Purple Steth - musings of a clueless intern

Life starts... now!

2012-01-11T00:45:00.000-08:00

Wednesday morning, just past midnight.

I am less than a week away from starting internship so I thought it might be a good time to resume writing. The holidays have slipped away, as often happens, all too quickly :-( I have disposed of my medical school notes in a timely manner; cleaned my room (sort of); and finally unpacked my suitcase and stored it away after practically living out of it since I first packed it for my rural placement in Lithgow in September (!).

There's a sense of change in the air - all too familiar, I've been here before. I'm still adjusting to life as a non-student. It's weird and I don't know what to do when I am at home. What do people do in their free time? I want to take up photography as a hobby and have been meaning to enrol in a community college course. It's only one class a week over eight weeks but you have to attend a set day and owing to the shift-work nature of my first couple of rotations, I will have to put it on hold until my third internship rotation where I will finally (hopefully) have a more predictable working roster. Speaking of rotations, I got very lucky in my allocation and will be doing the following rotations over the course of the year:

1. Emergency medicine
2. Relief/night cover/annual leave (where you cover for other people who are away on their normal rotations; do night-shift cover for the hospital and take annual leave)
3. Cardiology
4. Vascular surgery
5. Emergency medicine (at a different hospital)

I'm a bit freaked out about starting in Emergency Department because, unlike ward duty where you mostly just follow orders made by more senior members of the treating team, in the ED you actually have to make your own decisions. Do I order this test? Do I prescribe this drug? Do I discharge the patient home or admit them? We are supposed to present each patient to a senior supervisor at some point in our clinical work-up; but I don't know how much of that actually happens in reality and I'm actually quite nervous about being assigned a supervisor who will just tell me to pick up my slack and start making my own clinical judgements!! Okay, clearly I have been watching too many episodes or ER :-S Just to be sure I don't get into a pickle, I have ordered a copy of The Oxford Handbook of Emergency Medicine as a safety net in case I run out of ideas on what to do next with a given patient and can't find anyone to help me. There you have it people: seven years of university and I will be flipping frantically through a how-to guide before I do anything. Warning: do not become ill for the first few months of the year as there is a good chance that you will be looked after by a clueless intern if you present to the ED. Don't say I didn't warn you. Maybe they will just assign me all the triage category 4 and 5 patients who really should have gone to their GPs instead and I will be stuck all day writing sick notes for sore throats and blocked noses.

Anyway, I don't care what I'm presented with. I have gone into survival mode and I have one aim for this year and that is: to make it out alive.

Wish me luck!

Part I: The End of the Beginning

2011-11-23T02:50:00.000-08:00

Wednesday morning, just past 1:00am.

Presently, I am sitting behind my desk, tying up virtual loose ends - replying to old emails and fb messages, looking up places to have dinner in Nadi (Fiji), deciding what to "do next"...

I'm in the final of my four-week elective in Anaesthetics at Westmead Hospital - officially the last week of uni too (even though I completed and passed the final exams a good six weeks ago!). Absolutely loved the elective - I think I got really lucky in striking the right dose (for me) with regard to setting and content. If you had asked a more starry-eyed me four years ago, at the beginning of med school, what I planned to do for my elective term in my last year of med school - I probably would have sought something a little bit more adventurous than what I have done. Certainly, Trauma Surgery in Johannesburg did cross my mind at one point or another. But I have no regrets. At the end of the day, among other things I have learnt about the "system", I know that there are far less prudent things to do than spending a month with a department of career/academic interest to you, in a hospital you will be based at for (potentially) a fair few years. I'm still a bit unsure as to what the purpose of the elective term is, so I guess as long as each student has their own agenda and outcomes - as with many things in life - what you put it is what you will get out. My objectives were low-key and modest:
1. I wanted to familiarise myself with the route from my house to Westmead by car (and parking!!), as well as the layout of some of the hospital grounds; so that I don't have to stress about it early on next year.
2. Learn some more about Anaesthetics beyond what I learnt during my official Anaesthetics term earlier on in the year (btw - if we haven't spoken in a while, just an update - Anaesthetics wasn't chosen arbitrarily... I am just thinking of heading in that direction as a speciality... but more on that another day).

So, end of story - I haven't put in any chest drains as my colleagues in South Africa have done... but at least I know where I'm supposed to be for my first day of internship next year! Snaps for me :-D Logistics aside, I also did happen to fulfill my second objective and I picked up a lesson or two in Anaesthetic theory and practice during my time with the Department. Because I like making lists, here is an abridged list of what I learnt/practiced (medically) during my elective:

Cannulations +++ (what at least 20% of my work next year will involve, so never a waste of time practicing this one!)
Maintaining an airway and ventilating using a bag-mask system (for non-med people, supporting someone's airway and helping them breathe with some basic equipment. Again, important skill to know, even if it will (hopefully) not be needed that often)
Use/insertion of specific airway support equipment and adjuncts, e.g. intubation (sticking a breathing tube down someone's trachea to deliver air/oxygen straight to their airways. Okay, so this skill I will never have to do as an intern, but still cool to know nonetheless ;-)
Doing the above on morbidly obese/clinically unstable/medically co-morbid patients.
Pharmacology - what and how much/often to prescribe for two common (esp post-operative) complaints: pain and nausea/vomiting (this is an area that I knew very little about in practice, despite it being covered at some point during the course)
Plus other tid-bits of information specific to Anaesthetic practice, which I shan't bore you with.

Now, having argued about how awesome it is to undertake a local elective in your area of choice, I couldn't surpass the opportunity to, ahem, supplement my learning even further with a few weeks in Fiji. I have a bit of a soft spot for Fiji. A tropical island holiday destination for many; for me, it was the first place I ever travelled to on my own. This is where it (sort of) started - back in 2008, at the end of my first year of med school. Surpassing the popular resorts of the West Coast, armed with an older edition of the Lonely Planet Fiji guidebook that I had borrowed from the local library and the name of a hospital in Suva that I, literally, rocked up to. Two weeks later, I couldn't even bear the thought of returning home. There were many "firsts" for me during my placement at CWM Hospital - first cannulation, first spinal block, first stitches, first amputation, first birth, first death.... These are trivial occurances in the everyday life of a doctor - as they will be for me next year. But at the time, every moment was a novel adventure worthy of reflection and celebration. A few days ago, as I was cleaning my room and essentially purging it of all my med school notes, I found the journal detailing everything I had seen and done during my first visit there. Needless to say, I couldn't throw it out. So, come this Sunday, I'm getting on a plane to Fiji. I will be spending a week beforehand away from the hospital (will try to post along the way); but eventually return to CWM for a 2 week placement... back to where it started at the beginning of the beginning; but now, at the end.

Standing outside Colonial War Memorial Hospital, Dec 2008

Welcome to my blog!

2011-11-15T11:04:00.000-08:00

I just found out that I've passed my final exams for medical school. So, what happens next? As a clueless intern, the answer will reveal itself over the course of the year...

Although by no means the exemplary model of a fresh medical graduate, I hope that through this blog I can shed some insight about the work involved and also keep friends and family updated on what I am doing (because I have a tendency to disappear for long periods of time and emerge many months later without much accountabilty of where I have been nor what I have done..).

Welcome to my blog!