Wednesday, July 27, 2016

Reflections on ophthalmology

It is with some frustration that I record these events for posterity.

At some point in the past, I had an unpleasant interaction with the ophthalmology team at my hospital. A junior ophthalmology registrar (CR) had completed a review of a patient under our care (L), providing on our computerised note taking system, a diagnosis of 'keratoconjunctivitis, likely secondary to keeping contact lenses in at night'. The next morning she performed another review on the patient, this time noting on paper notes that the patient's condition had deteriorated rapidly requiring admission. This is in the context of the patient remaining in the emergency department, which in our hospital, uses a computerised note taking system (i.e. no one documents their clinical interactions on paper). That morning, I reviewed the patient, taking note of the initial report provided by the ophthalmology team, on our computerised system and promptly discharged the patient.

What ensued was a whole drama of hysterics and finger pointing, from the junior registrar (CR), her fellow (will call her EE as I cannot remember her name but vaguely remember thinking she might be Eastern European) and apparently their boss who was head of ophthalmology. The various accusations levelled at my poor self, included the fact that we had ignored their advice to admit the patient and not read the note that had been made about this patient. When I explained that in the Emergency Department, patient notes were to be made on EMR (the computerised system), the ophthalmology fellow insisted repeatedly that as ED had technically admitted the patient under an inpatient team, the patient's notes should be made on paper. Perhaps then to keep her happy (and to ensure ophthalmology receives no blame whatsoever in relation to this man's care - not that any blame was being placed, except from their end), we should ignore the fact that every other part of this man's care had been documented in the computer system and that ophthalmology had been the only team to make paper notes, after themselves documenting their initial consult on EMR. For convenience, lets also ignore that I actually looked at this patient's physical folder and did not see any paper notes, God knows where ophthalmology decided to hide them.

We move forward a couple of weeks and another patient (AD) presents, looking rather unwell and then proceeds to complain of decreased visual acuity. During this episode I practically have to beg for an ophthalmology review (you tend to have to beg in this hospital) and they reluctantly agree to see the patient 'as a peace offering' the new registrar (a male) says.. and for a couple of days I am again left wondering why I have not heard from ophthalmology after being reassured they would see my patient. Eventually I find a consult note documented on EMR of all places, when this patient is well and truly an admitted patient, who is not even in the emergency department and is PHYSICALLY on the ward.

I dont understand how ophthalmology feels it is fair to consistently be so quick to blame their colleagues for any incidents involving ophthalmology matters when they are inconsistent in their documentation of consults. For starters, I have never had a team be so eager to point the finger (instead of work with colleagues to achieve better outcomes) instead of take responsibility and consider what they might do in themselves and on their end to achieve better outcomes for our patients.

Wednesday, June 15, 2016

Reflections

The number of times I have felt slighted because of my gender has been countless. The number of times my male (and female) counterparts have silenced me, or taken me less seriously, are many. People will not acknowledge a problem that exists, if it does not exist in their world. If they do not experience the slights because they are any combination of rich, white, or male. We have come to a point where people will accept the presence of 'White Privilege' as a concept, but they do not truly believe that their accomplishments are any easier to come by as a result. And they do not care. Why would they when the establishment is in their favour?

I have come to learn many things about being female. I have learnt that some times we play a role in our own destruction. We wait to be rescued, or to be handed a hall pass, because for many years we have not been expected to excel on our own merit. We wait for mentors, without realising that mentors pick people in whom they see something worthwhile. But I have also come to recognise the gross injustice that exists against women. I have learnt to stand up for your woman-kind, sometimes just because she is female. Someone has to do it, and if everyone helps one woman forward, then perhaps there will be enough of us at the top, to change the system. I have learnt to let go of some battles. You can choose to believe that a man you loved has used you, lied to you, left you, or you can hold on to the decent memories (I hope there were some) and move on with your life. No one is more hurt by your rumination than yourself. I have learnt to let go of as many grudges as I can, to laugh more, in the face of injustice, because bitterness will eat you up inside.

I have learnt to appreciate the few people, male or female, people you have met or whose words you have only read, people who inspire you, encourage you, and help you along the way. I am eager to succeed in spite of my femininity. I am resolved to make it there, a better person than I am now. I think if we were to dwell only in the secular, then this is the best goal, the most satisfying goal; to be a decent human being, to have bided our time in the pursuit of goals and to reside in the warm embrace of friends, family and relationships.

Friday, April 22, 2016

Pain and its sequelae

Week One of my annual leave is now over and I have two more weeks to go. Being on leave means that I have had more time to reflect on life, which is not always a good thing because more often than not I find myself quite disappointed and dissatisfied with the current state of things. Unfortunately, I cannot bring you more optimistic news at this point. Let's start with some positives. I decided to have my annual dental check up (because I remember having this done every year as a child - though it was freely provided by the government while I was in school). While at the check and clean, I made a spur of the moment decision to have my teeth whitened using a process called Zoom Whitening. It seemed fairly innocuous because I had seen it done at Westfield Bondi Junction and if you can do it in a shopping mall how bad can it be right? So wrong. Wait, this is supposed to be about the good stuff. The good stuff is that my teeth have been checked, and they remain, as always in good health. And I also have teeth that are a few shades whiter. The bad news is that the procedure hurt like hell. It was the worst pain I had ever felt and continued to worsen through the day. The dentist prescribed Panadeine Forte which wasn't doing anything for me so when I was at hospital (where I had gone for a tutorial before the pain got even worse and more frequent) I tried to get a script for Endone because I didn't want to just steal some from the ward (plus you probably can't steal Endone anyway as it is a regulated analgesic). I asked a friend thinking it wouldn't be a big deal but she gave me this look as if I was asking her to do something criminal so I reassured her it was fine and I would ask someone else. I asked another three people after that, who had one excuse or another, by which time I actually started to feel like a drug seeker! I then sat in the Emergency Department to wait to be seen by a doctor (who would probably know less medicine than me, but whatever, I was kinda desperate by that point) but close to 2 hours later no one had seen me and the nurses were refusing to give me analgesia. Mind you I was in tears, and I WORK at this hospital, but no one gives a shit about you evidently. So that realisation majorly sucked, that your colleagues, and worse, your friends, knew you were in pain, but couldn't be arsed about it and would simply leave you to suffer. I've given active IV drug users more analgesia than my friends/colleagues bothered to offer me that day. After about 2 hours passed, one kind soul (not the ED but a medical registrar friend) came to check on me and gave me a script for Endone so I could give myself some analgesia since the ED didn't give a shit. That evening when I was home, I received a text message from someone who I had considered a closer friend which said "its kinda imposing on others to write you a script... I am fairly sure you would not hv liked us to be pressing you with things either." This is from someone who hadn't bothered to check on me in the afternoon either. I replied saying that if people didn't want to write a script then fine, but at least arrange for me to get a tablet, which basically amounts to writing 'Endone PO 5mg' on a chart which the nurse then administers. I mean, you shouldn't leave a person to suffer and I assume that's what any rational doctor would do for a patient. To which she replied "I would suggest we put friendship aside where treatment and prescription is concern (sic)"!!

Anyway, the events of Wednesday have basically left me reflecting on my life again. Largely on how pointless it seems and how alone I am in all this. I find it demoralising and perhaps revealing of how lopsided my life is, that as a doctor (with most of my 'friends' being other doctors) I was unable to find someone who would bother to help in my time of need.

Tuesday, April 12, 2016

Reflections - On whether I am on the right path in life.

I have spent the past 3 months working with a particular resident at my hospital. Some times when you walk around the hospital it is like walking in a Marcs/Country Road/CUE showroom. Many of our doctors come from affluent backgrounds - whose fathers, and sometimes mothers are doctors, university chancellors, business-people, lawyers, politicians. I often wonder if they have ever had difficulties in life. If they know what it means to earn your keep, and to actually have to work for their 'achievements'. Many of them live at home, or in homes paid for by their wealthy and protective parents. Their biggest problems is probably divorce between those parents. They travel extensively, with numerous photos of their exotic exploits posted onto Facebook. They are athletic, intelligent and beautiful. They will often go on to marry other wealthy individuals, usually surgeons, cardiologists, lawyers. They have massive impractical heirlooms on their ring fingers. They are entitled. They will express their anger when their workload is heavy and they will expect you to share it with them, although you have previously paid your dues. They will throw you under a bus because they think their 'right' to an easy life has been infringed upon, and it makes them angry. Junior medical doctors these days are an impetuous lot, quick to anger, ready to answer back.

When I entered medicine, I did not think I would be joining the ranks of such wealthy, self-serving, high-'achieving' individuals. I had romantic notions of an apprenticeship, where you learn how to assess, diagnose and treat your patients, from senior clinicians. I thought I would become an expert on medical diseases, and that I would spend some time with patients, and some time with my books and research papers.

I look around me and people seem happy with the current state of affairs. It makes me wonder if the problem lies with me. But this is not what I intended. I wonder if that is to come, or if I should count my losses and find another path. As easy as life in Australia can be, I wonder if Australia is not the place for me.





Friday, January 22, 2016

The Patient

I once had a patient - he was young, by inpatient standards, but had lived a life of sex, booze and drugs, resulting in viral hepatitis and hepatocellular (liver) cancer. He came to our hospital because of abdominal pain and his doctors found that the cancer had spread to his lungs. He came to my attention one evening when I was asked to review him for severe pain. By the end of the evening, he had bled into his liver and this leaked (via the cancer) into his abdominal cavity. The surgical registrar came to see him that night. "Sir, you have bled into your abdominal cavity and there is nothing we can do about that okay?" the surgical registrar said gently.

The patient looked up at the registrar. "Not even a transplant?"
"No, that's not going to work."
"Am I going to die?"
"If you continue bleeding into the cavity. But we will ensure that you are not in pain."

We asked if there was anyone he would like us to call. There was no one he said. He was not in touch with the family he had. Later, he gave us the phone number of a friend. We left a message when no one came to the phone. We found out later that the number belonged to a homeless shelter.

He lived another 24 hours. The next evening, I was told that he was crying. He asked for more pain medication, so we kept our promise and kept him comfortable. He died that evening. Life can sometimes end abruptly - what do we leave behind? Who do we leave behind? And does it really matter?

Thursday, November 26, 2015

Reflections

Being at the airport always gives me pause to reflect on the life that goes on around me, on my trajectory and on the things I have gained or lost. This year, flying has taken on a further nuance - the loss of three Malaysian planes in 2014, the wars of the Middle East which have spread west - while I cannot put my life on hold, I am reminded of the frailty of life which makes reflection all the more pertinent.

When I was a child I would sit in front of the telly, eyes glued to the screen, impatient for the day my 'adventures' would begin. On my daily bike rides, it was almost as though if I cycled fast enough I could propel myself into the future where all the fun stuff would begin.

I am now well into that future. In the beginning, it all seemed so exciting; there were so many possibilities. I have often wondered why my day-to-day is not as thrilling now as I expected it to be. As it is, my life is so close to what I wanted as a child. To my mind that should make me happier than I am. It occurs to me that the future seemed shinier because back then there were so many alternative endings. On Monday I could pretend that I would one day be a financier living on Wall Street. On Tuesday I would be an aid worker with the UN. On Wednesday I would marry my favourite pop star. But the thing about life is that we have to choose a single path. We cannot be all those things. So being a doctor every day, while being a life I cannot fault, is one that is not as exciting as my little heart had wanted it to be.

I met someone last year, who had actually been all those things. He too went on an adventure when he was a teenager. Then became an economist in England, then a consultant with the UN. He met a girl, moved to Australia, became a doctor. His is the future I am heading to, except he's taken the long route, stopping along the way, at all those pit stops I conjured up many years ago. I suppose it is possible, but when you've been there and done that, you'll find yourself at 40 years of age.

I am plagued by the eternal question - what have we been given this life for? In all things, I strive to make the right choices. But usually the right choice requires us to have an end in mind. I do not know to what ends I am working. I could have the nicest things, the nicest home, the nicest clothes, the nicest friends. I could be in Sydney, London or New York. I could become a cardiologist one day. But somehow I feel that every milestone will be fleeting. Every twist and turn and manoeuvre, marked by the same question - is this what you wanted? What about this? Is this enough? I already know the answer.

Tuesday, June 30, 2015

Geriatrics

There are moments when I wonder if I have gotten it all wrong. There is music in my mind that cannot be expressed through medicine. Today I broke out in dance because the day to day in medicine bores me. Naturally, my boss was not too impressed. Is this really what I want to spend the rest of my life doing? But what else really, could I do? While I do not have an answer, sometimes I feel like I've really gotten it wrong. Yet, I doubt I would have enjoyed anything else. It leaves me hopeless. There is a music trapped inside that cannot be expressed. So it is tearing down the walls. There is a battle inside of me. Eating me inside. And that gnawing thought that I have really gotten it all wrong.