i will do everything in my power to be an amazing medical registrar.
nobody and nothing is going to stand in my way.
Tuesday, December 4, 2012
Monday, November 5, 2012
mr js
before all the words i want to say get washed away in the (mundane) humdrum that is my life, i want to talk about mr js
when mr js came in to see us, he was a 92 year old guy who was more or less independently mobile. his main complaint was this terrible itch he had been having for the past few years. the poor guy had been scratching so badly that when i removed the zipzoc bandages from his hands there were multiple bleeding points. he had some very superficial leg ulcers but they weren't the problem.
when i saw him in the day room, he was with his son and his wife. his son was all flustered because he had parked very far away and had to go back to his car because he forgot mr js' medication list and medications. mr js' wife had severe dementia and was "?pleasantly confused".
as i checked his blood results we realised that he was quite severely anaemic and his platelet count was low. we went on an investigation through his notes and clinical portal and realised that he was under the haematologists for ?myelodysplasia and that they wouldn't do anything much besides give him blood transfusions periodically.
mr js also had some bother with angina as he had a history of ihd. he used to get extremely worked up every morning, and i think he was also very anxious about his wife. he told me that his wife used to wake him up at 3 am in the morning insisting that it was 9 am and that she had a clinic appointment to go to and would not be appeased until mr js pretended to call the surgery to 'reschedule' her appointment. she also used to leave all the gas stoves and heating on, but as mr js said "she liked a bit of heat and although the gas bill would shoot up i just let her keep the heating on". he used to be her carer and more often than not when extra carers came to the house they would end up having to tell mr js to take it easy and to "go out of their way and do things that weren't listed on their programme to help (mr js)". he was also worried about her because they had never been apart and he was so used to not going to sleep fully at night in case she got into an accident. there was also some concern about her needing to be put into a home on a permanent basis since it was clear that he would not cope at home with her now.
the anginal episodes got worse and happened more frequently. the cardiologists got the echo they wanted and mr js' medications were tweaked. this provided some temporary relief but the pains began to creep back again. he eventually ended up with two blood transfusions. throughout his stay, mr js kept telling me that he was worried about his wife. he said his sons were brilliant and they've been telling him that his wife is doing very well in the home (they eventually managed to procure some funding) and that she's even made a friend, but he was still very worried about her and wanted to see her for himself.
we were ready to send mr js home but the weekend before he was supposed to be discharged he developed an acute swelling of his wrist joint. blood cultures were taken and he was found to have mrsa bacteraemia. a subsequent ultrasound of his wrist showed that the swelling was in fact probably gout or pseudogout. mr js was started on iv vancomycin. he then contracted a chest infection and was being treated for that. whenever i asked him how he was doing he said he wasn't doing well. i tried to encourage him by telling him that he made it from the bed to the chair and he was now mobilising slightly with his zimmer frame. he wasn't convinced.
i left work on friday. nothing new happened.
i came back to work today and found that he was moved to the side room. as i had a ward round to go on i didn't give it much thought until the consultant in charge of him pulled me aside after the ward round i was on finished and started by saying 'oh, michelle will be up to speed on mr js...' what was going through my mind was 'mrsa bacteraemia - on iv vanc, stopped on saturday - pneumonia - on iv antibiotics - ?respiratory review today' but what i heard next was 'so mr js is on a syringe driver, just give him some subcut fluids to make him comfortable and make sure that he has morphine written up too'
i think i looked like i didn't understand english. dr cf had to explain himself again and briefly told me about mr js' deterioration over the weekend.
when i got some time and wanted to say hi to mr js, he looked like a different man. it's true how some people say that people who are dying look nothing like they normally look like. i honestly find it somewhat insulting and disrespectful to be thinking what i am going to be typing next, but - they all look the same. mr js had the mask of death on.
a million things are going through my mind as i type this. could i have done something different? did i miss anything? what will happen to mr js' wife? how is his family? they've been nothing but understanding and accepting of these events, but are they? really? is mr js comfortable? what does he think? he was supposed to be going home, what the fuck happened? when i left on friday he was still sitting up and having breakfast in his chair, and he can barely breathe now. what will mr js' wife think? will she remember? will she have to relive the moment of finding out that he didn't make it again and again? mr js came in properly alive. what the fuck. the people who are opposing the liverpool care pathway and are demonising doctors should fucking have to deal with things like these. it's so easy to just stand by the sidelines and just say what they think because they aren't involved. they don't have to worry about patients when they go downhill. they don't have to deal with deaths on a more-frequent-than-ideal basis. i have to be detached. i am a doctor. i cannot be affected. how can i not be affected? i am a human being and another human being is dying and i cannot do anything to stop this from happening. why am i a doctor? i'm sure there are many people who can deal with this better than i can. what am i doing? what am i not doing? i'm so sorry, mr js. i'm so sorry.
i'm so sorry.
i have never felt so affected by a patient's deterioration before. maybe it's because i played a bigger role in mr js' care than any of the patient's who have passed away in my work before. it's a horrible feeling. being the most junior doctor on the ward and being the one who is basically in charge of the care of all the patients on the ward. this is going to sound like a counselling leaflet but it can feel very lonely.
but i guess i shouldn't make it all about me.
i don't know if side room two is going to be empty when i go to work tomorrow. i don't know if i want it to be. i can only hope mr js is comfortable.
i don't feel like i deserve to be a doctor today.
let's hope that this too, shall pass.
when mr js came in to see us, he was a 92 year old guy who was more or less independently mobile. his main complaint was this terrible itch he had been having for the past few years. the poor guy had been scratching so badly that when i removed the zipzoc bandages from his hands there were multiple bleeding points. he had some very superficial leg ulcers but they weren't the problem.
when i saw him in the day room, he was with his son and his wife. his son was all flustered because he had parked very far away and had to go back to his car because he forgot mr js' medication list and medications. mr js' wife had severe dementia and was "?pleasantly confused".
as i checked his blood results we realised that he was quite severely anaemic and his platelet count was low. we went on an investigation through his notes and clinical portal and realised that he was under the haematologists for ?myelodysplasia and that they wouldn't do anything much besides give him blood transfusions periodically.
mr js also had some bother with angina as he had a history of ihd. he used to get extremely worked up every morning, and i think he was also very anxious about his wife. he told me that his wife used to wake him up at 3 am in the morning insisting that it was 9 am and that she had a clinic appointment to go to and would not be appeased until mr js pretended to call the surgery to 'reschedule' her appointment. she also used to leave all the gas stoves and heating on, but as mr js said "she liked a bit of heat and although the gas bill would shoot up i just let her keep the heating on". he used to be her carer and more often than not when extra carers came to the house they would end up having to tell mr js to take it easy and to "go out of their way and do things that weren't listed on their programme to help (mr js)". he was also worried about her because they had never been apart and he was so used to not going to sleep fully at night in case she got into an accident. there was also some concern about her needing to be put into a home on a permanent basis since it was clear that he would not cope at home with her now.
the anginal episodes got worse and happened more frequently. the cardiologists got the echo they wanted and mr js' medications were tweaked. this provided some temporary relief but the pains began to creep back again. he eventually ended up with two blood transfusions. throughout his stay, mr js kept telling me that he was worried about his wife. he said his sons were brilliant and they've been telling him that his wife is doing very well in the home (they eventually managed to procure some funding) and that she's even made a friend, but he was still very worried about her and wanted to see her for himself.
we were ready to send mr js home but the weekend before he was supposed to be discharged he developed an acute swelling of his wrist joint. blood cultures were taken and he was found to have mrsa bacteraemia. a subsequent ultrasound of his wrist showed that the swelling was in fact probably gout or pseudogout. mr js was started on iv vancomycin. he then contracted a chest infection and was being treated for that. whenever i asked him how he was doing he said he wasn't doing well. i tried to encourage him by telling him that he made it from the bed to the chair and he was now mobilising slightly with his zimmer frame. he wasn't convinced.
i left work on friday. nothing new happened.
i came back to work today and found that he was moved to the side room. as i had a ward round to go on i didn't give it much thought until the consultant in charge of him pulled me aside after the ward round i was on finished and started by saying 'oh, michelle will be up to speed on mr js...' what was going through my mind was 'mrsa bacteraemia - on iv vanc, stopped on saturday - pneumonia - on iv antibiotics - ?respiratory review today' but what i heard next was 'so mr js is on a syringe driver, just give him some subcut fluids to make him comfortable and make sure that he has morphine written up too'
i think i looked like i didn't understand english. dr cf had to explain himself again and briefly told me about mr js' deterioration over the weekend.
when i got some time and wanted to say hi to mr js, he looked like a different man. it's true how some people say that people who are dying look nothing like they normally look like. i honestly find it somewhat insulting and disrespectful to be thinking what i am going to be typing next, but - they all look the same. mr js had the mask of death on.
a million things are going through my mind as i type this. could i have done something different? did i miss anything? what will happen to mr js' wife? how is his family? they've been nothing but understanding and accepting of these events, but are they? really? is mr js comfortable? what does he think? he was supposed to be going home, what the fuck happened? when i left on friday he was still sitting up and having breakfast in his chair, and he can barely breathe now. what will mr js' wife think? will she remember? will she have to relive the moment of finding out that he didn't make it again and again? mr js came in properly alive. what the fuck. the people who are opposing the liverpool care pathway and are demonising doctors should fucking have to deal with things like these. it's so easy to just stand by the sidelines and just say what they think because they aren't involved. they don't have to worry about patients when they go downhill. they don't have to deal with deaths on a more-frequent-than-ideal basis. i have to be detached. i am a doctor. i cannot be affected. how can i not be affected? i am a human being and another human being is dying and i cannot do anything to stop this from happening. why am i a doctor? i'm sure there are many people who can deal with this better than i can. what am i doing? what am i not doing? i'm so sorry, mr js. i'm so sorry.
i'm so sorry.
i have never felt so affected by a patient's deterioration before. maybe it's because i played a bigger role in mr js' care than any of the patient's who have passed away in my work before. it's a horrible feeling. being the most junior doctor on the ward and being the one who is basically in charge of the care of all the patients on the ward. this is going to sound like a counselling leaflet but it can feel very lonely.
but i guess i shouldn't make it all about me.
i don't know if side room two is going to be empty when i go to work tomorrow. i don't know if i want it to be. i can only hope mr js is comfortable.
i don't feel like i deserve to be a doctor today.
let's hope that this too, shall pass.
Sunday, July 1, 2012
what does it feel like?
like i can't get a breathlike i'm being buried under a mountain of bubble wrap, unable to find a way out
anxiety - not the kind just before it's your turn to give a speech before a large crowd; the slow but steady kind, when you know something is not right, but not what yet
desperation
helplessness
confusion
it feels like i'm going to be sick - except i can't.
i am going to sleep
anxiety - not the kind just before it's your turn to give a speech before a large crowd; the slow but steady kind, when you know something is not right, but not what yet
desperation
helplessness
confusion
it feels like i'm going to be sick - except i can't.
i am going to sleep
Thursday, April 26, 2012
Friday, April 20, 2012
magic
very few things are more magical than the act of putting pen to paper
it's way more cathartic than typing words on keyboards
hello written word, i'm back. :)
(thank god - i won't need to sound so pretentious anymore, lol)
it's way more cathartic than typing words on keyboards
hello written word, i'm back. :)
(thank god - i won't need to sound so pretentious anymore, lol)
Thursday, April 19, 2012
peace
finally - a glimpse of perfect bliss.
it's gloomy outside (none of that inyourface sunshine crap for me, thanks), i have my blinds drawn, slow dancing in a burning room playing on 8tracks, and a cup of chocolate flakes tea from teapigs. to top it all off, i have work to go to in more than an hour!
(i wasn't being sarcastic - i foresee myself getting bored of sitting in my room and drinking tea very soon HAHA)
anyway - one day closer to going home! yay!
:)
(maybe it's good in a way that i don't really like my current job - i knew i was always a medic at heart!!!!!!!!!!!!!!!!!!!!!!!!!!! the smallest things that go right make my day)
it's gloomy outside (none of that inyourface sunshine crap for me, thanks), i have my blinds drawn, slow dancing in a burning room playing on 8tracks, and a cup of chocolate flakes tea from teapigs. to top it all off, i have work to go to in more than an hour!
(i wasn't being sarcastic - i foresee myself getting bored of sitting in my room and drinking tea very soon HAHA)
anyway - one day closer to going home! yay!
:)
(maybe it's good in a way that i don't really like my current job - i knew i was always a medic at heart!!!!!!!!!!!!!!!!!!!!!!!!!!! the smallest things that go right make my day)
Saturday, April 14, 2012
rantings
slightly more than a week into my new job - general surgery at ninewells.
have been teetering on the edge of being overwhelmed and being able to find my bearings and continue doing my thing. ninewells can be very intimidating and daunting; most of the time it feels like this exclusive club to which i have missed the membership application deadline - it feels like i will never fully belong here.
do i miss perth? yes i do. i miss being comfortable and knowing exactly what to do and who to talk to to get things done. i miss being able to navigate the hospital confidently without getting lost, i miss the h@n team and support workers, i miss some nurses. i was going through my night shifts and sometime during my second or third night, i realised that i started to feel that i knew what was going on, and certain things started to click. punching numbers into the pod delivery system is now more natural (although i still have to double check the numbers to make sure i don't send a bts sample to biochem by mistake)... having to bleep 4073 instead of 5106 for xrays and 4027 instead of 5122 for urgent bloods. not having to dial 13867 after requesting every xray.
part of me is somehow worried that i will forget everything about pri. 13863, 13643, 13229, 13225... fuck, i've already forgotten the number for cardiology.
but what does it matter?
5219, 5182, 5203, 5127
maybe i'm just worried that i'll forget everything about the one place i grew up (as a doctor) in. haha. actually honestly i think that i'm just being overemotional -_-
anyway.
have noticed a few things during my night shifts. kindness goes a long way, so do smiles. no matter how grumpy or unhappy patients are, few do not yield to a soothing voice and sincere apologies for waking them up and a get well soon wish.
have seen a few IVDUs coming in with accidental intra-arterial injections, have personally dealt with one. what i hope i will never forget is how he prompty dissolved into sobs and tears after one of the registrars just said something like 'i don't know what is going to happen to your arm, you might end up losing it'. i know how my reg felt, i felt the same thing when he first came in (it's your own fault this happened, you will just have to deal with the consequences that follow), but the more i dealt with him the more i felt sorry for him and i was slightly irked by how he was just told that he might lose a limb
we're all humans with our own shit to deal with.
i have also learned that i perform best when i am under stress. interesting.
i've always been secretly concerned about not absolutely loving my life/job constantly. i am more concerned about the (seemingly) frequent thoughts i have about just quitting medicine... and then, doing something else.... like what? i don't know. i cannot imagine myself doing anything else besides medicine.
i often try to entertain thoughts of what i would be doing if i had the total freedom to choose. (not that i didn't, not really)
i don't know what i want to do with my life, eventually. do i stay? what does 'staying' mean? do i go? where do i go? what do i want to spend the rest of my life doing? how will i get to where i want to go? which brings me back to ... where do i want to go?
life has become more of what i should do rather than what i want to do. and it's during days like these when i get so sick of everything and just want to give everything up and just cease to exist -_-
(bearing in mind that i have just finished 7 night shifts, and have had less than 2 hours of sleep in the past 31 hours)
certain things make me sad. looking through my retrospectoscope makes me sad.
ok i'm just going to go offline and feel sorry for myself
it's fine.
i will be fine in the morning.
have been teetering on the edge of being overwhelmed and being able to find my bearings and continue doing my thing. ninewells can be very intimidating and daunting; most of the time it feels like this exclusive club to which i have missed the membership application deadline - it feels like i will never fully belong here.
do i miss perth? yes i do. i miss being comfortable and knowing exactly what to do and who to talk to to get things done. i miss being able to navigate the hospital confidently without getting lost, i miss the h@n team and support workers, i miss some nurses. i was going through my night shifts and sometime during my second or third night, i realised that i started to feel that i knew what was going on, and certain things started to click. punching numbers into the pod delivery system is now more natural (although i still have to double check the numbers to make sure i don't send a bts sample to biochem by mistake)... having to bleep 4073 instead of 5106 for xrays and 4027 instead of 5122 for urgent bloods. not having to dial 13867 after requesting every xray.
part of me is somehow worried that i will forget everything about pri. 13863, 13643, 13229, 13225... fuck, i've already forgotten the number for cardiology.
but what does it matter?
5219, 5182, 5203, 5127
maybe i'm just worried that i'll forget everything about the one place i grew up (as a doctor) in. haha. actually honestly i think that i'm just being overemotional -_-
anyway.
have noticed a few things during my night shifts. kindness goes a long way, so do smiles. no matter how grumpy or unhappy patients are, few do not yield to a soothing voice and sincere apologies for waking them up and a get well soon wish.
have seen a few IVDUs coming in with accidental intra-arterial injections, have personally dealt with one. what i hope i will never forget is how he prompty dissolved into sobs and tears after one of the registrars just said something like 'i don't know what is going to happen to your arm, you might end up losing it'. i know how my reg felt, i felt the same thing when he first came in (it's your own fault this happened, you will just have to deal with the consequences that follow), but the more i dealt with him the more i felt sorry for him and i was slightly irked by how he was just told that he might lose a limb
we're all humans with our own shit to deal with.
i have also learned that i perform best when i am under stress. interesting.
i've always been secretly concerned about not absolutely loving my life/job constantly. i am more concerned about the (seemingly) frequent thoughts i have about just quitting medicine... and then, doing something else.... like what? i don't know. i cannot imagine myself doing anything else besides medicine.
i often try to entertain thoughts of what i would be doing if i had the total freedom to choose. (not that i didn't, not really)
i don't know what i want to do with my life, eventually. do i stay? what does 'staying' mean? do i go? where do i go? what do i want to spend the rest of my life doing? how will i get to where i want to go? which brings me back to ... where do i want to go?
life has become more of what i should do rather than what i want to do. and it's during days like these when i get so sick of everything and just want to give everything up and just cease to exist -_-
(bearing in mind that i have just finished 7 night shifts, and have had less than 2 hours of sleep in the past 31 hours)
certain things make me sad. looking through my retrospectoscope makes me sad.
ok i'm just going to go offline and feel sorry for myself
it's fine.
i will be fine in the morning.
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