Hyper-tension

Aah.  Today I got home at 6pm.  There's a small pile of late discharge summaries on my desk (the things we send out to the GPs telling them all the terrible screw-ups we made in hospital) but I have a new registrar arriving tomorrow so I seized the opportunity to be slack and took off.  My old registrar called me at about 5.45 asking me where I was and I was delighted to tell him that I was gone, all the patients were stable, and there were no new issues, goodbye and good luck.


I realized today that the suckiest thing about my job right now is not my job.  I actually kind of enjoy my job.  It's satisfying in that way that looking at a big pile of blood clots that someone has just pooped out can be.

No, the suckiest thing about my job is that when I get home it takes me about 4 hours to unwind.  I can't stop replaying the day in my head, wondering if I did this or that right, wondering what I forgot to do, trying to remember the detail of some x-ray or sputum culture in case I get asked about it the next day, trying to make sense of what's happening to me via the medium of sick people.  It makes me so tense that I lose my appetite and can't eat dinner, and I find talking to my Smaller Half and the Hatchling really hard.

I can usually stop this just before I go to bed.  Then I sleep (or not) and wake up tense again because I know that I have to go in for the ward round, which always brings a new shovel full of surprises.  So I can't eat breakfast much because I'm freaking out again.  As for lunch - ha!  The El Dorado of meals.  Much discussed, never seen.

I'm pretty sure that I've already lost about 5kg, especially when you factor in the brutal gastro that I caught in the first week on the ward.

So basically what I'm saying is that I've developed some kind of panic disorder precipitated by work.  From what I can gather, everyone does in this business when they first start.  It's just that people don't admit it.

Bee

 Oh. So. Tired.

Did another 13 hour cover shift yesterday (Sunday) and was busy busy the whole time.  Nothing too scary or deadly but it was exhausting.  It's a bit horrifying to realize that it's Monday and I feel like it's Friday.

The highlight of the shift was getting paged to go to a distant ward.  I walked in and the faces of the nurses behind the desk lit up like it was Christmas.  "Here's the doctor", they said, "He can help!"

At that moment I felt so proud.  The doctor is here to save the day.  "What seems to be the problem?", I asked in my most nonchalant manner, as if I've been doing this for years rather than two weeks.

They looked at each other eagerly, then turned back to me and asked, "How do you spell abscess?"

Telemedicine

On Thursday I was sitting in the ICU playing phone tag with my registrar and the cardiology registrar regarding one of my patients when my mobile rang:

PTR
Hello?

Caller
Hi, this is Kathy, could you please re-send that order for the iron infusion?  It's gone missing in pharmacy.

PTR
What?

Caller
The iron infusion for Mr Gibson.

PTR
[Desperately flipping through my patient list looking for a Mr Gibson and freaking out because I know nothing about him...]
Mr Gibson?  Where is he?

Caller
He's gone back to Caloundra.

PTR
Caloundra? I'm in Adelaide.

Caller
Is that Dr Hamface?

PTR
No, sorry, you have the wrong number.

My week so far

On Monday I kept telling myself that I just have to get through this year.
On Tuesday I kept telling myself that I just have to get through this rotation.
On Wednesday I kept telling myself that I just have to get through this week.
On Thursday I accidentally went to a nude beach.
Yesterday I kept telling myself that I just have to get through the day.
This morning I am telling myself that I just want to go back to bed.

Status idioticus

Thanks for your supportive comments to my previous post.  Since then things have improved a billion percent plus or minus 999,999,999 or so.  I'd like to think that it's because I am a winner, but that's only partially so.  Sadly, I still haven't managed to have any Vitamin C(ricket) but life can't be perfect.

Monday was not good.  I was there for 12 hours straight, didn't get to eat anything, didn't get to drink anything, if I hadn't been running around like a madman you'd have thought I was fasting for surgery myself.  Perhaps I'd be more productive if I wheeled a drip-stand around with me, with cool refreshing sea-water flowing into my veins, and a nice fat urinary catheter to cut out those pesky bathroom stops.

Things got off to a poor start when the Hatchling woke umpteen times the previous night.  I then managed to somehow miss half of the plans during the round and never quite caught up.  It didn't help that my RMO (the person between me and the Registrar, who is the person between the RMO and the consultant, who is the Big Boss) is away this week and there's no reliever so I'm kind of flying blind.

I failed to arrange some urgent consultations from cardiology and anaesthetics to prep a patient for surgery on Wednesday (today) because I simply couldn't get anyone to return my pages.  Either that or I wasn't in one place long enough to actually take a phone call.

Then the consultant surgeon came and asked me some questions about my patients and it turned out I had no idea about them because again I sleep-walked (slept-walk?) through the round, so he deservedly rebuked me for that.

Then I had two code blues (dramatic emergency for crashing patients) in 4 hours plus another patient started having massive rectal bleeding so I had to quickly arrange a whole bunch of stuff that I previously had no idea about.  And because of that, I fell further behind and the consults never got done and as I was sitting at my desk at 8pm scribbling out blood forms for the following day my Registrar came in and revved me about needing to get my shit together.

So I went home and the Hatchling was screeching because she hadn't eaten and was sick and was driving my Smaller Half bonkers because she's been just as busy as me and by bedtime I was pretty much ready to run away and join the circus until I realized that I already lived there.

Tuesday was better though and today was better again.  Here's some tips for new interns on how to make it so:

1. Get a student to write the notes.  Concentrate on trying to figure out what the plan actually is.
2. Review your patients yourself.  For surgical patients you need to listen to breathing, check IVT/fluid balance, check calves for DVTs, check the surgical wound is clean and ensure that they have correct anticoagulation.  This will put a cap on how much of an idiot you look like when the consultant starts quizzing you.
3. When your registrar starts flinging around multiple, ambiguous or conflicting instructions, make him clarify himself (or indeed herself).  He may in fact get annoyed that you "waste his time" by doing this, but if you don't you'll regret.  This is no time to be meek.
4. Page people once.  Give them 5 minutes to answer, then go through Switchboard to call their mobile.  Why we have a paging system when I am the only person who seems to actually use it is beyond me.
5. DO NOT LOSE YOUR PATIENT LIST WITH YOUR JOBS WRITTEN ON IT.  Seriously.
6. Ask for help within a few seconds of getting baffled or confused or being unable to find something or not knowing how to do something.  Sure, you might look silly, but at least you'll be able to go home at a sensible hour.  This is no time to be proud.
7. Write down everything you do in the notes.  Writing it down often makes you remember what else you should be doing as well.  Which may well make you yoyo back and forth between the patient and the notes, but hey, what's the alternative.  This is no time to be super-organized and work hard through med school so you know what you're doing.  It's too late for that shit.
8. Drink lots of water.  Do not eat the junk food in the office.
9. Stand up straight.  Sniff the morning breeze.
10. Be strong.  Be energetic.  Be determined.  Know yourself.  Be the ball.  Keep left.  Buy low.  Sell high.  Take the All-Bran Challenge.  Squeal like a pig.  Something's gotta work!

I just wanted to say good luck, and we're all counting on you.

Low

Someone commented recently that I hadn't been posting much, and then posted a link to a blog about Antarctica.  Well, Antarctica sounds pretty good right about now.

Never in my life have I felt so disorganized, so incompetent, so useless, so tired, and so over my new job which I just spent the last 4 years "preparing" for.  Time to get some rest and go back and do it all over again tomorrow, hopefully slightly less ineptly than today.

Aptitude

I'm great at never and always.  It's sometimes that I have trouble with.

Shock redux

And another thing.  One of the patients mistook me for someone he was once previously hospitalized with, who was getting electroconvulsive therapy.  Presumably this is another hint that I need to get my hair cut.

Shock

First real day of work today.  For some reason I got mistaken for an electrician (???) by the theatre nurse.  Soon the anaesthetist knew, and it didn't take long before she was answering the phone saying, "Well the new intern is here, I could get him to do it.  Yes, that's right, the electrician. Hahaha!"

Ha ha ha.

Dysorientation

For the week before D-day - when I'll be expected to actually do real doctory-type stuff - I am being subjected to a brutal program of "orientation".  It's bewildering.

The general gist of it seems to be:

1. A senior doctor comes in and tells us that we can do it, not to be scared, and to call them for help if we get worried about a patient.
2. A junior doctor comes in and tells us war stories about the past year and all the freak-out moments they've had and how you get shouted at if you call a senior doctor.
3. A cyborg administrator comes in and tells us that even if you are on the roster to eat the bits of capsicum out of someone's poo that you'll get paid a 15% penalty rate only after the fourth piece and it's a Sunday in Aries rising and your supervisor authorizes said payment in their own cerebrospinal fluid.
4. Some of the interns start backchatting the hand-hygiene apparatchiks with an argument that would seem to suggest that because self-defence is okay that recreational murder should be permissable too.
5. Insurance salesmen come in and give us lunches that look like they were catered by 15 year old boys.
6. And then it starts all over again.

I get the impression that in the far-distant Neolithic era, the orientation program involved mostly useful stuff like being told how to use your pager and where to park your car.  Then the lawyers got involved because if they could show that at some stage we were warned not to kill people, that when someone unfortunately died they could point the finger and scream "We told you not to let that happen!".  Then the new interns freaked out and complained that they weren't supported enough so they brought in the senior doctor to play nicey-nicey.  Then the interns found that they were being shouted at because they were labouring under the mistaken belief that senior doctors want to be their friends, so they brought in the junior doctors to tell horror stories.

I don't know why she swallowed a fly.  Perhaps she'll die.

Ceiling, Seville, Spain

New Years Resolution

First thing in the morning, I'm going to pour boiling water over the salt again whilst verifying my answer to that tricky problem that I worked out previously.