If I Could Teach Them One Lesson

Registrars are meant to be clever people. Duh, they’ve graduated medicine and practised a few years and are brave enough to specialise. I’ve seen a lot of registrars do a lot of stupid things, but I won’t dwell on that because that’s not what today is about.

I recently heard a registrar complain, “If you think fourth years are bad, wait til you get the third years next week. I feel like a total babysitter! They don’t know how to do anything and I keep having to check up on them!”

I laughed along and told them to team each third year up with a fifth year to solve their problem. But that’s not what I really wanted to say.

I wanted to tell them how fortunate they are. What a big gift they’ve been given. They get to INFLUENCE the way those third years will view medicine forever. They get to influence the way they will do things for the rest of their professional lives. They get to give those third years confidence in what they are doing… or to deny them that confidence.

Registrars… you get to either make them hate ward rounds, or you can turn it into an experience where they will learn more in a few weeks than they have in their entire medical education thus far.

Do you realise what a huge opportunity that is? And a responsibility, yeah. But you’re doctors. C’mon, responsibility shouldn’t be new to you.

I had an amazing registrar for Internal Medicine in my third year, and a horrid one for Surgery. And as readers of this blog know, those impressions have remained.

I think medical professionals (and students) sometimes forget the benefits of community. You know that saying about how it takes a community to raise a child? It takes a community to raise a doctor too.

I’m so thankful that patient people taught me the simple things like histories and physicals, and helped me not to give up when I struggled to get IV-access on patients. I’ve had my fair share of impatient mentors, and they have had the potential to leave lasting horrid impressions.

Third years aren’t babies. In the medical world they are, perhaps, but they are also adults. So give them responsibilities. Teach them where you can.

Cherish your role in raising tomorrow’s doctors.

“That’s SO Cool!”

I saw Janeway lesions the other day. Janeway lesions are rare and elusive, and usually present due to an underlying vasculitis or endocarditis.

The registrar on call had seen them only once before. In theory blocks we were told not to bother looking out for them because they are so rare.

My first reaction was to jump up-and-down with excitement. Fortunately I didn’t do so in front of the patient or her family. Her circumstances were not reason for excitement: a textbook-case of Systemic Lupus Erythematosus, fairly common in this part of the world. She was young and had signs of advanced renal failure.

The Janeway lesions were from a sterile endocarditis due to the serositis accompanying lupus.

It made me realise how excited we, in the medical community, become when we see a rare or textbook presentation.

A few days later I had a patient with advanced Huntington’s Disease. Something I’d never seen before. And I thought, “That’s too cool” – and then remembered again, it wasn’t.

It really, really isn’t.

Interesting, but by no means “cool”.

Nightmares

I get vivid nightmares often, but all through the last week on my internal medicine rotation I had the same recurring theme:

Needle-prick injuries

The dreams were always different, but they always involved some exposure to HIV, and the side-effects of the prophylaxis, and the fear of The Test six weeks later.

For the uninitiated, I should mention that the likelihood of contracting HIV from a single needle prick injury is minuscule, and even smaller when taking PEP.

 

But when your daily work revolves around AIDS, and you regularly see the effects of AIDS-related disease, the percentages aren’t soothing – no matter how small.

I have been extremely fortunate thus far. I don’t draw blood from a thrashing patient. I wear gloves even though they make palpating veins more difficult. I look around me and stay out of the way of people carrying sharps.

But the fear remains. I don’t need a dream analyst to tell me that these dreams are a mirror of my thoughts and fear, that much is obvious.

I just think this risk is underestimated, both by those in and out of the profession.

I don’t think the layperson realises the risk at which our lives are put.

Not a single casualty in this war is deserved.

 

Clearly I Have Too Much Time…

I had fun with this 9gag ish.

No, I do not have too much time. But with Internal Medicine over (for now) I at least have some time. I know I will miss it soon. Hence the inspiration for this:

A TMI Tough Week Crazy-Ass Rant

My internal firm has bad karma. Clearly somebody badmouthed a patient who was secretly a witch, because we have too many patients for a firm with only three students. The students on the other firms finish ward rounds and ward work by latest 12h00. Which doesn’t make a bi-weekly call that bad.

We get out of hospital for the first time at 16h00 if we’re lucky. Without a lunch break in between. Who doesn’t give their students a lunch break, seriously?! When are we supposed to study or wait, breathe?!

We might as well be permanently on call. We see more patients on a “normal” day than my counterparts see during a weekend on-call.

The cherry on top of my annoyance-cake?

 

 

I managed to pick up a germ from one of my many patients with the winter flu and community acquired pneumonia and such – hey, is it still nosocomial if you weren’t actually a patient when you picked it up??

The only reason I’m still standing is because I actually had the flu vaccine this year. Yes, b*tches, I do the vaccine-thing. 

I don’t get sick, even though I have close to zero nutrients in my diet.I take vitamins. They help a little.

But multivites make me polyuric and I refuse to use the disgusting loos in our hospital. And my bladder is not ten hours strong.

The Day I Cried in Hospital

Yesterday was a bad day.

It’s been a bad couple of weeks, emotionally; me being weaker than I ever thought I could be. I’ve been able to retain my composure mostly.

However, during ward rounds our consultant looked up disinterestedly while I was presenting a rather interesting patient and said, “Today is your last day, isn’t it? So why is it that you can’t calculate the feeds of these children?”

© Jill Greenberg, “End Times”

At the beginning of our rotation my partner and I had asked the sixth years to teach us the formulae for feeds. They tried kind of half-heartedly and told us that it wasn’t part of our outcomes. The registrar  agreed.

So I responded, not in a sarcastic tone, “I’m sorry – I was under the impression it was only part of the sixth-year outcomes.”

And she responded, “I’m sorry, how old are you?”

She then went on a tirade of how even if it wasn’t in our outcomes we should have learned it. Her tirade consisted mostly of personal insults.

We committed to reading it up and moved on to my next patient. And then my eyes started tearing. And my voice got all husky.

“Sorryitsbeenareallybadday canipleasejustgocalmmyself”

And out I went. In tears. They were big violent sobs.

It was kind of embarrassing. I don’t let people who don’t know me get me down. I’ve never cried in a clinical setup, not even when a patient died. I wait for the privacy and security of my room.

I don’t know why this affected me so much. I guess it doesn’t help that for the past two weeks, we have been mainly ignored by the rest of the team. Our (valid) questions go unanswered. Our input into difficult diagnoses is ignored. We had three OSCEs today, and not once were we told what to expect. Not once were we tutored in anything except breastfeeding and X-rays.

So after really going the extra mile for a team that seemed to be inconvenienced by our presence, I guess I didn’t feel they reserved the right to scold us for not sniffing that we were expected to know something.

I managed to calm myself down, but every time somebody made eye-contact with me the hot tears welled up. I have cramps in my jaw today from clenching my teeth so much.

It didn’t get better after hospital. I was teary for the rest of the day.

It was weird for me. I don’t cry a lot. Ever.

Consultants are mean, and often. I don’t mind being grilled for answers. I find it thrilling, actually. But personal insults in a professional environment are just so… unprofessional. Here’s hoping I’m stronger next time.

A Lesson in Strength

They have decided to unleash me upon the baby wards again.

I find this funny. My friends joke that they will need to check my handbag before leaving the hospital. Hah. Hah. They have sensors these days that trip an alarm if someone tried to steal a baby. Not that I’d steal a baby. I’m not that broody.

We are in the Neonatal ICU for two weeks. I think I saw a single term baby today – the others were all premature.

Did you know that prone position is best for a preemie’s lung development? But prone is also more associated with SIDS. And did you know that they sometimes give a baby caffeine for lung maturity? I didn’t.

They are so tiny. Their eyes closed tightly against the light, their hair dark and sticking to their scalp, their skin wrinkly, their little fists balled in defiance.

They are strong. They cling to life with a determination I wish I could see in myself.

The Unhappy Doctor

My presence in the medical community has not been lengthy, but I’ve noticed one thing: A lot of doctors are terminally unhappy. I know they think we don’t notice their scowl, their rush to get out of the hospital, their snide comments when the patient is finally subdued by the anaesthetic.

I see it. I see the way their shoulders sag and the way they hate talking about news regarding medical science. I see how rude they are to each other, to their nurses, to their students and even to their patients. And it means one thing: They are miserable.

Medscape’s Mark Crane recently revealed a study where it was found that doctors are miserable. Only 54% would choose medicine as a career if they could go back in time. It’s an American study, but I’m willing to bet that South African doctors would have similar results. Perhaps even more so.

Anycase, much of the cited reasons for the disgruntlement relates to finances. Doctors don’t “feel rich”, they earn a substantial salary but also have substantial debts to repay.

I hope that this reason will disappear off the radar soon. There is a perception that doctors are rich. Firstly, I’m really not sure that one should enter a field to get rich. But secondly, those days are long gone. Patients are poor. The economy sucks. Managed healthcare and medical aids are sucking the life out of healthcare professionals.

To prospective medical students: If you want to get rich, this is not for you. Medical school is one of the most expensive fields of study imaginable. It’s long, it’s painful, it’s expensive. If you want to get rich, you need to go into the stock markets, into business, into innovation. Not that you should do that to get rich, either…

Another reason is time lost on administration.

This is a sad but true reason. Life requires paperwork. Lack of paper trails are the reason doctors have managed to give the wrong patient the wrong medication. Anywhere you go, there will be paperwork. I guess here we have to grow up and learn to deal. Or get an assistant (note, “intern” should not be synonymous with “paperwork scutmonkey”!).

But again, I’m going to be a little bitter about medical aid schemes here. The amount of paperwork they require and the amount of telephone-time they want is ridiculous. And they truly leach our patients of their money.

I had to make the decision to study medicine at the tender age of 18.

It’s a harsh fact that many of us decide to go into this field when we barely know ourselves. It scares me. I have so many other passions, and yes, sometimes I wake up and I dread going to the hospital. I don’t want to be a miserable doctor. But life sucks for some people, and we don’t always get to save the world like we dreamed to do.

Are you happy in your job (even if it’s not in healthcare)?

How do you maintain job satisfaction?

When doin’ it wrong is fatal

Radiology was quite cool. It is amazing how many things physicians conveniently forget when sending a patient for a scan. Like not sending a proper history and examination report (erm, I’ve done that) or sending a patient without IV-access, or a hysterical patient without some happy medicine.

Or like people who want to evaluate an injured knee with an X-ray. Or projectile vomiting with an MRI.

Interestingly, did you know that MRIs can be really dangerous? Okay, so you only had to watch House M.D. to have seen the lead-based tattoos being burned out of that convict’s skin, so that’s kind of a no-brainer.

What surprises me is that it happens. Tobias Gilk writes about MRI safety and the damage that it can do if approached irresponsibly. It seems a little ironic: MRI’s use no ionising radiation, which makes it a real blessing of a scan. But come to close to it with metal objects and you are looking for trouble.

I don't know if this is a real image, but according to reports this kind of thing has happened many times before.

Oxygen tanks should not be brought near an MRI-machine. Neither should firearms – they can fire spontaneously. The doctors in the hospital say that they have not had such an incident (touch wood) and I could also not find any details of MRI-related accidents from South Africa. Which is a miracle, since our public hospitals don’t exactly have metal detectors or anything to screen patients prior to MRI.

But, having a look at the numerous pictures and horror stories on the net, it is clear that they happen. I am not a fear monger. I think MRIs are awesome, if indicated. But please people, be safe around those magnets!

Could Computers be an Infectious Risk?

My dad works a lot with Health Informatics, and is very involved in the digitalising of South African health care systems, especially when it comes to tele-health.

Recently, one of his colleagues mentioned something genius in its simplicity:

There has been a big push to computerise the administration of hospital wards – and with good reason. Even in rural South African hospitals, there are several large mobile computers (we call them COWs – computers on wheels) to be found in wards.

So, what does a computer consist of? A screen, sure, some network cables… and a central processing unit with a motherboard, which generates heat. Lots of heat.

Because of that, it also has a fan. And this fan draws air inwards to cool the CPU down.

I have a point, stay with me here:

Hospitals, as we know, are full of sick people. Obviously. And by far the greatest percentage of those are infectious diseases. And where do most of those pathogens thrive (apart from inside humans)?

In nice warm environments.

In the normal office, this is not such a problem. But in a hospital, where many different pathogens congregate, creating such a comfortable environment for bacteria is nothing short of ludicrous.

It would be interesting if sombeody did some sort of study on this. I’m sure someone in my dad’s department will, in due time. I know for sure that I don’t want to expose my patients (especially not the immuno-compromised ones) to such an onslaught.

I know that in more privileged countries, tablets are becoming the new best way for digital solutions in hospital.

Could this perhaps be the safest way out?