“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.

 

Feeling Dull and Disillusioned

I’ve been told before, “You’d be a better doctor if you weren’t so emotional about life.” I don’t consider myself a superbly emotional person in public, but yes, I am touched by stories. If you scan through this blog you will see that stories of compassion or triumph are dear to me.

I’ve always believed that as long as it does not affect the way I treat a patient, it will be okay.

But maybe not.

If I am touched by the mother who brings her teenage rheumatological daughter pink milk and a favourite blanket to hospital, then I am also affected by the injectable drug-user who shouts at me for drawing blood “incorrectly and from the wrong vein”. Or the patient who tells me to “hamba” (leave) when she sees me entering the room with a drip-set.

And if I am happy because of a compliment given (probably without second thought), then I will easily be saddened when the same doctor is rude because of something I presumably did wrong. Or the nurse who is in a bad mood and tells me I will “just have to do without a blood culture bottle.”

I begin to understand why doctors are disillusioned about their jobs. I begin to see why they choose to change careers. I begin to see why they feel unfulfilled.

Sometimes, “helping people” just isn’t enough. When other healthcare workers are rude, and when patients are moody, and your employer (in this case the State) does not look out for you, and working conditions are terrible… it’s difficult to remain positive.

I’m not even qualified yet, and I feel like this already. I used to promise myself I wouldn’t become dulled to this work, that I wouldn’t become one of those sad, dissatisfied doctors.

But I don’t know if that’s possible anymore.

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.

Latin, Law and Medicine

We are doing some forensics theory for two weeks. It’s a lot more work than the practical rotation I had at the beginning of the year, but also a lot less disturbing.

One of the specialists also has a law degree. They taught us something interesting: we can prevent justice from occurring. In a bad way.

Novis Intervenus Artis is a Latin term which directly translates to “by intervening with new art”. In medical law, it refers to the effects on a new intervention on a patient.

Here’s where it gets interesting:

You are on call in the ER. A patient is brought in with severe stab wounds and blood loss. He is unconscious. As part of resuscitation, you order two large-bore IVs. But because it is late on a Saturday evening, you forget in the rush to run the fluid through the line to eliminate air bubbles. 

A few seconds later the patient dies from a massive air embolism – which you inadvertently caused. 

It is likely that this patient would have died and that the person who assaulted him would have been found guilty of murder or manslaughter. But now he won’t, because your “new intervention” caused the death.

Do I sound like a fear monger? I don’t mean to be.

This scares me. Because I have lost loved ones to violence and because I believe in justice. And because I am a young medical student, soon-to-be a young professional: prone to mistakes.

There Was This Boy: Your Future Matters

A few times every year I see on Facebook, blogs and Twitter how high school students consider their options for life after school. 

There was this boy I dated in high school. He was not a genius, but he performed as an above-average student. He did well in Maths, Science and Biology. He was good at interpersonal relations.

In short, he was not meant to be a candidate for struggles later in his life.

But he had a family job lined up and decided, despite advice from people who cared for him, not to study after school. After all, he was the heir to the family business.

But the family business has now become insolvent. He, his older brother and his parents have no means of an income. His little sisters are still at school. And he cannot find another job, because he has virtually no experience and no qualifications either.

I am sad. I can’t offer him much help. And I am a little disappointed, because this needn’t have been his situation.

There are many unemployed people the world over who have qualifications and still cannot find a job, I know this; but I think his job-hunt may have been a little easier had he had some form of CV.

My heart breaks for the many people who cannot find jobs despite their best efforts. My biggest wish is that all young people (even the “trust fund babies”) will consider the long run and prepare for tougher times.

What Would You Have Been?

Last week, the fifth years had their last ever day of class. For the next eighteen months, until they graduate, they will only be doing clinical rotations.

It is a longstanding tradition here for fifth years to dress up on their last day of class and ambush all the other classes. The general theme is “What would you have been if you weren’t studying medicine?”

I’ve seen a lot of things, from hobos to blue-skinned Avatars.

These are two of my friends who dressed up:

It’s weird to think that in a year’s time, that will be me. I don’t even know what I’ll dress up as. There were many alternatives, to be honest…

So Radiology Is Kinda Cool?

This week I am on a short radiology rotation.

A lot of people really want me to declare Radiology as a specialisation. The income is ridiculously good compared to the workload and working conditions – even in public South African health care. With the growth of telehealth in South Africa, there are even excellent opportunities to either work from home or effectively have two jobs at one time.

I’ve never been too interested. I am not great at interpreting scans. I like working with patients.

It looked kind of like this picture.

But I have to say, it does have its appeal. We did a barium enema on a one-month old child with a “query obstruction”. The poor little child has had problems since birth and has already had surgery. He was clearly uncomfortable and the abdomen was hugely distended.

We saw a stricture in the hepatic flexure of the colon. If all goes well, he should be more comfortable soon.

Radiology has a lot of rules. I like having rules – and I like being able to break them. So I guess that’s problem (and oddity) number one.

The radiologists are super clever. We attend their meetings, and the way first year registrars just rattle off terms and interpretations is very impressive.

The biggest problem is this: I suck at anatomy. That really is not an understatement. So yeeeeeh…

The most ubiquitous statement we have been hearing is,

“If you are good at anatomy, you will love Radiology.”

Weekly Whine: Med School Comptetition

If you look around this blog, you’ll notice that I consider myself to be an average medical student (when it comes to academics, in anyway). Clearly, that wasn’t always the case. To gain entrance to this course, students must have exceptional academic and non-academic merit.

High School was competitive. Everybody knew that with the few tertiary institutions in South Africa, doing a little less than their best could very well cost them their future. But regardless, I went out of my way to help my classmates – I explained work to them whenever I could, and we supported each other well.

Recently I’ve become so aware of competition in my class. Don’t get me wrong, there is nothing wrong with a healthy dose of competition. But what I am seeing is students who will step on anyone to reach the top. And I don’t care how badly you want to specialise in a specific field, stepping on others is NEVER justifiable.

The Boy says I live in a dream world. I guess that’s true, and that I have realised more and more recently. People aren’t nice to other people anymore.

There are kids in my class who will look you in the eyes and say, “No, I don’t have any practice-exams” when, in fact, they do.

A while ago some group members and I were preparing for a group presentation. I couldn’t remember the latest PEP-guidelines and asked for a quick reminder. To cut a long story short, they told me that the prophylaxis is two protease-inhibitors. And when that question came up and I answered, they were so quick to jump in with a “No, actually it’s NRTIs”.

It was a group presentation, so they pretty much shot their own marks in the foot.

We have logbooks for clinical procedures to perform. Last year, instead of ensuring that everyone in a group gets equal opportunities to practise their skills, some people would push ahead and do, for example, a gazillion IV-cannulations, and then some poor people hardly had the opportunity to perform the mandatory three.

I get that we all have dreams and aspirations. But our classmates will one day be our colleagues in South African Medicine – where health resources are scarce and thinly distributed. There are way too few doctors (of any specialty) in our country. So surely one should want your  colleagues to be as well equipped as possible?

You can stand tall without standing on anybody.

You can be a victor without having victims.