medicine

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.

From My Notebook: November, 2012 – Stragglers

Empty wheelchair on cliff edge, desert

In the course of my medical studies, I met, very briefly, a man who was really a woman. He had been raised as a man, and had a man’s name. I later learnt that he had been born with ambiguous genitalia, and they–whoever they were, his doctors or his parents–had decided to bring him up as a boy. Somewhere along the way they had discovered that, genetically, he was female.

He was a very obese man, with the soft rotund face of an older woman. Between his bloated cheeks, sparse hair sprinkled his upper lip. He was poorly groomed and shoddily dressed, and walked with a stick. He was about forty years old.

I knew at once he was miserable. Every sentence that came out of his mouth was a spiteful, humourless joke that left his face and his shoulders sagging, slack, towards the ground. I wondered if he would ever fall in love or be loved. I wondered on how many days he felt that life was worth living. Could he count those days on one hand? An unpleasant feeling knotted my chest. Our world is brutal, and cares not for stragglers.

Ramble.

I am a doctor. Yes, I am.

A doctor with provisional registration, at the very least, who must still run most of her decisions past a superior, and whose main areas of expertise are, summarily: inserting drips, writing discharge letters, and looking for folders. If, by the time the end of this year rolls around, we haven’t accidentally prescribed someone 100 units of insulin, or ignored a head injury after a fall, we are rewarded with a full registration. (Which, of course, we need to fork out several hundred dollars for.)

The way things work in Australia is that junior doctors must re-apply to hospitals every year; we are employed as “temporary full time” workers, on a contract that only lasts for 12 months. It’s a bit sucky. You spend a couple of months celebrating the fact that you survived interviews and got a job, only to realise that you have to do the whole thing over again. And again.

I recently submitted an application to do a six-month job next year, hopefully as a psychiatry resident. I’m planning to take six months off to do something totally silly and wonderful: write. I’m really excited. And a bit scared. (A little of becoming poor, but more of failure.)

This is how the rest of my year is looking:

– a couple more interviews, maybe

– hepatobiliary surgical rotation

– emergency department rotation

– trip to China and Hong Kong, yayz!

– three weeks break in January 2014

– work, if I have a job

:)

I think I’m feeling optimistic.

My day is looking not too shoddy either. I’ve got work 4-10pm, which is manageable, but I’ll be grumpy because I’ve got a cold. In the meantime, I have plenty to occupy myself with. For the past year I have been struggling to finish the Bitterbynde Trilogy by Cecilia Dart-Thornton–an Australian fantasy author, with wonderful writing ability, but LORDY. There came a point in the third book where I felt like I was just being constantly slapped in the face by purple prose. Her turns of phrase are lovely, but really, does she need to spend three lines describing how beautiful the inside of a strawberry is? We all know what a strawberry looks like.

Paragraph about strawberry.

Paragraph about strawberry.

Normally I have a rule that I give up on a book if it’s really struggling to hold my attention, but the Bitterbynde Trilogy admittedly is very beautiful. It’s sweeping and bursting with Celtic mythology and it’s got Faeran folk in it. It’s well planned out and elegant. I’ve just had enough of fantasy tropes, Mary Sue characters and dizzying descriptions of heartbreakingly handsome Faeran heroes. I’m sure the trilogy could have been one book shorter. Anyway, I’ve only got about 80 pages to go so I may as well skim through it.

Ten dolla! I picked up this trilogy from an amazing little bookstore in Morwell, Victoria called "The Nook and Cranny". If you're ever in Gippsland and you're a book nerd, you have to step inside this place. It's so unpretentiously rad.

Ten dolla! I picked up this trilogy from an amazing little bookstore in Morwell, Victoria called “The Nook and Cranny”. If you’re ever in Gippsland and you’re a book nerd, you have to step inside this place. It’s so unpretentiously rad.

I recently also read The Mind of a Mnemonist, by the Russian neuropsychologist Alexander Luria, who lived and worked in the early-mid 1900s. I heard about Luria whilst listening to a podcast featuring Oliver Sacks (Sacks cites Luria as one of his key inspirations). Mnemonist is a detailed case study about a dude who can remember everything. He also has intense five-sense synaesthesia, which is bizarre and fascinating to explore. Luria really delves into the guy’s mind, how his thought processes work, how his gift affects his personality, and what his weaknesses are.

In the TV world, I’ve just finished the season 2 finale of Battlestar Galactica–several years too late, I know–which, as usual, keeps blowing my mind. I can’t believe I didn’t listen sooner to my friends (looking at you, Mookxi!) who told me to watch this. Spaceships plus Greek mythology plus intense character study. HOW COULD ANYTHING BE MORE AWESOME?

bsg

Speaking of ancient Greek myth, I highly recommend the Greek and Roman Mythology course over at Coursera.org for anyone looking for an intro into ancient mythology. The readings can be a bit intensive on top of full time work or study but I found it totally worthwhile. It’s a very well taught course and a great starting point for beginners like me!

Oh no, work looms in four hours. Time to work on my novel. Wish me luck! Have an excellent week, readers. Don’t forget to smile unexpectedly and creepily at someone to brighten up their day.

x

Grace

PS. Can’t help it, but toaster Cylons just remind me of Cybermen. I think they used the same sound effects :P

cylon cybermen

Doctoring and Homer-the-poet (and general excitement about life)

Just got home and cleaned up after the easiest medical cover shift in the history of cover shifts!

I felt like I was getting away with murder. I spent the first half hour chowing down my chicken schnitzel wrap, the next two hours browsing Reddit and snoozing on the most comfortable couch in the world (which, FYI, is located in the residents’ lounge of the hospital at which I work).

Said comfy couch is ugly, brown, obese and probably very grotty from the 278 different junior doctors who have kicked back in its cushiony depths. And yet it is so soft. It’s like sleeping on a gentle, giant, fluffy turd. Can you imagine anything more wonderful?

After 5pm my pager finally started going off and I trudged upstairs to the wards to review medications, rewrite drug charts, check fluid statuses and pop in drips like a pro. I was smiling at all the nurses and spreading cheer and goodwill like Santa Claus. One thing I’ve learnt from cover shifts is not to be grumpy. It just makes for more of a pleasant shift if you make an effort to be pleasant first.

Fast forward six hours and I’m home, rinsed of the hospital grime, dressed in rather comical polka dot mint-green pyjamas and wrapped like a sausage roll in a blanket. I’m way too excited about the three work-free days I’ve got ahead of me.

I can’t wait to hop into bed and read Book 24 of the Odyssey. I thought that when I started this Greek and Roman Mythology course on Coursera, reading a Homeric epic would be a long haul. And for a few chapters here and there, it was tough. BUT O-M-G. The Odyssey is SO EPIC. EPIC TO THE MAX! I love it. I do not want to read Book 24 because it will end. But at the same time I can’t wait to read it. Argh. Excitement.

In preparation for this course I ordered a few books online and now I’ve got a small pile of classics sitting on my desk, looking really hardcore and classicsy. They’re seriously intimidating me with their academic glory. I hope I manage to get through the set readings over the next seven or so weeks. The course pushes a tough pace and it takes effort to get the week’s homework done around my real job, social riff-raff and all those TV shows I’ve just got to watch…

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Speaking of necessary TV shows, THE OFFICE (US) IS ENDING. It is acutely tragic. I have lived with this show ever since the BF introduced it to me circa three years ago. I have sobbed for Pam and Jim. I have bust a rib cacking myself at Dwight’s antics. I have bowed to Creed being possibly the awesomest supporting character ever. The finale airs May 16th and marks the end of an era; the end of a show that helped to bring cringe comedy into the mainstream. I have no doubt I will cry.

Tomorrow night, worked around our irregular schedules, is a long-awaited date night. Planned events? Butter chicken and biryani rice, Star Trek: Into Darkness, Game of Throooooones, Office. May or may not be able to fit in all events, but I will update on the highlights.

Last week, half a month after everyone else, we watched Iron Man 3. Blockbustery pow-pow and unbelievably streamlined technology and a whole army of iron men and Pepper Potts going all uber. It was a super fun movie to watch, but had an unsatisfying ending. Best bit was Ben Kingsley. Oh, and that cute kid that helped Tony Stark out.

Sign that I’m getting tired. Amputated sentences and inventing fake adjectives by adding -y to the ends of nouns. I’m off to bed with Homer.

More next time,

Grace Le Fay.

A month in Samoa

Hi! In January of this hallowed Twenty Twelve I spent 4 weeks in the humble, humid country of Samoa. We spent most weekday mornings at Tupua Tamasese Meaole Hospital, Samoa’s main hospital. The rest of our time was divided between visiting the markets, cooking curries for dinner, riding utes and vans and taxis to so many beautiful beaches and waterfalls, taking a ferry to Savai’i island, dancing on a rockin’ boat, eating at the only Chinese restaurant in town, singing, and sneaking into resorts for some poolside lazing.

Samoans are known for their relaxed way of life, their strong family bonds, and their friendliness. Every time I got into a taxi, the driver asked me enough questions to find out where I was born, how old I was when I moved to Australia, what I studied and how many siblings I had. People smile and nod on the street. Whole families camp out next to the hospital bed of their sick relative. The whole town shuts down on a Sunday–you can’t exchange money, top up your sim card, or even visit a bank. It was bizarre and refreshing.

I learnt so many things from Samoa, medical and non-medical. My skin discovered a new dimension of blackness. I was inspired by the internal medicine doctors. I was forced to slaughter cockroaches (equipped with a thong, a can of Mortein, and wads of toilet paper…with large quantities of screaming, trembling and wailing). I survived some of the worst gastro I’ve ever experienced. And I was able to glimpse a very different way of life: a people who’ve never known any other way to spend their Sunday afternoons than sitting in the grass, watching the odd car pass through their quiet village. Bet they’ve never heard of Mark Zuckerberg…and they’re better off for it.

^ Traditional-style Samoan huts, known as fale–open to the air on all sides, but with curtains that you can pull down.

^ Veggie market. They had weird-shaped lettuce!

To Sua Ocean Trench: climb down the ladder and swim in the brilliant saltwater pool that shifts with the tides!

^ Lalomanu Beach. Postcard perfect beauty.

^ You can’t visit Samoa without watching a fafafine (ladyboy) show. Classic!

^ Getting lost in the wilderness on Savai’i island. I think we were trying to find a dormant volcano. We never found it.

^ One of the famous pork buns sold at the hospital. Pretty similar to the Chinese BBQ pork bun, and almost as tasty. I hope it wasn’t this that gave me gastro. In hindsight, it looks a bit dodge.

^ Even in the middle of the Pacific Ocean, I am a lady.

Winter is coming.

It’s the last few weeks before the Big Exams and the heat is on. Also, the heaters are on as med students huddle in common rooms, hospital libraries and the dark recesses of their own bedrooms in scholarly preparation. It doesn’t help that the temperature is shedding numbers and my fingers start to chill just typing on this keyboard.

Normally, I make it taboo for myself to write about medicine here, since this blog is supposed to be an escape from the world of physiology, pharmacology and lessons on how to be nice to patients. But, as the hard work of the past year comes to a point of culmination in the next month, I feel like my life is being absorbed in my studies. Almost like I am being absorbed.

The amount of learning demanded of us is ridiculous. Stress levels are high; students roam the corridors like zombies. I’m trying not to let it all rub off on me, but some days the combined feelings of expectation, competition and dread can be overwhelming. Yawning my face off while making the long drive from Rowville to Epping, and back from Epping to Rowville, only to come home to the loving embrace of my books…it’s no fun.

My philosophy to survive the next few weeks is to eat well, exercise, get enough sleep, and perhaps most importantly, slack off from time to time. ‘Cause I know I’m the type of person who sometimes demands too much from herself, even when it’s uncalled for. After all, it’s only medicine. It’s not life. Not mine, anyway =)

As I am a little girl inside, one of my escape mechanisms is to crawl off into an imaginary world. This weekend past, the imaginary world was…*drumroll*…WESTEROS!!!

Yes, that is Boromir. And yes, this is the TV series adaptation of George R. R. Martin’s Song of Ice and Fire series. I finally checked out episodes one and two on the weekend after recommendations from both Kat and Jez. The reviews are right. It is a 9.5/10, and it does have a lot of boobs and gore…usually not in the same scenes.

I’ve never really seen epic fantasy done in a TV series format before (well, apart from Merlin, but I don’t know if that counts…) and to be honest I never expected this adaptation to work so well. The big budget is evident: the buildings, costumes, armour, scenery, everything…it’s all done in such detail that it’s effortlessly believable. I love the ratty black cloaks of the Night Watch. The helmet shaped like a leering lion. The hemlines of the woollen gowns stained with mud.

Each episode feels like a movie. It’s Lord of the Rings, but grittier. Instead of orcs, there’s the freaky White Walkers of the north. Instead of your bearded, axe-wielding dwarves, you have the cunning, whoring midget Tyrion Lannister. Instead of gypsies, you have the half-savage Dothraki tribe, who eat horse hearts and slay each other at weddings. The King isn’t benevolent. The good guys might not win. In fact, who are the good guys?

If you want to watch Game of Thrones you’ll need to keep your head around multiple characters and concurrent storylines, which might be easier if you’ve read the books, or have someone awesome sitting next to you to answer all your questions. (Me! Meee!)

After thoroughly enjoying the first two episodes, I got to wondering aloud about why it is that all humans crave adventure. It seems to be built into our physiology. Though we claim that we are creatures of habit, we tire of monotony and dream of our own personal epics. Whether you are a housewife who dreams of being 20 years younger and swept off your feet by a “perfect, ice-cold vampire” or a kid who puts on a stretchy Spidey suit, we are all mesmerised by the thought of being a part of something bigger. Of being a hero to someone else. Of changing the world, and maybe leaving a small legacy.

Maybe it’s a pointer to the fact that we were designed for more than just our physical, self-driven lives. Or maybe it’s an evolutionary twist designed to keep us striving for greater achievements. It’s up to you to decide.