Sunday, January 30, 2011

"The next patient is....."

One day as a radiographer, I was taking some images of a patient that required radiological assessment. I saw the images once they were done and the patient was waiting in the change room, wondering whether what I was looking at and whether it was good news for them or bad news for their employer.

I wasn't sure this time round and decided to ask the radiologist on site, who was a hasty person and worked very efficiently.

The room was dark and all one could see was the endless list of patient referrals that the radiologist had to go through, lit dimly by the large monitors, which were unusually in the portrait position. Among the rare visual cues of the reporting room was the red glow of the dictaphone: the tool that a radiologist uses to dictate their findings verbally, which are then formalised by a typist who trains in medical terminology.

He realised I opened the door but that didn't stop him from continuing on.

"The next patient is Adam Smith with an x-ray of the left knee stop - Findings: there are degenerative changes on the anterior aspect of the tibia stop - joint capsule is intact and there is no evidence of effusion stop - if a cruciate rupture is suspected clinically, an MRI is recommended stop end report"


**Beep - File Sent**

"The next patient is Lucy Wong with a chest x-ray stop - Findings: the heart is not enlarged stop - there is no evidence of pulmonary oedema, consolidation or pleural effusion stop - the mediastinal contours outline normally stop - the lung fields are clear and there is no evidence of pulmonary fibrosis stop end report"


**Beep - File Sent**

He acted as though he didn't know why I was there but there were no illusions as to why I was. I needed his opinion and he didn't like the disruption. I asked him about the patient I had and he gave me his opinion just before starting off the next report with "The next patient is...." so I couldn't help myself and asked him:

"Why do you start every report with that? 'The next patient is...'? I mean they're endless aren't they? They're never going to stop presenting are they?"

He thought about what I said and as uncomfortable as he felt about what I had just said, realised that I regretted saying it because he was now annoyed.

"This is true."

Catching up

It's been so long since I've written here and well, it's a combination of reasons. The first is that I have been procrastinating; second is I don't really know what to write and the third is that I don't want to. But then again, there are always mixed feelings about all of them and one surpasses the rest, depending on which, I write, or not.

My girlfriend flew out to Thailand on Friday evening and she'll be gone for three weeks. Her 21st birthday was last weekend and I thought it went pretty well; she enjoyed herself at the venue but had a difficult time with her friends at the celebrations that followed. In fact, they didn't happen but that was simply unfortunate. Most of us had to work or had other personal commitments, which is to an extent, understandable. Essentially the most important people hung around that mattered most to her.

On her actual birthday, I spent the day packing to move into the accommodation across the street from the Hospital I would be training as a senior medical student for 2 years. So in that view, it was rather altruistic of her to spend the day helping me move. We borrowed my friend's Landcruiser and moved the most important of things and drove back home before I dropped her off and drove back the second time with my own car.

I've been rather stressed money-wise as I paid for most of her 21st arrangements and gifts are never cheap. She has offered to repay some of the expenditures, which I both welcome and resent welcoming. I need to save and given then I barely have anything to show financially show anyone that I have worked no less than 3 jobs for the past 4 years, it is necessary that I am able to retain most of the money I make especially since I have barely any financial assistance from anywhere else.

The first week of third year has started and gone right past. I'm already behind in the lectures I've had to watch and keep up with. I have been asked to give a preliminary lecture this Tuesday morning for a specialist in Radiology and senior lecturer in Anatomy; I have barely anything prepared and the gravity of the potential humiliation still hasn't hit me. I'm sure it will tomorrow at rounds when I realise how little time I have.

How fast time has moved is really eye-opening. It feels like yesterday we were sitting at Darling Harbour enjoying the fireworks of new year's eve. Now we're at the end of January and wheels are in motion that cannot be undone. Most of a medical student's spare time is utilised meticulously on work, important personal commitments, study and if possible, research. Above all that comes the patients and they, first and foremost, may present at any moment, any time and any where. So we may be in the middle of a personal commitment but must be vigilant when the needs arise of the general public, even if we are not qualified; we are still likely to be the most experienced there.



It never stops. I always have to tell people and definitely remind others like my girlfriend, that clinical science cannot be ignored, unless of course you have no moral obligations or commitments to it. It is definitely easy for people to tune out and 'enjoy life'. I have difficulty. My clinical mindset accompanies me everywhere. The worst is when I'm in a large shopping centre. I analyse everyone and for a while, I was doing it subconsciously until I realised that I was doing it without the person's consent. Ethically, that poses a problem; we are analysing people and not sharing our findings with them, which they as people or patients of other doctors, may or may not be aware of.

I still have difficulty stopping. So I'll be holding my girlfriend's hand and we'll be having ice cream romantically down the beachside until I see a person walking from a distance and realise that their gait (manner of walking) meets the criteria for stroke and then my mind dwells on whether the person knows about their pathology and the most likely causes in the community. Then I start verbalising it to my girlfriend, who at this point might as well be licking salt off a brick in the corner of a coal mine because that's how she feels with me right at that time.

I've been told that's one of the reasons I am at an increased risk of burning out, breaking down and completely falling apart. Burning out has happened before and well, I don't really know it's happening to me until it really happens. It's really specific but I can only define it personally right when it's happening; live and present within me and unfortunately, likely to be affecting those around me.

The problem is, there is always tomorrow's journey. Is it really a problem? I don't know.

Monday, January 24, 2011

Stage 3

It's been a busy week with organising a birthday party for my girlfriend and a thousand other things at the same time. God, there's so much to think about and I say that honestly without wondering about what third year would be like and how close it is. 

I often have trouble remembering my thoughts and feelings. Some good ideas spring to mind when I'm driving since most of it is long distance (i.e. from one part of Sydney to another) and by the time I get to my destination, I end up forgetting. So then I'm stuck with being clammed up in front of a computer like I am now, wondering what to write and filling in the phases of hesitance with broad, general sentence so to seem as though everything is generalised. 

It's late and there is a subtle breeze gently making its way to me from the window on the other end of my new room, across the street from the hospital to which I've been assigned. We start full time clinical rotations at 0800 tomorrow and I spent most of today moving out of home. 

So it was not until I had finally settled in properly that I realised that I was going to be here for a considerable length of time. I was going through my study drawer that I brought over from home and when I opened the middle drawer, there it was: my Littmann Cardiology III black edition stethoscope. Suddenly, I felt weak at the knees as I held it up and realised that finally, I was close to achieving my goals and the fear of clinical practice was only but a few short hours away. The suspense filled me with excitement but nervousness and a tinge of anxiety. 

It doesn't take someone to be a specialist to understand how busy you keep yourself.

My tutor from last year said that to me. Apparently I get emotional and it is very apparent. One thing that really bothered me last year was the lack of respect my colleagues had for specialists and their time to teach, despite the fact it was pro bono teaching. Just last week, on the first day of orientation at our hospital, one of my friends was already complaining about how the day has been dragging on for a long time and how she wanted to go home really quickly. "Oh God how I wish the day would go by quicker".

This snaps my temper. What are you doing here if all you want to do is be at home? Why don't you just stay there, do nothing and that way, you'll have nothing to complain about? Notice how those questions are not in italic font. Well the reason behind that is to remind me to keep them as thoughts and not as verbalised thoughts. 

I have a difficult minefield to negotiate this year and I must say, most of these mines could bear my name on them before they blow up. There is a lot to lose and there is even more to suffer. Hopefully by me and not by the patients I am assigned. 

Stage 3 - here I come.

Friday, January 7, 2011

Poor Compliance

It's already been several days since I wrote on this blog and I remember promising myself that I would write daily. It's so easy to walk away from personal commitments and I seriously do consider this a personal commitment. I'm writing for release, for freedom and I don't make the time for it. Why?

Similar concept to why people who provide advice always have difficulty accepting it, some to the point where they cannot accept it. I do accept advice, though the issue is that I have trouble sticking to routine. It's a reflection of poor compliance; poor discipline.

My girlfriend's 21st birthday is coming up soon and I've been more stressed than excited. I sigh hoping that it will be over because I am just afraid that things won't turn out the way she expects and she may have a very hard time with it. I'm having both financial and personal difficulty finding a gift - I know she would expect something special and sentimental. Believe me, I do want to get her such things with beautiful brands and amazing gold, silver or leather. Unfortunately, such things cost astronomical amounts of money. Not that I'm saying they're not worth it; it's just that I don't think I can justify spending such amounts as a student that is trying to save not only to survive by myself this year and the next, but also focus on my future - save for my future.

But I've already committed to helping her with paying for the venue and the bar tab as well as helping her with her trip to Thailand. This is in addition to a dinner I promised I would take her to, which means a very respectable restaurant. On top of this, I am supposed to get her something as well. So all of this will cost in the thousands, not the hundreds.

During my intense year of full-time work, I managed to save a fair amount of money for my future and definitely the future between my girlfriend and I. And when I say full-time, I don't mean 35 hours a week. When it struck January 23, 2009; it was my girlfriend's birthday and I thought I'd surprise her by taking her to an amazing restaurant with my best friend's car. He had a BMW 735i, which is a limousine and near impossible to find amongst people my age. So I borrowed his car and gave him my car as security. Not more than 45 minutes later, he calls me telling me that he has crashed it on a bridge and the front half of the car is completely destroyed: the tyres, the radiator, bonnet, doors. The only thing that was solid was the windshield. Being my best friend at the time, he promised to get it fixed and instead of giving it to a well-known panel beater (because he knew about cars and their repairs well), he gave it to some person who had excruciating back pain and had immense difficulty walking let alone fixing a car.

All I wanted was my car to be fixed before medicine started - I didn't want to have to concern myself with anything except medicine. But that, of course, didn't happen and I had to get my cousin involved to threaten him to pay us. Amazingly, 2 months in telling me he would pay or organise someone to buy it, my cousin convinced him in 24 hours. See that poor panel beater with the back pain managed to fix it but because my friend kept rushing him, he didn't do a good job at all and blamed my friend. So I wasn't in any mood to accept my previously immaculate car as a putt putt piece of shit. Don't get me wrong - it wasn't cosmetics that concerned me; when the gears didn't change properly or the transmission couldn't be changed to Park, that was a serious problem. My cousin threatened him and he paid me out for my car.

So now I was carless and had sixteen thousand dollars to go and look for a car. I had to get something quickly because medicine had started and I just wanted to forget about all of this and breathe. Unfortunately that didn't happen either. I bought a Volvo and the very day I drove out with it, I had issues and that is NOT an exaggeration. The spark plug cables failed the very day I drove out with it so only 1 or 2 of the pistons weren't working and the car felt like it was a tractor, shaking everywhere. I had nothing but headaches for 18 months with that car, spending well over seven thousand dollars fixing this and that, until nobody in my family could take it anymore. I had to get something else and now, luckily, with most of my savings, I was able to purchase another car and get rid of that monstrosity Volvo calls a car.

That explains why I hesitate to spend money the way I used to, even if it is for my girlfriend. I lost all my savings to gambling, bills (some mine and some not) and cars; the remaining expenditures I wouldn't call 'losses'.

So back to my girlfriend's birthday - I'm shitting bricks because I haven't much savings and whatever money I've saved so far in this holiday period is reserved for my survival this year and next for my clinical training (i.e. rent, food, petrol, etc). Yet, I have promised so much and I'm afraid of showing up empty handed, cancelling something. She reassures me that she will pay back the contributions I made to her birthday party venue, but what dignity do I have left if I accept that?

Besides the fever I have right now, I've got work over the next four days and my parents are in Melbourne. I sincerely hope they are having a good time. I have to develop another few things by this Tuesday when I meet the radiologists regarding the summer scholarship I'm enrolled in.

It's amazing what comes out of me when I sit down. I didn't even think I would write about the things I just did. The reality is that I feel that everybody has the right to enquire on a statement I made.

"You work so much, how come you don't have money?"

"Why do you need to save?"

"Why do you need to work so much?"

My response is "Why not?" - what makes people believe that saving is so bloody easy? It's one of the most difficult things to do because the companies that lend have made it so darn easy to spend anywhere, anytime. You can shop online, buy over the phone, take large sums of loans with the swipe of a card and with the swift signature of a pen in your hand.

I better get some sleep. I hope I can write more over the weekend.

"Complying..."

Monday, January 3, 2011

The Path to Medicine.

Ever since I was young, I found satisfaction in helping those around me, at whatever cost. The only problem I had as I progressed into adult life, is that people kept thinking I had a hidden agenda. My help was regarded as atypical and beyond the societal norm. So people, especially those of the opposite gender, started believing that I was going to ask for something in return or ask for a relationship in return for help. These thoughts always disgusted me because I just wanted to help.

The only way I could validate my help without expectation of returns in any manner or form was to study medicine. That's also another way of saying that I'm terrible with business, economics and any form of commerce except starting a savings account with some sort of interest rate that gives me returns enough to call someone who cares. Hah!

My lack of business or exploitable behaviour meant that medicine was the right choice. I could practice without having to worry about currency transactions before, during or after a consultation. Thank God this is the case in Australia - we are very lucky to live in such a beautiful country despite everything we complain about.

Medicine it was - from the age of 5, I was sure. As time flew by, my interest in topics of science, namely physics and the language of which it is spoken: mathematics had taken-off. I am a person that is easily influenced by movies and I quickly develop role models based on my deficiencies and qualities I envy in these movie characters. One of these movies, introduced to me in year 12 was A Beautiful Mind. At that time I was studying 4 unit mathematics; the largest challenge that life threw at me at that time. At my high school, one could only attempt it by invitation and I was happy to have received one out of sixteen. I was one of four wogs in a class-room of Asians, the majority of which English was a second language.

Back then, at the beginning of year 12, I was dating a Russian girl and at that time, she was the girl of my dreams. I was obsessed and couldn't get enough of her. The problem was that she had spent her summer holidays in Russia with her family and we couldn't really speak that much. When she got back and we saw each other; two weeks later it was clear that she was dating someone else at the same time and I was devastated. I cried my eyes out when she broke up with me that day and so much that my father also cried.

My family wasn't really pro-advice. When I opened up to my parents, the answers would be quick and responsive, as if to say "you should've thought of this long before you spoke to me." The worst of it was when their responses were so hasty that it felt dismissive and to me, I still believe that it was. Unfortunately that's one of my weaknesses now: I usually blurt out quick solutions without thinking about the ramifications of my suggestions.

So I would study mathematics whole-heartedly because I could get lost in the symbology that represented so much. A few short lines was packed with information that would take quite a bit of time explaining in English. A Beautiful Mind really helped me appreciate it as well.

Half way through year 12 was the first time I considered medicine seriously because I never thought I was cut out for it despite my passion to serve. I applied to UNSW, which required us to sit the UMAT, a pathetic test that was worth less than the paper it was printed on and also an interview, which I didn't make. So I had officially given up on studying medicine and reminded myself that I could serve others in healthcare without the title of doctor. The title never mattered, it was simply my opinion that in order to serve, one had to study medicine and become a doctor in society's perspective to be entrusted with the responsibility of care. Since my mother was a nurse in Turkey, she made me appreciate their importance well. I started thinking about that for a whole 2-3 hours until she talked me out of it. "You're not good with shit, blood or vomit." She was right. It was time to reconsider.

Radiation Therapy was the next logical choice. It contained a fair bit of physics to learn and to use in order to deliver radiation to patients with cancer. The radiation had to be delivered in a way that allowed the tumour to receive the maximum dose and the surrounding healthy tissue the minimum. I was quite interested and thought that the physics involved would be fantastic. However, my father had a few things to say about it. One of which that I'd be interacting with patients, most of which surgery is not an option or has failed. Also, it is offered to patients as a form of palliative care. My father was concerned about the emotional burden this would bestow upon me and insisted that I choose something less sensitive. I don't know if it was because I was young or because he was afraid for me. Or because he is afraid of dying himself.

The only other options were Nuclear Medicine technology or Diagnostic Radiography. Nuclear medicine of course being physiological investigations and radiography being more so anatomical, despite the growing field of functional MRI (which would barely be taught at undergraduate level anyway). So the answer was diagnostic radiography. I was quite content with radiography in first year - focussing on the subjects I enjoyed and ignoring subjects I found irrelevant or that were poorly taught. So I ended up with an almost binary academic transcript: distinctions for all the things I enjoyed and passes for all the things that were poorly taught or that I had no interest in.

As much as I enjoyed the radiography, I really did feel that our abilities to help others were limited substantially by first, the law and second, by our senior staff because of their concerns for the law. Plus it was a common reputation that radiographers had - "I care enough to help but not enough to do more". That's the crowd I was in and I felt uneasy about such a crowd. I wanted to give it my best. Humanity needs us to do more than what we're capable of doing and I believed that with everything in me. Giving it my best with the highest standards was the bare minimum.

So the time came to re-visit medicine at UNSW not as an candidate from high school, but from a transfer perspective. One rainy afternoon, I parked behind UNSW and found myself walking around the faculty of medicine looking for the administration staff. My path led me to this incredibly small, modest building, with glass doors. It was quiet and there was classical music playing. It seemed I was in the right place.

It was there my decision was made. I spoke to one of the office staff and he asked me the relevant questions.

"What was your UAI?"

"98.10"

"Good. What was your UMAT score?"

"Don't ask."

"Ok. Well you'll need to sit that again. What year are you in your course now?"

"Second year."

"Well how many years is it?"

"Three."

"You should really think about doing graduate medicine at Sydney."

"What's graduate entry?"

"It's when you finish you're degree and enrol into the medical program. If you transferred to UNSW next year, you'd throw out your 2 years in radiography because we have no exemptions. Then you'd have to do 6 years of medical school. So that takes 8 years all up. But if you finish in 3 years and do medicine at Sydney, which is 4 years, you'll be done in 7."

"How do I find out more about this?"

"Go to Sydney University website."

It was very interesting. UNSW staff convincing me to go to Sydney - what an act of selflessness! I'm sure it made no difference to him, but I know for sure that he spent a few more moments with me and that changed the course of my life. It's these little things people do, that perhaps don't seem much, but can have such gravity, such power. Amazing.

I had to sit the GAMSAT, which is like the graduate version of the UMAT as the 'G' implies. However, I decided to sit this in my third year in preparation for the year after. What's interesting is I decided to sit it without studying at all for it and I still managed to pass it, not enough to get me an interview. That's what allowed me to graduate from radiography and work full time for a year - something I will never regret doing. For it was then I understood what hard work really was. The year I was denied starting my journey in medicine was the year I embarked on become a fully accredited radiography plus more.

I decided to keep my job as a high school tutor and despite my heavy workload, I persisted with the list of students that I had, which had steadily risen from about three a week to fifteen a week. Each student was seen individually for an hour once a week or more. That was about 15 hours a week. Most days in radiography, due to the dynamics of the private practice (i.e. nobody wanting to work in x-ray instead opting for CT or more glorified imaging modalities) I was forced to work from 8am to 6pm most days. Not forced by the practice; forced by myself. There were patients that needed help and since nobody else was going to do it because they were "better then x-ray" I was left with doing it myself and sometimes with some help from friends. I also decided to persist with my job at Harvey Norman as a underwriter in finance, which was about 15 hours a week as well. On average I worked about 80 hours a week. Then I established a very good relationship with my lecturer in radiography who was the undergraduate director of the program, who offered me work in marking assignments, which I did at home when I wasn't working at other places. That turned into tutoring at practical sessions in imaging, which further turned into lecturing. Not that often, but preparing a lecture takes a hell of a lot of time. That year was when I knew that teaching was the most effective way of helping others. Teaching future healthcare professionals and sharing moral principles really meant that they too could practice well, deliver better care and definitely be more proactive. I'm not sure how successful I have been with influencing people in this context, but I can sigh with relief knowing I tried the best I could in the time given to me in a lecture theatre.

Here I am now. Ready to start my third year in the graduate medical program. It will still take me all up 8 years because I didn't get into medicine straight through from radiography - I worked full time for a year as a radiographer to become accredited and now I can work while I study as a healthcare professional. That year was a very sound investment; not financially. But clinically. My confidence with people has spiked and I feel so comfortable talking to patients and delivering care as a medical student couldn't feel more rewarding.

Saturday, January 1, 2011

1.11.11

As the title implies, this is the first of many days.

I've always tried to keep a journal on paper and even though I started with passion writing many pages, I found myself rushing through thoughts and trying my utmost not to write anything that would allow people to judge me should they find my work. However, I've nailed those problems here by blogging for the first time in my life. I can type quickly and can do it anywhere without wondering who has located a subtle leather book in my bag or on the communal desk. It's also clear that by writing online here, anyone can read what I'm thinking, so it's more like overcoming a fear.

So here I am, at work and it's 1007hrs.

2010 was an intense year for me. It was the 2nd year of medical school filled with chaos, knowledge and constant facts that were solid, controversial or both depending on who you spoke to. In between the lectures, clinical tutorials and anatomy theme sessions, I worked as a high school tutor in mathematics, lectured the masters program in diagnostic imaging and also started giving some medical based lectures at the undergraduate level. Then there was the x-ray and CT practising as well, so I had to keep that going. After all that came my parents to see and interact with and last, but definitely not least, my girlfriend.

It's a year that I am relieved to leave behind me. There have been some difficult times to say the least and I'm not exactly sure listing them would be for my benefit or to spark the interest of people around me; so for now, I will leave them tucked away in my thoughts and pulled them out from time to time.

After work, I was going to attend a gathering my friend Brad organised at his place. Nick and I were invited and we have done these sorts of gatherings a few times. I really enjoy them; we cook our steaks and share a few beers over some shits and giggles, then crack open a few bottles of respectable scotch to taste. All that combined with some nice Biltong (not sure of the spelling), which is a type of cured meat.

However I'm contemplating on missing it because of the sheer workload that I have to do at home. Just before our exams started at the end of November in 2010, I won a Summer Research Scholarship looking at how radiology is taught in the medical program given my background and to conduct some quantifiable research to publish so to get the faculty's attention. I haven't started on that as yet and I've still got auditing I have to do as well as the questions for the neuroanatomy online quiz by next week. So perhaps it's best I stay home and sort these out bit by bit.

At the same time I feel that my girlfriend isn't quite happy for me to go because they are her friends. In other words, guilt creeps up on me.

Hopefully I can hold true to my word and write in this blog every day.