I just can't concentrate this week with all the distractions of October/November. It feels like I haven't really done anything since Friday. All I've done is sit in front of the computer and tried to look up things or write notes in some kind of insensible random manner. Sure, I've had study breaks and tried to stay healthy.
I'm sensing some kind of anxiety brewing in the 4 week lead up to exams. In the last month or so, it has been so assignment/assessment driven that it became easy to get what I needed. Now, it's just been demotivating. I think I need a hot cuppa to sit down and re-thing, re-plan and start strategising for the ultimate academic war-games - exams.
Tuesday, November 1, 2011
Dude, where's my child?
You can't help someone who doesn't want your help.
That's the bottom line.
When a patient who comes into the GP clinic with bloodshot eyes to cry about the frustrations of his life and how he punched his brother this morning, it's a distressing experience. Expectedly he had a long and complex history of mental health disorders and substance abuse issues. He also did very little in his life. All he did was sit at the window sill and watched people walk pass on the footpath, for the entire day.
This seemed more exciting than my life, where I sit in front of a computer and waste away.
The only difference was that I was under the influence of marijuana, benzodiazepams, and methadone, which to him seemed all like a game anyways. He had massive compliance issues where he could not stick with one drug regimen. In fact, he took himself off methadone recently - which I applauded at first, but then raised suspicions of him taking something else or not coping with his withdrawal effects.
He also had some massive anger issues and social problems dealing with the lives of people in he supposedly screwed up.
We came to a point in our discussion where I told him directly, "I'm not sure what I can do to help you". I called my supervisor who came in to follow up the discussion with "go back to your home town, and don't come back". It felt like all that rapport and empathy I built up was destroyed in these few words. Nevertheless, my supervisor had known this man for years - and his antics to sink hearts and start the prescribing trend for his dependency to benzodiazepams and pain killers. Instead, he was offered anti-depressants which he refused and subsequently left.
When a patient who comes into the GP clinic with bloodshot eyes to cry about the frustrations of his life and how he punched his brother this morning, it's a distressing experience. Expectedly he had a long and complex history of mental health disorders and substance abuse issues. He also did very little in his life. All he did was sit at the window sill and watched people walk pass on the footpath, for the entire day.
This seemed more exciting than my life, where I sit in front of a computer and waste away.
The only difference was that I was under the influence of marijuana, benzodiazepams, and methadone, which to him seemed all like a game anyways. He had massive compliance issues where he could not stick with one drug regimen. In fact, he took himself off methadone recently - which I applauded at first, but then raised suspicions of him taking something else or not coping with his withdrawal effects.
He also had some massive anger issues and social problems dealing with the lives of people in he supposedly screwed up.
We came to a point in our discussion where I told him directly, "I'm not sure what I can do to help you". I called my supervisor who came in to follow up the discussion with "go back to your home town, and don't come back". It felt like all that rapport and empathy I built up was destroyed in these few words. Nevertheless, my supervisor had known this man for years - and his antics to sink hearts and start the prescribing trend for his dependency to benzodiazepams and pain killers. Instead, he was offered anti-depressants which he refused and subsequently left.
Friday, October 28, 2011
Medicine vs. Surgery
Whilst in A&E the other day, there were two patients in adjacent bays of both noteworthy medical student interest. One of them, was a tradesman who severed a tendon from playing with tiles. Something that is managed by the surgical team. The other was a man from a town 2 hours away, who GP was alerted by an abnormal ECG reading and decided to send him down, believed to be in SVT. Something managed by the medical team.
This fork in the road, was exactly a reflection of my future career options. Should I bend surgically or medically? This was a tough choice for a rural medical student who has to freedom to roam and decide whatever he wants to encounter throughout the year.
The culture of the hospital almost views this, to some extent, to be akin to sexual orientation. Of course, they also cast certain stereotypes between the two branches of medicine (largely based on generalisations stemming from early medical history - with the Barbers of Seville, and the early physicians; also worth noting the statement in the Hippocratic Oath which disapproves invasive techniques).
I tried to keep my head in both, but this was hard to keep up. And in the end, I decided to stay with Mr. C, the 69 year old gentleman with abhorrent heart conduction. C's story was interesting in that, here was another story of a stoic farmer with potentially life-threatening condition who did not want to be seen unless pestered by his wife. He had been having chest pains since a couple of days ago, but did not do anything about it until this day when he saw his GP who decided to do an ECG. The ECG revealed border-line wide QRS complexes, ST depression and T wave inversions, and signs of LVH. When he came in he was hypotensive and tachycardic, with a BP of 80/60, HR of 190, was still conscious and moving about and able to talk. He was put onto oxygen, given two large bore cannula, and monitored for hemodynamic stability. A continuous heart monitor and 12-lead ECG was employed to mark any changes. He did not respond to carotid massage or valsaveur techniques, which was the first clue that this could have been something more sinister than an SVT like a conscious VT. He had a background of Ischemic Heart Disease, but had not had any stents implanted to his knowledge. Despite our efforts in getting an old ECG from his cardiologist, these had all been difficult to retrieve since his last admission 10 years ago. A decision with the medical team to administer adenosine was carried out. C received 3 lots of increasing doses of adenosine as per SVT protocol. He sustained some chest pain as a result of the adenosine administration but his arrhythmia did not resolve. C was given morphine to ease the pain, whilst infusion of magnesium and Amiodarone were also given. This slowed his heart rate down slightly by about 5 beats every hour, and he was taken into ICU.
Overnight, his rate and rhythm did not improve and he was transferred to a major tertiary hospital to be further evaluated by specialist cardiologist services. The conclusion was that he was in conscious VT. Would have been a great case to follow through, although there were other things on my mind especially with exams looming in the not so distant future. It did make me revise my anti-arrhythmic drugs again, paying attention to some of the side effect profiles of things like adenosine (which causes chest pain) and amiodarone (which can cause acute respiratory fibrosis, thyroid disorder, etc). Perhaps, I will choose the medical path in the future?
This fork in the road, was exactly a reflection of my future career options. Should I bend surgically or medically? This was a tough choice for a rural medical student who has to freedom to roam and decide whatever he wants to encounter throughout the year.
The culture of the hospital almost views this, to some extent, to be akin to sexual orientation. Of course, they also cast certain stereotypes between the two branches of medicine (largely based on generalisations stemming from early medical history - with the Barbers of Seville, and the early physicians; also worth noting the statement in the Hippocratic Oath which disapproves invasive techniques).
I tried to keep my head in both, but this was hard to keep up. And in the end, I decided to stay with Mr. C, the 69 year old gentleman with abhorrent heart conduction. C's story was interesting in that, here was another story of a stoic farmer with potentially life-threatening condition who did not want to be seen unless pestered by his wife. He had been having chest pains since a couple of days ago, but did not do anything about it until this day when he saw his GP who decided to do an ECG. The ECG revealed border-line wide QRS complexes, ST depression and T wave inversions, and signs of LVH. When he came in he was hypotensive and tachycardic, with a BP of 80/60, HR of 190, was still conscious and moving about and able to talk. He was put onto oxygen, given two large bore cannula, and monitored for hemodynamic stability. A continuous heart monitor and 12-lead ECG was employed to mark any changes. He did not respond to carotid massage or valsaveur techniques, which was the first clue that this could have been something more sinister than an SVT like a conscious VT. He had a background of Ischemic Heart Disease, but had not had any stents implanted to his knowledge. Despite our efforts in getting an old ECG from his cardiologist, these had all been difficult to retrieve since his last admission 10 years ago. A decision with the medical team to administer adenosine was carried out. C received 3 lots of increasing doses of adenosine as per SVT protocol. He sustained some chest pain as a result of the adenosine administration but his arrhythmia did not resolve. C was given morphine to ease the pain, whilst infusion of magnesium and Amiodarone were also given. This slowed his heart rate down slightly by about 5 beats every hour, and he was taken into ICU.
Overnight, his rate and rhythm did not improve and he was transferred to a major tertiary hospital to be further evaluated by specialist cardiologist services. The conclusion was that he was in conscious VT. Would have been a great case to follow through, although there were other things on my mind especially with exams looming in the not so distant future. It did make me revise my anti-arrhythmic drugs again, paying attention to some of the side effect profiles of things like adenosine (which causes chest pain) and amiodarone (which can cause acute respiratory fibrosis, thyroid disorder, etc). Perhaps, I will choose the medical path in the future?
Friday, October 14, 2011
Yes, I am the doppler smuggler
How embarrassing was it to forget to return the Doppler machine after reviewing some antenatal patients a week ago. To have the midwife and the GP obstetrician chasing me for the machine which I hid in the Diabetes room (unintentionally trying to frame the diabetic nurse educator)!! Now I have adopted the new nickname of Doppler Smuggler from my midwife colleague! This lead to me not getting any pizza at the nurse's meeting despite delivering the cups and plates.
Serves me right....
I wonder what else I would get in the year.... not many weeks left now.
Serves me right....
I wonder what else I would get in the year.... not many weeks left now.
really dislikes it when I forget to see a patient
I was quite distraught to have forgotten to review a patient on Tuesday. The doctor whom I saw this patient last was away sick, and I presumed she had cancelled all bookings - despite this patient booking in to see me!
Oh, the horror of being reminded hours after the actual appointment by the ladies in reception who were utterly confused about what was supposed to happen.
Although it was just a routine follow up for a patient whom I was involved in starting on some empirical bronchodilators for her adult onset asthma. She had presented with symptoms of progressive breathlessness over time, with a background of allergic rhinitis especially with farm pollen. At one stage she thought it may have been a side-effect of omeprazole that she was taking for an hiatus hernia. According to the P.I., bronchospasm is an uncommon side-effect, but she has ceased taking it and was on some "internet wonder alternative" known as apple cider vinegar. I knew very little about it, but apparently she felt healthier as a result. I wondered if there were any interactions or whether this was a particular provocative factor for her breathlessness, which did not appear so. Anyways, we decided to start her on some Symbicort utilizing SMART therapy which uses the monotherapy as both preventer and reliever due to the short/long acting of the active beta-agonist.
Nevertheless, she ended up seeing the duty doctor who was unaware of SMART therapy and wrote her some scripts for ventolin as a reliever anyways. But perhaps she did know but was unsure how SMART therapy would have worked for when a patients asthma is exacerbated. I don't recall reading much about any transitional therapies between SMART regimens and conventional regimens. Of course, the reason why it's mostly prescribed is for its convenience and thus better compliance.
It would be interesting to find out what happens with her soon, if I remember to see her!!!
Oh, the horror of being reminded hours after the actual appointment by the ladies in reception who were utterly confused about what was supposed to happen.
Although it was just a routine follow up for a patient whom I was involved in starting on some empirical bronchodilators for her adult onset asthma. She had presented with symptoms of progressive breathlessness over time, with a background of allergic rhinitis especially with farm pollen. At one stage she thought it may have been a side-effect of omeprazole that she was taking for an hiatus hernia. According to the P.I., bronchospasm is an uncommon side-effect, but she has ceased taking it and was on some "internet wonder alternative" known as apple cider vinegar. I knew very little about it, but apparently she felt healthier as a result. I wondered if there were any interactions or whether this was a particular provocative factor for her breathlessness, which did not appear so. Anyways, we decided to start her on some Symbicort utilizing SMART therapy which uses the monotherapy as both preventer and reliever due to the short/long acting of the active beta-agonist.
Nevertheless, she ended up seeing the duty doctor who was unaware of SMART therapy and wrote her some scripts for ventolin as a reliever anyways. But perhaps she did know but was unsure how SMART therapy would have worked for when a patients asthma is exacerbated. I don't recall reading much about any transitional therapies between SMART regimens and conventional regimens. Of course, the reason why it's mostly prescribed is for its convenience and thus better compliance.
It would be interesting to find out what happens with her soon, if I remember to see her!!!
Unexpected pregnancy and other rantings...
When Molly (not her real name), a 15 year old school girl, came to the practice about her ongoing depression management with her mother, I did not expect that she would be pregnant. Molly had been skipping school because of increasing lethargy, nausea, vomiting, and abdominal pains. Naturally, her mother was growing more concerned about this, and with my GP supervisor’s permission I felt that it was worthwhile doing some blood tests, including a pregnancy test, to exclude some alternate causes.
What could have made issues a little more complicated was the background of her psychiatric diagnosis and the relationship she had with her boyfriend and family. Previously, there had been some issues in the past with her mother who had to be separated from the family for a period of time to their dismay, such that when she returned she seemed to controlling and disempowering to Molly. At the time, their relationship was on the mend with Molly and her mother receiving counselling and psychotherapy. At the time, Molly and her mother had a high degree of transparency in their relationship which was therapeutic in helping her manage her mental health. This made things easier, as there was a mutual acceptance of each others involvement in Molly’s health. However, I felt that some sensitivity needed to be observed during the consult to respect and honour Molly’s rights as a growing and maturing young individual. Perhaps, interviewing the two individually and then bringing them together (what is known as the HEADDS approach to adolescent health) may have avoided such feelings, although it does feel awkward inviting someone to be out of the room and the discussion. This would have been more useful in delineating Molly’s thoughts in confidence limiting any direct influence from her mother.
Molly’s boyfriend had also been faithful to her for the last few years, but was now overwhelmed by the news and is unsure what to do. His parents have tried to stop any contact between their son and Molly, as he is 18 years of age and concerned that he may face legal ramifications (having sexual relations with a minor). And as far as we were concerned, he was not in the picture at this time, even though he would have had responsibility as the potential father of a child. This brought up the issue of father’s rights in deciding issues surrounding pregnancy and childcare, which can often be overlooked.
After further investigation, Molly returned with her mother to discuss her unplanned pregnancy with Dr. Wilson, my GP supervisor, and me. We discussed Molly’s options with a high degree of maturity, weighing up her health, her capabilities to continue on with her pregnancy, options and contacts for medical termination. This was a very ‘human’ discussion with many important and controversial ethical considerations. This was a very comprehensive exploration of all the possible avenues for Molly, her boyfriend, and her family.
Despite being a joint discussion, an assessment of Molly’s competence for consent of medical termination or refusal for treatment of her pregnancy was considered. My understanding of the situation was that the ‘Gillick principle’, where parental consent could be overridden by the child’s decision if they are considered capable and mature enough to make such decisions regarding their own health, would be applied. What was unknown to me was how such maturity could be measured and assessed?
There was no standardised algorithm or manual to deem a young person competent or not. It was purely subjective. Dr. Wilson’s opinion on the matter was that most girls aged 15 or above generally have the capabilities to understand a procedure and its consequences and therefore be able to make a decision accordingly. I reflected what exactly made 15 year olds special, and why the law did not consider this to be the cut-off age for legal adulthood. I was curious as to whether Molly fully understood the consequences of her actions when she (presumingly) consented to have sexual intercourse with her boyfriend, whether she understood the risks that she was undertaking without contraception. As her parents may have thought at the time, “what was she thinking?” This was undoubtedly very difficult to know, as even adults can have unplanned pregnancies and do silly things with their lives. I figured that this was not at all useful for her situation at hand and that it was better not to dwell in her past.
During this session, I wondered whether her mental health issues had any influence on her competency. Had she been where she was two years ago and admitted to a mental institution with loss of insight and self-harm behaviour, and was considered not competent to make decisions as a mature minor then what would happen? Marion’s case came to mind where the convoluted process of seeking power from the parens patriae of Supreme courts is required for consenting process in the child’s best interests (for Marion this involved consent for a sterilization procedure). Would this necessarily apply for Molly? Conventional thoughts in my mind think that Molly did have reasonable understanding of the situation in spite of her mental health. That she was currently controlled on medication and stable in the community setting. Also, that her communication with her parents, in particularly her mother, was sufficient and that a joint decision could be made with the agreement from both parties.
Disappointingly again, the HEADDS approach was not adopted. To an extent, our assessment of her competency did not feel adequate. Fortunately I wondered her mother had an open-mind on the situation and was very supportive towards Molly’s wishes and concerns. However, it would have been very interesting to learn what her mother would have said without Molly being there and to understand her thoughts and feelings about the situation; and to elicit any disparity in opinions. This perhaps, would be something that I have learnt from this experience which I will adopt in future encounters with mature minors in this situation.
In the end, Molly was referred to undergo medical termination for reasons that protected her ‘best interests’. This was a decision that Molly independently reached but was agreed upon by her parents, as she understood the financial, emotional, and physical repercussions the pregnancy may have brought to her life. She figured independently that this would be the best position for her, her family, and her boyfriend. Interestingly, although this may have been in her ‘best interests’, it was by far not ideal.
In the following two encounters I had with Molly, I learnt that living in a small country town with only two high schools, meant that when news leaked, it spread fast. Molly was subject to much discussion at school which exacerbated her mental condition, subsequently causing her to drop out of school. In addition to this, there was the traumatic stress involved with the whole experience which left her questioning whether the decision she made was the right one. Nonetheless, in the time that has past her relationship with herself, her boyfriend, and her parents has dramatically improved.
For me, Molly demonstrated to me the complexities surrounding legal and ethical considerations for mature minors. The principles of respect for the child, competency assessment, liaison with the parents, and application of common law (namely the Gilick test and Marion’s case) are not easy to employ in a case such as this, or indeed for the case of contraception (which for Molly followed not long afterwards). However, the ability to provide transparency between all parties and reach some sort of consensus appeared the most relevant lesson when avoiding litigation. To my mind this seems to be the gold standard of preventing horrible legal mess such as Marion’s case. This is of course very difficult when the child is rendered incompetent, but is worth the thought in more common cases.
What could have made issues a little more complicated was the background of her psychiatric diagnosis and the relationship she had with her boyfriend and family. Previously, there had been some issues in the past with her mother who had to be separated from the family for a period of time to their dismay, such that when she returned she seemed to controlling and disempowering to Molly. At the time, their relationship was on the mend with Molly and her mother receiving counselling and psychotherapy. At the time, Molly and her mother had a high degree of transparency in their relationship which was therapeutic in helping her manage her mental health. This made things easier, as there was a mutual acceptance of each others involvement in Molly’s health. However, I felt that some sensitivity needed to be observed during the consult to respect and honour Molly’s rights as a growing and maturing young individual. Perhaps, interviewing the two individually and then bringing them together (what is known as the HEADDS approach to adolescent health) may have avoided such feelings, although it does feel awkward inviting someone to be out of the room and the discussion. This would have been more useful in delineating Molly’s thoughts in confidence limiting any direct influence from her mother.
Molly’s boyfriend had also been faithful to her for the last few years, but was now overwhelmed by the news and is unsure what to do. His parents have tried to stop any contact between their son and Molly, as he is 18 years of age and concerned that he may face legal ramifications (having sexual relations with a minor). And as far as we were concerned, he was not in the picture at this time, even though he would have had responsibility as the potential father of a child. This brought up the issue of father’s rights in deciding issues surrounding pregnancy and childcare, which can often be overlooked.
After further investigation, Molly returned with her mother to discuss her unplanned pregnancy with Dr. Wilson, my GP supervisor, and me. We discussed Molly’s options with a high degree of maturity, weighing up her health, her capabilities to continue on with her pregnancy, options and contacts for medical termination. This was a very ‘human’ discussion with many important and controversial ethical considerations. This was a very comprehensive exploration of all the possible avenues for Molly, her boyfriend, and her family.
Despite being a joint discussion, an assessment of Molly’s competence for consent of medical termination or refusal for treatment of her pregnancy was considered. My understanding of the situation was that the ‘Gillick principle’, where parental consent could be overridden by the child’s decision if they are considered capable and mature enough to make such decisions regarding their own health, would be applied. What was unknown to me was how such maturity could be measured and assessed?
There was no standardised algorithm or manual to deem a young person competent or not. It was purely subjective. Dr. Wilson’s opinion on the matter was that most girls aged 15 or above generally have the capabilities to understand a procedure and its consequences and therefore be able to make a decision accordingly. I reflected what exactly made 15 year olds special, and why the law did not consider this to be the cut-off age for legal adulthood. I was curious as to whether Molly fully understood the consequences of her actions when she (presumingly) consented to have sexual intercourse with her boyfriend, whether she understood the risks that she was undertaking without contraception. As her parents may have thought at the time, “what was she thinking?” This was undoubtedly very difficult to know, as even adults can have unplanned pregnancies and do silly things with their lives. I figured that this was not at all useful for her situation at hand and that it was better not to dwell in her past.
During this session, I wondered whether her mental health issues had any influence on her competency. Had she been where she was two years ago and admitted to a mental institution with loss of insight and self-harm behaviour, and was considered not competent to make decisions as a mature minor then what would happen? Marion’s case came to mind where the convoluted process of seeking power from the parens patriae of Supreme courts is required for consenting process in the child’s best interests (for Marion this involved consent for a sterilization procedure). Would this necessarily apply for Molly? Conventional thoughts in my mind think that Molly did have reasonable understanding of the situation in spite of her mental health. That she was currently controlled on medication and stable in the community setting. Also, that her communication with her parents, in particularly her mother, was sufficient and that a joint decision could be made with the agreement from both parties.
Disappointingly again, the HEADDS approach was not adopted. To an extent, our assessment of her competency did not feel adequate. Fortunately I wondered her mother had an open-mind on the situation and was very supportive towards Molly’s wishes and concerns. However, it would have been very interesting to learn what her mother would have said without Molly being there and to understand her thoughts and feelings about the situation; and to elicit any disparity in opinions. This perhaps, would be something that I have learnt from this experience which I will adopt in future encounters with mature minors in this situation.
In the end, Molly was referred to undergo medical termination for reasons that protected her ‘best interests’. This was a decision that Molly independently reached but was agreed upon by her parents, as she understood the financial, emotional, and physical repercussions the pregnancy may have brought to her life. She figured independently that this would be the best position for her, her family, and her boyfriend. Interestingly, although this may have been in her ‘best interests’, it was by far not ideal.
In the following two encounters I had with Molly, I learnt that living in a small country town with only two high schools, meant that when news leaked, it spread fast. Molly was subject to much discussion at school which exacerbated her mental condition, subsequently causing her to drop out of school. In addition to this, there was the traumatic stress involved with the whole experience which left her questioning whether the decision she made was the right one. Nonetheless, in the time that has past her relationship with herself, her boyfriend, and her parents has dramatically improved.
For me, Molly demonstrated to me the complexities surrounding legal and ethical considerations for mature minors. The principles of respect for the child, competency assessment, liaison with the parents, and application of common law (namely the Gilick test and Marion’s case) are not easy to employ in a case such as this, or indeed for the case of contraception (which for Molly followed not long afterwards). However, the ability to provide transparency between all parties and reach some sort of consensus appeared the most relevant lesson when avoiding litigation. To my mind this seems to be the gold standard of preventing horrible legal mess such as Marion’s case. This is of course very difficult when the child is rendered incompetent, but is worth the thought in more common cases.
Saturday, September 10, 2011
Addicted to Emergency
I did it again.
In the words of a wise Nigerian Pharmacist, "Medicine is your calling".
I received a text from a fellow med student this morning saying that the ED was short of its boss and that it would be a great opportunity to go help out. And so, I decided to go down there and check it out. As soon as I sunk my teeth into my first patient, I knew that I wasn't going to leave for a while. In this case it was 10pm and I was supposed to go back to Melbourne - 3 hours drive away.
There's something about the emergency department that brings a sense of togetherness to those who work there, especially when you know everyone on a first name basis. To me, the atmosphere of ED reminded me of some of my fondest childhood memories, being in "after-school care" or hanging around the front gates of school waiting for mum or dad to pick me up after work. There's something about the ED which wants to make me linger and not care about what is happening in the rest of the world. Perhaps, it's the lights and lack of windows which everyone talks about, where no-one has any idea of what time of day it is until they walk out the door. Perhaps, it's this sense that the staff have tried really hard to make the department their home to help them cope with the stress of their work when seeing patients. I'm not sure. Whatever it is, ED always feels like home to me.
The hardest thing for me this year to sort out, was that things continue to happen with you or without you. That no one person could fully appreciate everything that occurs in the hospital. I've thought about this purely from an exam vs. reality perspective. This is especially after spending a good top half of the year entrenched in getting as much clinical exposure as possible. The result was a poor paper-based exam outcome. Sure I was really good at talking to patients, but I really lacked the knowledge for academic success. This half of the year I felt better at integrating these two worlds, as I catch up in the book study department. Just let it all go, Chris.
The thing about ED is that there is often so much distraction that it is hard to let go of what it has to offer. The only thing that holds me back is tiredness. I wanted to know about the patients I saw. I wanted to know whether I called the same shots that my senior colleagues did. I want to know that the patient in the resus bay is stable and made it through the night. It's hard, because sometimes I might even lose sleep over the worrying.
On Friday, I was so busy trying to help out that I totally did not realize that my phone died. I was so caught up that I decided to change my plans to go to Melbourne without telling anyone. And as a result upset the apple-cart, causing everyone to worry. Not a good look. There are just so many things going on in my life, that I lack the ability to organize it all. Sometimes I wish that I had no strings attached and could do anything that I wanted whenever I wanted.
Obviously my other life commitments (parents, sister, girlfriend, friends) were more important and it was a simple temptation to sacrifice these, when you're caught up in the action of emergency - after all I am tending to other people's emergencies, right? Breaking promises over this excuse, is probably going to cost my the trust of others for a while. Maybe I have a problem with commitment, but why does it always happen when I'm doing something altruistic? I don't know. People weren't happy at me, but I'm okay about it. I guess I'll keep trying to make them understand.
In the words of a wise Nigerian Pharmacist, "Medicine is your calling".
I received a text from a fellow med student this morning saying that the ED was short of its boss and that it would be a great opportunity to go help out. And so, I decided to go down there and check it out. As soon as I sunk my teeth into my first patient, I knew that I wasn't going to leave for a while. In this case it was 10pm and I was supposed to go back to Melbourne - 3 hours drive away.
There's something about the emergency department that brings a sense of togetherness to those who work there, especially when you know everyone on a first name basis. To me, the atmosphere of ED reminded me of some of my fondest childhood memories, being in "after-school care" or hanging around the front gates of school waiting for mum or dad to pick me up after work. There's something about the ED which wants to make me linger and not care about what is happening in the rest of the world. Perhaps, it's the lights and lack of windows which everyone talks about, where no-one has any idea of what time of day it is until they walk out the door. Perhaps, it's this sense that the staff have tried really hard to make the department their home to help them cope with the stress of their work when seeing patients. I'm not sure. Whatever it is, ED always feels like home to me.
The hardest thing for me this year to sort out, was that things continue to happen with you or without you. That no one person could fully appreciate everything that occurs in the hospital. I've thought about this purely from an exam vs. reality perspective. This is especially after spending a good top half of the year entrenched in getting as much clinical exposure as possible. The result was a poor paper-based exam outcome. Sure I was really good at talking to patients, but I really lacked the knowledge for academic success. This half of the year I felt better at integrating these two worlds, as I catch up in the book study department. Just let it all go, Chris.
The thing about ED is that there is often so much distraction that it is hard to let go of what it has to offer. The only thing that holds me back is tiredness. I wanted to know about the patients I saw. I wanted to know whether I called the same shots that my senior colleagues did. I want to know that the patient in the resus bay is stable and made it through the night. It's hard, because sometimes I might even lose sleep over the worrying.
On Friday, I was so busy trying to help out that I totally did not realize that my phone died. I was so caught up that I decided to change my plans to go to Melbourne without telling anyone. And as a result upset the apple-cart, causing everyone to worry. Not a good look. There are just so many things going on in my life, that I lack the ability to organize it all. Sometimes I wish that I had no strings attached and could do anything that I wanted whenever I wanted.
Obviously my other life commitments (parents, sister, girlfriend, friends) were more important and it was a simple temptation to sacrifice these, when you're caught up in the action of emergency - after all I am tending to other people's emergencies, right? Breaking promises over this excuse, is probably going to cost my the trust of others for a while. Maybe I have a problem with commitment, but why does it always happen when I'm doing something altruistic? I don't know. People weren't happy at me, but I'm okay about it. I guess I'll keep trying to make them understand.
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