Heroes

I'm attending the 2016 RACGP 'Women in General Practice' conference in 

Melbourne this weekend and the excitingly brilliant day of learning has ended with a dinner with one of my heroes.

Professor Leanne Rowe is the co-author of 'First Do No Harm: Being a resilient doctor in the 21st century'; the other co-author being Professor Michael Kidd, another hero of mine.

In the time she was speaking to us, without her realising it, Professor Rowe had answered every single one of the lingering questions that have been painfully plaguing my mind for the past 6 months.

A part of me felt relieved and ever so grateful. Another part of me felt guilty, embarrassed and ashamed.

She reminded me of the person I aspired to be. And it wasn't the list of accolades and accomplishments that she's acquired over the years (although they indeed are mind-blowingly impressive)... It was her. Not Leanne Rowe the Professor... But Leanne Rowe the woman, the mother, the general practitioner.

I have spent a large percentage of my life in pursuit of my life's true purpose, with life events leading me down the path of General Practice. But in light of that, I look at myself and my life right now and I can't help but feel somewhat out of place. I don't recognise my reflection. I feel uncomfortable under my skin. I feel betrayed and like I've been a betrayer.

I've put my life on hold when I said I wouldn't. I've let go parts of myself when I promised myself I'd hold on to them. I've focused on the wrong things, I've got my priorities mixed up and it feel like the foundations under me have shifted.

I've let my fears and unrealistic expectations of myself direct me down a road that, while I enjoy taking, would have much rather strolled through while stopping occasionally to sniff the roses and admire the view, rather than whizzing by on the bullet train.

After deliberating for so long and agonising over what would be the right way to live out the next 5 to 15 years of my life, I have finally found the courage to make the decision to live my life the way I want to, and not the way I feel that I should.

I'm putting on the brakes and stepping off the bullet train. I think it's time I put my runners on and went for a stroll instead. Recharge myself to the fullest and take in some solitude.

To Professor Leanne Rowe... Although I doubt you will likely ever stumble upon this... In the off-chance that you do...

I just wanted to say, Thank you. 

A Brave New World

There is a certain discomfort that comes with doing something new and unfamiliar. Quite often though, it's the initial bit that scares you, but once you've actually done it, the anxiety dissipates and you come out of it with the knowledge that you've conquered something.

As a brand new General Practice Registrar, every day and every patient is new and unfamiliar. There is so much to learn and just when you think you've got it down, you get thrown a curve ball.

If I could give some advice to my past-self from a month ago, it would be this.

Get used to the feeling of discomfort. You and it are going to be best friends for a while.

There will be wins and you'll get some time to recover if you make time and effort for it, but ultimately, it's going to be hit after hit after hit, and you won't get a choice but to get up each and every time.

Set up a good support system. You'll need it like a drowning person needs a lifeline.

And above all else, don't lose sight of why you're in it. It's the only thing that's going to get you through.

The Come-Back

Nothing so frightens me as writing, but nothing so satisfies me.

Maya Angelou

I am a writer. I always have been.

When I think of the things that define me, what comes to mind is not my profession, but what has led me to it.

My first love was a love for the written word. As a child, I loved nothing more than to curl up with a good book, churning through multiple in a day. My day would begin and end with the usual things that filled the life of a child, but I still strongly recall the joy that I found in those quiet moments when it was just me and those incredible words that illustrated different lives and far-away worlds that seemed foreign and yet all too familiar.

I started my first journal at the age of 7, and wrote my first serious novel not too long after that. From there, I went on to writing poetry and, after teaching myself the guitar and drums, moved on to writing songs. My love for music, art and literature preceded my love for medicine. I was an artist long before I ever imagined becoming a doctor.

Author Joan Walsh Anglund once wrote, "A bird doesn't sing because it has an answer, it sings because it has a song." Writing, like all my artistic pursuits, has always been about self-expression. I write for me; to organise my thoughts, to make sense of my world. I write what I know, and although what I know is extremely limited, writing helps me put it together and figure it all out.

Since I stepped into the world of medicine, it feels like every other part of me has needed to come second to my pursuit of being the best doctor I can be. My writing, my art, my music... Language and philosophy... Health and fitness... Family and friends... Everything else has been allocated a smaller piece of the pie because medicine just takes up so much.

I have recently been given the opportunity to write an article on a topic that means a lot to me. It scares me that I might not do it justice because I'm so out of practice, but it's a piece that I would love to write well.

I can only hope that, in my attempt, I'll find what I need to make it great. And here's hoping that I find a bit more of myself in it as well.

Wish me luck.

Resident

In the last month, I've understood the full extent of the term 'hospital resident'.

Yeah, ladies and gentleman, that's me.

I spent most of my year as an ED resident, which hasn't been too bad to me in terms of working hours, as you're typically rostered for 76 hours a fortnight. Given the high intensity of the work, this is understandable... You wouldn't be able to function very well in a cardiac arrest if you've worked 140 hours a fortnight as you sometimes do as a specialty resident. Sleep deprivation results in your brain cells committing suicide and the last place you'd want to be working in with that kind of mental reserve is the Emergency Department.

ED has been fun. I've even taken up the Emergency Medicine Certificate this year because I've enjoyed it so much, and I wanted to get something out of it. Probably the only thing I would change about my year in ED is that the year has been mostly unsupervised, given that night shifts are only covered by 2 residents. There are no consultants on overnight and there are no ED registrars ever.

As an ED resident, I've had the opportunity to cover specialty wards after hours and overnight, which adds a bit of variety to the work. But again, you're pretty much the senior on-site. Don't get me wrong, I've loved the experience and I've gained plenty of new skills... I just feel like on the flip side, I've missed out on opportunities to learn from a mentor, which is really what being a junior medical officer is all about. To me, the lack of supervision is a pretty big deal... Especially at this stage of my career. Sure, I'm qualified to do the job... That doesn't mean that I wouldn't love the opportunity to learn from someone who's done the job for far longer than I have.

My last month at the hospital involves me working as both the Hospital Redesign HMO (a position I've held for most of 2014) while working full time as the Paediatric Resident. As expected, Paediatrics has been fun. There's been a lot of learning and mentoring opportunities, as the treating team consists of just me and the 4 rotating Paediatricians. As we do not have Paediatric Registrars, I'm pretty much performing that role... Except I'm paid as a junior medical officer. There have been plenty of opportunities for procedures and I've even gone to doing the last few unsupervised as my skill and confidence have grown.

As much as I love the work, the days are long and fairly busy. It takes a lot out of you. I've been rostered for seven 14-hour days a fortnight, which include cover shifts where I'm also responsible for the O&G and Psychiatry wards as well, including admissions and discharges. I was on the phone with one of the Paediatric Infectious Disease Consultant in a metropolitan hospital a couple of weeks ago and at the end of the discussion she asked, "I've spoken to you quite a few times this week... What are you still doing in the hospital at this hour of day on a weekend?" After I explained what my rostered fortnight to her looked like, she exclaimed in disgust, "That is just ghastly!"

Indeed, it is... But, hey... Somebody has to do it.

It certainly didn't help that all the other residents decided to take their annual leave all at the same time, followed by a couple of them being off sick. When it came down to it, there were so few of us left that we needed to take on extra shifts but even then, everyone agreed that I have the worst roster by far. I really does feel like I'm residing in the hospital. The good of it is that it's great for experiential learning, the bad of it is that I'm exhausted... And that's not very conducive to learning.

However, I'm on the home stretch. I've done the hard yards and I'm almost at the finish line. After today, it's just one more day and I'll be done. So that's what I keep telling myself.

Just one more day... And then I'll get my rest.

Sick Days

This is getting ridiculous.

No sooner have I recovered from the URTI from hell (that's 'Upper Respiratory Tract Infection' for all you non-medicos), here comes the gastroenteritis.

The plague never ends.

The good news is that I'm currently rostered on 4 days off after a 6-day stretch.

The bad news is that I'm meant to be attending classes for these next 4 days, before going back to work on a 10-day stretch.

The bottom line is... I'm far too busy to be unwell!!! 😫

But it is how it is. Willing myself not to fall sick does not unfortunately make it so.

Despite all my efforts with hand hygiene, protective gloves and face masks, the bugs still get me. Partly due to my crappy immune system, partly due to the sheer volume of exposure.

And, yet... I doubt it's just me, but it's incredibly hard to take sick days when you're a doctor. Even when you're entitled to it; even when you need it; even when it's the right thing to do. It's really hard.

For starters, sick or not, if you don't show up to work, there's no one to do your job. Guess what happens then? Your colleagues are asked to not only manage their unmanageable workload, but also yours as well.

Another side of it is, nobody really cares about doctors being unwell. Especially other doctors. They just want you to be at work because hey, they're also sick and they're at work! Why shouldn't you be?

In any other profession, you'd call that sadistic. In medicine though, it's just the culture.

Puking your guts out? Take a chill pill and some metoclopramide. Bloody diarrhoea? Here's a cup of concrete, you'll be alright. (Disclaimer: That was sarcasm, not a prescription...)

We all know the rules with gastro. If a hospital worker gets gastro, they're meant to stay home until 48-hours post the last episode to minimise the risk of transmission to others (colleagues and patients alike).

Realistically though, I know a doctor who once had an acute gastro attack on his shift and rightfully informed the senior doctor of this. The senior doctor then said, 'No big deal. Just push on, it's all good.'

You might be thinking, 'I'm sorry, but I don't think it's right for doctors to be treating patient when they're sick, particularly not when they're infectious.'

My response to that is, 'Congratulations! Right answer. And while I whole heartedly agree with you, medicine can be a really cruel and thoughtless profession sometimes.'

I find this particularly true when it concerns the intraprofessional expectations of fellow doctors.

A nurse once said to me, 'Medicine is the only profession I know of where they eat their young.'

Young or old, I think doctors do tend to have very little compassion for other doctors. And that's a terrible shame.

According to Beyond Blue's 2013 'National Mental Health Survey of Doctors and Medical Students', 40% of medical professionals perceived their fellow doctors to be less competent if they have had a history of mental illness and 59% felt that being a patient results in embarrassment for the doctor. Sad to say, stigma within the medical profession is alive and well.

If you've ever wondered why there are so many doctors out there who seem tactless and uncaring and appear to lack compassion, it's because to a certain extent, the profession breeds them. The perception is that it's the 'tough' doctors that survive the decades of rigorous training, ragging and gruelling hours. The profession prides itself on being resilient; on rising above the decades of physical, mental and emotional torture and abuse that is perceived to only make us stronger.

And often it does. But amidst all the success stories, you can't look away from the other side of the truth.

We don't all escape the trauma of self-neglect unscathed.

Mirrors and Walls

I was on Day 3 as a resident.

I was in a new department, working with new people, fulfilling a new role in a new rotation.

Even on Day 3, I still felt completely lost.

She was on Day 3 at her new job.

She was in a new town, working with new people, fulfilling a new role in a new and unfamiliar field.

And on Day 3, she was stretched to her limits.

We spoke about the stressors of her new work and life, the guilt that comes with putting herself above a commitment that she's made, and the feelings of uncertainty and inadequacy that she felt in her new role. We talked about the difficulties she was facing and discussed options that could assist with making things better.

Even today, I'm not sure if the nature of the discussion we had was part of my role as an ED resident, but I stuck with it because it was what needed to be discussed. If not now, then when, and if not me, then who?

As I worked within the limits of our professional relationship to defuse some of her fears and anxiety, I had to make a conscious effort to go against some of my own natural responses that were driven by my instincts of compassion and empathy and this was a real challenge.

Medicine is a paradox of incredible proportions. Isn't it funny how the exact qualities that draw individuals into the profession, the very fundamental values that we seek to instill in our doctors and the ones that we identify present in good doctors, are the ones that they are often required to silence in order to appropriately fulfil their roles?

I have no doubt that she will be okay. All that she really needs is time to prove to herself that she, in the words of Christopher Robin, is "braver than she believes, stronger than she thinks, smarter than she thinks", and that there are always options in her favour. And in the time that she is discovering that, all she needs is someone to be kind to her on days when she hasn't got the ability to be kind to herself.

In retrospect, I wonder if some would have thought that I had spent to much time with her in that consult. The truth was that I took as much time as I needed to get the work done. 

I gave her the time she deserved, the time that she needed and the time that I secretly wished I could give to myself for the same purpose.

In the end though, I think what matters most is that we ended the consultation with her stating, "I don't feel sick anymore".

Amidst all my doubt about whether I'm following all the rules, fulfilling all the criteria and being and doing my best, I can't help but be extremely comforted by her parting statement.

After all, if my patients can honestly say that they feel better after a consult, surely I must be doing something right.

Isn't that what I'm ultimately here for?

What Kills You... And What Makes You Stronger.

It is my first fortnight on General Medicine and it has been brutal.

Not only has there been the compulsory Week 1 breakdown, there has been around 6 breakdowns in the past 12 days.

While covering the wards last weekend, I felt completely burnt out. But of course, Monday came along so I kept on going.

That's just what you do.

I started out the year on my 20-week GP rotation, and I loved every minute of it. Moving on to Orthopaedics was tough, but as the trend seems to go, you find that you start to get the hang of things by Week 9, only to switch rotations after Week 10 and end up back where you started - lost in unfamiliar surroundings.

All throughout my internship year thus far, there have been ups and downs, but ultimately I have found that I've been enjoying my training tremendously and even at the worse of times, I love what I do.

General Medicine, however, has been hard. It's a hard unlike anything else I have ever known.

It's the kind of hard that makes you run like your life depended on it, then knocks the wind out of you and then as you crash to the ground, delivers a fatal blow to the back of your skull.

You don't want to get back up, but you do anyway.

What makes you do this?

The fact that you don't have a choice.

It's do or die.

I started my rotation thinking of what a great opportunity this would be to learn and grow in my clinical skills and experience. But now I just feel bruised and battered. I'm just tired.

The real danger is that exhaustion has a tendency of beating the enthusiasm out of you. In the past fortnight I've tried so hard to struggle through the exhaustion and to fight off the apathy. It has not been easy, and it required me to call upon an internal strength that I did not know I had.

Now that I'm finally facing my first day off since starting on Gen Med, I still find my thoughts stuck on the wards. It's a form of psychological trauma.

Have I done all the blood slips for the weekend? Are there investigations that I haven't followed up? Have I missed something important?

That's the problem with hospital medicine. The work never ends and as everyone else has their own work to do, there's no one to cover you if for whatever reason you don't do yours.

And at the end of the day, after being so invested in the treatment and progress of so many patients, it's hard to just shut off when you finally get to leave the wards.

Another problem with hospital medicine is the high turnover rates and the high patient load. As an intern, your days are busy and there are always investigation results to chase up, referrals to be made, tests to order, notes and drug charts to write up, admissions to be done.

The work is constant, and a reliable pen is your best friend. With my 30 - 40 patients a day load in the past fortnight, I have very easily run dry a total of 4 pens.

With the nature of the job being so task-oriented, it's very easy to lose sight of why you're there. It's also easy to lose the empathy - there are just too many pressures on you at any one time, and when you're struggling to catch your own breath, it's very easy to inadvertently look over someone else who is also struggling to breathe.

Rather unfortunately, their lives depend on you. So sink or swim, your patients are your priority.

Rightly or wrongly, medicine involves a lot of self-sacrifice. It involves sacrificing your time, your life, yourself, for someone else, simply by virtue of the role that you choose to take on by being a doctor.

We are told on airplanes that when cabin pressures are low, you first need to put the oxygen mask on yourself before attending to those under your care.

It's an important principle, but unfortunately the medical world has not yet adopted this principle. It is expected that doctors take care of themselves, but the nature of the work and the hours that we work do not logistically allow us to do this.

It is undeniable though that when exposed to a consistent state of low oxygen, the body learns to adapt. We learn to function at a much higher level than most under much less desirable circumstances. We become stronger.

Still, there is a fine line between learning to thrive under extreme circumstances and failing to thrive. Everybody has a limit and often the factors that test those limits are not within our control.

Sometimes it feels like a game of chance. Like Russian-Roulette.

If you're pushed hard enough... Who is going to be the next to have a breakdown?... Who is going to be the next to make a mistake?...

Who is going to be the next one to stop caring?...

Because when the work ceases to be fun... When it starts feeling like a chore and all you do is rush about doing your daily jobs to get them all done before midnight, which is 2 hours past the time you were meant to leave, knowing full well that you have to be back at work at 6am...

When you're pushed so hard that your own reserve tanks of hope, love and joy run empty and you couldn't care less about anyone else's wellbeing...

That's when it ceases to be good medicine.