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.
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.
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.
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.
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.
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.
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?