Sunday, June 26, 2011

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.

Sunday, June 19, 2011

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.

Wednesday, June 1, 2011

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.