Facing the fear

So the fist week of being a Dr is over and I am a little less terrified now. Partly because my last shift was actually fun, where I got to see and do some cool stuff and learn a lot as well, but mostly because I have some wonderful people in my life that are prepared to listen to me talk about my fears and insecurities but more than that, they are able to give me some good practical advice on how to overcome them.

I had dinner with a Dr A this week, a good friend who has been where I am today, not so long ago herself. She understands the pressure I put on myself to be good.. Not perfect or the best (I’m certainly no overachiever) but definitely better than the average intern, and as such, is able to offer an insiders perspective.

As a teacher, senior emergency physician and the man I live with, the other person I turn to has a wealth of experience and knowledge not only in medicine, but also in handling me.

The ED I am working in has a tracking system where the most serious or urgent case will always be at the top and when “picking up” or seeing another patient, we choose the top one.  The problem with this system is you can also see what’s wrong with them,  for example it might be abdominal or chest pain, altered consciousness, self harm  or suicidal ideation, or maybe just a stubbed toe. Nothing wrong with that in itself, its always nice to be forewarned about what is wrong with you patient, the problem is the ability to choose or refuse.

I have a couple of clinical areas that I feel I’m weak in, these are including but not limited to psych, neurology and paediatrics.  With the system mentioned above, it is easy to see if the next patient in line is one I would feel comfortable in choosing, if not, I can skip and pick up a lower priority patient that is more to my liking.

Not  a good idea for multiple reasons. Firstly, if you never work outside your comfort zone you’ll never improve and always be a little frightened . Secondly…one day someone will notice if you are for example skipping all the “girly” problems and make you do every pelvic exam that comes into the ED for the next week!

So I talked my fears through, got some advice on how to handle the things I’m afraid of and decided that my next shift I would face fear head on and take whatever came – no exceptions.

That shift happened to be a late on Australia day. Public holidays put pressure on emergency departments. People drink to much, take too many drugs, do silly things, get lonely, depressed and fight with each other.  So it was good for me. An altercation with a plate glass window gave me a young man with an arterial laceration in his arm who was trying to bleed out, and too much alcohol gave me another young man whose heart an arrhythmia that I needed to shock.  Just a couple of the more exciting things for the shift.

So when I finally made it home sometime after midnight I was exhausted but exhilarated. I had worked hard, challenged myself , remained focused, organised and confident and received a lovely compliment about my work from the consultant in charge.

Six days off now and a chance to reflect before I start my first night shift later this week.

What's up Doc?

What happens when the Dr becomes the patient?
I'm sick. Acute Bronchitis; Asthma; Lower Respiratory Tract Infection; the Flu; Chest Infection. Call it what you will, I'm just sick.
Not dying, I need to come to the ED call and ambulance or see a Dr kind of sick...but the kind of sick where you look and feel like crap and everyone at work has been saying for the past 2 days..."why are you here? Why don't you go home?, Do you need, steroids? a nebuliser? What about a chest xray? No? How be we intubate then?"
These are the benefits of working in an emergency department....I can get everything I need. Well almost.
I got sent home early from work last night...I was happy about it too, my patients had been testing me and I  wasn't feeling good about being a Dr.
I get home...Mr Awesome cooks me some dinner, listens to my chest offers some doctorly advice and then remembers he is not MY Dr and what I actually need is a good old dose of TLC.
Sometimes that is all our patients need, to talk, to feel listened to, to feel important, understood and cared about.
I may not be able to cure everyone but if I can make all my patients feel this way then I'm not off to a bad start.

The First Patient

Do you ever forget your first real patient as a Dr? I hope not, as he was so lovely and sweet and made my day.
It took me a while to get into the swing of things yesterday. I didn't save any lives, but I didn't kill anyone and I may have just relieved some pain and suffering.
I felt completely overwhelmed, anxious and out of my depth.  I was checking, double checking and triple checking everything I signed and my poor consultant must have thought I was crazy as I ran absolutely EVERYTHING I did past him first.....I was so terrified of making a mistake!
The day moved slowly and I eventually got my groove on. As I was discharging Mr Eric (not his real name of course) ...my first patient, he said to me "thank you so much for looking after me, you are the best Dr I have ever had".
I laughed as I thanked him and said "Eric, I'll let you in on a secret...today is my first day as a Dr and you were my very first patient".
He took my hand and said...."well Tracey, you are wonderful and will go far I'm sure."
A warm fuzzy feeling came over me....I had helped someone and they liked me!

It wasn't all cotton balls and baby ducklings though.

I also had a very difficult case that kept me awake last night and will play on my mind for a long time as I wonder what I could have done differently.
A very anxious patient who had come in for something simple. Something I could fix easily, but in the course of my investigation I found something wrong, completely unrelated as to why they had come in.
I found something hiding, lurking silently, not giving any physical signs or symptoms to the unsuspecting patient that it was there.....a spot.
A dense spot on the chest X-ray of a young, fit 40 year old....my age.
I sat and looked at it. Was I imagining it? I had been looking to rule out rib fractures not to find this.
I waited for the radiology report to come through and tell me I was crazy and I needed new glasses but it confirmed my fears.
How was I going to tell my patient? Oh it's all good no fractures.....just cancer! Have a great day!
I took a deep breath and went to talk to them. I talked about how I wanted to do a CT scan so I could check the spot out and make sure it was nothing sinister.
My patient refused. What? Why? They were too busy. I talked some more, about what it COULD be and how important it was to find out.
I asked questions, explored their history further looking for risk factors....they don't smoke, never have. I asked more questions and explored their fears...the patients mother died of lung cancer. Surely then they would want to have this further investigated? "No thank you, I don't think I will" my patient said to me calmly.
Well maybe I could write a letter to the patients GP and have them follow it up? But they don't have a GP....they never have been sick, they don't go to the doctor. Well what about their kids GP maybe they could go and see them? No.
In the end......they left. Left against medical advice. Refused follow up. I was deflated.
Patients have a right to refuse treatment, we can't force them.
What else could I have done? Was there a magic phrase, something I could have said to change my patients mind? How could I have handled this better?
These are the questions that keep me awake at night?
Maybe Mr Eric is wrong....maybe I'm not a wonderful Dr after all, surely if I was I would have been able to convince my patient to stay.
I hope that they woke up today and decided to take my advice.

Abracadbra!

I need magic spell, or a Time-Turner like Hermione has in the Harry Potter movie so I can get everything done.
I was talking with my dad today and he seems to think I have superhuman powers....I must have, how else could I fit it all in?
So lets do a breakdown
There are 24 hrs in a day.
It is a 45min drive from my new home to work - door to door. Lets say an hour from door to seeing my first patient of the day.
I need an hour to get ready for ready work.
I work for 10 hrs...not including overtime......usually 1-2hrs /day so lets say 1.5
Give me an hour after I get home to unwind, say hello to the dog, check my email / Facebook / mail / think about dinner / talk to my man-freind  and make a list of all the things I need to do tomorrow.
I need 8 hrs sleep or I'm grumpy and difficult to get along with.
So far...2+1+10+1.5+1+8 = 23.5
And I haven't trained, seen or spoken to my friends, done housework, looked up all the things at work I made a list to read about so I don't suck the next day....and I certainly haven't had time to stop and relax!
So how do I get it all done my dad asks??
NO IDEA!
But it is now past midnight and I have to leave home at 6am to be on time for work....something has to give I guess.
The dog might not get exercised, there will be takeaway dinners, often it will be my relationship; my friendships and social life; my studies; my duties as a mother; the training I need to do to reach my Ironman goal; and my family that will suffer.....and sometimes....it will be sleep.
Goodnight.
xoxo

In a former life

So, what did you do before med?
 I must have been asked this question at least 100 times just this week. I wish I could recreate myself...I was a vet, a helicopter pilot, a musician, an artist, a lawyer, a writer.
 Why did you do medicine? The second most frequently asked question. My answer is always "I don't know". Maybe I should have gone and had a career in one of my make believe professions.
Today was the first day in the real world, not too daunting as I had a lovely senior Dr holding my hand. My first rotation is in the Emergency department for 10 weeks. Fortunately  I did two ED rotations as a student and worked as a nurse for a year in the public hospital ED, so it's not a completely foreign place. Today I learnt....it doesn't matter if you tell someone you can do something, or have done something a million times, or know something well. As an intern they think you know nothing, can do nothing and have never seen anything.
So when a trauma resus comes in and I get the cannula first go, take the bloods, run my own ABG, write up the X-ray and path forms correctly....they are surprised!
So, what did you do in a former life? I was / am and always will be a nurse, thank god!
Today...I did not suck!
 Dr.T xoxo

Survive or Thrive??

According to the pharmacists, lawyers and some physicians....interns kill people!
The weapon of choice is the pen.
My brother still has a scar (well a tattoo really) on his neck from when we were kids. I stabbed him with a writing instrument for taking my ice-cream, so  I can totally understand how death by pen can happen.

I have no doubt that I will want to stab A LOT of people (e.g. consultants, patients, nurses, radiologists, pharmacists, orderlies, and myself) with my pen in the next year.
So how do I and all the hospital staff not just survive this year, but thrive??

Some tips from the head of the Radiology Dept which I think can be used not just in the hospital but in all areas of life.

1. If you forget something...admit it...don't lie or try to cover things up...it will only make it worse.
2. Treat all people with respect....you never know who is going to determine your future.
3. Help your colleagues...if you are ready to leave and someone in your workplace is swamped...offer a hand and lighten the load....you will appreciate it when they do the same for you.
4. Swap a shift...if someone asks and you can, do it. In real life, this translates to "be flexible" sometimes plans change. Work with and accommodate others...you may need a favour one day yourself.
5. Be organised....this might need a little work. I like the idea of being organised, but never seem to pull it off.
6. Be humble....plenty of people without a medical degree, know more than you do. So true.
7. No matter how overwhelmed you feel, you are never alone.
8. Don't piss the radiology dept off! (insert - husband, mother, child, friend, barrister...anyone really)
8. Have Fun!!

So day 2 as an Intern...I have a name badge, a provider number, a prescriber number and a poison pen.
I want the lovely pharmacist to be on speed dial on my phone! How will I ever write an insulin order or a Heparin infusion without her leaning over my shoulder?

Sailing.
Smooth calm waters with a firm but gentle breeze, which allows one time to get their bearings, plot a course and enjoy a safe ride.
This is what I hope for my intern year.
Man-friend and I just did the first weekend of our Competent Crew sailing course. It was so much fun, relaxing, exciting and tiring all at once.
Whilst the smooth sailing was nice and steady, the rough and unpredictable sailing, although nauseating, was exhilarating and when I learnt the most about the wind, the crew and my own abilities. (just quietly I'm an excellent helmsman and not so good at winching)

I expect to get a bit of both this year.....not just as I navigate the hospital and my new career as a doctor, but in my personal life as well. I just hope my vessel is seaworthy and my "crew" know when to put on a life jacket and clip on!

Always,
Skipper Trace
xoxo









,

Waking up to an alarm

Why is it so hard?
My first day as an intern and I set my alarm early so I could go for a run (I find running relaxing...I don't think when I run) I did not get up, but rolled over turned the alarm off and decided sleep was far more important.
Thank goodness I have a back up alarm....the one that is set to get me out of bed when I'm to lazy to run, but  still set early enough so I can get ready, grab a coffee and make it to work early on my first day.
It went off..... I rolled over, turned it off and elected for another half hours sleep.
Fortunately I have a backup, back up alarm. This alarm goes off and crap! I really have to get out of bed now. No time for makeup or morning sex or I'm going to be late!
Why is it that I can get up at the same time or earlier when I am on holidays without an alarm, with no problems and look forward to going for a run?
I think it's obligation.
The alarm means I HAVE to do something. I don't have a choice, I'm not being asked nicely if I would LIKE to get out of bed and come to work.....I'm being TOLD to.
I don't like being told what to do. Never have.
Anyway, so I make it to work...last one to walk in and pick up my name tag. No flying under the radar for me! I have been noticed already (at least I'm not wearing a red Hawaiian shirt)
The first day was  paperwork, introductions, hospital tour and learning really important things like healthcare funding.
A lot of TLA's (three letter acronyms) DRG, WAU, LAM,  MAP, DMR, ABF....and the list goes on, it's like being back in officer training school and I start to tune out.
Someone please wake me for lunch.
The afternoon passes with a refresher on hand washing, cannulation, spiking and IV and how to take blood. Interesting for those who have not been nursing for 20years. Mostly boring for me, however I try to forget that I am a nurse and realise that even old dogs can learn new things and different / better ways of doing old things.
The day ends and I am happy to report on my first day I did not suck at being an intern....if only it was going to be this easy everyday.
A drink at the local with the other newbies and I am done for the day.
So the two most important things I learnt on my first day as a doctor have nothing to do with doctoring and more about learning how to live with my man-friend (this is just as new and scary if not scarier than being an intern)
1. If I set an alarm it can only be ONE alarm and I have to get up and let him sleep.
2. There is NO talking in the morning when we are both getting ready for work-it makes us both late.

Tomorrow it begins.....

This time 23 years ago is was in EXACTLY the same position as my almost 18 year old daughter is today. She has just finished year 12 (hated school) although incredibly smart and capable she has not yet reached her full scholastic potential, and faced with the reality of not receiving a uni offer is wondering "what the hell do I do with my life now?"
I hope she can take some comfort in knowing that whilst I was there once, I have now finished my Medical degree and am about to start work as a doctor (and for the record....I still don't know what I want to do with my life either!)
There is so much going on in my head at the moment, in an effort to get some sleep at night and to not drive my wonderfully patient manfriend away with my constant need to talk about EVERYTHING , I have decided to write it all down.
I am not a writer, don't expect greatness.
I am nervous about starting tomorrow, even though I know it will be all paperwork and admin, in fact all of orientation week will be much of the same.
But it is all new.....a new hospital, new people, new routines, a new role.
I no longer have the safety net of being a medical student and not actually being responsible.
I no longer have the confidence and self assuredness of being an excellent nurse with 20 years experience; I am a minion and a sponge.
I don't feel like I have learnt anything at medical school and am certainly not prepared to be signing my name to a script or a X-ray order and god help me if I am the first person at an arrest (first rule in any emergency- check your own pulse) and I am terrified I might actually kill someone.  I am however, willing to follow the advice of someone I admire and respect  which is "just try not to suck at being an intern" I hope I can do him and myself proud.xo