The Littlest Doctor

If you have a paroxysmal tachyarrhythmia don't take caffeine pills.

Hypothetically speaking, you could decide to start taking them so you can have more energy for the holiday you've saved up for a long time to afford. And 3 days into your holiday, you might end up in hospital for 3 days before being discharged to go back home, your long awaited holiday ruined.

That'd suck. Hypothetically.

Telling me that you're not drug seeking does not, in fact, reassure me that you're not drug seeking. Following that up by asking for IV morphine pretty much guarantees you paracetamol and the door. Hope it doesn't hit you in the butt on your way out.

Also, if you present telling me you've lost your authority meds (the same day you got the script filled, such a shame!), I will do whatever I have to do to make sure you don't get more than 2 days supply. Even if it means running from ED to pharmacy to dispense the tablets myself.

Enough already people! Detox and start contributing to society, please! Your mum will appreciate it.

Hrm, my posting has been quite sporadic… Probably not entirely surprising considering my work schedule and the fact that I’m supposed to be studying for exams.

I don’t have a very reflective nature. Part of starting this blog was to get me thinking about things, and to maybe come up with a way to express or work through some of the things I encounter. For the most part I just roll with things, but there are still a lot of joys and frustrations that I experience. I find myself in some very odd situations, or listening to some very odd stories from people with lives so wholly removed from my own experiences.

I’ve seen a few people reflecting on the end of the decade. It made me think (briefly!) about how far I’ve come in that period of time. 10 years ago I’d just hung up my high school uniform and was excited to be heading off to start uni. I had a few friends from high school heading to the same course and I was looking forward to freedom, fun and figuring out what I wanted to do with my life. Medicine was a background thought but I figured I’d see where life took me.

Now, I’ve progressed in my career. I’m no longer a resident (no more ward call, thank goodness!!), and I’m working towards being an emergency doc. My relationship with emergency medicine has its ups and downs. Sometimes the crap patients get me down. The entitled ones who present with a chronic problem and expect miracles. The aggressive patients who make me feel as though my safety is threatened while I try to help them. The people who present asking for help then tell me to get stuffed when I suggest treatment.

But then there are the people who I begin counselling through their miscarriage. There are people who lay in the trauma bay scared and crying, who I can comfort and help. There are people who I can reassure and send home. There are people in unfortunate circumstances with fascinating physiology.

Last night as I was examining a very polite ex-con it occurred to me that I would never have imagined things would quite have ended up like this. I’m tougher than I thought. Life has its ups and downs but I’m happy with where I am. And where I think I’m headed. But I’ll continue to see where life takes me.

Hopefully to Paris somewhere along the line though! :)

I heard of this terminology for the first time today. I like it. I think one of the best things we are able to do as a doctor is to help someone die with measures for comfort and dignity when we can’t cure them. But somehow, we can get into situations where what we as medical professionals believe is best for the patient is different from the beliefs of the family.

I think a lot of people don’t realise how violent CPR is. I had the lovely family of a frail, older patient ask if we could do ‘gentle’ CPR. It’s a nice idea, but doesn’t exist unfortunately…

It makes me sad that when a person comes into hospital they risk losing the right for a peaceful death. We have to obtain consent to allow a person to die. For most, the idea of dying peacefully in one’s sleep is how they want to go, and how they want their loved ones to pass away. But when people are actually confronted with giving medical staff permission to stand back if their loved one is found near death is a very difficult decision to make. And caring family members unwittingly expose their loved one to a violent and prolonged death.

When this is the likelihood, I tell people this. I tell them honestly, CPR won’t work and we might hurt more than we help. But sometimes they won’t or can’t listen. They can’t understand. Or some doctors (understandably) don’t want to give families graphic details. But I think they need to understand what they may be insisting we do to their family member.

All I can do is hope she keeps breathing and her heart keeps beating. Because I don’t want to break all her ribs, and watch her suffer and end up bloodied and bruised instead of quietly passing away. If it comes to it, that’s not the dignified ending she deserves.

When I was a medical student I completed an elective in emergency medicine. I met an amazing doctor. I was actually supposed to be supervised by another doctor while I was on elective, but that doctor was on annual leave, so the head of the department took me under his wing. This doctor had been practicing emergency medicine for a very long time… But now, he was older, and not well, and couldn’t work clinically anymore but he lead the department at this large, tertiary hospital. He was so loved by his staff.

He taught me about compassion. He taught me to pity people who self harm, to treat aggressive dementia patients with respect, to have sympathy for people who are addicted to drugs, and not to blame people with mental illness for their disease. It can be frustrating, but whenever I find myself starting to get annoyed with patients I remember him.

But he loved his staff, and said that if someone chooses to be abusive they can pick up their leg and leave of his department!

He stopped working not long after my elective, and sadly passed away earlier this year. I am so grateful I had the chance to meet him. It’s so easy to be influenced by the many bitter, angry and cynical doctors you meet, but his compassion made me a better doctor, and I’ll be forever grateful.

I’m ambitious. I want to do well, in everything, work and personal life. Right now I don’t have a personal life, but I’m hoping that will come in good time. Hoping…

At work, I’m ambitious. Everyone knows I want to do emergency medicine. I’m on a rotation there at the moment, and I want to do well. I think maybe I put myself under too much pressure. I want to do well at work. I want to be on the ball, doing the things that need to be done and generally impressing the bosses, but I feel like I so often fail at that.

I don’t know what to do.

I probably need to stop thinking so much!

No wonder I’m sick of work! I’m having a quiet, fabulous and delightful evening, sitting on my comfy couch wearing a fluffy robe and watching Private Practice, one of my favourite shows. I need a favourite non-medical show… :P