L A T E S T P O S T S
Writing. It is a personal favourite when it comes to relieving a burden off my chest. There is a freedom to it that can’t be explained, only felt. The raw emotion, the power of words and the ability to evoke a response from the reader are all part of its majesty.
It mesmerises when engaged by a master. It can brighten your mood, uplift your spirit, darken your soul and send you to the gallows all at the same time. It is the power of writing. In fact, once many leaders discovered and adopted it as a part and parcel of governance, it was donned to be a form of ‘magic’.
You would no longer need to keep all information stored in your head. It could be documented and preserved for many more years than an individual’s life-span. Words were indeed timeless. They could take you on a journey through time without needing a time-machine.
They well up tears of joy, crush your dreams or even render you speechless. It is the power of writing. In the hands of somebody that appreciates its value, it is a weapon like no other. In the grasp of a fool, beware of its ability to make the truth appear a lie and a lie the truth. It is the power of writing.
It can allow you to transcend into a fictional land that has been designed for you by a manipulator of its powers and create a world that only exists in your mind. It is so powerful, you can even forget your current reality and use that world as an escape from your real-world problems. It is the power of writing.
For some, it wells up a sense of national pride, an urge to serve and put their bodies on the line. Others it pushes to opposition, sedition and making it their life-time goal to be a thorn in the patriot’s side. It is the power of writing.
It polarises, is responsible for paradoxes and it’s understanding by individuals leads to varying interpretations even on the same text, read with the same eyes! It is the power of writing. It’s marvel is endless and my admiration for its power is also infinite. These pages are unfortunately limited and time doesn’t permit to continue without an end-in-sight.
Although writing’s power is worth much more than these quickly dotted points, its value is only held in esteem by those who understand its usefulness. Indeed, it is the power of writing!
The phrase ‘get comfortable being uncomfortable’ is out of touch with reality. Let me explain.
The expression by its very definition goes against what it means to get out of your comfort zone. When we are told to get out of our comfort zone, it is to reach the boundary between inner peace and anxiety. You are to push yourself to the point where you induce an anxious state that through experience you have learned to qualm.
Case in point
The greatest example highlighting what’s been said above is that of public speaking. I remember reading a ridiculous stat that said something like 75% of Americans are petrified of public speaking. I’m sure the figures are similar in other parts of the world.
When getting up to speak publicly, everybody feels a little queasy, knots in their stomach and to a certain extent, has a mini-anxiety attack. This is an uncomfortable situation for the vast majority. However what differs whether you drown in sweat and panic or rise to the occasion and nail it, is mindset and experience.
Experienced speakers go through the same pre-talk nerve wreck stage, but they have been through it so many times they can skip the pre-game nerves. They develop coping mechanisms allowing them to take it all in their stride. Some may hold their hands together while others walk across the stage.
Where’s this going I hear you ask? Time to bring it altogether.
Bring it in
Public speaking is something people often feel very uncomfortable doing. It represents an uncomfortable state of affairs that brings many to their wits end. It is not dissimilar to transcending an individual’s comfort zone and moving into the world of discomfort. As children we did this on a regular basis as it was necessary for progression from one phase of human development to the next.
As a child you experienced many moments of anxiety and embarassment. Difference is, you did not worry about how you looked going through these phases. You accepted this as the standard or didn’t think of what the standard was at all.
As adults, we are more in tune with our emotional side and find it increasingly difficult to deal with the blows to our self-esteem. In turn, we can develop ways of coping with these feelings when they arise, just like the public speaker. Every person will find a unique way of doing this, or hear it from someone and find it works for them.
If there’s anything I can contribute it’s to be that child again, only this time a wiser version.:)
“Number 328 to Consultant Room 12 Blue”
I spun around in my chair and stood up, opening the door. My partner sat at the only place available-the bed. We were sitting in our own consult room at fracture clinic, taking in turns to see patients. The one we had just called in was a woman in her 60s, with what seemed to be a minor fracture on the calcaneus. A man approached, pushing a woman-my patient-in a wheelchair. I greeted them, and whilst the man seemed quite engaged, the woman merely smiled, and already I was beginning to question the lady’s cognition.
Don’t be so judgmental, I told myself. Perhaps she just isn’t in the mood to visit clinics and get questioned, poked and prodded.
I began to ask her questions, to establish her history of presenting complaint. I’d already read most of her story from the correspondence and outpatient notes however we had always been taught to learn the story firsthand. Despite my best efforts she would look at me blankly every time I directed a question at her, and eventually the man would respond. I found myself directing more and more questions to him before catching myself and returning to the patient. From the consult I had determined that although she was wheelchair bound due to the fracture (which resulted from a fall), there was a number of other co-morbidities, the most limiting to the issue we were addressing being her weight.
“I’m basically her caregiver, you know,” the man was saying. “Like I cook and help her and take her around and everything, I look after her.” I nodded and glanced at her for a reaction. Nothing much. I decided to move on to the examination.
I examined her foot, which seemed tense and leg attached a little swollen. She indicated there was some tenderness over the area where her fracture was on the X-Ray however she didn’t seem completely certain that that was the case.
“So before the fall, how much were you able to walk around?” She gazed at me, with no indication that she intended to respond. “She hasn’t done much walking for years,” the man answered for her. I nodded. “I had a walker. “ She interjected. I repeated the last word inquisitively, hoping she would provide me with more information without me needing to ask directly. “Yeah I used to go shopping, with my walker. I could go for hours, I just took a seat when I was tired.” I tried to delve further, to ask how long she had been on the walker, but when she didn’t seem to comprehend my questions I turned to the man. “So before the fall, what was your mum’s mobility like?
The man nodded and smiled. “Well she hasn’t been properly walking for years, and then she got a walker you know, because of her legs and her weight you know, and then the fall and now this. She hasn’t been walking for years. I’m her husband by the way.”
The seconds for which I was rendered speechless seemed to last forever.
Did I just?
I thought he said mum?
Oh God no, he said caregiver.
I could almost sense the amusement emanating off my partner. I made a conscious effort to not glance in her direction.
“Oh my gosh I am so sorry!” I gasped. Thankfully they seemed amused. “For some reason I thought you mentioned that you were his mum.” He laughed “Oh really, no no, we’re married.” The woman looked at me and sighed in jest. “Yeah.”
I shook my head and laughed at myself. “Wow, I am so sorry. What I’ll do now is I’ll have a chat to the bosses and we’ll have a look at your X-Rays and work out where to go from there, how does that sound?” They nodded and said no worries, and as I stood up I had to apologise once more. “Again, I’m so sorry, we’ve had a few kids come in with their mums so I must be in that mindset, sorry!” They smiled again and told me not to worry.
Alright Priscilla, you haven’t dug a ditch, you’ve dug a ravine, time to back out and recompose.
The management was simple: the X-Ray had shown complete healing of the fracture, and so it was recommended that she weight bear as tolerated. The husband thanked me as the patient smiled. “Great, we’ll try to get her back on her walker. Thank you so much.” I nodded and smiled. “No worries, hope it all goes well. It was lovely to see you, sorry again for my slip-up before!”
They left the room and I turned to my partner.
“So how do we do this what are we doing?”
We peered at the computer screen as my partner typed her login. “Goddamnit, we need to set a new password.”
I have yet to see a hospital computer using at least a Windows XP and this one was no exception. As the screen loaded slowly I tried to curb my frustration. We’d been dropped into a consult room and told to see some patients and we had no idea what the process even was. The registrar was not unkind, but there was a lack of communication of vital information (like how do we find out which patients we’re meant to see). And there was a fine line between asking the perfect amount of questions and asking way too many to the point of wasting the registrars’ time.
After about 20 minutes of fluffing around trying to log in to the right programs, working out where to find the outpatient progress note, and realising that we needed IT support to add the patient calling program to my friend’s profile, we were finally ready to begin.
“So who do we want to see?”
“We don’t know what they’re in for, what if it’s something we don’t know at all.”
“Oh god, how about we just look through their details and see if it’s an easy one or not.”
We selected our first patient, but she hadn’t arrived yet (she didn’t arrive at all in the end), so in fear of being accused of dawdling we decided to choose another patient. My partner and I took turns leading the consult, feeling more and more comfortable with every session. Before the end of each consult we would consult with the registrars about their X-Rays and their management plan and then relay it to the patient. Thankfully, every person we saw had no qualms about the fact that they were talking to medical students, and we were greeted by smiles and no condescension.
“This isn’t too bad.” My partner said, in between patients. “I think we’re doing alright.” I agreed. I was less anxious now and feeling a bit more invigorated, and more useful. We were looking through the notes of a patient and was about to click the call button when her status was changed to “Called to Consult room Yellow 11.” I paused. “That’s not us. Why has she been called to 11, we’re Consult Blue 12.”
“But I’ve got the notes.” What we knew the system to be was that if you intended to see the patient you would go into the drawer, pick up the patient notes and take it to your room. Therefore if someone else was to have the same intention, they’d see the missing notes and realise the patient was being seen to. Yet our patient had been called to another room…whilst we sat in ours holding her notes.
“What do we do? We can’t just knock, can we?” I grimaced. On the one hand we could knock, interrupt the consult to let the resident know that he just so happened to be seeing the patient without the notes which might give off an impression of incompetency, or we could wait and give it to him afterwards. We decided on the latter.
Standing outside the room, I felt mildly uncomfortable. We were feeling a bit (for a lack of a better word) shafted by this particular doctor. The registrars were kind and happy to listen to us report back, whereas this resident seemed to dislike our very presence, and had even made an offhand comment during ward rounds about us not needing to attend clinic even after the registrars had extended the invitation. First impressions count, and he did not make a good one.
The door opened, and the patient left. He swivelled around and looked at us.
“Um, sorry, we’ve just got her notes we were wondering if you wanted them.” He smiled (sort of). “Oh uh, I just did it electronically, so, I don’t really need them. But thanks, I suppose.” We gave them to him and returned to our room.
“I don’t like him.” My partner said. I agreed. His tone seemed slightly irritated that we had the audacity to come and give him the patient notes. “We’re not the ones who just ignored the system and did our own thing.” We had a bit of a mumble and grumble before we decided on our next patient.
And that one, is another story.
“…and unfortunately, Jacqueline, he is going to die.”
There was silence. The nurse rested a hand on Jacqueline’s back. Her face was blank, and she stared unblinkingly at the space above the consultant’s head.
Then at once, as if her control had completely snapped, her face crumpled. Her tears were silent. No-one moved. It was as if we were afraid that movement would intrude on her grief.
We were sitting at a round table, yet still there was a divide. The bedside nurse with the devastated wife on one side, and the small panel of doctors (plus my curious self) on the other-sympathetic but serious, a solemn row of doomsayers changing a family’s life forever.
The family meeting was brief, but heavy. We left her in the room alone (by request) and filed out. Once we were back in ICU however, as if the veil of mourning had been whipped off, the senior doctors began speaking earnestly, discussing details of the palliation and the patient’s family situation. The wife was estranged from her in-laws and wished for them to not be present whilst her husband’s support system was being switched off. This meant that the consultant was to inform the parents and sister of his palliation the following morning and allow them only the morning hours to say their goodbyes before the wife was to return in the afternoon.
“This is such a shitty situation,” the senior registrar was saying. “He’s dying.” The nursing manager nodded. “Exactly. The poor man is passing away yet his wife and family can’t set aside their differences for one day just so they can say goodbye together, it’s so sad.”
He sighed and shook his head. “You do see it happen though, sometimes. But I suppose mostly it’s when the patient’s been in here for a long time, and they’ve had time to come together. He only started deteriorating last Friday.”
Meanwhile the consultant turned to me. “See it’s actually really important that you specifically say the ‘d’ word-you’d be amazed to know how many people can walk away from a family meeting thinking something completely different if you don’t explicitly say it.” The junior registrar was nodding in agreement. “People can be really dense when they’re grieving, or they simply just stop listening. Don’t beat around the bush, you have to be straight and honest.” Having seen from my wide-eyed look that I definitely got the message, they began to discuss the patients that needed to be seen first in the afternoon ward rounds.
Thus began my short-lived stint in ICU. We were only rostered on for 1.5 days, my reasoning being that if I were an ICU doctor I probably would not want a clueless third year medical student running around after me for 5 days of the week. It was unfortunate for us but also fair enough-as a medical student in her first year of clinical placement I was probably as useful in ICU as a solar powered torch.
It did make me think however. I’d been warned by one of the registrars beforehand: “Just be aware, Priscilla that this can be very tough, and you just need to stay calm. It doesn’t really help if you start crying.” I had been expecting to feel completely overwhelmed, yet whilst I felt sympathy and compassion I didn’t feel such overflowing emotion. Perhaps it was because I was simply an observer and felt no personal connection. Or perhaps it was because he was not my patient, and I had only seen him once and only very briefly.
It made me wonder what it would be like if I knew the patient, and had made a connection. How would I handle it? Would I struggle? I am a curious mix of stoic and highly emotive. Sometimes I can be surprised by my own reactions. My desire to attend the family meeting was to not only observe firsthand the proceedings but to also challenge my mental strength. Could I deal with it? It appeared I could, but I was not completely convinced.
I suppose this is something I would find out in the future, and all I can do is be as ready for it as I can.
“He’s a bit grumpy this one, but we’ll see how he is.” It was just me and the Gen Med APT, as we had chosen to divide and conquer (the patient list). She was a wonderful woman and thanks to her and the rest of the team I had been thoroughly enjoying my rotation with the General Medicine department. I scurried after her (she was much taller than me) patient folder in my hand, as I had by now learnt to write proper patient progress notes without needing to question what needed to be included with every second sentence.
“Hello Frank (pseudonym), how are you?” the APT was a tall blonde woman, a British accent giving away her country of origin. The patient was in a single room with the windows covered. He had sat up as we’d come in, and after flicking a quick glance at me, he now looked at her expectantly. I positioned myself behind her against the wall in the standard furniture position.
“I’m good, I’m good, are you my doctor?” She told him yes, she was. “Oh good, good, I just don’t want one of them oriental doctors you know?” I stifled a snort. He was an old Caucasian man, and frankly I was not surprised. The APT turned to glance at me, eyes wide. I merely grinned.
“Uh well I’ll be your doctor while you’re here is that ok with you?” He waved his hand. “Yes, yes I just had an oriental doctor last time I was here and he was awful, I did not like him, so I just don’t want another oriental doctor this time.”
If only he’d said oriental doctor one more time in that sentence he might have just summoned one.
She shook her head and repeated that he would be seeing her, the interns and our consultant (all of whom thankfully for this fellow were not ‘oriental’) and that they would be doing their best to make his stay as comfortable as possible. She then moved on to the actual consult, and discussed his current issues. I paid attention, but having already had my opinion of this patient lowered by his outspokenly racist comments I was not inclined to participate any further. I wrote my notes, and nodded goodbye as well left.
The door closed behind us and we went back to the nurses’ station. “Oh my god, Priscilla, I am so sorry!” I laughed as the APT put her hand to her mouth, looking absolutely mortified. “I can’t believe he said that, you were right in the room, I’m so sorry you had to hear that!” I shook my head. “No it’s ok, I’m not offended! There are people like that everywhere.” She shook her hand, one hand on her hip. “I just can’t believe-let’s just fix him so we can get him out of here. That was so rude.” We carried on with our day, and I stored the moment away as a story to tell.
Racism is something that so many people experience, and as a Chinese-born Australian who grew up in an Italian/Greek populated area I have had my fair share of offhand comments and confrontations about my appearance and background. This experience (which occurred several months ago) however, was my first as a medical student and it gave me a glimpse into my future.
Recently there was a female Asian emergency physician who posted tweets about patients who had refused her care because of colour of her skin. What baffled me (and many others) was that because she had the audacity to be born a non-Caucasian woman she was refused the expertise and skills she had studied for years to develop. Imagine finding yourself hanging off a balcony and refusing the hand of your Indian next door neighbour simply because his ancestry did not trace back to Europe. All that tells me is that there are some people who would rather die, than accept the aid of someone whose skin colour is not akin to Dulux 15W (for those not much into renovations, that is the number code for the paint colour ‘Natural White’), which for a human whose basic instinct is to survive, seems a bit odd.
What’s hard, I’ve found, is trying to change the mind of a racist/sexist/homophobic (the list goes on) bigot. It is most definitely their loss and some other person’s gain. We’re told to treat each patient equally and indeed if that were the case, I would give that patient my best care. But if they refused it I doubt I’d waste my energy chasing after them. I would ensure someone else took over and not give them another iota of my attention.
Perhaps it’s better, but while I am an aspiring doctor, I am also human.
Maybe it’s just me, but the practice of medicine is/should be centred around patients. Why do I say this I see your mind box confusingly thinking? Well, one of the surgeons I had the pleasure of joining for consults forced me to remind myself of why I entered the profession.
When sent to shadow a doctor or specialist, students normally look to achieve two outcomes; one is clinically related and the other professional. The clinically related aspect of being with a mentor is the more self-explanatory. Students look to learn about the kind of work doctors engage in, the type of knowledge required to practice in that specific area and to reinforce their own knowledge in the specialty.
The professional related outcome is the more difficult to implement, describe or practice. As students, we look to observe the way mentors treat and interact with patients, as well as the manner in which they question, examine or acquire information. Much of this can be summarised by an often overused term; soft skills. This is the nuance that can be the difference between a non-compliant, aggressive patient response and a more smooth-sailing and beneficial consultation.
Why the whole charade about the details of shadowing? You’re now placed in prime position to understand the frustration of the following situation. While sitting in on these consults with my mentor, he had great clinical knowledge and really knew his stuff. However, his demeanour and overall mindset towards patients was quite concerning. He would finish what seemed like a normal consult to me, and come back to complain how rude the patient had been.
Seeing the confusion on my face, he would begin to elaborate, ‘Did you see how unappreciative they were? Unbelievable’ or ‘We really don’t get the respect we deserve, in other places the doctors word goes unquestioned, who do they think they are?’ or ‘They just don’t get it, they really don’t listen it’s so frustrating’. There are more along the same line, but I think you get the jist.
Here is poor old me, absolutely horrified that this guy in front of me is saying a whole lot of crap I can’t stomach to just ‘let slide’. I somehow managed to brush him off till his tirade was done and he’d had enough of either quizzing me about anatomy or being livid with the patient’s lack of respect.
I think it’s worthwhile to note that when it came to the way he treated me, it’s hard to believe but he was remarkably forthcoming and willing to assist. I still can’t quite work out why he opted for a passive-aggressive approach when with patients.
I think it goes without saying, despite this being quite a stereotypical case of what I’ve often heard called ‘arrogant doctor syndrome’ it is by far an exception to the rule. The vast majority of doctors don’t have a ‘chip on their shoulder’ and feel the need to constantly prove a point. Patients are their number one priority and come down on us as students, if we fail to keep that at the forefront of our minds. Some may see it as harsh, I see it as protecting the core of medicine and maintaining it’s noble purpose.
Despite his often lack of concern, I find there’s one of two ways you can think about what I’ve just explained. You can either look at it from an elitist point of view and begin to think about how you really do deserve to be treated better, or as a lesson for what not to do when you begin practicing yourself. The choice is yours
Learning is a lifelong process in which you encounter teachers and educators of all kinds. Some educators are etched into our memories, whether it be as a result of a pleasant experience or otherwise. I used to wonder why people would often differentiate between the term master and teacher. My thoughts were that a master was an exemplary form of teacher. Why create another word for the same thing, I left it at our willingness to be creative in the way we describe our surroundings. That was until a recent experience that contrasted two people of the same profession taught me otherwise.
During an anaesthetics rotation, I came across two educators with drastically different levels of competency in teaching. The first anaesthetist seemed to be quite competent, however as a teacher it was a different story. Initially I didn’t realise because I’d had no anaesthetics training prior. It was only until the next day that I met with ‘the master’ that I noticed the other was lacking.
The first experience was more a recount of what he did on a daily basis and operational matters that I wasn’t really privy to. Not to mention he lost me in the unnecessary detail for a student of my level and spoke to me for a whole of 10 minutes, if I’m being generous. In 2 hours of being in the operating room, he dedicated 10 minutes to teaching me what in the end was pretty useless information. In fact, the attending surgeon noticed my lack of activity and made a passing comment about ‘my thumbs working much harder than they should.’
Now, if I contrast this with my next anaesthetics training session, boy did my little brain get a shake up! Let me put it to you this way, I was in theatre for approximately 4 hours, in that time I think my mind rested for about 15 minutes in total and I wasn’t even complaining. I have never been so tired after a teaching session, but also so satisfied. It was a weird and wonderful journey in which he picked my brain and brought out archives I’d forgotten were even there. They had been covered in dust and he was able to wipe that thick layer off it and put it to good use. He went as far as taking me back to year 11 and 12 chemistry, which I thought would never be useful in real-life. In summary he took it back to principles.
In the image below, is a very good summary of the individual that I was grateful for having taught me:
When first learning anything, the foundations are the most important part of any subject as you will always refer back to them. This anaesthetist hammered that home. He said to me, ‘Stop, stop, stop! You keep throwing buzzwords at me, go back to first principles’ he repeated over and over. It took my thick head a little while to register, but when it did it was a light bulb moment. This is how any form of learning should be, the foundations are established and then built on.
The actual content of what was taught is not so important, the method of teaching is what I wanted to highlight. This kind of masterful teaching is available within every industry and even within specialisations. However, this level of engagement during a lesson is rare and not to be taken for granted. It takes a unique kind of teacher, a master.