Merry Christmas!

Wishing you all a wonderful Christmas and the best for the new year.

Summer

You know that Summer has struck when you finish work while the sun is still shining, and feel a sense of disappointment, because at least when you leave the building just after the sun has set, you will melt a little less when you get home.

I appreciate the daylight hours a lot more when the days don't feel like you are living in a sauna.

Soon the people who live in the house behind ours will likely be jumping into their pool and yelling helpful things like, "Gee, isn't having a pool great!" while we swelter, pool-less, in our home.

One day I will do the sensible thing and move somewhere cooler. One day.

Happy

My concern preceding the last rotation was entirely unwarranted - I just loved it and had a great time. I have a feeling that the next rotation will be similar.

It is funny, if I enjoy the work then I don't mind putting in a few extra hours here and there. Naturally there is a limit, but I would rather be in a job I liked and stay for an hour or so extra each day than be in a job where I felt miserable and bored. Of course, all things are a trade-off, and working in an excessively stressful environment with huge mountains of overtime would destroy any benefits of working in a field I loved, and I would rather be bored and go home on time.

So like all things, it is all about balance.

Anyway, I can't believe that we are now in the last rotation of internship. It has gone so quickly, and yet so much has happened. The first half of the year was probably one of the most challenging of my life, and the second half was more about learning how to enjoy work again.

I really don't know how much more I have to add to this blog, seeing as how it started out being about life in medical school, and now that internship is over, it feels like I don't have much more to say about work. I don't know if I'm ready to bow out just yet, so I'll pop in and post every now and again, but it feels as if life has somehow moved on.

The important part is, I'm happy. :)

Worry and relaxation

I have just had several lovely weeks away from work. It has been such a blessing. I have been so blissfully relaxed. I'm happy, I'm dreaming about things apart from work, and I have had the energy to do non-essential cooking.

It has been a nourishing time, and a much-needed one.

Now I'm wondering how I can carry this feeling of peace and being chilled with me into the next rotation. I know that I probably won't, but I really, really want to try.

The last time I managed this was during my psychiatry rotation. I'm hoping to be able to obtain it again when I start to specialise in this area. I like to do things promptly and in an organised fashion, but it is far more relaxing for me to know that they do not need to be done right now and can probably wait a few hours or even a day or three.

I was quite relaxed during my emergency rotation, but found the style of work very tiring and thoughts of having missed things or having documented something incompletely often plagued me in my sleep. Bed block and ambulance ramping are nightmares.

You can tell that I'm worrying about it a bit already - after all, I have just written this post.

10 years ago (in Australia)

I'm not any good at poignant writing, I'm afraid. I wanted to give a glimpse from another country on that day, from another part of the planet. We will never be able to understand what it was like to be in the USA on that day.

Yesterday I walked to the park down the road from us to get some fresh air. There was a whole park full of birthday parties and children playing. All of them were younger than ten. None of them were on this earth when it happened. Life has gone on, and I don't want to look at those images any more, but I still find tears at the thought of those people who died on that day, and those who have lived ten years without them.

It will never be a symbol for me, just a giant mess of loss. The Bali bombings are the same. So many gaping holes in lives where there used to be people. Some of them stick with you more than others, but they all matter.

I am Australian. I have not yet been to the USA, although it is on the cards. I grew up immersed in the culture of the United States via television, and taught myself to read and spell from Sesame Street. Mulder and Scully were my teenage idols and Friends was a staple at my residential college. Parts of the country are so idealised in my imagination that it would almost be a shame to visit and have that picture brought back to reality.

Like so many of my generation, I feel very close in spirit to the country, her citizens and parts of our shared culture. Ten years ago, we watched and wept, too.

I was in my last months of my first university degree, getting ready to marry the man who is now my husband, in the middle of worrying about the wedding, job applications for the next year and my final exams.

Like the majority of the Australian population, I live on the eastern coast of our country. I was fast asleep when the twin towers were hit. Some of my family had been up watching the late news, but they hadn't contacted me - they are quite practical so I imagine they didn't the point. They knew I would hear soon enough.

The next morning, on our September 12, I turned on the tv as I got ready for uni. I walked across the room and saw the images of the planes and thought it was another promo for a Hollywood blockbuster. As I sat down to eat breakfast, I read the scrolling text and listened to the newsreaders and the reality began to sink in.

Passenger planes had hit the twin towers in the middle of New York, nobody knew how many people had been killed, nobody knew who had done it or why, and nobody knew who would be next. I felt sick, but all we were getting at that point in time were pictures of burning buildings and estimated numbers. I could hardly tell the news to my fiance- I just got him to watch the tv, too.

I still went to university that morning. I caught the ferry into the city, as usual. My route took me through an affluent part of town along the river, and the main stop was the financial district. Normally the ferry was packed with people in suits. That day there were only 4 people on board.

Two others were students and there was one businesswoman. I overheard her on her mobile phone. Most of her colleagues had stayed home because the head office of their company had been in the WTC and nobody knew if any of them had gotten out. Australia has huge ties financially with the USA. Many of the big financial businesses with offices in the city either had head offices in the WTC, or had very close contacts and partnerships with people there.

At uni, everybody was in a bit of a daze. Many of them were in denial, many were avoiding thinking about it, and some, like me, could not get it out of our heads. There were large TV screens in the business school on campus that were normally tuned to the market information. That day they were full of footage of planes repeatedly slamming into buildings, falling bodies, people weeping and crying in desperation, and speculation on numbers. My least favourite part (as always) was crass speculation about whether Australia would be next.

I tried hard not to weep, and mostly succeeded. Most of the crying came later. Sometimes it still does. I cry for those whose family members never made it home. For the sheer and utter cruelty of an act that would attack innocent people and kill them in the thousands, all because of some twisted ideology and misplaced rage.

In the months that followed, so many people wore shirts with the USA flag on them, or "I *heart* New York", even those who had never been to the USA and had no family connections. We all felt so powerless and sad.

One pointless death is a tragedy. I still have no words for the loss on the scale that was experienced that day. It rocked our sense of what was safe, of what was untouchable, of what twisted individuals would actually do in their depravity. It was followed in the years to come by multiple other international incidents.

One year, one month and one day later, they bombed Bali. Having known some of the victims who made it back, part of me shares the sense of rage that accompanies the loss. There is no justice in this world that could possibly be fitting for people who do these acts.

You go about your life, and everyday tragedies happen. God forbid they happen to us or anybody close, but they will and do happen. We all die, sooner or later. The sheer scale, intent and the fact of the occurrences on the 11th of September, 2001, is something that I don't think any of us will ever really get over.

We will never forget.

Life, recent

And now for something a little different, as pictures seem to say more about my life right now than words:

Some things make me too sad for words. But then, I don't have to speak. I can support the foundation that his parents have set up in his memory, trying to make sure that what happened to their son does not happen to other children.

Right now I still feel the sense of sadness and loss whenever I see his parents on the news or at a press conference. What I also feel is a rumbling sense of rage, that somebody stole this life, this future from him and his family, and that this criminal has presumably been kept hidden and protected by other criminals, leaving his family, friends and community in painful limbo for years.

The Australian media and social media have been told to be very careful about what is said in relation to the case, because a man has finally been charged after so long, and they do not want to risk any form of mistrial.

As his mother said, I hope that they can see Daniel buried with dignity soon.

On a lighter note:

At least somebody is enjoying the chives in my garden.

It is great noticing this creature AFTER I have just watered the plant. Really. At least he or she had the good sense to sit very still.

I hate it when they jump. It is so very random. One landed on my face once. Now they scare me. Out of all of the things in Australia, I probably hate locusts the most.

Congratulations, Interns of 2012!

The job offers have starting trickling in for next year's interns.

I can't believe it was only one year ago that this was me. So much has changed since then. My career aspirations are still the same, but a lot of other things have shifted slightly sideways.

So, to next year's interns, I can share with you some things that happened to me, and you may also experience in the first half year of your working life as a doctor:

You will find your feet as a junior doctor. Granted, like me, you may spend the first couple of weeks absolutely scared out of your skull. But you'll get used to it and after a few months, you will manage to have some nights where you don't dream of clinical scenarios and ward rounds all night long . . .

You will face challenges, both personal and professional, that you will overcome with varying degrees of success.

People will find their way into your lives, if you let them, and these people will change the way you see the world.

Some people will loosen themselves from your lives and move on and you may miss them for what they used to be to you, but that is okay because we all change.

You will grow up, some of you will become more cynical, but some of you will become more zen and learn how to enjoy the small things in life, and many of you will do both.

You may go from being terrified at choosing to write and dispense that first script for a drug (probably an antibiotic) to writing them in 30 seconds flat and knowing the number in a box off the top of your head.

You will hopefully come to see that being a doctor is a job, not some mystical calling sent out to you from the universe. I think this is good. If you see it as a job rather than an entitlement or a state of being, you are more likely to realise that you need to work hard at it to be good, and more likely to leave it at work when you can. You may also realise that other doctors are people just doing their jobs, too.

You will encounter death, grief and loss. If you can meet this with compassion, dignity and humility, it will be better for everybody involved.

The first death you need to certify will probably be in a room full of grief-stricken family. Know what you are doing and have a plan before you walk in, and although this is your first time, hide your uncertainty and terror. Be kind.

Document, document, document. This will be reinforced whenever you look back at your notes after something has happened, and you find that you clearly documented what you needed to. Document!

Good luck! And don't forget to take care of yourselves, both physically and mentally.

New

Sometimes things shift in life, and you feel like you have grown a new pair of eyes. Or new lenses.

Things don't look the same, it is as if you have just bought a new pair of glasses and you look at a scene that you thought you understood before and find that there are so many details that you just didn't notice, and you are just now starting to see them.

Life still does that to me - it still surprises with little details that change the whole picture. People aren't always right and they aren't always wrong, they are just people, and life is the same.

Nothing really prompted this post, it is just random. But sometimes it is good to know that you never stop maturing, and you never stop learning. Because if I never stop learning, than I am never really fully grown up yet so perhaps part of me has an excuse to always be immature. ;)

Going wild

When I am at home, particularly when I'm doing medical-related things (like study), I like to do things that are verboten at work. These aren't things that a non-medical person would realise are particularly exciting, but when you aren't allowed to do them all day, sometimes it is fun to go a bit wild at home.

These days I like writing in coloured ink. Yes, I like blues normally, but since starting work as a junior doctor, I like to branch out and go wild at home, occasionally taking leave of all common sense and writing in pinks and green.

(It is compulsory to write in black ball-point pen in medical documentation where I work.)

I like to use white-out. I always avoided the stuff in the past. Now that I am not allowed to use it, it is liberating.

It is nice not having to sign and date every single time I write something down.

One day I will be senior and hopefully in private practice. I will either use a computer all day (and the notes won't go missing after they are printed out because somebody does not realise that all information about a patient's admission is slightly important) and/or I will go wild and write in dark green fountain pen. I can dream.

When I start writing in red crayon at work, it will be time to retire. Unless I'm in a paediatric therapy session. Actually, this is another reason to work in paediatric psych - the promise of using coloured pencils or crayons for work-related activities. ;)

Things I Have Learned During Internship #4

A few brief extras, suitably random:

a) Find a system that works for you. You may carry around a clip-board with printed notes, a card system in your pocket, some big plastic box with everything you will need should there be a mini-apocalypse at the work station that wipes out all of your request forms, an iPad or just a scrap of paper that you keep in your pocket with the salient information on it for the day.

Feel free to change this at any point. Just don't lose all of your patient information and then have everything explode and fly everywhere in the middle of a busy ward round because you won't recover until later in the day and this will throw off your groove completely and not even a big cup of coffee bought for you by a sympathetic medical student will help.

Also, what works for one rotation will not work for the next in the same way.

b) Having a weekend off any responsible adult activities and subsisting on Indian takeaway, toasted sandwiches and Twisties will leave you feeling crappy. Add wine to this list and your mouth will taste terrible by the end of the two days.

c) On-line shopping: Good for a temporary mood boost, both at the time and when that package you have forgotten ordering arrives a few weeks later. (Yes, being in Australia and ordering from the USA teaches you patience.) Unfortunately, it is easier to spend more than your overtime and you may not get paid it correctly anyway, so be a bit penny-wise while having some fun.

On-line shopping where you buy exercise DVDs that you actually use must be a positive, seeing as you don't have time to even see the sun any more, right?

d) Applying for your next job roughly 6 months before you will be starting it is a strange experience. I'm just starting to really feel comfortable as an intern, but not only do I have to start considering where I might go next, I need to actively plan and apply for it.

e) Paying somebody to clean your house is a luxury, but it is a brilliant one, and may save your life by preventing the next super-bug from its genesis in your uncleaned shower. That is my excuse, and I'm sticking with it.

f) You will have loads of tips for other interns, but you may lose the attention span and motivation to write them down on a blog post, and go with random stuff instead. All of the iPhone apps and personal diaries in the world cannot help you, your only saviour is the passage of time and the hope that one day you will be finished internship.

I really meant to write something more useful, but alas my brain is in a field somewhere frolicking in the sun and is refusing to stop playing and come back inside the house, so I'll stop now before this degenerates into a drivel of random words.

Take care.

And onwards

I have finished our second rotation of the year, and this was the one I dreaded the most - surgery. I like the idea of surgery and I can appreciate how some people love it, however I am not one of those people.

I know what I like and surgery isn't it. I prefer taking my time with patients, having reasonable starting and finishing times and access to cups of tea and chairs when appropriate (yes, this is a little facetious, but it is the little things, right? ;) ). I like the sunshine, and I like vitamin D. I love seeing the patient as a whole person, and while there is a possibility for doing this in surgery, many of your relationships start and end within the space of a few hours and you get to say good-bye to the patient, having fixed their issue to the best of your ability.

I met some absolutely lovely patients whom I felt very privileged to spend time helping. One of the wrenching things about working in a hospital is that you get to see a lot of terrible things happen to lovely people. You need to find some a healthy way of dealing with this.

I don't think I realised this so much before now, but the staff at the hospital do get attached to their patients and many come to genuinely care. I have seen staff at every level get emotional away from the eyes of the family and patients when then need to. It is a part of being human and I never want to lose it. Of course, excessive attachment is bad and scary, but it is normal to form some sort of bond with people you spend hours looking after every day, particularly when they are with your for weeks or months.

I will also miss the staff I have worked with. A lot of the surgeons are good fun, most of the nursing staff are helpful and really know their stuff, and I will really miss just how helpful our ward pharmacists are.

I'm just not a fan of working in surgery. Fortunately I got the opportunity to do so with some really caring and helpful people, who made it all bearable. In the end I got through, and I think I did a good job while I was there, which in the end is what really matters to me.

More Things I Have Read: Shrink Rap

I have been reading their blog and listening to their podcasts for years, so it is no surprise that I rushed to pre-order and then read the book Shrink Rap, written by the three psychiatrists (whom I will always think of as Roy, Dinah and ClinkShrink) behind the venture.

What did I think? I am quite biased, as I really enjoy psychiatry, but I think this is a fantastic book and that anybody who is interested in the way that healthcare deals with psychiatric patients should go out and read it.

Clearly my experience is from a different country, but most of what they describe (aside from the major differences between our medical systems) is very similar to the things that I have seen in psychiatry here. They explain the processes very well in an accessible and easy-to-read way, and I really liked the way that they use fictional characters to illustrate examples of both the illnesses themselves and the ways that psychiatry may deal with them.

Many clinical books have case examples in them, but these stories feel more lifelike than the all-too-often dry scenarios that textbooks present, and as a result they become more interesting and believable. I think that anybody who has been in contact with the hospital system for any period of time (or, indeed, with humanity) has seen many people whose stories closely mirror those told in the book.

I would also encourage medical students to read it, as it humanises the patients in a way that brief clinical contact and textbooks cannot, and can help give a better picture of some of the disorders described. I also really enjoyed their discussion about things they disagree on, and their honesty in presenting some of the failings of modern psychiatry.

If somebody were to ask me to recommend a book to help them understand what psychiatry was about, it would have to be this one. I'm looking forward to seeing what they come up next, as clearly Dinah Miller, M.D., Annette Hanson, M.S., and Steven Roy Daviss, M.D. love their work, and love teaching other people about psychiatry.

P.S. This blog isn't going to be all book reviews from now on. Honest.

Things I Have Read: This Won't Hurt a Bit

This afternoon I finished reading "This Won't Hurt A Bit" by Dr Michelle Au. Actually, I read 3/4 of it today - I just couldn't put it down.

Michelle writes a great blog called "The Underwear Drawer" although my writing this is probably complete overkill because if you are reading this blog, then you are probably far more familiar with hers. If you aren't familiar, then you should be.

I have been reading her blog for years, and her post "It gets better" struck a very loud chord with me. Internship can be awful. It really can. It has it's moments, but on the whole it is just one of those things that you do because you have to. Nobody becomes a doctor because they want to be a resident.

I get through the day thanks to the patients I interact with, their families, and the staff I meet. Also. the promise of the job I will get to do in the future is just hanging there in front of me, so close and yet so far.

Not many people talk about it publicly, possibly because within the medical fraternity you are supposed to be tough and stick it out, and when you are talking to people outside of the profession, very few of them actually get it and if you complain they may look at you as if you are mad.

After all, don't people spend years, countless dollars and sometimes concoct truly bizarre schemes in the hope of being in your shoes? They look at you, standing where they would almost kill to stand, and you have the temerity to whine about how little sleep you get, how awful things can be and how you have forgotten what your house looks like in the daylight hours, and they just don't get it.

You also lose your ability to write with any kind of finesse, so please excuse this post. Or maybe that is just me.

It was such a relief to read this book, and I think I may just read it again almost immediately. It gave me hope that not only could a reasonable, professional doctor feel the same way that I have at times, but she has continued on with her career and managed to do things that I am yet to do.

I laughed, I cried, and completely identified with her experiences. It was a good read, and cathartic to boot, yet was never overly sentimental or cloying.

If you want to see what it is like to actually be a junior doctor or a medical student, this is the book that you MUST read. Don't forget the blog, either.

Strange Things To Be Jealous Of . . .

. . . when you would rather not be on your way to work.

1) The magpies by the side of the road. They get to be outside all day and leaping around on the grass. You get to be inside doing paperwork.

2) The people out on their morning walk at the crack of dawn, while you are already in your car on your way to work. They have more leisure time and will probably live longer lives.

3) The person who cleans your house. Some days medicine is too stressful and you would rather wipe benches and clean toilets.

4) The mother getting her kids ready for the school run in the morning. Because sometimes you question your life choices.

5) Your pets, who will still be on your bed when you have been at work for 6 hours and it will be at least another 7 hours before you are home again.

6) Your spouse when he/she is sick for the day, for the same reason as number 5).

Most days I am glad to be where I am. But every now and again there are moments when I look out and dream of being elsewhere.

Pushing through

Yes, I'm still here.

The current rotation I am on is quite demanding, and I am regularly clocking up more than 60 hours per week.

Still, I am not over-tired and am learning quite a lot. Frankly, it would be hard not to learn.

In a few weeks I am hopefully going to be 2/5 of the way through my intern year.

In the Australian system, we enter a specialist training program after being an intern/resident for a year or more. This means we get to see a bit of areas that we have no interesting pursuing and theoretically get a well-rounded grounding as a doctor.

There are a lot of advantages to this and only a few disadvantages. One of those disadvantages is that I am now too tired to type any more because this rotation is sucking a lot of time and energy out of me (but this is okay), so this is all I'm going to write.

Take care.

Dangerous Australian Animals and the Circle of Life

Today I had the good fortune of having the Saturday off, and while the weather is lovely, my husband and I went for a drive into the hills.

We stopped at a quaint cafe and ordered lunch. The view from the deck was gorgeous, and we were surrounded by green bushland with a clear view of a lake.

I was working my way through my burger (with a knife and fork because it was so huge) when a kookaburra flew in, landed on the rail and eyed me off for a couple of seconds. It chose the exact moment that I was looking at my food to swoop in, grab nearly half of my lunch and fly away.

Unperturbed, I finished the rest of my lunch and stole some of my husband's. (He did offer, honestly!)

Life has a way of finding balance.

Things I Have Learned During Internship #3

Three things this time:

1) It seems that you get good and comfortable in a rotation, and then is time to move on and I don't want to move on from this one because I really like it. Also, the next rotation scares me.

2) I am tired. A lot. Sometimes it seems like it is out of proportion to the hours I'm working, which aren't bad, but I know this tiredness isn't excessive. This happened last time I started to work full-time after uni. It passes. Slowly.

3) Being looked down on as "just an intern" by patients is now amusing rather than affronting. I know I'm just the intern and I'm happy to have somebody else look after you if you don't think I'm good enough. It makes my "to-do" list a few items shorter. ;)

And one extra thing that I already knew:

I don't get a lot of time for blog posting, and there are so many things that I can't and won't ever write about, so the writing here is more sporadic.

Things I Have Learned During Internship #2

I actually enjoy teaching (or trying to teach) medical students.

It probably helps that it has been a very short amount of time since I was a student, so I remember what it is like. As a student, any time you get doing interactive learning of practical skills feels immensely valuable and helps keep you interested.

Also, there are no "gunners" in the group of students who are on my ward, although they are all generally enthusiastic, so it is fun to tell them what I know and try to get them to start learning practical skills.

Nobody has followed me into the bathroom yet, so all is well with the world. I guess that since I'm not the one marking them, they don't feel the need to impress me with their keenness at every opportunity.

This results in a level of interaction where they are with me for only short periods of time, and are doing other things most of the time, allowing for brief and enthusiastic interactions where I don't get tired of them, and they don't completely exhaust my limited pool of knowledge. Fun times.

New blog to follow

A previous commenter mentioned her blog, and I liked it so much that I had to link to it here:

Wellness Rounds.

I'm a huge advocate for looking after your personal health, both physical, mental and every other aspect of your life, so this is just the kind of thing I am passionate about, and it would do you some good to have a read, too.

I know that it is drummed into us all of the time - doctors and medical students don't take enough care of our own health. This is bad for us, and if we end up unhealthy as a result of lifestyle choices, our patients are less likely to believe our advice when we counsel them to change their ways.

Plus, we end up miserable and ill, and nobody really wants to end up an unhappy and sick, particularly if your entire day is spent looking after people suffering the exact same issues, right?

We don't need to be health fanatics, but a little moderation, exercise, stress relief and balance (where we can fit it in) can go a long way.

Ironically, two months into internship I'm feeling better both physically and mentally than I have in a long time, and I was genuinely happy by the end of medical school. I got into some healthy habits to cope with the extreme stress I felt when starting out, and as a result, they have helped me feel much happier now that I have gotten used to life as a junior doctor.

What have I learned works for me? Meditation (relaxation, mainly), moderate exercise with my significant other (making it social), and eating well.

My favourite tip so far? I read from various sources that it was a good idea to have some kind of ritual when you finish work at the end of the day that would help you disconnect from your "work time" and help you enter in to "home time".

For me, that is going for a nice walk or run with my husband. I get to have a good chat and get some incidental exercise. I know it isn't much, but it has gotten to the point where it doesn't feel like exercise any more. I know I'll go through rotations where this isn't possible every day, but it has been lovely being able to establish this habit.

For other people, the ritual can be five minutes of relaxation and deep breathing in the car before getting out when you arrive home. Others need to spend a certain amount of time alone in their own space when they get home from work, so they can switch off and re-energise before entering into their family space.

The point is that we need to be able to detach from work in order to live a full and well-rounded life. Medicine can be all-consuming, but this does not produce healthy or happy doctors, and being a well doctor is a vital thing that you can do for your patients, yourself and for your family.

Take care.

Things I Have Learned During Internship #1

You can survive a whole busy evening shift on nothing but adrenaline, two biscuits from the ward kitchen and a bottle of water.

But you don't want to do this, and it is awful.

Alive

Yes, I'm still alive.

Internship has been challenging so far. Each day gets better. Things run smoother. I can handle more.

I like to think that in a year's time I'll look back and realise how much I have learned.