Dr KR/Ms K

As I had always anticipated, medicine has turned out to be an all-consuming reality; a fact that had deterred me from it initially. The people I most often see day to day are associated with hospitals, the tasks that plague my never-ending to-do list are medically related and, most sickeningly, when I'm out on social dates with my friends (all of whom are unfortunately also in the medical field) the topic of conversation that eventually creeps up and takes over is, of course, medicine.

And in the midst of this inescapable, personality/individuality-sucking medical black-hole, my head screams, "How did I get here? I am not this person!"

For certain, I am not.

And five years ago, I most certainly did not envision myself where I am today.

I was an ever-curious and adventurous child; my favourite activities being reading, arts and craft, experimenting, exploring and treasure hunts. I was also very active and I loved swimming, swinging, and just about anything that involved running around and expanding energy.

Twenty years later, I'm still this person. One could say (and many have) that I really haven't grown up at all.

Throughout school and college, I always found my niche, and it always involved more than just academics.

In high school, it was music. I was the drummer-girl of a rock band with three other guys, and I loved it. That virtually sums up my memories of high school, although I'm fairly certain there were plenty of other things that kept me busy.

In college, it was foosball. I was dubbed 'The Foos Queen' by the boys on campus after winning first place in the A-levels tournament with the help of my infamous 'Kate-shot'.

Those were the days. I was young and carefree, and my only responsibility was towards self-development. And in all honesty? I feel I did a good job.

These days, I'm a final year medical student. One of many; but I love what I do.

I'm one of those lucky people who gets to wake up in the morning, go to work, and feel like I'm where I'm meant to be. I fit in, I belong, and I have a purpose that I feel capable of fulfilling. And that fulfils me.

If I had all the time in the world, I would publish my novels and non-fiction work, work on my art and sketches, record my musical albums, open my school of philosophy, and devote my time to the hundreds of other items on my non-medical to-do list that often gets neglected due to my more pressing medical priorities.

Medicine has not changed me. Not one iota.

However, out of necessity, my priorities have been reshuffled and it's easy to forget that there is another side of me that needs just as much nourishment as the medical side.

Self-care is something that is taught in most medical curriculums. After all, it's hard to care for others if you're having difficulty caring for yourself.

Often though, it's something that needs to actively be worked on as the work will steal your soul if you let it.

And a soulless doctor is no good to anyone.

Successful Aging

I was reading up on the concept of 'successful aging' when ironically I met a woman on the bus who seemed to be the epitome of the phrase.

Maria is a woman of European descent who is close to celebrating her 95th birthday. On the day we met, she had just been to her great granddaughter's birthday party and was on the bus heading home.

When she let slip that she was 95, I could not hide my surprise. She looked like she could have been in her mid-70s to 80s, but mid-90s? I wouldn't have guessed.

The thing that came to mind next was, what was her secret?

In life, we often imitate actions and behaviors that we believe are proven to have good outcomes. This is where our personal evolution meets our survival instincts. This also happens to be the basis of evidence based medicine.

For me, this woman was a walking testament to the fact that successful aging does in fact exist.

And so it was that a woman in her third decade of life found herself with the curiosity of a child, sitting beside a woman approaching her eleventh decade of life, wanting to learn.

Maria was not a woman without her fair share of challenges. Four years ago, she had lost her husband to metastatic cancer, and four years before that, she was struck by a thoracic aneurysm (which, ironically, the doctors advised not to operate on because she was apparently "too old").

It just goes to show, doesn't it? Doctors don't always know best, and our patients can often still surprise us by beating the odds.

In that short 45-minute bus ride, I regret to inform you that I did not end up getting Maria's secret recipe for successful aging (although given more time, I'm fairly certain she would have gladly listed them down for me).

However, I did note a couple of things:

1. Maria values her independence and does most things on her own

2. She has a good support system in terms of her friends and her family, despite all family members living in different regions, interstate and overseas

3. She keeps mobile and seems fairly active, despite the normal limitations of her physical state

Overall, Maria states that she is satisfied with her life and she has no regrets. She told me that she has no desire to live forever and would be quite content to meet her Maker, whenever that may be.

One thing she did comment on was her difficulty with her husband's passing. Although she had initially thought that time would heal all wounds and she would eventually get used to being on her own, she has found that this is not the case.

And after almost seven decades of marriage, one could certainly understand if it is something that she never gets used to.

I wish Maria the very best in life and I hope that life continues to treat her well. I am thankful to have met her and grateful to have had the opportunity to learn from her.

And, without a doubt, I hope to one day be able to help my patients age as successfully as she has.

The Essence of Aged Care

This poem was found in the belongings of an elderly woman who died in a nursing home in the UK.

It's one that I keep at the back of my mind to remind me that patients are people; first and foremost.

Many of my Aged Care patients have pictures lining the walls of their room, and I am constantly amazed at the stories that come with them - often detailing a rich and full life.

At times, when all you have in front of you is an elderly man or woman who can barely walk or even speak, it is hard to envision that in the place of weakness and clumsiness, there once had been strength and vitality.

This poem reminds me of two things regarding the elderly:
1. They've all been there from the very beginning
2. We'll all end up there at the very end

And, with that in mind, I hope you appreciate this beautiful poem as much as I do.

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What do you see, nurse; what do you see?
What are you thinking when you look at me?

A crabbit old woman; not very wise,
Uncertain of habit, with far-away eyes.

Who dribbles her food and makes no reply,
When you say in a loud voice, "I do wish you'd try!"

Who seems not to notice the things that you do,
And forever is losing a stocking or shoe.

Who, unresisting or not, lets you do as you will,
With bathing or feeding; the long day to fill.

Is that what you're thinking; is that what you see?
Then open your eyes, nurse; you're not looking at me.

I'll tell you who I am, as I sit here so still,
As I move at your bidding; as I eat at your will.

I'm a small child of ten with a father and mother,
And brothers and sisters who love one another.

A girl of sixteen with wings on her feet,
Dreaming that soon now, a lover she'll meet.

A bride soon at twenty; my heart gives a leap,
Remembering the vows that I promised to keep.

At twenty-five now, I have young of my own,
Who need me to build a secure, happy home.

A woman of thirty, my young now grow fast,
Bound together with ties that forever should last.

At forty, my young ones have grown up and gone;
But my man stays beside me to see I don't mourn.

At fifty, once more, babies play 'round my knees,
Again we know children; my loved one and me.

Dark days are upon me; my husband is dead,
I look to the future; I shudder with dread.

For my young are all busy rearing young of their own,
And I think of the years and the love I have known.

I'm an old woman now, and nature is cruel,
‘Tis her jest to make old age look like a fool.

The body, it crumbles; grace and vigor depart,
And there now is a stone where I once had a heart.

But inside this old carcass, a young girl still dwells,
And now and again, my battered heart swells.

I remember the joys; I remember the pain,
And I'm loving and living life over again.

I think of the years; all too few, gone too fast,
And accept the stark fact that nothing can last.

So open your eyes, nurse; open and see,
Not a crabbit old woman; look closer - See me.

~ Written by Phyllis McCormack ~

The Art of Happy

Happiness is a puzzling thing.

There are some days when I've got every reason to feel miserable and yet I don't. And then there are days when I've got every reason to feel happy, and yet I find that I can't quite get there.

Clearly, happiness is unreasonable.

People often talk about happiness as being a choice; that you can choose to be happy.

Rightly or wrongly, I am not one of those people.

I don't think you can choose to be happy any more than you can choose to have a hundred dollars in your wallet.

You've either got it or you don't.

However, if you'd like to have a hundred dollars in your wallet, there are ways of making that happen. Just like there are ways to making yourself happy. In both cases though, it is a process, not a split second materialisation.

The mind is a beautiful thing.

After over twenty years of living with mine, I still haven't quite figured it out, and it's not from lack of trying.

I am certain that I'm not alone in my quest for happiness. For a lot of people, it's a never ending struggle.

The funny thing about happiness that I've found is this. You need to have had it to fully appreciate it. You need to have tasted it to want it bad enough to actively seek it out.

In a sense, happiness is like an addictive drug. The more you get of it, the more you crave it, the better you are at recognising the things that give you that high.

Just like it takes money to make money, it takes happy to make happy. If that makes sense.

And so, my summary of it is this. Happiness can only be attained in pursuit of happiness. It is both the journey and the destination. Every little success that gets you closer to your ultimate happy goal, gets you there.

It is an elusive conundrum that plays us all for fools, and yet, it's worth living and dying for.

So what do you do when happiness serendipitously pays you a visit?

Ask no questions and simply bask in the glory.

And that's just what I intend to do next.

Fly

Ever since I was a child, I have had dreams of flying.

In these dreams, I have have full control of my flight (i.e. I am able to fly higher or lower, turn left or right at will), and occasionally, although I am aware that I am dreaming, I am so intoxicated by the freedom and exhilaration that comes with my flight that I just go with it.

Of course, as all dreams in sleep must end, I eventually wake up to reality. Despite it being all in my head though, I still value these dreams very much.

Yesterday, Keira took me to see a performance at the National Institute of Circus Arts (http://www.nica.com.au/) and I realised that for some people, what I only experience in dreams, they taste snippets of in reality.

Ultimately, we are all a product of chance or fate; whichever you choose to call it.

It dictates the opportunities that we encounter, as well as everything that influences us (directly or indirectly), which includes our environment, and the people we meet.

I found myself thinking yesterday that I would have been happy as an acrobat. If the opportunity to learn and experience the profession had been available to me in the past, perhaps I would have found myself walking down that path. Or at least engaging in it as a past time.

But today, I am who I am. And I am where my life has brought me.

Having said that though, it's never too late to discover sides of yourself that you've never known, and it's never too late to incorporate new things into your life that can make you happy.

Lesson for today?

Insight comes with new experiences.

So, go ahead... Immerse yourself.

A Good Death

So this morning, Vincent and I were asked to put in an in-dwelling urinary catheter.

And one hour, two final year medical students, two doctors, three sterile packs, four attempts, and multiple glove changes later... The procedure was a success.

Now, before you start yelling out "Medical incompetency!", let me just enlighten you on our patient, Cassandra.

Cassie is a 98 year old woman with a pelvic fracture.

Here's hoping that bit of information put things into context for you. And if it still doesn't... Let's see you do better.

On another note, one of my first patients at the Lodge passed away today.

I met her two weeks ago when I was assessing her for her back pain (she referred to my palpation technique as a gentle massage) following which, I advised her to practice deep breathing exercises, keep mobile, and practice all those good healthy habits that keep your lungs happy.

I recall that at the time, her lungs were clear. It didn't take long for that to change, however. Once the pneumonia hit, she deteriorated quite rapidly. Despite our best efforts, it came to a point where the most we could do was keep her comfortable.

In the end, we managed her pain, she had her family with her, and as far as it can go, I'd like to think that she experienced a good death.

Is there such a thing?

I'd like to think so. One would hope that it exists, as given the fact that death is the one sure thing about life, it's nice to think that it could actually potentially be a positive experience.

However, only time will tell for sure. And on my part, I'll do my best to keep you posted.

My House is an Ice Box

*ehem*

My house is an ice box of red bricks and wood

The latest attraction in my neighbourhood  

I wake in the morning and nobody knows

If overnight I've lost all my fingers and toes  

My house is an icebox all frozen inside

Despite my warm heart, there is no place to hide  

With icicles and snowflakes aligning the hall

Tomorrow the Snow Queen might pay me a call  

'Tis the season again, evidently, it's clear

My house is an icebox now that winter is here.

Needless to say, it's another harsh winter. By my standards, at least.

Coming from the tropics, my threshold for the cold (and the heat, for that matter) isn't particularly high, but given that it's been four years, I'm learning to cope.

I am currently on my Aged Care rotation and enjoying it tremendously. It rekindles my love for Geriatrics and Palliative Care, and interestingly enough, Mental Health.

The polarity of Aged Care, however, can be quite a roller-coaster ride. All in one day, you could celebrating a successful treatment of pneumonia in one moment, and delivering bad news about terminal metastatic lung cancer in the next. At the end of the day, it's about taking in all good and making the best out of a situation that may be less than ideal.

And, of course, it's about knowing that even with an impending death, there is still good work left to be done.

That is, assuming I escape from my ice castle soon enough to do the work required!

Australia's Intern Crisis

Original article: http://www.mjainsight.com.au/view?post=james-churchill-an-intern-crisis&post_id=9436&cat=comment

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An intern crisis

Written by James Churchill

HUNDREDS of students graduating from Australian medical schools this year may not get an internship in 2013.

The Australian Medical Students’ Association has been concerned for years that the rapid and sustained increases in medical student numbers would, at some point, lead to the clinical training system failing to provide sufficient internships for graduates.

The number of medical graduates has rapidly doubled from 1633 in 2006 to this year’s predicted 3512. With the lack of adequate workforce planning over a number of years, it’s no wonder that our health systems are struggling to keep up with graduate numbers.

In 2006, and again in 2010, the Council of Australian Governments (COAG) guaranteed “to provide high-quality clinical placements and intern training for Commonwealth-funded medical” students.

Despite these guarantees, it is concerning that many state agencies have advertised fewer internship positions than the estimated number of domestic applicants. In these states, the job prospects for Australian-trained international students are even more alarming.

International students, who make up about 15% of graduate numbers, are not guaranteed an internship in any state or territory, and are generally prioritised after domestic students in the allocation systems.

Our estimates show that, overall, 456 medical graduates will not gain an internship that is required for full medical registration, and will therefore not be able to work as doctors in Australia. As domestic students get first allocation, it will be international students who will bear the brunt of this lack of places.

Many of these students will be forced to seek internships overseas after being trained specifically for the Australian health care system and the complex medical needs of its ageing population.

The prospect of medical graduates not being able to continue training in Australia represents an appalling lack of workforce planning by governments and universities. It is concerning on a number of levels.

First, producing medical graduates without jobs will not solve the shortage and maldistribution of Australia’s medical workforce, and will leave graduates unable to serve communities in need.

The recent Health Workforce 2025 report predicts a modest undersupply of doctors by 2025 in a range of likely scenarios. It also highlights that Australia’s current reliance on overseas-trained doctors goes against many conventions to which Australia is a signatory.

We are now in a ridiculous situation where, on the one hand, Australia produces more doctors than internship positions, forcing doctors to continue their internship training overseas, yet, on the other, we continue to rely on vast numbers of overseas-trained doctors to meet Australia’s health needs.

Second, significant federal, state, university and private financial resources go into training a medical graduate, all of which is wasted if that graduate cannot practise. The waste of immeasurable and valuable clinical resources is equally significant given the various pressures of increasing student numbers.

Third, this situation has significant implications for the sustainability of Australia’s medical education sector. As many of those students likely to miss out on internships are international full-fee paying students, a loss of confidence in graduates’ ability to continue training in Australia may precipitate a decline in demand for international full-fee places at Australian medical schools.

Many medical schools are significantly reliant on international student revenue, the loss of which may have severe consequences for the quality of medical education in Australia.

Progress on this issue in the coming weeks will be critical for those medical students concerned about their future careers.

Sufficient funding and support must be provided to health services to ensure that the maximum number of quality internship positions is available for Australia’s medical graduates.

It will not suffice for university medical schools, and state and federal governments to simply blame each other for the problem and hope that it will somehow resolve itself.

Governments and their agencies must recognise the significance of failing to provide medical graduates with internships and the ability to continue the training that is needed for Australian medical school graduates to fully participate in Australia’s future medical workforce.

Mr James Churchill is the president of the Australian Medical Students’ Association.

Updates on the internship crisis are available the Australian Medical Students’ Association website. AMSA has also started a petition — Health Ministers of Australia: Train the doctors Australia needs.

Posted 4 June 2012

Help Us Help You

This is a call to arms.

We need your help to ensure that Australian-trained medical graduates are able to gain internship training following their graduation from Australian medical schools.

Join the cause. Help us help you.

Click HERE to sign the petition

Silent Symphony

I remember the first patient I ever examined as a medical student.

He was three years old, and his mother had brought him in to see her general practitioner as she noticed him with a slight temperature.

As I gently auscultated his chest, I was struck by how beautiful the soft breathing of a child sounded through my stethoscope.

Even today, it is still the most beautiful sound I have ever heard.

The Physician's Prayer

 Endow me with strength of heart and mind 

So that both may be ready to serve 

The rich and poor, the good and wicked, 

Friend and enemy 

And may I never see in the patient 

Anything else but a fellow creature in pain

Moses Maimonides, AD 1135 - 1204

In The Beginning...

There was the Hippocratic Oath.

I swear by Apollo the healer, Asclepius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: 

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; to look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart the knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.