Career Direction.

[This started out as a part complaining, part proud-of-my-work-&-achievements-today kind of post, but instead I’ve come back to the what do you want to do? question and on a possible career choice I’m not sure if I’ve talked about before, apologies if I have.]

Wise Words #1:
That the powerful play goes on, and you may contribute a verse.
– Walt Whitman.

It doesn’t look like I did much today, but it was a busy day.
(Part of the reason was that I was in a more senior role today – little bit scary, but we got there okay.)

9hrs in the Emergency Department gave me…

Fractured nasal bones + relocation
Syncope/collapse
Lacerated lip + suturing
Lacerated forehead (+ supervised student suturing)
Constipated (previously, now well) child
Abdominal pain + nausea (?UTI)
Missed miscarriage
+IV cannulation x2
Corneal abraision
Hand abscess/cellulitis

Everybody was discharged home (with adequate advice and follow up of course : P).
I also supervised the medical students + residents.
I was even bold enough to say to a registrar “you can thank me later” since I’d saved them a lot of trouble.

+2 hrs of overtime, mostly to finish writing my notes! (hopefully paid; I’ve requested this time)

My favourite was the abscess – there is something quite satisfying about relieving someone of their pus under pressure. If you enjoy pimple-popping you know exactly what I am talking about (and if you haven’t already youtube has some excellent videos of abscesses or comedomes or pimples being squeezed).
It definitely made my day (and I know that sounds weird).

Otherwise it’s nice to make someone feel better, or fix them, even if there’s not a definitive answer for what made them feel unwell.
I thoroughly appreciate it when a patient thanks me for the work I’ve done (today I got a “thank you, you’ve been amazing, you really made me feel better”) – it makes the hard work worth it.

Yesterday one of the consultants said that I’d be a good ED doctor because he saw me ask a patient’s wife “Are you okay to drive?” because she’d been up all night trying to make her husband feel better. Apparently it’s important to be able to consider the whole picture (because a patient’s social situation and therefore their family members are important too) – I thought this was just common sense!

I don’t know if I feel comfortable enough with the idea of working full time in the ED, or taking on more of a senior role.

At the moment I don’t feel like I know enough or have enough experience to be able to handle everything that gets thrown at me. But maybe with the extra study and the experience I’ll learn.

There’s also the fact that it’s shift work. And the shift work never ends. Though the lifestyle is more flexible and shift changes are much easier.

The only specialty I’ve so far really “enjoyed” (if you can call it that) was a term I was not expecting to like at all: Palliative Care.

______________________________(A little backstory)________________________________

My experience in pal.care as a student was tainted.

Depending on the university, third year med school in Australia is the first of the clinical years. I was part way through my palliative care placement (at the hospital I now work at), when my dad (stepdad) was in another hospital some two hours away, dying of metastatic prostate cancer. It was not easy to try to learn about the process of caring for the dying from a doctor’s perspective when I was already experiencing it from the family’s perspective. I used to say that I couldn’t understand how someone could work in the palliative field, how cold they must have to be to distance themselves from all of that grief and hurting, how could you go to work every day knowing that in the end you know it’s all futile?

My dad passed away on the 17th April 2010. I had left the hospital not two hours before. My mum was with him at the time (and has yet to watch Sweet Home Alabama since as it was playing on the TV at the time). The experience was also made worse by the university’s attitude. I’d already taken two weeks off to spend time with my dad and my mum in the time leading up to his death, but there were only a certain number of seminars that were allowed to be missed per semester – a number I had just maxed. The funeral was held on the same day as another seminar, and aside from the fact that I was giving the eulogy (mum didn’t have the strength, brothers weren’t going to be able to be there), this wasn’t exactly an event I could postpone, ask to rearrange the time for, nor was it one I could just skip — so I contacted the uni and offered solutions to the problem (repeat seminar in second half of the year with other students, go to another hospital for same seminar run at different time, just skip this third one with ‘special consideration’), but  – no. the university reiterated the requirements of my degree and of the components of the clinical placements. essentially making me choose between my dad’s funeral and a seminar. bastards.

For the principle of the thing, I attended the seminar, cried the whole way through, it finished early for my sake (hospital was completely understanding), and I drove the hour and a half to home to make it to the venue only 15 minutes after the ‘starting time’, but of course we had people filing into the room long after I arrived and it didn’t officially start until later so there was plenty of time. Never forgave the uni after that. And certainly left a bad taste in my memory of my pal.care term.

_______________________________________________________________________

I did two weeks as the pal.care resident last year while I was on my relieving term. I found that some of my ‘skills’ (for lack of a better word) in medicine are perfect for palliative work – I am good with patients and their families, I have a lovely bedside manner, I care about my patients (sometimes maybe too much), I take a holistic approach to treatment and consider many of the non-medical factors that might impact on a patient’s treatment.

As doctors we spend our days trying to keep people alive, sometimes fighting hard and doing absolutely everything we can. But in pal.care this idea goes out the window – we’re already at the point of acceptance (even if the patients are still going through their own stages of grief); we recognise the eventuality of everyone’s mortality; we can help, as best as we can, to prepare a person and their family for death; we can try to bring a sense of dignity to the process, and also a sense of control for those who need it; and we can try to make someone’s last moments easier and more comfortable for them and for their families.

This was the side of my pal.care student placement I didn’t get to see because I was too wrapped up in the very personal situation I was going through. Strangely, I can now see working in palliative care as an incredibly rewarding area of medicine.

If this is the path I’m due to take, I would like more experience in oncology and general medicine – there’ll be a lot of work ahead of me.

Theory #24: When you have achieved what you want to in life, or found the path to take you there, contentment will follow. If you are not satisfied, continue your journey.

For now, we’ll see where life takes me.

– Dr Orist.

Advertisement

The One Question.

I am approaching my last shift for the medical year, the end of my second year out of med school.

Some of my friends are leaving, or have already left. We are now getting to the time when careers take everyone in different directions. It’s like the end of high school, but so much worse because at least then I didn’t know so many of them, or their goals, or dreams, or anything in their lives. The group of people you go through medical school with, and the group you work with in medicine over the first few years, become something of a family. I’m just worried reunions with my Med-Family are going to be tough.

I am staying at the same hospital. Partly because other options haven’t formalised enough yet, but also partly because this is the easiest option. This hospital, however much flack it gets in the community, is a good hospital and it has also been good to me and I’ve been given some decent rotations for the year.

But I am already at the point where everyone asks the one question asked of all medical students and junior doctors:

“What are you going to do? What do you want to specialise in?”

Because medical school isn’t enough of an achievement.

Because you must surely have your entire career path mapped out before you even apply for medical school.

And because half-a-handful of hospital work is more than adequate for gaining enough experience in a wide variety of specialties to be able to predict what will suit you and your lifestyle until your retirement in 30 to 100 years.

Bee tee dubs, “No Freaking Idea” doesn’t really go down well I’ve learnt. (And I don’t swear that often, so it’s not like I say anything more colourful).

I admire those of my friends, and I try not to be jealous of the medical students I meet, who have already decided and can emphatically, enthusiastically answer with their dream specialty.

My journey through all of this has been a bit odd, with my top choice changing regularly:

Pre-med: ?maybe Cardiology, or Neurology. Because they look interesting, complicated, and I wanted the challenge.
First yr med school: It’s all interesting… Cardio and Neuro top choices though because (a) minimal time to consider the one question, and (b) nothing had jumped out at me yet.
Second yr: Maybe Obstetrics/Gynaecology. Something less challenging.
Third yr: NFI. Questioning whether career of ‘Doctor’ was even a good choice to begin with.
Fourth yr: GP; it’s a specialty too. People often ask it as “What are you going to specialise in, or are you going to be just a GP?”.
Internship / Post Graduate Year 1: “GP” But then I didn’t get on the training program.
Resident / PGY2: Initially “?GP” (Still didn’t get on program); Maybe ED (didn’t take long to realise I liked the team I worked with); Later in the year – NFI. I have enjoyed each rotation for different reasons, and I like the paperwork and ward work, but I can see the parts of each rotation I know I would not be able to remain enthusiastic about in the long haul.

And from Monday I begin ‘Resident / PGY3’ with, still, no solid idea.

Ultimately, I have come to a conclusion about something. I’ve decided that instead of responding with “NFI”, or the long-version, or the pessimistic I’ll never find it/please don’t ask me/I’d honestly be happy as a resident forever…

Theory #13: If you lack an answer, better be bold and ask instead the Questioner’s opinion.

…my new response to The One Question will be, with a smile,

“What specialty do you see me in?”

– Dr O.