Tag Archives: Other Things I’m Learning

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.

Leave a comment

Filed under Family

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.

2 Comments

Filed under Med School

Possibly Neglected to Mention

In no particular order, since June:
Received a one-year rural medicine scholarship.
Did my first Arterial Blood Gas ‘Stab’ – Easy as.
Still suck at plain old cannulation.
Attended an arrest call and kept out of the way.
Told by patient “You look like kd lang… not in a bad way.”
Got my hair cut on the back porch for $10. Trauma-free.
Started Bootcamp and got hooked.
Survived 12 days at home without The Girl and Yellow Dog of Happiness.
Spent a day as interviewer for Med School applicants.
Started interval training for running, again.
Buggered my knees, see above.
Don’t care, not stopping.
Avoided Med Ball.
Ooh, was in Med Revue. Again.
Remain madly in love with Girl.
Flirty guy doctors. Wrong tree.
Random encounters with mothers of two babies I delivered last year.
Delivered one baby.
Attended 21st birthday party (possibly first since own).
Mistaken for Senator Penny Wong. Sense recurring theme.
Stephanie Alexander’s chocolate chip cookie recipe is exceptionally good.
Jointly disposed of 3x large bin bags of oversized clothes.
Mostly just happy.

2 Comments

Filed under Family, Food, Med School

Faultlines

For a long time, I wore a jade bangle. It was a part of my arm, part of me. It had threads of deep and lighter green, red-browns, and specks of white. In Chinese culture, jade has a particular energy and significance, and the jade bangle is believed to protect the wearer.

I was walking home from work one day when my bangle broke in two places. I didn’t notice it break because largest part of the curve stayed on my wrist. I wondered what it had protected me from – a breakage is supposed to represent an escape, a dodged bullet. I retraced my steps and found the missing piece.

I liked that bangle, even though I detest the word ‘bangle’. Something in that stone – its colour, its weight, our shared warmth, a vibration – it resonated with me. It fit.

So carefully, I glued it back together. I let it set. It broke again, in different places. This time I let it stay that way, until the night before my med school interview. Glueing it together, I superglued my thumb… but that is another story. I wore it. It broke again.

All the time I was doing this it I knew it was a futile exercise. The circle was broken. The milk had been spilt. The nature of the thing had changed.

Some things mend themselves. Fracture a bone and the faultlines heal stronger than they started. Slice your hand open and bit by bit the fabric of your muscle and skin will knit itself together until you barely see the scar.

But some things are just broken. They start off broken, they break before their time, or they were always meant to break. No matter how neatly you glue the handle on the teacup, if the porcelain is truly crazed with faultlines there is no fixing it.

Sometimes the nature of the thing has changed for the better, sometimes for the worse, or not at all.

Some things can be fixed. But some things, some people, relationships, lives – some are so riddled with faultlines they are broken, just broken, always broken. They can mend, but they have to mend themselves.

And that is nobody’s fault.

1 Comment

Filed under Family

Seek And Ye Shall Find

The search terms which have caused people to find this particular patch of internet are a regular source of amusement to me. Sometimes the search term itself amuses me, and sometimes it amuses me that someone would actually click on the link to this site when it pops up in their results.

So to thank these faithful searchers for the hours of amusement they have provided me, I feel it is incumbent upon me to provide some answers from time to time.

Let’s start with something recent, and I admit, not unreasonable, given that I present myself as providing advice on how not to hit a golf ball.

golf ball not going in the air when hit

Keep hitting it the way you are hitting it. See, I’m qualified to tell you how not to hit it. If you want someone to tell you how to hit it, I’m not the best person to ask. However if I were pressed, I would suggest that you hit it somewhat inferiorly to the current point of impact of club on ball. This should give you some loft.

Loft is such a great word.

in which countries is the term “dad joke” used?

I’m curious as to why you need this information. Is it to be used in planning a travel itinerary? More likely you are employed by a pharmaceutical company and are testing market viability of a new cardiac drug you’re considering naming something like “Dadjokesin”. I will help you regardless: You may add Australia to your list. Of countries, not potential drug names.

cell organelle analogy harry potter

It sounds like something I would know about, but I honestly can’t think of one. If Harry Potter were a Golgi Complex… I think I shall come back to this after exams.

soob medical terminology

This is an important abbreviation, and close to my heart. It is used when writing in patients’ notes to record observations. SOOB stands for “Sitting On Own Bottom”. Sometimes you will also see “SOSEB” which stands for “Sitting On Someone Else’s Bottom”, which is indicative of significant improvement in the patient’s condition.

free air underwear

This is a good idea, but I think I should test the market with t-shirts first.

2 Comments

Filed under Golf, Med School, Travel, Uncategorized

Feathers

    I

I was maybe eight, looking through the green of the mesh of the patio shadecloth. He had asked me what was heavier, a tonne of feathers or a tonne of bricks. I said they weigh the same, but the bricks would fall faster.

    II

He coughed as he opened his eyes, blurred with sleep and choking on a mouthful of feathers. They stuck white to the sweat of his skin like scales, and lit the room as snow floating on slivers of late morning sun.

    III

I think he said bricks, but he might have said cheese. In a race between bricks and cheese, the cheese would fall faster on account of its smooth surface. The physicists will say the relevance of the aerodynamic differential is dependent on the height from which they fall. Gravity is a constant.

    IV

She is bricks, solid and immovable, secure in her knowledge. He is cheese, he has churned himself hard. He sweats under pressure. I am feathers, I can fly. The form of things, the shape of things, the shape of things to come.

Leave a comment

Filed under Uncategorized

The Seventh Dwarf

I was sitting in a consultation room having just taken a brief history from a new patient. New to us, anyway. Not new to him – he had been referred to our team with his fourth recurrence of a particularly fickle malignancy. He’d been treated further afield, but this time decided he didn’t want the travel. Cynically, I wondered if his specialists had flicked us a literal hospital pass.

He needs a name. Let’s call him Mr Sherrin.

He was our last patient of the day. I took a good history. Talked with his wife. Had a look at the problem. It was pretty bad. Ugly, obvious, fast-growing, metastases all over the place. Disfiguring.

I handed over to the consultant. He and the registrar came back to the consult room and we all had another look and a feel and the consultant talked about treatment options. Cures are off the table, this is palliation. The treatment might slow things down or make them worse.

Mr Sherrin is not young but he’s not old either. Mrs Sherrin is visibly anxious but Mr Sherrin is quite calm. He wants to give it all he’s got. There is no hesitation as he opts for treatment.

I was watching the consultant, talking, feeling the lumps, asking questions of the Sherrins and the consultant. I wondered, for the umpteenth time, how oncologists deal with the daily load of poor prognoses. Who drinks? Who swims? Who prays? Who kicks the cat? Who washes their hands at the end of the day and leaves all the work in the sink?

Somewhere in amongst all this, Mr Sherrin and I had a long moment of eye contact. We knew what we knew. As that moment passed, I felt a rising tide of grumpiness.

Cue lightbulb.

I’m not welling up and I genuinely, honestly, don’t feel sad. I feel grumpy. Not about anything, or toward anyone.

I’m not angry with death, and I’m not afraid of it or uncomfortable around it. I know, and I feel, that I’m not part of the life and death stories around me any more than a flight attendant is part of a traveler’s holiday.

Something in the way I’m emotionally and intellectually processing what I’ve learned and experienced on this rotation is producing a consistent response, because that grumpiness has been here pretty much every night for a month.

I guess I shall stomp off somewhere soon and get my head read. Come up with a better plan. Life is not a Disney movie, but Grumpy is no way to be.

Leave a comment

Filed under Med School

All Cute And Fluffy Things Must Die

That’s how I feel. This week I am in Palliative Care, and maybe it’s some sort of reactive stress, but I’ve temporarily lost my tolerance for naïvete in medical students.

Not that I wish to kill the cute fluffy things, I just get that they are mortal like the rest of us. We are all going to die: it is just a question of how and when.

And fine, be sad. It is sad. But the guy you just watched while he was told his cancer can’t be cured? He’s not your father or your husband, he’s not your son, he’s not even your neighbour, or the guy who drives the bus you take to school. It is not your story.

It is not your story. You are nothing more than a bystander, maybe not even that. One day it will be your job to influence the when and how, but even then, it won’t be your story.

We need to learn to move between the stories without becoming a part of them. Our role is to give each patient appropriate care while maintaining our own wellbeing.

My loss of tolerance is temporary, and I won’t be popping any kids’ balloons. I’m grumpy today, but I haven’t lost my empathy, and I know that we are all learning about these things at our own pace.

However, it remains the case that if I had a giant rainbow lollipop it would be difficult to stop me from bopping people over the head with it.

1 Comment

Filed under Med School

Uh, Wait, I’m Only A….

Back to school today, which meant back to hospital, specifically an oncology rotation, out of town. As you may recall, my revision schedule took a bump so I was not feeling prepared or in any way competent when I walked into the big ole hospital building and blessed its airconditioning.

For once a medical school pep-talk-slash-boot-up-the-can worked on me, and I left the morning intro session feeling like I had a mission and a purpose. Maybe even some chance of passing exams in count-em-four-months. (sorry if you study with me and just puked a little at the thought)

Oncology, day one, awesome. It is said that one learns best on the margin between the zone of comfort and the zone of distress. This concept was neatly represented throughout my day. I felt comfortable enough to admit I didn’t know things, and distressed enough to actually learn them.

Well, I actually didn’t feel either particularly comfortable or particularly distressed, but the Consultant and the Registrar I am working with for the week were both very keen to get me doing things, and very keen to help me learn. Which is comforting, overall.

And then there was the moment. It was late in the day, there were just two new patients to see. So I sat down with one of them, explained my role (medical student, ask some questions about why you’re here, your medical history, some details of your life… pass that on to the doctors who will then see you…).

This was my third or fourth such consultation for the day, and I like taking histories, so I was reasonably within my comfort zone. These are not patients who will be finding out for the first time that they have cancer, so there’s not much risk of me having to break that kind of news.

This patient had undergone surgery to remove a tumour some two weeks earlier, and was not dealing well with the aftermath. She expressed some distress, there were some big big psychosocial issues, and I could see she was fixing for a cry, or more.

And so I had the moment. The one where you think “I’m not ready for this, I’m only a [insert role title here],” and you mentally cast your eyes wildly around the empty room in search of someone, anyone, more senior, more experienced, more appropriate.

But the train was on the tracks. I was on my own, and so was she.

Sure, I’m only a med student. But I’m a human and a grown-up, and I was in the room.

I won’t go into the detail, but I’m damn proud of how I got through that moment. She had the cry she needed, she told me how she felt, I listened to her story. I kept good hold of that train, and had a solid history to hand over when our time was up.

That moment, however fleeting it may be, is when you choose whether to really learn or whether to just go through the motions. I could have skipped past her ’emotional stuff’ and kept to the hard facts; I could have excused myself and asked her to wait for the registrar.

Medicine is about more than the hard facts, and if you can’t deal with the human aspects of a diagnosis, you should probably not deal with humans.

I fully acknowledge that my comfort zone tends more to the human side than the hard fact side, but it’s only ever the medicos who get to push my hard fact comfort zone. I’m used to that particular zone of distress.

I feel like I passed a test today, or cleared a hurdle. It was one that was only in my mind – for sure the patient didn’t know she was about to push me. No one else saw it happen. It’s not an assessable part of the course, though I honestly wish it was.

I’m not even entirely sure that I’ve articulated what it was that happened today. I had a moment. I squared my shoulders and reached for a box of tissues and found my way to make it work.

The hard facts and the human. I found my way to make it work.

Leave a comment

Filed under Uncategorized

The Things I Missed

Wednesday we drove out to my aunt’s farm. It was an overcast day, and Ma told me to take a jumper. I don’t get to the farm much, so I thought, maybe it’s cooler out there. I was hot in shorts and a tank top. Ma had long pants and a jumper on.

We arrived bearing some fairly solid iced finger buns which had been in the fridge at least six days, and the remnants of a barbecued chicken which had been uncovered in the fridge for at least four. Did I mention Ma was recovering from Salmonella? Thanks to the wonders of text messaging, my aunt was forewarned and thus armed with a fresh chicken roasting in the oven. The old one quietly disappeared.

We ate, I hung out with my cousin, we watched some coverage of the floods, we left. Ma looked peaky. She napped in the car. Overnight I could hear her coughing.

Thursday morning, back to the doctor, No, Doctor, I feel much better. My stools are normal. I feel fine. What about that arthritis in your finger, Ma? It came up overnight. It was red and swollen. No, no, that’s just my arthritis. But I will get my pills in a bubble pack after all. Hurrah! We’d been applying subtle pressure on this for a year. Off to the chemist with all the scripts. Walking up the ramp to the chemist she was breathless and we took it very very slowly. Come back and get them at three? Sure.

Lunch was scheduled with my mother. I thought Ma looked overtired. She insisted she was fine. I insisted it would not be rude of her to stay at home. That I would be fine on my own. She refused.

She ate a bit of soup. We stopped back at the chemist on the way home and picked up the bubble packed pills. We got home. I went to do some washing. She put on a coat and started peeling vegetables.

A coat?

My uncle fetched the thermometer. 38.9°. I grabbed us a bag of clothes and we headed for Emergency. Her first set of rigors started in the car.

The triage interview happened fast and then we sat in the waiting room. When the hallucinations started, we went straight through.

Fluid resus. IV antibiotics, complicated by allergies. I sat with her all night while her blood pressure swirled, her heart raced, and her body convulsed with rigors. She kept trying to send me home. I held her hand through the wild-eyed terrifying half hour that we all thought would kill her. I talked her through the hallucinations and the strange surrounds and the man who was screaming all the foul words down the hall. I talked to the Med Reg and to ICU. I held her hand through her “final indignity” of insertion of the urinary catheter, keeping her eyes on mine while we talked about the beach and old holidays. I bossed her around for the first time: We are not having this conversation; I am not going home until you are on a ward.

She stabilized, more or less, so they sent her to a ward rather than ICU. I went home and cancelled my flight and called my dad and my aunt. When my uncle woke up, he asked what I thought would have happened if we hadn’t been staying.

What would have happened? She would have put on another coat, and gone for a lie-down, and covered herself with all the blankets she could find. And when those rigors hit her and she was wild-eyed and thinking she would die, with her failing heart desperately trying to keep her brain alive, if she thought to call for help she’d have not been able to dial the numbers. There would have been no one to hold her hand. And that would have been how it ended.

Septic arthritis in the finger. Incontinence pads in the bedroom. Increased work of breathing. Intermittent fevers. Thermal flaming underwear. Intermittent confusion, query delirium. Those are the things I missed, even though I saw (most of) them.

The answer, med nerds, is severe sepsis. The bug was e.coli, origin UTI. It’s a damn scary thing to see in your 87-year-old grandma. Especially when she says she’s fine.

Leave a comment

Filed under Family, Med School