My Writings. My Thoughts.

Countdown to world domination

// January 23rd, 2015 // No Comments » // Uncategorized

The only reason for time is so that everything doesn’t happen at once.  Albert Einstein

One week until I finish at The Northern Hospital, a place that feels like home.  I have so many colleagues I will never work with again, and it makes me really sad when I think of it.

One week until I move home and be a full time Mum again, if only for a month.  It’s been four years since I have been at home full time, back when Mr A was only a baby and I was waiting to commence training again.

Two weeks until we say goodbye to Doncaster Church of Christ (February 8).  I have attended there since I was two, and Luke and I met and married there.  We have been members for most of our married life, and the kids have never known a different church family.

Three weeks until our house must be packed, into storage and cases, and we leave Australia.  We will be temporarily homeless.  Both Luke and I are feeling shaken by that, and the kids are on edge, although we are not discussing it out loud.  Our current house has been home for eleven years.  I remember bringing all our babies home to it, and my memories of their early years are tied up with the rooms and backyard.  Birthday parties, barbeques and that disastrous attempt to have MissZ and Mr J share a room.

We’ll spend a week on the way relaxing on a beach, and apologising to the kids for our crankiness while packing.

Four weeks until we arrive in Kathmandu (20 February).   We will explore the capital, but also surf the bureaucracy to get our visas and my medical registration organised.  Once that is done, we will attend a weekend conference of one of the mission agencies.

Five weeks until we arrive in Tansen, and I meet my new hospital.  And we find our new home.

The more one does and sees and feels, the more one is able to do, and the more genuine may be one’s appreciation of fundamental things like home, and love, and understanding companionship. Amelia Earhart.

Intern Arc

// January 21st, 2015 // No Comments » // Surgery, Uncategorized

In general surgery, I am privileged each year to witness the development of interns into competent, confident medical practitioners.  Interns are in their first year of work after medical school.  The year acts as a provisional training year - the final test before being awarded general registration.

The task of an intern is basically to be there and take time.  They are often the first doctor to assess a patient and they try to assemble some facts in a logical manner.  If the problem is straightforward, they might manage it - like writing up medications, changing painkillers, organising a follow up appointment etc.  They are also responsible for a lot of the brainless administrative work that requires a qualified doctor - documentation, organisation of scans and tests, chasing up results, and making referrals to other services.  In lots of ways, they are the personal assistant of the unit, because their job involves a lot or organisation, list keeping, tracking and chasing.

When interns start their job, they have some natural ability, but most of the tasks they do, they learn by experience.  Organising a CT quickly is a skill specific to the hospital, as well as the radiologists on that day, and the intern’s own organisational style.  Over twelve months, interns turn from unsure, nervous young doctors, into confident, capable residents (well, mostly).  It is probably the greatest learning year in any doctor’s career and often transforms them completely.  They are not magic at the end of their year, but they are infinitely better than an unformed medical student.

So last week our new interns started.  Our confident 12 month old interns, were replaced by newbies, who have a lot to learn.  In honour of all the wonderful interns I have worked with, I would like to share the differences between the new and the old.

  • Old interns can listen to a room full of consultants talking and walk out with ten tasks written in priority order.  New interns can’t tell which ones are consultants.
  • New interns call me Ms Cuthbertson.  Old interns have no memory of respecting me in that way.
  • New interns are scared to come to theatre with me because they worry about contaminating the sterile field.  Old interns are scared to come to theatre with me because they know I will ask them anatomy questions.
  • New interns triage tasks by time.  Old interns actually triage tasks.
  • New interns colour-code tasks to keep from missing important things.  Old interns can pick a deteriorating patient out of a scrawled task list at two am.
  • New interns ask their registrars to help them resite an IV cannula.  Old interns know which resident in the hospital has the current unbroken record for successful IV resites (and which is the butcher of B ward).  They never bother asking their registrars.
  • New interns need to be asked  to look up a result/bed number/previous operation note.  Old interns stop at three generations of family history and five years of old results, but only if they run out of time during the ward round.
  • New interns ask at the end of the round which ultrasounds they should organise first.  Old interns organised it before the round started, based on probabilities.
  • New interns give their mobile numbers to consultants who ask.  Old interns have learnt that all consultants are not created equal, and are reminded each time they are woken by a 2am control-freak SMS.
  • New interns call anaesthetists/radiologists/other registrars without all the answers.  Old interns laugh at their folly.
  • New interns have to run three laps of the hospital to get a serum rhubarb and a request signed in blood.  Old interns can get a CT approved in 30 words or less, while avoiding all known rage-trigger-phrases.
  • New interns think people will remember their name.  Old interns tell you their name each time they meet you.  And give you a feedback form with a photo and a brief description of all the impressive feats they performed in front of you.
  • New interns approach most staff members with an open mind.  Old interns have an internal list of people they plan to slap one day.
  • New interns think similar basic management rules apply to all patients, regardless of admitting service.  Old interns can navigate the minefield of IV fluid orders, suitability of non-steroidal administration, when to give medications and fast everyone for everything.
  • New interns think registrars and consultants are important to impress.  Old interns know senior ward nurses, radiologists and booking clerks are much more important.
  • New interns think they know where they are going and what their career will be like.  Old interns can tell you the one job, or one registrar, one consultant or one experience that completely affected their view of medicine, and changed their plans forever.
I want to welcome the new interns.  I’m so excited that I’m going to out of the country while you’re learning to be rockstars. And I would like to salute my past interns, who are now well past their awkward career phase, and starting to deal with interns of their own.  May the force be with you.

Lingering in Surgical Training

// January 15th, 2015 // 3 Comments » // Family

NB.  This article was originally published in Austin Health Surgical Trainees eZine “LAMINAS” November 2014.  Its now time to share it here.  The Zine is distributed to other trainees and surgeons in my hub.

When I was a third year resident I had a conversation with an orthopaedic surgeon about having children.  He assured me, “Someone will have found the easy way to combine a family and surgical training. Ask around - someone will have found the answer.”  During my surgical training, I have had three children, completed a PhD, stayed married, and I don’t think I found the easy answer.  At times, fitting life into surgical training feels like a thousand unfinished tasks. However, I am now a surgeon, and I finished training with a rich family, home and professional life.

Mr J listening hard

Mr J listening hard

It’s hard to describe having children without sounding like a greeting card, but they are simply the coolest thing I have ever produced.  Taking the time to have children and watch them grow has increased my maturity and given me perspective on work, which otherwise can consume my focus.  It’s hard to walk away from ill patients who need you, but it’s easier when you walk toward someone who also needs you. My children have also introduced me to other parents - people who live and work outside the health industry. All of these things have helped me develop as a human and a surgeon.  Plus, I met and get to live with three really excellent people.

My period of full time research was an amazing experience.  I never wanted to submit a “crap registrar project” so accepted the opportunity to perform full-time research.  During those years, I got to do what “real scientists” do - I prepared H+E and immunology slides and analysed them, I used a scanning electron microscope to take ultra-macro pictures of capillaries and I met a lot of white rats.  I learnt how to understand statistical analysis (properly this time) and I drank a lot of coffee. In practical terms, I did experiments and wrote papers, giving me a much better critical understanding of experimental design and quality of evidence.

However, by taking all these exciting opportunities, I lingered in training for longer than planned. I have taken ten years from AST1 until my fellowship, with an unaccredited year prior to that.  I have worked for multiple bosses who are my age or younger.  The consultant I am on call with today (as a fellow) was in medical school when I started surgical training. I know that if I had my time over, I might not choose to do all the things that I have.  I am disappointed that making the most of opportunities, professional and personal, needs to be a struggle, particularly when the detours I’ve taken have made me a better clinician.

It took me a long time to realise that I was born a surgeon.  I fell in love with general surgery as an intern when I realised we actually fix people, cure some, palliate others.  People thank us for what we do, more often than not.  Certainly the most magical branch of medicine.

MrA focussing on his goals

I started surgical training at Austin in 2004.  During my first year, I was approached to do a PhD.  It was an easy sell to my husband, who was frustrated by my registrar habit of living out of Melbourne.  I started my PhD in 2005, and threw myself into this completely foreign skill set.  I enjoyed the process of project planning, and setting my own goals, hours and responsibilities, under the supervision of two surgeons and a fantastic lab manager.  I was initially funded by the university department, and then received a surgeons scientist scholarship from the college.

Soon after starting my PhD, I turned 30.  We became pregnant soon after and had our first child in 2006, less than twelve months after leaving clinical training.  It was never my intention to do my PhD in order to have children.  But the way my life worked, it simply turned out that way.

Interrupting a university degree for maternity leave, or to study part time, is straightforward - a few forms and a letter of approval. I took maternity leave, and returned to my PhD part time.  I went on to have two more children, and took leave to look after each of them.  Each subsequent period of leave was more fun, because I had some time to lavish on my older children.  During times I was working/studying, the research world - being self-directed and results oriented, tolerated odd working hours and I was able to fit my responsibilities around formal child care.  It was almost like I was a “normal” person (as opposed to a surgical registrar, as we know, vastly abnormal).

However, I wasn’t just a university student during this time, but also a deferred trainee, and dependent on the College of Surgeons for my scholarship income. The College, at least at that time, seemed to view every episode of leave as a personal insult or trick.  There is still an “I did it, you need to do it” mentality that seems to be the default position if decisions become too difficult.  Or perhaps that’s just my memory.  I think the frustration and discrimination I experienced at times was due to the genuine difficulty of trying to reconcile maternity leave and interrupted training with the idea of “fairness” in training.  And I was trying to do things that hadn’t been tried before - take a scholarship part time, interrupt a scholarship midway, and extend total training time for legitimate reasons.  It seems so strange in retrospect that all the choices I made seemed to be unique or new requests, and every one needed some sort of council ruling.

I met some very supportive surgeons through my training (particularly at the Austin, the Victorian State Committee, and the Board in General Surgery).  A few surgeons seemed genuinely excited that I was finding rules that were poorly written or unfair, so they could be changed.  For example, at that stage you could interrupt a college scholarship for up to twelve months for a medical condition, but not for maternity leave.  By the time I finished my scholarship, that had been changed.  However, by trying to do things in a way that hadn’t been done before, I created a lot more work than if I had have progressed through training without detours.

I never tried to take a difficult path.  I was continually surprised that the choices I made caused so much trouble for others.  I’m proud of all my decisions, and I think I would take the same path again. love the life I have now, and the training I have had, and the family I have waiting for me at home. However, I’m not entirely sure that those choices were always the smart ones.

Any medical training is a series of compromises, which becomes more complicated when you have more things to care about.  Even a straightforward course through training causes conflict in relationships with partners, children and friends due to long hours, shift work, and interstate rotations.   I don’t believe there is a simple way to fit your life around training; or being a surgeon, or any other job, for that matter.  But I do believe there is a path of least dissatisfaction.  At each decision, I have tried to genuinely look after my most important priorities first.  And then I have struggled and scrambled and fought to add all of the other cool stuff I want in my life.  In that way, I’ve ended up with a family I love, amazing surgical training, a great job and very few regrets.

Waiting

// January 13th, 2015 // 1 Comment » // Nepal, Preparations

It is now only one month until we leave for Nepal, and we are still waiting.

This process has felt very slow at times, but suddenly the bus is starting to speed up.  We first approached UMN to volunteer in 2013, and there has been a process of application and approval, including background checks and psychological profiles.  Although our initial expression of interest was well-received, the process of approval was finalized only in December 2014.

On top of that, we have had logistics to work through.  Slowly, we have achieved and organised.  We have a house to move into when we return (currently rented out) and just before Christmas, I got a job appointment (in the same town).  The kids have said good bye to their school, knowing their next school will be in Tansen.

We are now just one month away from hopping on a plane, so we are full into the waiting phase.  You know those times when you “check out” before truly finishing a task?  That.

Cris is at the hospital in the summer “go slow” with reduced operating lists, and full strength registrar workforce, vying for cases.  So she’s at work, but with less responsibility.  The kids are halfway through the Fifty Year Storm of summer holidays - which is turning into two months of Minecraft and cricket.  Luke is wrangling summer holiday kids, struggling to find time for himself, and perpetually preparing the house to entice potential buyers.

We’re waiting.

At the same time, we’ve been energized and excited about our lives in Nepal.  About meeting the people, understanding Bollywood, learning Nepali cooking, and meeting board game geeks.

But until something changes here, we’re still waiting.

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