Boy, I seem to be writing a lot of posts on medicine these days. I guess that’s to be expected when so much of my life at the moment is spent in the hospital.
There are certain skills – essential skills, even – that you need to survive as a junior doctor which aren’t taught in medical school. And no, I’m not talking about things like breaking bad news or performing basic practical procedures. That stuff they seem to teach reasonably well in medical school these days (although actually practicing them in real life can be a very different matter).
I’m talking about other more subtle skills that don’t really get any mention at all in medical school. The list is probably endless, so I’ll just give you my top 5:
1) How to memorize all the details of all your patients – quickly. Today I had 28 patients to look after. That’s 28 sets of medical histories, examination findings, blood results, scan reports, operation details and clinical progressions to memorize. About 10 of these patients I had never met before this morning. Yet I’m still expected to know whether Mrs A is diabetic, when Mr B last went poo (and what colour/consistency it was), and how Mrs C’s inflammatory markers have changed over the past week. This is definitely one of the trickiest skills I’ve had to learn on the job.
2) How to write quickly and (sufficiently) legibly in the most awkward of positions. Hospital patient records are notoriously messy and can be ridiculously huge in complex patients. Imagine a 4-inch thick set of paper notes, held together loosely by weakly hole-punched paper, with loose sheets of varying colours and sizes shoved in random places. Then imagine having to write in it whilst standing up (with nothing to lean on) and having to simultaneously flip through a second set of bedside notes with your magical third hand. It’s no wonder why doctors’ handwriting can be so illegible.
3) How to write as fast as your registrar and patient can speak. This is tough. So you have your crazy huge pile of notes, which you can barely hold together and write in at the same time. Now the patient is telling your team “Yes, my tummy pain has gotten this much worse over this many days, and three days ago I was vomiting up this amount of bile-colour liquid” (all key points you need to document in the notes). At the same time, your registrar (senior doctor) is reading from the bedside chart saying “patient was spiking temperatures of 38.7 yesterday, today afebrile at 37.1, current pulse 86, blood pressure 124 over 68, urine output about 50mls an hour since midnight, nil from NG output today, 300ml of bilious fluid drained yesterday…” Yup, and all that you gotta write down. Fast. Into your notes, which are steadily slipping out of your arms.
4) How to handle an insurmountable (and ever growing) workload. When you’re faced with an impossibly large list of tasks to do, it’s so easy to get overwhelmed and feel the burn of your brain frying itself. I touched on this in one of my recent posts, but it’s worth highlighting again here for this list. My advice? Breathe. Prioritize. Delegate as much as you can. Work quickly. And be prepared to stay late to make sure your patients stay safe.
5) How to spot the truly sick patient. Patients who are in imminent danger of dying have a certain look to them. It’s hard to describe, but when you see a patient with “the look”, you know you should be scared and that you need to prioritize them above everybody else. As a medical student, I never appreciated how important this skill actually is (or even that it existed!). Two solid months of working in intensive care has taught me otherwise, and I can think of at least one recent occasion where this skill has helped to save someone’s life.
So, that’s my top 5. I’m still very much learning the ropes myself, and I’m nowhere near mastering any of these skills. But I’m getting there… and if you’re reading this and are still a medical student, this is your big heads up!
Posted on January 8th, 2010 by B.J.
Filed under: Medicine | Comments Off
Note to self: always wear an apron when catheterising patients. I just catheterised a guy and things splashed around a bit more than usual.
I need to wash my face when I get home tonight.
Posted on December 20th, 2009 by B.J.
Filed under: Medicine | 1 Comment »
There are times when I really struggle to see God at work in my workplace – especially in the life-and-death tragedies that I often encounter. Thankfully, there are also times when I really can see God working around me, and tonight, I believe, was such a time.
I was meant to finish my shift at 8:30pm tonight, but at 9:15pm (over 13 hours into my working day) I was still wandering around the wards trying to finish off all the jobs I had left to do.
One such task was to insert a new IV drip into a patient who was known to have very tricky veins. I quietly approached the patient’s bed and gently woke her up (partly out of good bedside manner, partly out of total exhaustion). After introducing myself and explaining what I was about to do, I proceeded to fail twice at inserting an IV cannula into the patient’s arm.
The lady, who was so incredibly kind and patient, bit hard onto her blanket to try and hide how painful the whole ordeal was for her.
Frustrated with myself, but determined to get a cannula in, I told the patient I’d try one last time before giving up. I knew this IV cannula was a really important part of her treatment, and that if I didn’t succeed on my last attempt it was highly unlikely anyone else would try again overnight.
Taking out a small blue cannula, I prepped the vein as best as I could and inserted the needle. No flashback. After manipulating the needle a bit more under the skin, it still wasn’t in. “Aw, no… no…” I kept thinking to myself. Then, from the corner of my eye, I saw the patient praying quietly under her breath that the cannula in my hands would somehow work.
I doubted it. I’ve stuck over 200 of these cannulae into people and I generally know when no amount of further wiggling under the skin is gonna make any difference. Still, for some reason I pressed on, and even started praying in my head “God, please let this go in” whilst simultaneously thinking the situation was completely hopeless.
Then, suddenly, I saw a faint hint of blood (“flashback”) coming back through the needle. Bingo! 30 seconds later the cannula was sitting neatly inside the vein and secured firmly with a dressing.
I was amazed, to say the least. I mean, I didn’t actually believe God would help me salvage this situation – me, this lone F1 doctor, working overtime in a quiet little hospital ward late in the evening.
After telling the patient the cannula was in, I said to her “You were praying for me back there, weren’t you?”. She smiled sweetly, and said nothing. I responded “Well, so was I. I guess God really does answer prayer”.
I cleared my things up and left the patient to go back to sleep, quietly amazed by this little miracle God had performed before my eyes.
Posted on December 3rd, 2009 by B.J.
Filed under: Christianity, Medicine | Comments Off
Medicine really changes you as person. Things that would completely phase a normal human being don’t really seem to affect you as much. Death, sickness, stress, anxious relatives, suicidal patients, insurmountable workloads… they all become “normal” when you’re hit repeatedly with them every working day.
When you’re the doctor “on call” – i.e. working at night or over the weekend – all of the above gets stacked into one ram-packed intense experience. I’m on call this weekend, and I tell you, I am feeling it.
My hospital pager (affectionately known as a “bleep”) went off about 10 times during my exceptionally short lunch break today. It was ridiculous. I’d take a bite to eat, get bleeped, answer the bleep on the phone – and before I could even put the phone down, my bleep would go off again. Repeat the scenario 10 times in a row, and you understand how I was feeling. In the one hour that followed, I got bleeped another 10 times by nurses and doctors who were piling more work on to me; meanwhile, I had to rush over to see a patient who was literally dying and screaming in pain.
What keeps me going in the midst of all this madness? I don’t know. God must be working in the background, I’m sure. On the surface, I just force myself to keep going. Quitting is not an option. You just suck it up, prioritize your jobs, work at them one-by-one, and hope that you get all the really important ones done by the end of the day.
Having a really supportive and encouraging team of doctors working beside you really helps. You’re all experiencing the same proverbial poop (to put it politely) that has hit the fan and smothered itself all over the walls. Together, you help each other pull though, and having that support network there makes all the difference.
To any prospective or current medical students out there: read this and understand that this is what you’ll have to experience yourself someday. To any other overworked and stressed junior doctors out there (which I think includes all of us): allow me to put my hand on your shoulder and say “come on guys; we can get through this”.
Posted on November 8th, 2009 by B.J.
Filed under: Medicine | Comments Off
Ever since I got mugged in my first year of university, I seem to have developed an anger problem – particularly against street-roaming teenage runts who roam the streets in wannabe gangs at night.
Those of you who live in England know the type; you can find them anywhere in any sizeable city or town. They’re all teenage kids dressed in black hoodies and black sweatpants, often found drinking cheap alcohol outside “off-licence” liqueur stores, throwing eggs/rocks at people they see passing by, and generally causing a menace to society.
In a sense, it’s understandable why I feel this way towards these kids. It was three “scally” kids who tried to beat me up and stole my camera five years ago in Liverpool. Since then, I’ve had eggs thrown at me in the street, been shot with a paintgun on my bike, and seen a couple of them running behind old ladies trying to scare them from behind. It’s disgusting. And these kids totally get away with it, which really… angers me – to put it lightly.
Last night I had a bit of a reality check when a couple kids started shining a green laser into my car mirror as I was setting off from home. After trying to ignore them for 10-15 seconds, I got fed up and ran outside my car yelling “WHAT DO YOU WANT?! PISS OFF!!”. The kids laughed and cycled away on their bikes. I was so furious.
When I got back in my car, my older sister (who had been waiting inside) was completely shocked – not by the kids, but by me. Never in her life had she seen me so explosively angry, or so violently yell at anyone. And that’s when I realised… I really do have some unresolved issues after my mugging five years ago.
In my life, I think I’ve only ever yelled like that three times. The first time when I was being mugged telling the guy to give me back my camera, the second when some punk-ass kids were throwing rocks at me and calling me racist names, and the third was last night at those laser-shining kids.
In a macho (yet entirely unhelpful) way, it feels good being angry. It makes you feel tough. It makes you feel strong. But at the end of the day (and especially in the days to come), it actually makes you feel awful. You turn bitter, moody, and generally very unpleasant towards people around you.
There’s a lot of wisdom in those verses in the Bible that say “In your anger do not sin. Do not let the sun go down while you are still angry, and do not give the devil a foothold.” (Ephesians 4:26-27) Anger can be a good thing at times. But more often that not, it makes you act impulsively, irrationally and turns you bitter and resentful if not checked-in early.
Time to lighten up. Time to be more patient. Time to be more like Christ.
Posted on August 27th, 2009 by B.J.
Filed under: Miscellaneous | 1 Comment »
Coming from Hong Kong, home of the advanced “MTR” subway and overground rail system, I feel like I should be a pro at taking the London Tube. I mean, we INVENTED the “Octopus” card system that the British took and made into their “Oyster” card (coincidence? I think not).
Sadly, my arrogance shows itself time and time again when I blitz through the stopovers and hop on the wrong train. Why? I’d like the blame the poor signage, convoluted passageways and similarity of all the tube line colours. In reality though, it’s actually my pride stopping me from standing and staring closely at all the Tube signs “like a tourist”.
I hate looking like a tourist, even when I am one. Time to suck it up and start looking acting touristy, because man I am so frustrated with getting on the wrong train.
Posted on August 23rd, 2009 by B.J.
Filed under: Personal | Comments Off
In medical school, people often joke about what a waste of time communication skills teaching is. “It just teaches you common sense – stuff any idiot would already know!” / “They keep harping over and over about the same things – as if we didn’t know it all already!” / etc etc.
To say I never joined in with the complaining would be a lie, but I will say there was one “comm skills” session that I shall never forget.
Towards the end of my second year, I was getting a little fed up with all the “easy” simulated patient encounters I had been getting. Up to then, they had all involved shy, nervous patients (played by professional actors and actresses) who just needed a little coaxing before they were completely cooperative and sharing their medical histories freely.
Being the gung-ho and over-confident medical student I was, I asked my comm skills tutor to give me a “hard” patient – ideally an angry one just so I could see what it felt like and how I would react. My tutor was quite surprised at my request, but willingly obliged and had a quiet word with the simulated actor who was preparing outside.
What happened next all flashed before me like a painful and confidence-bursting blur. The angry patient (played extremely admirably and realistically by the actor) slammed open the door and immediately began yelling at me. He accused me of all sorts of problems that I had no control over, and even began insulting the fact that I was just a student – demanding to see a “proper” doctor immediately.
My gut reaction was to stand up (bad move #1) to face this really… unpleasant man (to put it politely). At first I tried apologizing to the patient for all the trouble he had been through, whilst simultaneously thinking in my head “Why am I even apologizing to this guy?! His problems had nothing to do with me! I can’t just let him steamroll over me and break my back trying to appease him!” When the apologies failed to placate the patient, my responses quickly turned defensive and I soon began to argue with the guy (bad move #2).
One thing led to another, and next thing I knew the patient thrust his finger right up to my face and said something like “how dare you tell me what I can and cannot do you little…”. In some sort of reflex defense mechanism I immediately grabbed the patient’s hand and pushed it away (very bad move #3), before the tutor quickly shouted “Time out!” and halted the whole simulated patient encounter.
Needless to say, I learned a lot that day about what to do in a tense situation – and especially what NOT to do. The actor (actually a very nice man in real life) told me in the debriefing that had this been a real situation, he would’ve slugged me a good one to the face after I pushed his hand away (so glad it WAS actually a simulated scenario!).
Why do I bring up this story? Well, a recent encounter with my landlady cast me in a similar position to the one I described above, though much less physical or violent. As much as I’d like to describe the actual situation with all its specific details, I realise the public domain isn’t the most sensible place to discuss these matters. Suffice to say, my landlady and I suffered from a combination of miscommunication errors and uneven expectations of each other’s responsibilities, leading to a minor dispute in the house.
When things started getting significantly more tense, I immediately asked if we could sit down to discuss the issues at hand, rather than standing and walking past each other round the house (lesson learned #1). When we eventually sat down, I quickly began to apologize for everything I could apologize for and express my grattitude for all the time, effort and money the landlady had put into renovating the property for us (lesson learned #2). The landlady never swung her finger in my face, so it’s hard to make a direct comparison with my simulated patient encounter for lesson #3. I guess the closest correlation came when some potentially very offensive remarks were made in my direction, but rather than throwing her metaphorical finger aside, I held my tongue and let the comments gloss over me.
For any current medical students reading this, I guess my advice to you would be to not belittle your comm skills teaching and actually pay attention in class. You never know; it may actually (and probably will) become useful one day!
Posted on August 20th, 2009 by B.J.
Filed under: Personal | Comments Off
