Australia

My Guest Post on Dr M’s Notes: Empathy for the mad man

Originally posted on May 14, 2014 at Dr M’s Notes (www.thehealthquotient.com)


 

It’s easy to dismiss the patient with mental health issues.

When they pop up in our Emergency Departments, on our wards or in our clinics, there’s a common urge to handball responsibility to another party. They’re not my problem. They’re already sick. What help can I be to them, anyway?

The very practice of psychiatry is full of labels and names. Schizophrenia. Manic depression. Borderline. Dependent. Schizotypal. Involuntary. When one of these terms pops up on the admission notes, it’s easy to let the person fade behind the jargon. Especially when we’ve got fifteen other patients to look after; patients who are more relatable, more help-able.

Since February of this year I’ve been working in a community psychiatry clinic. It’s an experience I’m thoroughly enjoying. The diversity of patients constantly astounds me. There are people from families like mine, and families completely removed from anything I know. There are people from rural Victoria. There are middle-aged women living alone in boarding houses, young men on the streets, older men in their family homes. There are refugees from Vietnam, Somalia, India, Cambodia. I’ve used interpreters for many different languages.

Sometimes, when you meet a person who is suffering from a mental illness, you look into their eyes and you’re not sure if you’re reaching anything there. Sometimes they feel as vacant as an abandoned house. You wonder, how did they ever get to this stage? What happened to them to bring them to this point?

Over time I’ve seen some patients improve and others deteriorate. But what I’ve noticed this job growing in me is an ability to empathise with people from various walks of life. And I’m delighted that I’m becoming more genuine, rather than more jaded.

I’m learning to pause, to really listen. I’m trying not to simply search for the answers I’m expecting, but to absorb the sense of who a person was before they became unwell. And some of the best moments with my patients are when they crack a joke—usually a wry, half-true joke, but a joke nonetheless—and they look over at me to see if we’re on the same page. And for a split second, the interview transforms, and we’re just two people sharing a laugh.

It’s funny how simple and effective a joke can be. It’s prompted me to realise that we’re all made from the same dust. We’re not really different from the people we treat, at all, and we shouldn’t go down the path of thinking we are. If not for a different set of life circumstances—a different set of genes, a different childhood—you or I could so easily be the one with the label.

via Empathy for the mad man | Dr M’s notes.

The End of an Era

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Today I officially finished my internship.

In Australia, after you finish a medical degree, you have to work for a year in a public hospital under probational registration before you are granted full registration as a doctor. I spent my internship year at Monash Health, which I truly enjoyed, and completed five x 10-week rotations: Inpatient Psychiatry (Youth and Young Adult), Acute Assessment Unit, General Medicine, Upper Gastro-Intestinal Surgery (Hepatobiliary) and Emergency Medicine.

I won’t deny that it has been a tough year. At times, the days have dragged. At other times I marvel at how quickly the time seems to be flying by. You enter a new department, lost and clueless, trying to learn all the nurses’ names, keep track of room numbers and figure out where the damn radiology request forms are kept. Just when you settle in, you’re shuttled off to your next rotation. There will be moments when you are bombarded with so many jobs that you just want to hurl you pager onto the ground and bawl. Disasters will happen in bunches: one afternoon, a patient began to die of bowel obstruction while another, simultaneously, had a heart attack.

The wonderful thing about internship is that you work, and you earn money, and you don’t often have to work too much more than what you’ve been rostered for. And outside of work, you have a freedom that is different from being a student. I played soccer, ate out, bummed around with friends, watched movies, read books and travelled without worrying about having to go home and hit the books. It was great, and I treasured it, because I know it’s a rare period in life to have so few obligations.

My first year of working life has also taught me that I am not invincible. I do not have endless reserves of energy, and my health may not be perfect if I do not put some small daily effort into looking after my basic needs. In fact, I am definitely someone who needs more than an average amount of sleep. During my general medical rotation, when I got 6-7 hours of sleep per night on weeknights, I struggled to make it to the end of the shift each day. Running around doing jobs kept me awake, but any time I sat down to do paperwork, I’d be yawning my head off. During my surgical rotation, where the roster was more irregular, a 5:30am wake-up would completely knock me out for the next few days. And when I went into my last rotation, Emergency, where I was swinging back and forth between morning shifts, evening shifts and overnight shifts…my body clock pretty much started waving a white flag. I got headachey, exhausted, and had abdominal pain and pretty horrible IBS.

It probably didn’t help that during this year I really wanted to keep up my social obligations. I played in up to three futsal games per week, went to dinners and parties, and even dabbled in Dungeons and Dragons for a good few months ;P (Yes, that counts as a social obligation…) I suppose this year has taught me the challenges of establishing a work-life balance. Everyone talks about it, and it always seemed so straightforward–just make sure you do heaps of fun stuff outside of work, no? But it’s a little bit more complex than that. You will have to make small sacrifices on both sides to get the balance right. Sometimes you will choose to uphold commitments and you will be very tired. Other times you will have to learn to say no, and put your own welfare first.

So I now have three weeks of leave (YAY, YAY, YAY!) and on February 3rd I’ll start work as a resident in psychiatry. Last week I did feel a little scared. I had a moment of profound realisation: I may never look after a patient ‘medically,’ ever again, if I keep going down this road. I may never put in another IV drip, or ponder the cause of a patient’s low blood pressure, or perform basic life support. My general medical knowledge will dwindle and fade, despite my best efforts not to forget. And I will become a pseudo-doctor, a part of the system that the other doctors don’t really regard as real doctors. Will I love it or hate it? I don’t know.

Being an ABC (sort of) and why your well-meaning questions come off as ignorant…

This is an issue that is often on my mind, but I never thought I’d write a post about it.

An ABC, also known as an Australian-Born Chinese (although I suppose it would work if you were American-, Armenian or Antarctic-born as well) is a person of Oriental ethnicity who was born and raised in Australia.

Technically, I’m not an ABC. I was born in Malaysia and migrated with my parents to Australia at the ripe old age of 9 months. When I travel to Malaysia, I go to pig out on laksa, shop, and sightsee. All sense of coming home is at the end of the trip, when the plane descends into the green and brown patchwork of Melbourne’s far northern suburbs, when I’m in a car with a heater and five seatbelts, whizzing down the Eastern freeway with a vibrant blue sky overhead…it seems there’s no city in the world where the colours are as vibrant as in Melbourne. Not to me, anyway.

I would proudly call myself a Melbournian. And why shouldn’t I? My life is here. I went to the local primary school, one of perhaps six Chinese kids in the year level. I jog the neighbourhood streets. I sprint to the milk bar in PJs when I’m halfway through making a cake and run out of milk. I make the long haul from the south-eastern suburbs into the city. I complain about the trains. I’ve memorised the city grid. I attend university as a local student. I work and volunteer. I take road trips into the country. I roll on the beach.

I know we’re supposed to have come a long way. Even in a few short years. Back when I started Prep, I had my fair share of 6-year-old white boys calling out “Ching Chong” when I walked by. I wonder if that still happens in primary school now…? I’d like to think not. (My mum told me several things to say in reply…I wish I’d had the courage to follow her advice.)

As an Asian in a western country, I still experience the odd racist slur–hurled from a passing car, or muttered in a crowded place. But thankfully, those experiences are rare. More common is the subtle racism often exhibited by people who just couldn’t care less, or even those trying to be nice.

As a student and a volunteer in different hospitals, I’ve had so many people ask me where I’m from. Sometimes six times in one day. Some days I loathe this question. If I were fair-skinned, brunette and brown-eyed, would I be fielding the same barrage of curiosity? Probably not. I never know how to answer. Often the conversation goes like this:

Person I’ve just met: So, where are you from, sweetie?

Me: Oh, I’m from (insert home suburb), just down the road.

Person: Yes, but where are you really from?

Me: Oh…uhhh….well….I was born in Malaysia, but I grew up here.

Person: Oh, that’s lovely! Me and my husband, we’ve been to Malaysia twice, you know! And we loved it both times. We just love the people there, and the place, and the food–oh, the food! It’s a wonderful country.

Me: Um…thanks.

“WHERE AM I REALLY FROM?!?!” For your information, sweetie, I really am from just down the road. I have an abiding adoration of the English language, I read voraciously, I pore over the same paper that you pore over on Sunday mornings over your mid-morning brekky. I actually have tried to learn how to pronounce Welsh names, ’cause I think they’re absolutely beautiful. So honestly. What right do you have to make me feel less like an Australian, just because I have olive skin and almond-shaped eyes?

The thing that gets me angriest is when white kids exclude us because they just see as as a ‘bunch of Asians.’ To them, we are an indiscriminate mass of squinty eyes and yellow skin. We’re not even worth seeing as individuals. And yes, I have definitely experienced this.

I don’t care if I sound grumpy and whiny. I feel that I deserve it. After all, being an Asian-looking girl means I’m automatically put into a box, stamped and stereotyped. It is one of the most difficult moulds to break out of, and I hate it. I am not only the sum of what I look like, and I do have something splendid to offer society. Just watch me.

Yeah! *punches air*