The easiest rotation in the year...?

A good three months have elapsed since the last post, and I absolutely forgive every single one of you for thinking that I will run off into the night and never return to post on this blog anymore. A couple of things have to fall in place to create the wonderful occurrence that is a blog update - the first, of course, being bothered to write a blog update - given that, unlike some reflective journals in the course with a similar style to a blog, there is really no tangible reward for the blog update. Contrary to beliefs, neither are bloggers necessarily self-centred persons and so would garner their reward from simply spouting about themselves and the little intricacies of their lives - otherwise I would be posting daily - and wouldn't you love that! Heh. The second is that one needs to have time to write a blog update, and often, both the desire and the time don't necessarily correlate - in my case, this magical occurrence only happened three months after the last post. So, without further ado, should get into the meat-and-potatoes of the blog; the medicine.

In the three months that I've not posted, I've finished an entire rotation, one out of four in the year, with this particular rotation being notable for actually containing TWO rotations. Half of it is the research project as I mentioned before, the other half being oncology - the study and practice of cancers and its management. Reportedly, this was considered the most laid-back rotation out of all four in the penultimate year of the course - reflected in my style of dress during the research rotation - the hoodie became my personal uniform. As an aside, I am particularly fond of hoodies; ever practical, ever versatile, unfortunately culturally perceived as significantly more casual than a normal jacket, and thus restricting its use in certain situations. I have bought two, which is two more items of clothing I've personally bought of any other type of clothing. This also demonstrates my love for clothes shopping. It's just below ironing, another clothes-related activity which brings me great joy to delegate to my sister.

So, the group research project was in fact fairly time-consuming; the process of data collection, analysis and writing was complicated by our decision to do a qualitative research paper over quantitative. For those who don't know the difference, quantitative research involves the use of numerical findings to draw conclusions, whilst qualitative research involves methods of communication to draw conclusions, such as interviews, forums and the like. Statistical significance is a phrase that applies to quantitative research, as opposed to qualitative research where the buzzword is probably 'thematic analysis' - unearthing themes that were elicited from the participant's collective voices. So for us, qualitative research meant full days of data analysis, and significant amounts of time writing and editing the final paper. Though our group was well organised in starting the project during the summer holidays (yes, we did coursework during the holidays, voluntarily), we still submitted it on the due date, using the entire time allocated to polish the paper. We were also considering publication; but in getting into the flow of the rest of the year, that may be a challenge for us to do, juggling the requirements for publication with the standard coursework of the other rotations. We'll see how we go for that, I guess.

After the research was oncology. The most pertinent experience from this was the dying patient - of course, in medicine, you will come across death fairly frequently, significantly more than your age-matched peers. In fact, the first patient I took a history from last year died less than 24 hours after I spoke to him. Palliative care was part of the oncology rotation, and was indeed a sobering portion of the rotation. Thinking back on it, I was struck by the care, determination and love demonstrated by the patients and families, and watching the patient and family together was a privileged insight into the beauty of human relationships. This happens in the normal wards as well, but at the hospital I was at, the palliative care unit was not even physically attached to the hospital, and the atmosphere was more homely and less clinical - which served to allow families and patients to have a small degree of separation from the 'hospital' setting. It also struck me as to how important small gestures were to people. The friendly touch of comfort on the shoulder or hands was so evidently, so visibly effective, as was the act of getting a box of tissues and offering it to them. They would continue to grieve as is normal, but in the space of a few minutes, after recollecting themselves, or even in the process of grieving, they would look at you with an expression of gratitude and thankfulness. In the context of imminent death, the value of human relationships, gestures and communication become enormously amplified, and the display of compassion and empathy were hallmarks of the palliative treatment of the patient.

Palliative care also included time in clinics - not all of the time was spent in the ward. Here, we saw a number of approaches by palliative care physicians in their mannerisms, from the overtly sympathetic, to the energetic and compassionate, to the blunt but good-hearted - the last always made it evident that the intentions were for the patient's benefit. Patients responded differently to each, but it was interesting to see that the blunt but good-hearted physician had very good rapport with patients; in fact, this had a tangible effect on management when a patient revealed information to the physician that had not been unearthed by any other; this, however, occurred over a period of months. It goes to show that it is not your personality that must become that of a compassionate mother-hen, but rather that, in your own unique way, you can connect with the patient, empathise and build the relationship. I think this was a perception that I had, where I believed that there was simply one way to act around palliative care patients, that I now don't have with the exposure of multiple, effective, clinician approaches.

Oncology also included medical and radiation oncology; both were fantastic, especially radiation oncology with the amount of teaching that everyone gave us. I will gloss over it however because though there may be much to say, I've not much time left anymore!

So, easiest rotation in the year? I wouldn't necessarily say so. The complexity of research and oncology can be limitless, especially the research component, which involved both an extended period of groupwork and thus co-ordination of the team, combined with a general inexperience of research, and especially inexperience with the type of research to do, qualitative vs quantitative. There was however a one-week break between the two sub-rotations though - which was mostly consumed in my case by various other extracurricular commitments.

Currently, I've already started my second term, that of paediatrics (kids medicine)! It's my first week and I am excited to really get into it; we had a relatively unrelated conference to attend on Monday, and currently it's the school holidays so this week is a little bit odd for the special schools attachment that paediatrics includes - and it is this schools attachment that I am currently on. By far the most difficult thing I've encountered so far is actually getting down to the level of a child, and I think this is something that might face many people who do not have much experience with children. When saying things, or playing with children, sometimes thoughts race around my head such as: "am I doing it right?" and "I don't know what to do/say now" and "This feels childish" - all of these thoughts are probably stemming from the adult-child dichotomy and levels of thinking, and most likely also my own stupid propensity to think and write using words like 'dichotomy' and 'propensity'. I don't even know what they mean, I'm just writing it to sound smarter. But seriously, it is challenging, and one of the teachers has called it 'daunting' - I absolutely agree, not just with children with special needs, but children in general. I had even gone so far as to see if there were any papers on building rapport with children (which there are by the way, there are papers on everything) and asking parents what they do with children. Anyway, I'm fairly sure this will fade with experience with children, and I've hoped that my exposure with my nieces/nephews (ranging from 2-8yo) will help somewhat. But in no way do I feel ready to be a parent, haha - I personally think that's one of the hardest jobs in the world, full respect to parents juggling parenthood with everything else going on at the same time.

Blood

I've seen a lot of it these past couple of weeks, as I've started my first surgical rotation. I remember I was fairly opposed to the idea of going down the path of doing surgery, for a variety of reasons - including rather pragmatic and practical reasons, down to the more medically related and life-path incompatibility that doesn't mesh well with a surgical career. However, I've vowed to myself to always remain open-minded and liberal to all persuasion relating to my medical career, so in I went.

So, what can I say? Well, for all you budding surgeons out there, I can tell you that surgery is what you imagine it to be - and more. My friends have said that surgery is really a "see it once, you know it all" thing - but I don't know if they are the owner of laser-sharp eyesight and a photographic memory, because I certainly can't see how I would know the procedure based on one scrub-in alone. I'll take the example of a laparoscopic cholecystectomy (aka the "lap chole", chole pronounced coh-li - you can Google what this procedure is), the bread and butter of general surgery, which by the way is not really general so much as abdominal. In one week, I saw two standard lap choles, two complicated lap choles with abnormal anatomy, and what amounted to removing an acute gallbladder - a massively inflamed gallbladder filled with stones and what appeared to be lots of gunk (a non-medical term, by the way). Each one was different, and each one was a learning experience for everyone involved - or those who were watching, anyway.

Amongst other operations I witnessed included hernia repairs (one of which was complicated and turned into open surgery), an abdominal defect repair (technically a hernia, once again, you can Google the type of hernias), and a laparotomy combined with a hemicolonectomy (open abdominal surgery, with the removal of half of the colon). The variety of operations combined with the sharp learning curve, the number of complications and variations, and even the organisational side (anaesthetics and operating theatre nurses) really broke the image I had of surgery being a rather repetitive job. When you then take into account the invariable changes in technology (laparascopic technology being quite a recent advance in general surgery, requiring surgeons to re-learn the procedure of gallbladder removal again), I think it's fair enough to say that the operating side of surgery will remain fascinating and challenging for at least as long, if not more, than the tasks of being a physician, radiologist or pathologist.

The other side to surgery was the pre and post-operation care of the patient. The ward rounds for our surgical team inevitably clocked in at under an hour, with many patients being seen for five minutes or less. When thinking about the ward rounds of the medical teams (generally lasting anywhere from 2-4 hours, but in some unfortunately busy teams, up to 6-7 hours), the difference was really quite stark. I found myself knowing little about the patients under our team unless I took the time outside of ward rounds and attending surgery to see them, besides what they came in for - and this disappointed me. I was somewhat pacified when one of my friends who is on our team (our team composes of the surgeons, a surgical registrar, a resident/intern and three medical students) sat in on one of our surgeon's clinics, held once a fortnight - there, the personal side of pre and post-operative care apparently flourished, so I am looking forward to attending later on in the rotation.

I also got the impression that surgeons knew pretty much everything about the medical side of their specialty. I don't know if it's just my registrar, who is brilliant and keen on teaching us, but he seems to know everything in the domain of the gastrointestinal physician, in addition to the detailed anatomy and procedural skills necessary - it overwhelms me when I think of how many hours they study...and then I think about how much I study right now, haha...

So I'll be back after my surgical rotations for another update, and then it's exam time! More fun and games for all, yay...

One down, three more to go

Just decided to pop back in, as I've just finished my cardiology rotation. The past six weeks have, in general, been pretty awesome, but it is interesting to see how people progress throughout the rotation.

As somewhat expected, towards the end of the rotation, people started doing things less. The number of students attending the morning 8am handover meetings steadily decreased. The number of students going home at 1pm (or earlier) steadily increased. And yet I soldier on. Woo, go me.

Cannulations are still tricky, my histories and examinations still aren't perfect, and sure, I don't think I'm ace at cardio now - but I've been encouraged by my supervising doctors, who have been brilliant in doing what they do and trying to accommodate us at the same time. Although we are exhorted to be part of the team and thus help the team, we're still a hindrance in terms of time - except when we do discharge summaries, which I actually haven't done since the fourth week, thanks to a very efficient resident that joined our team.

Whilst I'm here, for those who haven't got a clue as to who's who, here's a brief glossary of people you see in the hospital:

Intern - Post-graduate year 1 (PGY1) - they know the practicalities of being a doctor but definitely still need to be supervised. We actually didn't have an intern during our rotation.

Resident - PGY2 and above, aka RMO/MO (for Medical Officer) - good people to hang around, as they teach you many things.

Registrar - PGY3+, in a training program to become a specialist. These can actually be really great resources as well - the registrars I've come across have inspired and taught me a great deal. They're also quite up to date with details, seeing as they have to study for exams.

Consultant - completed fellowship of a post-graduate college; if they're not a staff specialist (i.e. employed by the hospital on a full-time basis) then you see them quite sporadically.

Nurses - come in a multitude of flavours; you'll mostly come across enrolled nurses (EN) and registered nurses (RN), as well as some clinical nurse specialists (CNC) and some nurse educators. They run the wards, love to let you try your hand at cannulas.

Allied Health - physios, OT (occupational therapists), speech therapists, social workers, pharmacists, dietitians - they're the main allied health professions on the ward and you see them very frequently. Important people, especially when aiming to discharge patients - which seems to be the main goal of the hospital.

Others - there's a number of other people, such as the ward clerks, jan itors, and of course the support staff at Blacktown Clinical School. Love those people ;)

So I'm heading off to my second rotation in Endocrinology/Geriatrics, they seem to be a lot busier than Cardiology, so I may not post back until the end of that. Meanwhile, apparently everyone has exams around this period - I would like to take this opportunity to say "SUCK IT!" - it's a rare occasion when medicine is able to trump other courses on workload, so I savour every opportunity that comes along.

On that note, I would like to reflect on something that's popped up quite a lot. There's obviously a great number of med hopefuls around Australia and even abroad, looking to study in Australia as a medical student. Over the last month or so, I've noticed a couple of situations where doctors begin to stress and agitate over the workload, physically and mentally, placed upon them. These are invariably the junior doctors (interns and MOs); we don't see enough of the consultants to observe anything like that (and anyhow, they've reached the end of the tunnel and are out the other side), and the registrars seem to be somehow dealing with it okay. However, to see the junior doctors with a vacated expression during a half hour lunch break, or to break down during ward rounds, or become frustrated with a difficult patient - I mean, we know it's not an easy profession to go into, but it still hits me hard. The overwhelming sense of everything crashing down upon you is something I've personally only experienced very rarely, and I don't wish it upon anyone, yet in the short space of a month I've already witnessed this. Support services for junior doctors are certainly an important aspect in this, but I don't expect that even brilliant support and continuous lobbying will stop these incidents from happening, it appears to be a part of the workforce - a 'just live with it' attitude. This is happening in a country where our health system is comparatively tame and standards, thanks to bodies such as the AMA, have been established to prevent burnout and, worse, mistakes being made - what about doctors in countries that aren't in these situations? The overseas-trained doctors that I've talked to all mention how Australia has beyond world-class standards for working hours and conditions of junior doctors - which makes me think what world-class actually means.

I'm no specialist in these kind of issues, so I don't really want to say anything more about this, but just thought I'd share this with people. A number of med hopefuls may also be members of forums or have talked to doctors, and have wondered, maybe, if the negativism that sometimes exudes from others stems from trying to prevent people from trying out to get into medicine and basically being self-serving by making out doctors to be messiahs and self-sacrificing members of society, of which no other profession comes close. I believe that it's not - it's out of a wish to open the eyes of those who have not had experience, and not to dissuade them, but, in some way, to encourage those who enter medicine to strive and work for what they believe in. To walk into medicine, knowing that these things exist, makes for a better student and a better doctor, and a better person, as objectiveness allows people to prepare for situations and make the best hand out of the cards they're dealt. I also want to say that this is not unique to medicine - I met recent law graduates who are undergoing the same thing; and in fact, worse - the attitude and culture is exactly the same; live with it. I've heard the same for business and finance as well - and especially important is the difficulty in hunting and securing that first job, which we thankfully do not have to worry about much.

So, we who are not working - enjoy, savour, treasure the time we have as students. For those who are living with parents, enjoy the fact that you only contribute partly (or, even not at all, as I did for the last couple of decades, I will admit) to the running of the household. Procrastination is fine, but use this time to grow in other aspects, find out where you want to go and what you plan to do, and be hungry to learn, not just the contents of your course, but skills and abilities that you want to pursue - because there is no better place or time to do it, than now.

And with that, I shall head off to bed - off to another rotation, and looking forward to it, the experiences and relationships with patients and staff I will soon acquire, whatever it may bring :)

P.S: The experiences I've mentioned do not happen every single day. Nor to every single doctor. In addition, everyone else is not immune - although I've yet to see anyone else besides the doctors in emotionally charged situations, possibly because I'm following the doctors around. And yes, they're true, I'm not exaggerating.

Busy as a bee can be

As one may have noticed, my rate of posting has really, really slowed down. I guess it's inevitable thing that happens as priorities pile up, and I've noticed the same goes for computer games and watching TV series - all huge time-wasters that eventually have little to no place in my life anymore... for once, I'm seeing some truth in the stereotype that games are for kids, the adult's life seems too busy to regularly follow the games scene, especially since it is so fast-paced.

Anyway, third-year placements came out just a few days ago. I'm especially thrilled because not only do I have the closest hospitals to my home possible (Blacktown and Mt Druitt) but also because the rotations that I got happened to be amongst my top preferences! For those who don't know, UWS' medical degree from years 3-5 is essentially full-time clinical rotations, which involve you being attached with a medical or surgical team for the large bulk of the year, in the hospitals; with some time being given to other types of attachments such as Medicine In Context, which I'm still not quite crystal clear on. So yes, this means that second year already marks the end of our "university" university experience; I recently attended a friend's 20th, which was surprisingly lavish for a 20th - one of my other's friend's speeches remarked upon the idea that the party was so lavish because it was the last year our grade would be together as a combined cohort, and I suddenly felt quite moved. Yes, we will see each other during conference weeks (epically long days of lecture after lecture for a week) and in hospital, but not in the frequency as we do at the moment. I guess it was appropriate, then, that the party had quite a 'year 12 formal' feel to it.

So, I'm only two weeks away from our summative OSCE, one day away from an event I'm co-organising as part of the student union, and a few days away from a week-long sports event that a student collective at UWS Campbelltown is organising. Oh, and if you're curious, we made a promo video for the week: Inter-Society Sports Week on Youtube. Busy as a bee can be, you see.