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.