rather than treat myself for something I don’t have, I switched over to preventing something that I may easily develop.

In short, life has been boring for a blog, but exciting for me.  Interesting election huh?  I wasn’t surprised by Tony Abbott winning it, and I got a sausage AND a cake at my local voting station.  What have you been up to?

Dichotomies abound!

When you’re a medical student, two things are certain.  The first is that you’re going to be some sort of uber-specialist and either cure cancer or rake in the prestige or both.  The second is that you have absolutely no clue about how the profession works.  You’re also told you must be very clever, and this continues when you’re a junior doctor and someone asks you what you do and you say ‘doctor’ and they ask you what you want to go into and you say you don’t know.

Now that it’s getting toward the end of my internship it’s becoming uncomfortably apparent that it’s time to pick something.  All through medical school I was going to be an oncologist.  I’d had family members with cancer, I’d had a healthy enthusiasm for all things cancer molecules in medical school and dammit, physician training was in some way noble, like you were becoming one of the guardians of humanity.  Simple right?

And then I started working.  Doctors are expected to put up with a lot of things because they’re paid reasonably well.  And the way we’re bashed in the media as Mercedes-driving, rich, corrupt, minions of the big pharmas with no ones best interest at heart means we don’t garner much public sympathy.  So we’re expected to put up with a lot of things.  Like when you’re on sick relief for the night shift only the night shift person doesn’t call in sick until 6pm when you’re just leaving your full day of work for the day which started at 8am, meaning you have to stay at work until 6am the next day.  You’ll be fed a line about how you should go home and sleep which makes you wonder if they’ve seen the traffic outside because by the time you get home, it will be time to turn around again.  And there’s nowhere for you to sleep in the meantime.  Apparently there are rooms but no one knows where they are and they sure as hell don’t tell you during orientation.  So you stay up for 24 hours and in your 22nd hour of being awake the nurses call you to ‘just come and review this guy’ and you get there and find that the guy is really sick and your brain is an unholy fog but somehow you manage to call a MET call and convince the blood bank to give you a bag without their results yet.  And then once the guy is stabilised you sink into your chair and realise just how close he came.  Or the fact that in your contract, you get a half hour break.  For the whole day.   And how you essentially change your entire job every ten weeks and while your contract says you’re supposed to get a roster for the afterhours work (which you do on top of your dayjob), two weeks beforehand, you invariably never do and simple things like planning a trip to the GP becomes impossible and suddenly a year has passed.  But alas I digress, there’s a lot of good about the job, I just had to let that out.

Suddenly things like bucketloads of prestige, nobility and curing cancer get lost in this mire of tiredness and endless collections of blood, and missed birthdays and Christmases.  So you start thinking about what’s really important to you.  Things like time.  And no nightshifts.  And fewer weekends.  And actually seeing your patients faces instead of their med charts and notes aside from a cursory ‘can I just have a quick listen to your chest?’ because in your head there are a million more people who need reviewing. All that bullshit as a medical student about certain specialties being more ‘worthy’ than others evaporates.

So you start thinking about becoming a GP.  And this amazing dichotomy presents itself where people say things like “oh it’s good for women” and “oh you’re just going to be a GP?”  I’m sorry?  Just a GP?  Suddenly you’re not as ‘clever’ as anyone else who wants to do say, neurosurgery, or renal medicine.  You’re certainly not going to earn the same money.  A family member told me they were disappointed I didn’t want to be a surgeon after a few surgery bosses had encouraged me into it.

But what if the ‘clever’ people decided they wanted something else?  That they knew they were perfectly capable, and hell, even interested in those so-called higher specialties but for the purposes of life satisfaction (as opposed to job satisfaction) went down a path that was just as satisfying and gave them more time?  What if that was perfectly okay?  This is blasphemy in medical school.  And the idea that you should want normal working hours and a good life is almost laughed at, it means you can’t hack it.  Or in my case, don’t want to.  And shouldn’t have to.  I have a friend, whom in medical school, was a quintessential overachiever, perfect in every way, and really really nice.  And going to be some sort of superspecialist.  She turned to me recently and told me she was considering paeds or GP because physician training was a shit life.

The social pressure to not be a GP, this idea that you are in somewhere not clever anymore (what, did I just get lobotomised overnight?) because you pick this path (which by the way is it’s own college and own specialty training program now, it’s not a matter of finish med school and hang out a shingle), is just status anxiety at it’s ugliest.  If I were the sort of person who put more weight in how I appeared to others and less to myself, I might pick a really hard specialty, kill myself passing it, and become the sort of hardened doctor everyone hates.  I tell you this now – that uncaring doctor everyone has met was not always like that, once upon a time they really did care until something burned them out.

I got into medical school.  I passed the GAMSAT spectacularly.  I didn’t fail any exams while training, I kept up with my cohort, I beat them in some areas.  I graduated medical school and now I get great feedback from each rotation.  Surely that’s enough?  Suggesting that GPs are in some way lesser because their college has their shit together in terms of good hours for training and fair exams is the sort of howling insecurity that pervades the field.  But it is as it is and in spite of all this, the idea of it is growing on me more and more every day, in spite of what anyone else thinks.

And really, if you don’t define yourself, someone else will and you wont be you anymore.

A time to live.

I’m not counting the months (months!) between now and my last post.   But now that I’ve come up for air after drowning for a bit, I’ve decided to make a few changes.  I was originally going to keep work out of this blog but I can’t.  It adds a dimension to my life, an appreciation for the simplest things that I think is important.  Plus I spend most of my life at work.

I’m a junior doctor in a very busy hospital.  I’m first year out.  On my second day as a doctor this year, someone asked me how long I’d been one for.  How do you answer that?  Moreover, how do you answer that when you’re about to do a procedure on them? Two days, but I swear I’ve done this tons in medical school!  I’m not very good at being evasive.

After being a student for far far too long, I’m now getting paid and I can’t tell you how empowering it is to earn your own money, to spend your own money, and to support yourself.  No, I don’t earn squillions and drive a porsche.  I earn less than a registered nurse and I drive a hatchback.  Very very few people in medicine make a lot of money, often at great personal sacrifice.  The rest of us just love our job and are quite content.

As well as my forays into the world of fashion and consumerism, I thought I’d share some work-based anecdotes from time-to-time, some heartbreaking, some funny, sometimes both.  I’m saving them up for you, promise.