You Should Blog.

This is a blog about ‘how not to hit a golf ball… and other things I’m learning.’

People talk about the learning curve that is internship year – the steep exponential curve of the first six months. I remember exhaustion, uncertainties, frustrations and feeling so, so inept. Stupid things I did. The madness of my first weekend shift. Most of all I remember the security of having colleagues I could trust – nurses, clerical and allied health staff, and more experienced doctors – who helped me find my feet and not screw things up too badly.

I was lucky enough to have the first five months in my home hospital. Starting a stressful new career was made so much easier by not just the familiarity of my surroundings, but by having The Girl there by my side every step of the way. Making me coffee every morning, and dinner every night. Amazing, wonderful love and support. None of ‘all this’ could or would have happened without her.

Which brings me to something I’m still learning, which I can’t really wrap up into a neat set of words. It’s something about family. I’m just writing and deleting words from this paragraph, none of which really make sense, so I’ll leave it there and hope that something coherent unfolds at some point in the future of this post or this blog as a whole.

My grandmother died suddenly in February this year, in my father’s arms, a few weeks short of her 90th birthday. I spent some time with her in December, and I’m so glad I did. She had a wicked sense of humour. I wish I’d written more about her.

I was late to the funeral. I expect I will be late to my own.

That’s enough for now.

Free Air!

I dedicate my comeback post to the young lady I saw yesterday with chronic, asymptomatic, pneumoperitoneum – for the players at home, that’s free air in the abdomen. She is hoping we’ve given her enough radiation to turn her into the Incredible Hulk in time for Christmas. A girl can dream…

The best semester of med school ever is drawing to a close. With final exams behind me, I launched into my pre-internship term in surgery and loved it. Then two electives, close to home. It’s been fabulous. Not having the pressure of exams and assessments makes learning more enjoyable.

Today was my last day on the wards, the last day I could tell a patient “I’m not a doctor…” – an exhilarating and mildly terrifying thought. Three days on campus next week and then I’m done.

I truly wish I had kept better record of this year. Maybe I’ll do a retrospective during my luxurious six-week holiday – the one that comes between the last day of school and the first day of work. Or maybe I’ll work on my golf swing. As with Miss Incredible Hulk, only time will tell.

That What You Fear The Most

I spent so long being afraid I didn’t know enough, or that I wasn’t working hard enough, that by the time exams were upon me I had lost the power of sleep.

Even after a relatively pain-free first hurdle – the clinical examination – I still didn’t trust myself.

Two days later in the first or our written papers, my head was so fuzzed I couldn’t connect what I knew with the questions on the page – and I working at a snail’s pace, I simply ran out of time.

So, like Crazy Mary, what I feared the most just met me halfway.

Decisions, Decisions…

I’m overselling this somewhat, as it’s not really a huge decision. Though it could have been. It’s Intern Application time!

In overview for the uninitiated, becoming a registered and fully qualified medical doctor goes a little something like this: Graduate – Intern Year – Resident Year – Registrar (Specialty Training) – X Years Later Qualify as Consultant. Where X is a variable according to chosen specialty training program structure, individual preferences, and clearing of assessment hurdles.

It’s a little more complex than I paint it, but that’s more or less it.

Medical graduates across Australia for the 2013 internship year will exceed the available intern positions. This is exceptionally bad news for our overseas students, who may miss out on a position both here and in their home country. Most states are guaranteeing Australian graduates of the state’s medical schools priority in position allocation, so there is a strong incentive for me to stay in my home state.

The Girl is keen to stay put, in our house, in our home of 3.5 years, in the town we have both grown to love. She’s looking to start a business in the next few months, and we both have great friends here. Our geriatric menagerie is also a factor in any decision to move. We are all happy here.

And so it is that the local hospital network will be my first choice for internship, and being a regional network, the chances are good that I’ll get my first choice. I have no desire whatsoever to go back to the city. The downside is that I’ll be able to do a maximum of only two from five rotations in the hospital here in town, so I’ll spend most of the year commuting. We’re going to practice for that next semester, when I’ll be doing my pre-internship (PRINT) and elective terms at the mothership hospital.

Decision made, all I have to do now is finish filling in the 3,000 pages of application forms… oh yeah and… pass the exams.

The Finals Countdown

My final exams start a month from now, to the day. Between now and then I have four (count’em, four!) more days in General Practice, one more Emergency shift, six days on campus, and gaps in my knowledge you could drive a truck through. And so it is triage time.

I am hoping that, somehow, the things I don’t know I know are greater in number than the things I don’t know I don’t know. As these two knowledge groups are inherently unquantifiable, I will only think of them again if I need to confuse somebody.

Which leaves me with the things I know I know and the things I know I don’t know. Right now I feel like the split is about 20:80 – that said, the 80% is probably half things I have forgotten and need to embed in conscious recall, and half things I have just not got around to reading up on.

I feel a bit sick now.

It Depends on Your Definition…

In my ongoing quest to bring the world helpful explanations about medical stuff, mostly the meaning of certain medical terms, I’ve been paying extra special attention to the different classifications of the common symptom of ‘Pain’. Here, for your education and my general catharsis, are excerpts from two memorable consultations I have had during my General Practice placement.

Me: Can you describe the pain?
Mrs Payne: Well, it’s a paining pain.
Me: So… is it like an ache, or a burn? Or maybe a stabbing pain?
Mrs Payne: No, it really is just a paining pain… You know, it just pains.

I know, it’s a paining pain.

Me: So, this pain in your legs, can you describe it for me?
Mrs Akers: Oh, it’s not a pain.
Me: Oh, I’m sorry, I thought you said you had a pain in your legs?
Mrs Akers: No, no, it’s not a pain, it’s an ache.

Definitely not a paining pain, then.

Revised Numbers

Today’s updated figures for today’s 31.9km GP pilgrimage:

Speed Zones, Outbound Journey: 50 – 70 – 60 – 100 – 90 – 60 – 90 – 80 – 40 – 90 – 100 – 60 – 80 – 50
‘Road Work’ Sites: 2
Workers Holding Signs: 4
Workers Working: 1
Kilometers Driven With Fuel Light Lit: 31.9
Rail Crossings Accidentally Crossed While Lights Flashing Red: 1
Boom Gates Destroyed: 0
Average Speed of Local Freight Train: 4kmh
Times My Car Hit By Train: 0
Trouble Thus Avoided: 8 (Please Rotate 90°)
Average Distance Between Speed Limit Changes: 2.28km

If you think I’m kidding, you’re wrong.

It’s About Medicine

Final year of med school has just hit me. There is a subtle shift – knowledge and facts coalescing, light dawning. I still feel like I know nothing, but every so often I feel like I know what I’m doing and why I’m doing it.

Another subtle shift is underway on the hospital floor. Next year I could be a colleague. People ask where I’m applying, offer advice, discuss cases of interest like my thoughts could matter.

I decided about ten days back that I needed to stop avoiding the things that freak me out – practical procedures. And Whammo! No sooner had I decided this than a flurry of practical procedures came my way. Under supervision, I drained 2.4L of fluid from an elderly lady’s chest (“I can breathe again!”), and did not generate a pneumothorax. I sutured (extremely badly). I backslabbed a man’s fractured wrist and completely failed to get a cannula into a vein for a man who desperately needed one. Two in fact.

Today I assessed a patient in ED, summarised my findings, proposed a diagnosis, recommended therapy, and discharged them home with scripts and instructions.

I second-guess myself.

“What if it was amyloidosis?”
“What if I sutured his skin all wrong?”
“What if he’d got fluids earlier?”
“What if I introduced an infection?”

What if I never made a mistake and never learned anything?

The Numbers

From Home to General Practice Placement:

Total Distance (each way): 31.9km
Times per Week: 2
Speed Zones, Outbound Journey: 50 – 70 – 60 – 100 – 90 – 100 – 60 – 80 – 50
Speed Zones, Homeward Journey: 50 – 80 – 60 – 100 – 90 – 100 – 60 – 70 – 50
Speed Cameras (Fixed): 3
Traffic Lights: 7
Average Red Lights on Arrival: 6
Roundabouts: 2
Golf Courses: 2
Cow Crossings: 2
Cow Crossing Delays Experienced: 0
Rail Crossings: 1
Rail Crossing Delays Experienced: 2
Rail Crossing Delay Duration: 11mins / 8mins
Bridges Crossed: 3
Properties for Sale: 14
Wineries: 2
Winery Delays Experienced: 0
Factories: 2
Smokestacks (Gas Flame): 1
Hitchhikers: 1
Hitchhiker Sightings: 3 (Same Guy)
Minimum Journey Time: 24mins
Maximum Journey Time: 49mins
Early/On Time/Late Arrival (%, est): 30/40/30
Maximum Ground Speed Attained: Fine Exceeds Boyish Desire To Tell
Times Speed Limit Unconsciously Exceeded by Maximal Amount: 1
Times Rihanna’s S.O.S Unconsciously Played On Loop, Single Journey: 11
Total Distance Driven for GP Placement, Phase 3: 2424.4km

;l.

The title of today’s post is brought to you by McCat, who joined me at the table on the laptop and somehow managed to type this ;l. into the Google search window AND hit enter. He also opened iTunes, possibly trying to find an appropriate musical message to accompany the emoticon. I’m glad he’s in a good mood.

Yesterday I stopped procrastinating on a core task – writing up a year planner with my timetable. If I had done this when I intended to, at the start of the holidays, I would most likely have done a bit more uni work and a bit less relaxing. Not that the relaxing hasn’t been fantastic.

I’m trying to develop a routine for the next semester, and the second-last week of holidays seemed a good time to kick it off. Up at 5:30, exercise 6:00-7:00, eat, get to work.

Today’s ‘get to work’ part started off with… well… taking the Yellow Dog of Happiness (who has been a bit down in the dumps) for a trot through the bush and a swim in the creek. I was more up for the trot than the swim, and had passed up swimmers for my pre-dirtied bootcamp shorts and socks from earlier, a fresh crop top and shirt, and my running shoes. Eyes peeled for snakes.

He had a lovely dog-only paddle in the first swimming hole, and as we trotted on down the track I pondered an impending visit from my paternal parental unit. I haven’t yet brought them to the creek. I must call them and get them to bring their swimmers. And maybe a fishing rod.

I spotted a faint track from the path to a shady spot on the creek bank and whistled the dog back to check it out. As I stood on the boulder overlooking a nice deep bit of creek, a school of eating-sized fish cruised by, followed by a dog-like splash.

Having taken a nice refreshing slide down the boulder into the creek, he paddled calmly for about three seconds before he realised the creek bed was far, far beneath his furry feet. He turned back to the mostly-vertical rock face. Oh SHIT, his face said. Quite futile even trying to climb out. Nevertheless he tried in vain to haul himself up with his front paws while scrabbling against, well, nothing with his back legs.

Stay calm, Dogface. I surveyed the surroundings as I stripped down to the crop top and my spotted undies. It was a big boulder, but either side was shallow bank covered by mangroves. Easy for a dog to climb out. Fixated on the rock face and hanging on with front paws for dear life, he could not be convinced to let go and swim to safety.

And so it was that I slid down the none-too-smooth boulder and into my new favourite swimming spot. Treading water just clear of the boulder, armpit-depth with my feet in the leafy mud near the edge. I tried to guide the hound around the boulder to the mangroves, but he would have none of it. Your hand is on my rump, clearly that means you can lift me out. He willed himself up the face of the rock, with me as his launch pad.

Admittedly I could now have swum around to the mangrovey bit and waded out of the water. But it was… creepy. And leafy. And there could be snakes. From water level, I could see the dog’s point.

Add rock-climbing to my skills list.

I gathered up the dry bits of my ensemble and we trotted on to his usual swimming hole, complete with jetty. Yellow Dog said no thanks. I said come on, Dogface, I’m still in my soggy cottontails, let’s get back on the horse. We swam. Neither of us drowned or were eaten by sharks. Passers-by failed to materialise until I had my shorts back on.

All up, a good morning’s work. ;l.