Term 3 almost done

Yay!

Three-quarters of the way through internship.

I've been very busy indeed.

Term 3 (we do 4 terms a year here) was surgical for me and I was lucky and got ENT (ears, nose, throat).

We work 6:30am to about 6pm plus some occasional weekend shifts. It's a lot and I've become burned out at times and needed a day off here and there. Luckily the admin people are very supportive if you let them know what's going on and just take a day here and there and otherwise keep pushing through.

I took a Gen Med assessment of my WBA and completely bombed it. It was not prepared to the standard that was expected of me and I really just didn't have the time to prepare adequately. It really threw me and I wasn't sure I could manage internship, having small children, AND the WBA so I took a small break from it wiht the support of the hospital.

I have decided to attempt my surgery assessments though as I've had a full surgery term and think I can manage it. I only have a week to prepare which is difficult with this schedule but I've decided to sacrifice the next week to make it happen, hence I'm still at the hospital library now after work and though I'd take the opportunity to quickly update here.

I've to do:

1. Prepare three Case Based Discussions and present one
2. Physical exam for head and neck
3. Patient counselling

I think I hit my low a couple of weeks ago and cracked. Strange thing is I came back to life and am more relaxed at work; its almost as if I had an epiphany but what has actually happened is I don't care as much as I did before. Although that sounds bad, its probably what I needed to do. I was too uptight about everything and not relaxed. I still do care about my patients but I don't care as much about whether the other doctors are judging me, or if I don't know as much as everyone else, or I'm not as good as my peers, or what would happen if I missed something (theres safety nets for that and I don't have to protect all the patients by myself).

Well that is all I have to report really. I still miss ambulance but not as much as before. I started to feel more like a doctor than a paramedic a few weeks ago finally.

Just about half-way through internship

Oh, wow, I'm almost half-way.

I've been THAT busy that I haven't even had time to blog. I have no idea whats happening in the world either.

So I completed 8 weeks of Gen Med which means I have to do two more to meet the minimum requirements as set by the Medical Board of Australia. I've just done 11 weeks of Emergency Medicine (minimum 8) and have two more weeks of this term then I'm half-way through internship! That is if you include the first 5 weeks which I wasn't technically officially working (see previous posts) as my "leave". (I'll take paid leave after Jan 14th 2020 so I can finish internship on time).

I have learned  A LOT. It has been really difficult. I've struggled a lot as well. There's nothing quite like feeling stupid all day, every day, and working you butt off to only meet minimum requirements! I'm not sure I'm even meeting "average".

Luckily for me though, my Home life is amazing. We have bough the most beautiful house that I'm totally in love with and is like a "dream house". The kids and husband are great too and living in this area there is so much to do and so much beautiful nature that I'm so happy when I'm not at work.

Anyway, I have to only write a short post as I've come into work early to sit in the library and prepare for a WBA assessment today. I have passed the first 3/3. I need to pass 16/20 in total to get my full "general" medical practitioner registration.

The completely terrifying life of a new intern medical officer

Oh..wow.

So, anyway there was a delay with getting my medical practitioner registration through. It got submitted lat due to a late job offer and I had to wait for it to properly start work.

I did a couple of observing shifts and realised this was actually going to be hard.

Then, tonight, this is my second proper shift. And it's a night shift. And the nurses are asking me stuff I don't really know and its terrifying.

I feel like the stupidest intern to ever walk through the front doors of this hospital. I may well be, or maybe I'm not and this is what most interns feel like, I'm not sure.

My goal at the moment is to survive internship. It's difficult because I don't want anyone to find out I know nothing but you have to ask for clarification and help to do your job safely. Simple decisions I have no problem making in class are causing paralysis by analysis in reality. Simply prescribing paracetamol or eye drops has me second-guessing absolutely everything.

I am SO thankful for my paramedic background. I honestly don't know if I could do this without it given I did not attend the local medical school like every single other intern here except for 3 others. I feel like if I went to a "normal" medical school then I would know I was up to scratch by doing the same course with everyone else.

Sitting and passing gate AMC was mildly reassuring at the time but that has all gone out the window!

As I write this my shift is progressing and with every repeat of the same condition/management/prescription my confidence goes up about 1%. I suppose by the end of the year that will get my confidence from the current 0% to above 50%.

My calls tonight so far have been:

1. Two spiked fevers. One already had blood cultures and urine analysis, and the other did not so I ordered them for him. Both patients already had CXR. Otherwise observing stable.

2. Three patients who can't sleep. Temazepam for all, one with a reduced dose due to poor renal function and concurrent use of opioids, one phone order.

3. Patient wanting to self-discharge. Was able to talk to her about it and convince her the hospital is the best place for her right now,

4. Rechart regular medications.

5. Rechart insulin chart.

6. One spiked fever patient became hypotensive. Needed med reg review. Requested albumin (blood transfusion protocol required).

7. Patient with runs of VT and sleep apnoea with decreasing haemoglobin. Called in pathology service for urgent bloods. Another med reg review.

8. One maintenance fluids order.

9. Two discharge summaries completed (poorly but whatever)

10. New intake list updated.

11. Ward list updated.

And its not even over yet! It's 4:22am and I'm on until 9am. Wish me luck!

Additt:

It is now the next day.

At 0422h I had no idea of the shit-show that was to come roughly between the hours of 6am and 9am.

6am - I try to update the ward list and new admissions list for the 8am handover as this is one of my primary roles and to do this I need to physically go into the ED to confirm patients and bed numbers. I get asked by my reg (who has been dodging helping me all night) to help him admit a patient who as it turns out is quite confused and takes a life time to answer my questions. Oh and I've never working in ED before so I don't know where all the correct forms are. I fail to get anywhere.

MET call goes off and its part of my role to attend every MET call. Severely hypotensive man with confusion, and as it turns out is having an Addisonian crisis.

Phone call from ward for one of the patient's I'm covering for the night who I have not yet met whose haemoglobin has come back dangerously low at 65. I commence ordering packed red blood cells for transfusion, a process that require a registrar to co-sign.

Another MET call, this time surgery, Is is APO, is it asthma? Whatever the patient is sick, One med reg still at the last MET call and now the other stuck wiht this one, I get called back down to the low haemoglobin patient who is likely bleeding out into his abdomen. I hadn't finished filling out the paperwork for the transfusion. I know this because I can't do it without a reg. Nurses ask me questions about units and speed of transfusions meanwhile I don't even know how to order the bags of RBCs.

By this time the day shift nurses come on and they've started to pick up on things that need doing: this medication doesn't have the total 24 hours dose, this medication is illegible can you please re-write it, this patient is hyperglycaemic, this patient needs a daily prednisone dose. All while I'm trying to handle a blood transfusion on my own. And geez I thought I had all 28 patients completely covered at 4am.

I call for help. My reg instructs me to call the consultant. I don't want to. Its' early on a Sunday morning and it doesn't feel right. I mean, you're only supposed to call them if you absolutely have to.  The consultant as kind as he can be and informs me I should've called the specialist registrar. I regret the phone call and call the specialist registrar who isn't too bad but I don't leave the conversation feeling very good about myself. This is bullshit.

All the while, one of my sole purposes of the shift, to have the current new patient admission list ready for handover, has not been done. It's a gapping hole. Day shift do not care that all the new patients were admitted at the exactly the same time a patient was bleeding out and others were stuck in MET calls. Great. I look like a failure. Great.

The intern taking over from me is lovely but I can't help but feel like a failure. I leave him two simple tasks to do which were sprung on me by the nurses last minute, but I feel it is reasonable. I hope he agrees. Next time he tells me to call him to come in early to help. He is so kind but I leave feeling completely inadequate.

I can only hope that this is what most new interns describe as the steep learning curve they experience in the first few months of the job. And I can only hope that it will get easier but I found last night really challenging and I'm back for more tonight.

First week as a doctor

Oh wow my first week is done.

It was mostly powerpoint-style orientation. You know, the boring stuff such as fire/emergency procedures and how to fill out your timesheet.

Everyone has been so friendly and welcoming so far. I am sure there will be moments ahead of me when people are not so kind, but so far I am enjoying it.

I am having a lot of trouble sleeping though as my mind tends to worry about the calls I may have or not knowing something I clearly should know.

Just a short post as I am flat-out juggling my new job (so so busy) and being a mum as well.