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.

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Parasitic work.

Anyone looking at a career in medicine needs to take a good hard look at their life and decide whether they are willing to give all of it up for the sake of trying to make other people better. Oh and those people? Some of them are demanding, ungrateful, rude, irresponsible, stupid, non-compliant with treatment, and generally so entitled and so unaware of the time, effort and energy that you have put into their medical management that you mightn’t even get a thank you.

Some days, you want to be rude back. You want to yell at them that it’s their fault they’re sick. That they need to be better parents. That they need to use protection. That they shouldn’t use Doctor Google. And that they should get a job and stop relying on the government and expecting that everyone else has been put on this Earth to fix all of their problems.

*cough*.

Sorry.

*deep sigh*

It annoys me some days more than others. Particularly when someone has been particularly rude and it reminds me: I still have to put up with all of the crap while I’m at work; because I work, I pay taxes; taxes that help support government schemes like the PBS, medicare, public health system, and welfare payments; which, more often than not, these people are heavily reliant upon; which amplifies their sense of entitlement because they have most it handed to them on a silver platter. It is very frustrating to trace the loop around – essentially I’m at work so they can be rude to me if they want to.

The worst days happen when you add difficult patients to unpaid overtime any overtime.

Overtime is an expected part of being a doctor. You are also judged, and critically so, by other doctors if you are walking out on time (…mustn’t be a very good resident/must be neglecting so much work for someone else/must be a Q-word* time of the year/must be a breezy rotation.. have to get my hands on that one). There is always more work to be done, you are almost never on top of anything, and if you were to leave something urgent for the following day, there is always the potential you might kill someone. Nothing like the threat of medical negligence, or even manslaughter, bearing down on you as you try to complete your mountain of paperwork.

*Q-word will not be typed by myself in work context or I will be smote upon.

I have become acutely aware of what the hospital and its overtime steals from me.

Sleep. Lunch. Dinner. Time. Rest. Relaxation. Exercise. Hobbies. Sun. Fresh air. Holidays. Dates.

 

I do love my job, but it can often be quite hard to remember what regular life is like when you have chosen a career that will always take precedence and always be demanding and suck away at just a bit more of your time/energy/life.

Yep. A medical degree is like having an extremely needy toddler. Minimal symbiosis. It’s a parasite.

 

Theory #15: Give up on trying to fix people and you can have a much happier work/life balance.

– Dr O.