Thursday, 24 November 2011

Tips for Junior Doctors part 7: sometimes medicine is really, really easy.

Sometimes medicine is really easy. 

Exhibit 1:

60-year-old lady with ridiculously long medical history and a 3-page drug list (requiring 15 minutes to write prescriptions for upon admission) and UTI is somnolent; family is really worried. 'She's like this all the time now'. 

A glass of lemonade fixed her hypoglycaemia.

Exhibit  2:
50-year-old male with chest pain, nausea, vomiting and a heart rate of down to 36/min. 

Asking the family to keep talking to him persistently raised the heart rate to a safer 45-60/min, while I waited for my labs to return. 

Explaining to him that he is most likely suffering from good old stress, but we need to do a stress test (har..har..har..) and repeat some bloods just to make sure, made him a lot better right before my eyes. He literally stopped sweating and put his (still empty) puke bowl away. Heart rate 60. 

Sunday, 20 November 2011

Such a clean fellow!

Spent my Friday afternoon in Emergencies. I love Emergencies; have I mentioned that? Oh, yes, I have. A few times. My Patient Of The Day wasn't an Emergencies patient, due to a viral outbreak all 112-calls have been forwarded to another hospital and we had very few medical emergencies. I saw a guy with probably a large psychological component in his complaints on the surgical ward instead.

And I watched the hassle-bassle of the Emergency Department going on. There were a few interesting patients for the surgeons. One of them presented with a shampoo bottle up their bum. Bottom-side first, of course. Not only had he managed to insert a normal-sized shampoo bottle into his anus, he walked around with it inside of him for a few days before working up the nerve to go to Emergencies. It showed somewhere in the middle of his abdomen on X-ray. I always thought the colon propulsion went toward the exit... I don't know the end of the story though, I do know that he wound up in the OR.

Gentlemen, should the need arise to insert a bottle into your anus, please, attach a string first so you can pull it out if it 'slips in too far!'

Monday, 14 November 2011

The Return of the Blonde Doctor.

Meanwhile I'm half getting somewhere when it comes to beating my black dog. I'm all drugged up and ready to go.

OK, not really, I'm on the lowest possible dose but I'm having a blast with the side effects.

And really, I feel like there's some sort of taboo on mental health issues in doctors. But really, we're people too, and anything that can happen to you can happen to us. The depression hit me hard, and the resulting relapse into anorexia hit me harder. I am fighting.

And right now, I'm struggling to regain my career, to return to work, to make it work. I've been given the green light to start seeing patients again, limited to one a day three days a week. I see them in the emergency department, the only place where I can do this.

And today was my first day. I was nervous. I went to work at around noon, after having some trouble collecting my medical gear. I was not as much nervous about seeing a patient, I was nervous about colleagues and consultants.

So I got to the hospital, and faced my first challenge: how to get hold of a white coat. I didn't know the autovallet doesn't work between 10AM and 1PM, there's no sign to enlighten me either. It was somewhere betwee 12:15 and 12:30, and I wasn't entirely hoping to sit there and wait, so I went around to the linen room. A very cross lady handed me a coat, in the same size I wore before, and I'm drowning in it now.

I don't know why hospitals always insist on letting us wear ugly coats.

Went to the emergency department. Welcomed by colleagues. Stared at by a medical student. Not-sure-what'ed by nurses. (But I brought them home-baked biscuits, we had too many). One colleague told me 'well, we have dyspnoea, dyspnoe and dyspnoe, which do you prefer?'
Eh, I'll see the one with dyspnoea...
New nurse handed chart to dr Olderguy, Dr Olderguy handed it to me 'It's dr Blondie's patient'.

Old-ish lady with heart failure. Gave her some lasix and sent her to CCU.
On my way out:
Patient: 'Dr HerGP said I have ladies' legs'
Daughter: 'Well, old ladies' legs then, because mine don't look like that'.

And then, actually, I was tired. Need to train that brain a bit.

I have discovered the use of podcasts though. As I'm (more or less compulsively) walking around, I can now study at the same time!

Thursday, 27 October 2011

Sometimes, you do get credit...

Nightshift, somewhere early AM. Busy night shift, I might add.
Patient on emergencies starts grumbling about how long it's taking and about my ringing phone.

Me: I'm sorry it's taking so long; I'm the only medic in the hospital at the moment.
Patient: You mean there's no other doctor on Emergencies?
Me: Well, not for medical emergencies, no.
Patient: Oh, you poor thing!

Friday, 14 October 2011

Tips for Junior Doctors part 6: How to let someone die.

A few weeks ago, a lady came to my ward just to die. I've had that happen to me a couple of times, most of them go peacefully.

This lady was in her fourties, and died of breast cancer. Her parents were there. That was a first for me; usually young ones die too fast for the parents to watch them. She was on morphine, and not really conscious any more. The oncologist went in with me that morning during ward rounds, and talked to the family, and told me I'd be checking up on them. She did not leave me any other instructions.

I checked on them about three times that day, the last time being around 3:30PM, after which I was busy talking to patients and families and doing other doctor stuff. Pretty close to handover, I went to check up on them again. At 3:30 she seemed comfortable. At 5:15 or something, she was restless. Nurses have already upped the morphine. I phoned the oncologist, who told me to start midazolam. Nursing staff needed about two hours to get it.

She didn't actually make it. My shift ended at 6PM, but I was still rounding up at 7:15 when the nurse came to tell me she passed away. Normally I don't do any actual work after hours, but I felt I couldn't let the nurses call the on-call to pronounce her if I'd been involved in her dying all along. I went in, pronounced her and shared my condoleances.

Then, the family told me it was horrible to watch her go like that, all restless. They thought she were suffering. They were unhappy. They wanted her to go smoothly. I told them I would have liked to see things go in a different way too, but I wasn't sure how I could have acted differently. I did not know it would take 2h to get midazolam to a ward. I can only act on what I know, and I didn't know she was getting restless until it was too late. I didn't want to go in there all the time, I wanted to give them their time. I explained this to them.

These kind of situations make you really nervous as a doctor. These are the 'I am going to sue you' type of situations.

They accepted it. They said they were happy to be able to discuss it, and that maybe they should have called me. They were going to talk to the oncologist too.

I also mentioned this to the nurse who was working the morphine dose. Turns out it was her first abstination. Next time she'll fetch the doctor sooner.

But the thing is, none of this is part of medical school. Medical school teaches you to save lives, and, given that this is Holland, they teach you about euthanasia. Nobody teaches you how to act, how often to check, what to say when someone is on your ward with palliative sedation and slowly dying.

Tuesday, 4 October 2011

Grumpy Junior Doctors

Somebody searched, and found my blog using 'Grumpy Junior Doctors'. ,


Sunday, 25 September 2011

my IT band, continued

Since I'm on recovery time for other matters, I decided that I had time to visit a physio. Half a year onwards, and I still can't run properly.

His verdict: Yes, it probably was ruptured, yes, you probably were a bit stupid for not seeking help (but come on, everybody was looking at me as if I were whining), and now there probably are some adhesions causing my problems. He'll try to fix that.

And I got some pretty Kinesio tape, criss cross over my thigh.

My homework was to run 15mins and see what it does. So I did that today, and the lateral side of my right thigh feels oddly exhausted. Not painful, just nagging.


I tried so hard to prevent this from happening. But it did. I had to call in sick from work, because you can't do much doctoring if you're barely capable of getting out of bed and have the attention span and memory of a goldfish.
I do actually feel like a goldfish.

I'm considering taking meds again. Considering my past history. Considering the fact that all my brilliant 'relapse prevention stuff' failed me, and I went down whilst trying my hardest.

But then again. I'm feeling ever so slighlty better after a week and a half at home. Maybe it's simply because I sometimes manage to sleep. But my current level of functioning is nowhere near what I need.
And then there's the relapse risk, which is statistically 90%.

Everything I do is a fight. Getting out of bed is a fight. Getting to sleep is a fight. Eating is a fight.

Wednesday, 7 September 2011

Black puppy

I haven't been writing here much lately. To be quite honest, I haven't been reading much either. I just don't really have the mental energy for it.

My black dog seems to be back for a visit. I'm fighting really hard not to let it crush me. I'm not all the way down there yet. Today, I had a good day. I felt neutral during the evening. It's the best day I've had all month. It's not serious yet, I've been a lot worse in the past. I'm still working, I'm still sort of functioning, but it's there. Haunting me. I can't remember if I was fully depressed as a teen. I don't think I was. Regardless; if this thing follows through, it's my second depression if I don't count the BC pill-induced one I went through in 2009, the third if I do. I get agitated-depressed, so basically I remain more or less functional for a long time.

I'm not keen about the idea of anti-depressants, and I'm not entirely sure how to go from here; but I'm fighting.

Yes, I'm also on a new BC pill. But actually, this time I don't blame it. See; I was going down BEFORE I started the pill, and actually, I'm calmer when taking it than I was in the pill-free week. And I have a good enough explanation for what's happening, the pill-induced depression just seemed to happen out of the blue and lifted within 3 weeks after switching to another pill.

Yes, I know doctors and mental health issues are taboo. I also know that I'm not alone. Depression is a common ail amongst physicians. In fact, doctors commit suicide relatively more often than most other professions. (Ironically, female psychiatrists are most likely to take their own lives!). I know 2 GP's who went through depression.

And I'm fighting.

Wednesday, 17 August 2011

Tips for Junior Doctors part 5: DO wake your patients.

My patients and I survived the first night shift. I'm apparently not the type who is extremely sharp in the middle of the night. My sharpness returned with the sunrise... and my, what wonderful sunrise it is if it promises the end of a night shift.

Typically, there are two doctors on call (SHO/residents), a surgical one and a medical one. I'm the medical one. It's just me, and the entire hospital. Me, the wards, and emergencies.

And it was busy. I work in a relatively small hospital, in international standards. My phone kept ringing, a few sick patients on the wards who required attention, a random transfer in the middle of the night from another hospital ending up on the wrong ward because I didn't know the patient was expected and 'admit through emergencies' was misinterpreted, and an emergencies department which never got empty. Until 7:45AM when I sent my last patient home, and the patient arriving had blood all over him, which means it's surgical.

Surgical doc had phoned me at 11:30pm to ask if he could use one of the on-call rooms. He slept most of the night, and his ED patient arrived at a decent time. I didn't even have time to go to the medics room to eat something.

But then again I forgot that I have no appetite at night.

Because it was busy on Emergencies, I didn't have time to go and admit the misplaced patient before he fell asleep. I phoned the lung doc (patient got admitted to pulmonology) to let him know that patient is there... because really I had no idea how to go about this. Basically, the problem itself was something that required no immediate attention. Lung doc normally is a very nice man, but not when sleeping. I got burned down. Because I didn't wake a completely stable patient to take a history.

Actually the main thing that went wrong is that Ghost Doc saw said patient earlier in the evening, and sent the patient to a PCI centre who sent them back to us (because it turned out to be a suspected pulmonary embolism and not a heart attack). Ghost Doc wanted to finish off the case herself, and didn't hand it over to me. She fell asleep in one of the on call rooms, with the patient's chart. Ghost Doc's shift ended at 11PM, but she always haunts the halls of the hospital when she's not supposed to be there. I got phoned by the other hospital, who wanted the patient on a pulmonary ward, not a cardiac one. I didn't know the patient was already expected on the CCU, in the end the message was 'fine, send them in through Emergencies'. And they told the ambulance to go straight to the pulmonology ward. Had I know the patient already had a bed, we wouldn't have a problem at all, because I know that CCU nurses are capable of administering Fragmin, and are capable of detecting respiratory distress, and that the doc on the CCU is capable of organising a CT scan for the patient and transferring the patient to another ward after the friggin sheeth had been removed!

Monday, 15 August 2011

Medicine drugged my creativity

Or maybe just my inspiration.

See, I used to be a talented artsy kid. Part of this artsiness already went slumbering in my teens, I guess, maybe. But still, I've made some pretty nice things. But it wasn't all dead, I was known for my style in medical school.

I also used to be a talented writer. People liked reading what I wrote because I wrote it well, even if I only wrote about something rather uninteresting.

But nothing seems to work right any more. I don't even look as nice as I used to; in part because there's no point in looking pretty for dreary hospital work. I'm not happy about my writing, my painting for a friend failed and even the tray I'm pimping instead just doesn't have it ...

And I don't really know how to revive it. It's like I have forgotten how to create.

Something is missing from my life!

Monday, 8 August 2011

Adventure running

I went for a little explore-run yesterday. Recently moved to a new place, and the weather was good. I never went fast, and I walked bits in between, and I discovered bits of trial and lots of water and green... and I was having fun in the sun and then in bits of rain and then in the sun again (all in a matter of less than an hour!). At some point I found myself eye to eye with a couple of bovine ladies.

At some point I failed to notice a bump in the road, and the result is a very sore knee. Guess that makes for the end of running again, for now.

Saturday, 6 August 2011

Motivational Speech

I used to be a child psych intern. I switched to medicine, because, well, psychiatry is not the right career for me. That doesn't mean I wasted my time with psych. I've learned skills which I use on a day to day basis still; sometimes managing things my consultants don't (or I like to think so).

Example number one: a more-or-less elderly lady is a notorious care-avoider; leading to her losing her mobility and her vision in one eye. She probably has OCD and some cluster C personality traits, maybe even obsessive compulsive or avoidant personality disorder, says my own quick psych screening. Now she's here with a diagnosis of double cancer, and she's tending to start avoiding it again. The oncologist worries about it, and after the bad-news convo orders me to go over it again with the patient and the family. I managed to get her to acknowledge her cancer and the prognosis, and a few days later she was able to tell me she wanted to fight for what she had left of her life.

Example number two: a depressed 80-something year old lady who just returned from ICU where her life had been saved a few times BUT she still has her chronic abdominal pain (possibly psychogenic) and I have to tell her -wearing this:   that we have no answer for that, but the best for her is to enter revalidation and go home in the end. Her son wasn't impressed, they want her to go to an academic centre to find the cause of it all. The reason for my pretty yellow outfit is that she's got three super-opportunistic multi resistent bacteria on her, and if I get those on my ward the ward can be closed down. She started crying, she doesn't see the light, she sees no progress in it all and she's still in pain. So here I was, dressed as a duck, motivating an old lady and her son until they both started listing tiny progresses.

Wednesday, 27 July 2011

European 48h laws... and those damn interesting patients!

I worked from 8AM till almost 9:30PM today. This is no rarity. I am tired, and I am beginning to regret certain choices in my life. I fought damn hard to get my life back from the claws of my past; and all I do is work. I don't feel like a hero, or 'special' because I'm the doctor. In reality many patients still can't comprehend the fact that women can be doctors too and call me 'nurse'. I have all respect for nurses, but if I wanted to be a nurse I would have gone to nursing school.

The best one?
Me: Goodmorning mrs Little old Lady, how are you doing today?
LOL: Morning Nurse, I'm fine, actually!
Me: Eh, Doctor...
LOL: Oh, sorry, Doctor. You know, I think it's so great that young women are doctors nowadays! Go Girls! But aren't you too young to be a doctor?
Me: Eh, thanks, and no, I'm the same age as most other graduates!
LOL: but you look so young!
Me: I suppose I'll appreciate that in ten years. Now, have you had any more black stool?
LOL: Not much, Nurse!

I spent the rest of the day talking drugs, infidelity and shit on the gastro/onco ward. Always fun!

Internist nr 1: So, if you were a little Clostridium spore, what would make you think 'Ah, this is great, I'm going to become a bacteria'?
Internist nr 2: Spores don't have brains.

Gastro doc: You have a colitis, but it's not bleeding anymore. We'll observe you for a bit, and if your stool is normal, we'll discharge you on Friday..
Old lady: Ok. So if I make a good poo, I can go home?
Me: Basically, yes...

But seriously. EU regulations state a 48h max work week for doctors, with good reason. I'm tired, and I'm regretting certain life choices, and working 65+h weeks isn't making me love medicine any more. Yesterday I was naughty and went home before 8PM. I paid the price, but I don't regret having time for a DVD. Today I spent the entire day running and talking, and I still had a lot of admin to do at 7:30PM. I went home when the system stopped responding.
Monday I left the hospital at 10:01PM. One of my patients died at 7:15PM. I came home close to tears, not because she died, because that's what cancer patients do. I came home close to tears because all I had time for was a shower and a quick cuddle with my rats... and then sleep and the whole thing would just start over again. I want to go pick up a new rat at the shelter, but I don't have the time for it.

The problem is, roughly, that there aren't enough doctors to take care of the patients in 48h a week. Mind you, I don't even have time for the discharge letters, and meanwhile specialists and secretaries are moaning about unfinished letters. I have no idea when I'm supposed to do them.

Sunday, 24 July 2011

Tips for Junior Doctors part 4: do your wondering beforehand

New patient got transferred to my ward with a hypo (insert every electrolyte here). And oh, yeah, something with his thumb. Now the hypokalaemia, hypocalcaemia, hypophosphataemia, hypomagnesaemia, hypoalbuminaemia, hypochloraemia and hyponatraemia and oh, the diarrhoea he had as a result of the phosphate suppletion were things I'm supposed to be able to deal with as a medical SHO. The resulting hyperkalaemia too.
Thumbs, however, are too difficult. The chart read 'consult plastics'.

I phoned my colleague who took care of said patient to find out if plastics have been consulted. No, they haven't.

So; I phoned Plastics, who, I might add, only have consultants. Said consultant was operating.

Me: 'Eh, I have a consult for you. Mr X has been admitted with about every possible electrolyte disturbance after quitting alcohol. Now I just got him on my ward, and I also discovered that you haven't been phoned yet for his *reads chart* eh... chronically grown in thumb nail'

Right. I just phoned an operating plastic surgeon to come and see a grown in nail. 

Dr Silicone: 'Right, I'll come see him Monday on my round'

My return and my primary school; they're completely correlated.

Oh, by the way, I'm returning to the Blogosphere. Just so you know.

Also, just so you know, I'm fascinated by the random search terms that lead to my blog.

I'm nearly done with my apartment, was just sorting out my jewellery. I found some stuff I haven't seen in years, including my very first pair of stud earrings. I had my ears done when I was 8. They're blue, to match my blue school uniform.

Speaking of which, my grade 3 teacher still teaches grade 3. I used to be scared of her, she was a notorious slapper. In hindsight, she was fair and only hit you when you actually did something wrong. For the record, in the 1990s South-Africa, physical punishment of children was the most normal thing in the world. The school as a whole has gotten smaller. It's not a private school. They have 3 classes per year now, we had 5 and we were already somewhere between 30 and 40 in a class.
In Africa we didn't get the whole pedagogic schooling European kids got. We went to school to learn; child rearing was our families' job. I got homework from grade 1 onward, and from grade 4 onward I was responsible for getting myself to class and making sure I got the right books with me AND that my homework was done. (At this point, we were past Mandela, and physical punishment was technically not allowed, but detention was allowed...) Imagine the shock I went through when I set foot in a primary school here! I was turning 12, and the kids didn't get homework, they didn't have to bring books to school... they just had to bring their food and drinks for breaktime... which was placed near the sink so they don't lose it. The result was that I dropped out of primary school, skipped a year and went to secondary school.

Many of the teachers still work there. A bunch of others look like they're my age. Ah, the joys of internet! All I wanted was a pic of my uniform, to demonstrate it's blue-ness.
Luckily this bloke used his daughter in one of his flicks, and coincidentally he also sent his children to my school (the school's in the background!)

A Good Work Out

I'm a runner turned gym bunny.

(And while typing this, I'm watching BBC's Robin Hood; and wondering how likely it is that his Merry Men had crucifixes tattooed on their arms in medieval times....)

Anyway. So I'm a runner turned gym bunny who also suffers from sub-clinical ADHD. Apparently.

I miss running. I miss being outside, but not as much as I would have if we had an actual summer this year. I was at the gym, doing the Fit and Fun Circuit and meanwhile watching the WC swimming in China something. (No sound, and I was too far away to read it). Then that made me miss swimming.

I did a BodyCombat class. Then, I did the 10 minute ab workout. Then, I did two rounds of the Fit and Fun circuit. Then, just for the sake of it, I did a 10-minute trot on a treadmill. I want to retrain those running legs; but the legs themselves seem to be the problem.

At least, being a gym bunny, I can work on my fitness without busting my still fragile IT-band again, and then, when the time is right, I'll be able to run again, and run fast.

In the meantime I suppose I'm wearing my running tights and running shorts to the gym; and while it's fun to run in the rain once in a while, it's been doing nothing but raining lately. Also, my gym shoes are in better condition than my running shoes (wonder why...) and my funds are slightly low these days... so it's good to know I'm making the running shoes last a bit longer!

Sunday, 17 July 2011

Tips for Junior Doctors part 3: remember everything.

I'm on a ward with mostly oncology and gastroenterology patients. (However, pretty few gastroenterological oncology patients, they tend to hang out at the Colon Cutters). It's not my favourite ward to work on; patients are complicated, time demanding and everything else is chaotic because I have 3 different supervisors. Apart from that, a certain nurse drives me nuts.

But that aside; I made the mistake of forgetting to fill out the paperwork to send a CD with a scan to another hospital. To err is human, but to be a doctor is to be superhuman, you see.
Ever since the oncologist who ordered me to fill out said paperwork keeps on telling me to write everything on my list.
To the point where simply prescribing the drug then and there would be easier than writing it down and then prescribing it.

And then I have to go find the nurses to do stuff; and they're always nowhere to be found.

Saturday, 9 July 2011

New apartment!

Yes, I've been MIA.
And yes, I have a very good reason: I just moved and I have no internet at home yet, and my phone sucks. I promise I'll be back! And a great July to you all!

Sunday, 26 June 2011

Tips for Junior Doctors part 2: be not the bearer of good news.

At least, well, just don't.

Mr Grumpy presented with a ridiculously yellow face, and after some tests and an ERCP he got told that it's likely pancreatic cancer.

Enter dr Blondie.

MRCP showed localized inflammation, and my task was to tell him and his family this glorious news: he was going to live.

Mr Grumpy was happy and relieved. 'Thanks for taking care of me, doc'.
Mrs Grumpy and the 4 junior Grumpies however, were mad. Really mad. Mrs Grumpy kept going on about how she's a nurse and how this is not how things are done. The 5 of them verbally attacked me, going on about how I'm unprofessional (because I memorized what I was going to say and did not have the file with me, simply because I was bringing GOOD news) and how this is horrible and then asking me impossible questions only to tell me that I know nothing. Mrs Grumpy had a grain of decency and used the words 'excuse me', while the mini-me's were simply harsh in their 'I'm right and you're wrong'. Then they demanded to see the internist RIGHT NOW. Not going to work, he has other patients too.

And they kept going on; the internist told me they called me a 'twit who knows nothing'.

All because I told them their father was going to be just fine.

On a lighter note:
Patient quote of the week:  It feels like there's a marble rolling around in my head.
(good, that means you haven't lost all your marbles)

Sunday, 19 June 2011

New House

I have a new house. I have a demanding job. Moving house and medicine doesn't go well together...

Today I moved the first stuff. Paint, carpets, linoleum, some other stuff.

So, no, not much time to blog.

Monday, 13 June 2011

A day at IKEA.

As you may or may not know, I've found an apartment. A 3 bedroom apartment (WITH walk in closet) and it's all for me.

That calls for some budgeting (as I need to pay a warranty) and a visit to IKEA.

Today was not the best day for that. I doubt any of the days I have available for such expeditions are the ideal day, but today must have been the worst idea. The entire Holland thought it was a good idea to go there today. I have no idea what they were doing there because I am VERY certain that not all of them were moving or redecorating. IKEA had a sale, and Dutchmen love sales, no matter how lousy they are.

Apparently, for some people, IKEA makes the perfect family day out. I don't get it. I don't find it inspiring. I find it cheap and practical and very unoriginal, but some people find it incredibly inspiring to walk around the IKEA and eat cheap meatballs. Maybe they're the same people who park their cars in the loading zone?

What I understand even less, is why they bring their children with them. I found a little boy complaining to his dad about how boring it is; and the dad said 'I know son, I don't like it either'.
So then why are you here?
And why are your children running around where I'm trying to push my heavy cart?

Another challenge was getting my stuff on a single cart. It's more than I thought it was going to be. Kitchenware takes a lot of space.
So does a full length mirror and the massive framed poster of a red London bus against a black-and-white background. The idea is an entirely black-and-white hall with just the red bus and maybe a red vase sticking out.
I went slightly over my IKEA budget (damn kitchenware, and I insisted on getting the exact rug I wanted, come on, I'm working as a doctor...)

but afterwards I went to CarpetRight and managed to get a really good deal on my carpetins and vinyl, spending 200 euros less than I bargained for, so all in all I'm playing quitte.

Now still needed: curtains for the living room and one of the extra rooms, blinds for the bedroom, a DVD-player, an iron and ironing board, a clothes rack, a stove and a broom. Oh, and the paint.

I'm poor.

Sunday, 12 June 2011

Tips for Junior Doctors part 1: Make sure you have the right patient.

Highly advisable: being efficient and seeing the patients in one room in one go.
Not-so-advisable: getting your patients mixed up.

Friday afternoon, cardio ward. Short-stay room. I have 2 grey-ish-but-not-yet-fossilised males, both returned from a coronary angiogram that morning. There also are slight differences:

Patient A has a wife who has been hanging around the room the entire day, boasting about how annoyingly rich she is. (Seriously, I don't care that you made a bid on a ridiculously famous estate in South-Africa, I care even less that you can compare the most expensive shopping streets in the country; and I'm not as flattered as you think by the fact that you're impressed with my medical school. The main reason I went there as opposed to my colleagues is that I had the guts to go there.). Patient A also had the worst outcome and needed a CABG.

Patient B is younger than patient A, and probably was a good man, your average Joe. His outcome was fine, and he was good to go ahead and get the planned valve surgery.

One of them had an angioseal, the other didn't; both had palpable masses over their femoral arteries.

I mixed them up, went ahead and told patient B that he had several options for his surgery. Then I phoned the cardiologist because I could not feel a femoral pulse, asked him if it was fine to let the patient go home. All this time, I thought I was talking about patient A.

Until at some point mrs A pointed out that that was not her husband.

Trust me, no matter how human such a mess-up is; the patients are not impressed. It's hard to get your stories straight afterwards.

In hindsight, I should not have ignored the fact that I thought that it was odd that such a high class citizen as 'mr A' pulled down both his pj bottoms and his underwear the minute I told him I needed to check the place where they stuck in the catheter.

Sunday, 5 June 2011

I quit running. Or let's make it an intermezzo.

It's not a conscious decision, it's not a permanent thing either. I have just completely lost my motivation to run. The reason? I'm not getting anywhere. I am getting extremely frustrated. I can't face another 5k lap which I can't even fully run. Ever since my IT-band drama (which also is my most-read post on here) I've been slowly, extremely slowly, increasing my running, every time I went a bit faster or ran a bit further, a dull ache in my right thigh reminded me to go slower. I haven't even finished a 10K run ever (the injury happened at 9.5k in the build-up to the 10k race). I'm not getting what I wanted out of running.

Apparently I don't have a body that takes too well to sudden increases in work-out load. Or maybe my body was in worse shape than I thought, years after the anorexia still... because come to think about it, prior to getting really thin I went through years of compulsive exercise. Looking at my body now, I wouldn't know where I lost those extra 10kg from, but well, it had to be muscle mass. I'm a doctor, and I want to understand what is happening now.

I never went up to the amount of exercise I did as a teen. (I had a resting heart rate of 54 at age 15, and I was about the strongest girl in my class). This winter, I still did not come close, but it's the most I've done since the anorexia. There probably was more strain on my muscles and joints than I thought, because I did not take that into consideration. I think my body just couldn't handle it, it was still too weak, and it was probably leaning towards overuse. Combine fatigued muscles, joints and ligaments with the way I cooled down on that fatal day, and the IT band just sort of tore. There is no other way I can explain the lumps on the thinnest part of the band.

In case you were wondering, such an injury takes long to recover.

And now, in prime running season, I've lost all motivation. I haven't run in a week. I can't make myself. I hate how slow I am, I hate how I can't run 5k in one go, I can't bear to face the same laps again and partly, the solitude is too much for me right now. And maybe, at this point in time and place, I was once again asking too much of a still weakened body.

So, I quit.

Here's the most interesting part: I don't quit. Not for good. Never for good. I'm just taking a break. I've been looking at gyms and I've been doing my Pilates (and I'm getting better at it, I'm ready for a new challenge) and actually, right now, my goal is where it should be: I need to get stronger first. I need to not be running ahead of myself; and if I want to be doing the things I want to be doing, I need to get physically stronger. I need to be doing something that does not require level 4 sports bras, as the sports bra level reflects the impact on the rest of your body too. And meanwhile, when the weather is good and so forth, I will sneak in a little jog and dream of long runs.

I'll call it Project Fitness. Maybe this is the last hurdle in my recovery, maybe it isn't. Maybe the last hurdle would be finding and keeping myself a man.

Sunday, 29 May 2011


So, life has been getting on, I've been busy and you can blame the hour and a half I need to get to and from work each day for my lack of posting.

I may have found a place to stay, but I'm shutting up about it till I actually have it. It's lovely, and large, and that's all I can say.

I am getting used to the hospital life, and I am absolutely shocked at how far I've come in just 3 weeks on the wards. I even managed an unstable patient while his family came rushing in (fair enough, we had an appointment) with tons of questions.

And then I got my first pay check... and I treated myself to a pair of sunglasses. I worked hard enough for it, and I needed something special. They're perfect, and they're the real deal:
Mirror-glassed silver Ray Ban aviators. They look really good on me, and the style suits my personality; the combination of light and slight and tough and masculine. It's a little dream come true; and I know it's maybe superficial; but I really enjoy owning and using things that are 'perfect'.

It's maybe my old strive for perfection in a non-lethal form. Not just stuff, but also time, people, activities and food: it has to be worth it. The older I get, and most certainly after my shopaholic phase, the better I get at only spending 'it' if it's really worth it.

And then, I enjoy it.

I still love and adore the green trench coat I bought in 2007. It makes me sad to think it's it's last season; but it's getting a bit too 'vintage'.. (and I still have no idea where those stains came from)

I bought a blouse too, and a gift for someone, new mascara, new shoes (my old ones sort of became seperated from their soles, good enough reason for new ones) which are basically what I've been looking for for 2 seasons now and this:

The powder was an impulse buy...

Sunday, 22 May 2011

Looking back on new years projects..

Remember these? My 11 projects for 2011? The 22th of May sounds like a perfect day to look back on them; simply because I thought of it today.

1) find and start my first job as a doctor

2) Get my driver's licence.
Eh, STILL working on that. I'm probably going to get an automatic gear licence rather than a manual one. I recently found out I have/had a mild form of some type of developmental dyspraxia, which has absolutely no significance in normal day-to-day life, but given that it's based on a brain development abnormality, it's not going to get any better than this and I'm struggling a bit with the driving.

3) Run 10k, and run a race.
Neither of these have worked out. I got injured at 9.5k and had to forfit my race. Running is on a low now, but it seems like my IT-band FINALLY healed, and I did go for a run yesterday. Might do a 5k race towards the end of summer, I think I should.

4) Get my diving licence

5) Join a club
I need to live somewhere first....

6) Improve eating habits and get back to set point weight
Working on that still, and am half way there weight-wise.

7) keep up cross- and strength training.
Considering I'm a bit sore from my pilates yesterday and this morning: doing so!

8) Learn to cook new dishes
Er, I collected some recipies to try, and then never had to cook again!

9) Make time for creativity

Basically, I'm working on a painting. Not just any painting, but a wedding-gift painting.

10) Be more organised.
Not entirely sure how and what, but in order to do my job I have to be somewhat organised. I do actually tidy up my room sometimes, if that counts.

11) Learn something new
I've been busy learning new things for my job, if that counts, and if it doesn't, well, I've learnt about Zulu culture, how to take care of a gerbil, what the different measurements on a bicycle tire means, how to put on new pedals on a bicycle, that Spanish is an easy language... just to name a few.

All in all, not doing to bad, I think.

Saturday, 21 May 2011

Oh, hey, it looks like we survived!

Dear mr Harold, I know it's only 10:20PM.... but I think we would have noticed something by now if the Rapture was going to happen today, don't you think?

Um.. Oops?

Yesterday I was the only ward doc, again. It was OK, as the front-half's specialist did her ward rounds herself and I had a grand total of 7 patients to attend to. Or make that 8. It was a calm day.

I started out the week with 12 patients; and ended with 4. Mine all got discharged or turfed. My colleague had one 96-year-old lady who wasn't doing too well, and right from the moment I heard that I was going to be alone on Friday, I had this funny feeling that she was going to pass away on Friday.

She did.

When the nurse came in; I asked the specialist who was going to pronounce her formally. She went. And she left for her OP clinic. Half an hour later the ward administrator came in and asked for the paperwork. I told the med student to phone the specialist. The med student handed me the paperwork. I knew it, that's why I asked who was going to pronounce her. So I basically had to re-pronounce her... and go talk to the family again.

Turns out that once again, the patient's full names aren't registered in our system, and once again I had to ask for them.

'Mary Magdalena'

So I filled out a death certificate for a 96-year-old Mary Magdalena, and she went off to the morgue. And I went off to my free lunch.

At 4:45PM the family phoned. "I'm so sorry, we gave you the wrong names. Her full names are 'Mary Madeleine', not Magdalena."

When I phoned the morgue, she had already gone, together with the paperwork. No worries, the morgue-man (whose number is a fax number) said: he'll let the officials know when they come by on Monday.

Monday, 16 May 2011

No, I don't like my job

right now.

Look, I know nothing, can do nothing, and yet, people are expecting everything of me.
Meanwhile, I'm running a ward, and I have anything between 6 and 12 patients to attend to; and they're MY responsibility.

I want to run very very far away; I'm nervous, I'm exhausted, and considering that I'm pretty high up on the hospital food chain, I work long hours without overtime pay.

Medicine is not ER or Grey's Anatomy, it's Scrubs. (Although I did enjoy the 'bronchial tree' patient on Grey's, loved the word play, but it's not high on my diff diagnosis in any patient).
Oh, and it's not House either.

It's Scrubs, and I'm pale and sweaty and I hope nobody dies.

So ask me again, maybe in a few months or longer, if I enjoy my job.

Saturday, 14 May 2011

Well, that explains it!

Mrs. Cushing-Addison: 'Well, since I started taking only 5mg of prednison a day I've been really poorly, I've lost my appetite, was nauseous, I was sleeping all the time and I'm hurting everywhere'
Dr Blondie: 'Wait, you're only taking 5mg? Since when?'
Mrs Cushing-Addison: 'Well, dr Lung said we were going to taper off the prednisone so I did it at home'
Dr Blondie: 'But... we were planning to do that here, in hospital'.

(The irony is: after her predisone booster for her respiratory problems I have tapered her down to 5mg now, and she's perfectly fine as far as I know)

Wednesday, 11 May 2011


Day 3, early morning.
I'm heading back from handover when a nurse calls me into a patient's room, the sats have dropped. It's a gentleman who somehow landed on my ward the previous day without my knowing. I discovered him when I went looking for him, and gave him a quick look before heading home. Complicated case, and a DNR.

I did not resuscitate. I watched him slowly deteriorate; I informed the family; I talked to my supervisor; I started him on fluids when the tension dropped.

Then he refused to have his stats taken. I told the nurse to phone me if he got worse, thinking he was going to die somewhere in the afternoon. We had lunchtime presentations, and given that there's nothing more I could do for this patient, and all the others were set, I decided to go. (Besides, free lunch!)

I barely grabbed a sandwich when the nurse phoned me. He had died. I just had to pronounce him.

Tuesday, 10 May 2011

First day on the wards...

Remember that very first episode of Scrubs?

Yesterday was that day.
I arrived later, I had the driving test in the morning. (The pulmonologist thought I was there yesterday morning... interesting.)

"Hi, welcome, the back half of the wards is yours."

There's two of us on the ward; a final years med student and a regular med student. The final years is on my half, which I really appreciate as she does 4 of my 12 patients (and needs prescriptions for them quite often).

I didn't know how stuff worked. I didn't know my patients. I didn't know jack about medicine. (I still don't.... or at least it feels like that).

I barely ate yesterday, I was so nervous. It wasn't really warm, but I was sweating. I almost cried a couple of times (to be fair, I was really upset about my driving test still, but that's another matter)... I left at close to 9PM in the end. It was just a nightmare, really. One of the nurses offered me a cup of coffee at some point. At the end of the day I finally knew more or less why my patients were there (only to have them sent home today ,but that's another matter), I had clerked my first official patient (who of course is too complicated for the med students) and I had figured out how to prescribe stuff.

Then, today at the handover it turned out that there were problems with my patient. I think I froze, and wondered if I did something to almost kill her. But she's on the transplant list for a reason, and I wouldn't be surprised if the same thing happened tonight.

Of course, it's Grand Round day. I think I almost threw up, but luckily the specialists are very nice and everything went fine.

By the end of the day I felt like I was getting the hang of the ward work...

... now I just need to learn some medicine.

Sunday, 8 May 2011

I love exercise!

That's all I wanted to say for today. Went to Scheveningen and back on my bicycle with a friend, then went running and then did pilates and now I'm nice and tired.

I'm just not too happy about where I am with running. I want to be going fast and far, but I'm getting nowhere. I'm still doing run/walk intervals, the pace is still around 5'30/km... and I get this very tired feeling in that right IT-band after running. That means I can't push harder than I'm doing. I have resolved to do those lateral stability exercises every day.

Slowly but surely I'll get there... one day.

Wednesday, 4 May 2011

How appropriate...

The 4th of May is 'Remembrance of the dead' in Holland. The 'dead' being those who died in war. (Because 5th May is Liberation day, you know, WW2?) I don't know what to do with today as a special day really, my 'dead' survived their wars and died of illness, and I remember them when I see fit.

However, through some random coincidence, I spent 'Remembrance day' doing Advanced Life Support and Paediatric Advanced Life Support courses. Roughly, the idea is to prevent dead people from further dying.

You know the scenes in ER when they yell 'clear' (and everybody is still touching the bed) and then shock patients with a flat line, who usually wake up after a few shocks?

Well, real life is nothing like that. Most of the patients who needed CPR I've seen actually died. The most dramatic was the 21-year-old. She had a pulmonary embolism; had been started on streptokinase, and then crashed. During the resuscitation she started bleeding from her old TB laesions; and there's no way to stop the bleeding. Her lungs filled up. She was younger than I was at the time.

I don't know how I've managed it; but I've seen more cardiac arrests than almost any other fresh graduate I've spoken to. (I'm not drop dead gorgeous, it's not me...) And now I'm the doctor. I'm the internal medicine 'resident' / 'SHO' (Dutch term doesn't translate); and I'm the one who leads. Today I learned just how much I learned during my 10-week Acute Medicine elective last year. We worked through a couple of acute scenarios, and I didn't do worse than the others, despite them having actually worked as a doctor already.

I have tomorrow off; and then Friday I'm going to do the ALS etc exams.

Had a lovely run today though. Last run at 4min/2min, next run 5min/1.5min... am slowly working towards 30mins straight. Again. But there's no pressure really.

Monday, 2 May 2011

First day at work

Well, today was the Big Day. I got up at 6AM, got myself dressed and ready, took care of the rat's ear (he has an ear infection), made myself cucumber and philadelphia sarmies and got on my green bicycle to go to the train station. Now that bit was less than amusing: the wind came from the wrong direction.
15 minutes in the train and a few minutes' walk and I was at the hospital; but I couldn't find the building I was supposed to be at at 8AM.

After a walk around the hospital, I finally found it, hidden behind tall trees and what used to be the parking lot before they started building the hospital.

I'm starting with an intro course and the acute care courses. I sort of lost track of all the things and people I saw today.

But it involved a lot of walking and a lot of listening and getting my ID and trying on white coats. We have this very cool system where you scan your hospital ID card, and then your white coat (or nurses uniform) comes flying towards you.

But that's all for today.

And I must admit, I skipped my run yesterday.

Saturday, 30 April 2011

Queen's Day!

Since yesterday was all about the British Royals, today is all about the Dutch Royals. And I did fairly nothing about it.

Really, I should be doing this:

or this:

or maybe even this:

But No.

I spent my afternoon working on my sun tan. That did not even work; it's only April and I think my skin is as dark as April is going to get it. See, I'm not really such an un-fun girl; I just really wasn't in the mood and didn't have the right people with me. Plus, I'm broke. Plus, well... there will be a Queen's Day next year too.

We celebrate Queen Beatrix birthday every 30th of April, even though her actual birthday is on the 31st of January. Her mum's birthday was on the 30th of April and she wanted to keep the celebrations on that day in honour of her mum, and because, well, it's freezing cold on the 31st of January. It's a day of festivities, the colour orange (Because the Royal house is the house of Orange-Nassau), vrijmarkten where random Dutchies can sell their junk on the streets, and every year the royal family visits a different town or city in the Netherlands.

I did not entirely miss out on the 'fun' though. When I went to the shopping centre for bread and paracetamol I sort of innocently and involuntarily walked in on the local vrijmarkt where -mostly- kids sold their family's junk (mainly their old toys) and used their earned money to buy someone else's junk (because Dutch people like cheap things, even if it's completely useless). There even was a fanfare band (named the Pomme Toeters), followed, naturally, by a bulky, tall black man with cigarrette, bald head and staffie bull. Some people sold ugly cupcakes, one of the supermarkets had a stall with the unusual combination of candy floss and strawberries, a Hindustani woman sold traditional Dutch treats and this guy also earned an euro or two on his merry-go-round contraption:

Yes; it's a bicycle with a merry-go-round on it, and he provided the music himself too.

Thursday, 28 April 2011

Bye bye life...

Sooo, I'm starting work on Monday.
Sooo, I'll be starting with an introductory course.
Sooo, part of the course will be Advanced Life Support; Paediatric Basic Life Support, ABCDE (wasn't this covered in med school?), immediate care for the sick child and some other stuff I don't see as a separate item.
Sooo, I suppose I'll be studying this weekend. 

Tuesday, 26 April 2011

House Hunt

Along with finding a job (check!) comes finding a place to stay. While it's OK to spend your extended holiday at your parents place, it's NOT OK to be in your twenties, working, and still living with your mum and dad. 

I can travel to work by train quite easily, but with a 48h work week, I think I want to live closer by. The city I'm going to be working in is a fairly small city in the (relative) countryside. The province of 'Zuid-Holland' has no proper countryside. It's close enough to the big cities anyway. So, I decided I'm going to move there. 

Finding an apartment turns out to be a little more trying than I expected. I'm just me, and I don't want to be spending all my money on rent. Problem is, 'all my money' makes me ineligible for subsidised housing, which means either I pay up, or I rent from a potentially dodgy landlord. 

Results so far:
- Apartments scheduled for demolition in 'medio 2012'. Cheap, and if they're still in good condition (built in 1960), well, might be an option. Only problem: 'medio 2012' could be anything from March to September, and I really need to be able to stay there until June. 
- The PERFECT place, not too expensive, close to the city centre and the hospital, big enough, with a fireplace and a WALK-IN CLOSET and a balcony.... but someone else thought it was perfect too, before I found it. 
- A cheap one-room apartment, rather small but with a complete kitchen and a balcony, but only one room and a bathroom (I'm dreaming of having a seperate bedroom, you know)...and it may already be taken. Near hospital and city centre.
- A mildly affordable place which might work, from a decent broker.... in a nice neighbourhood about 3k's from the hospital, only slight problem is that it's on or near the shopping centre where there have been some problems with youths hanging around causing trouble. (Look, if it's the same as here, I'd consider it)
-A nice-looking apartment in an adjacent small town (less tax), yet still only 3k away from the hospital. Not too expensive. Only problem is: 'only for rent to 2 people'. 


Monday, 25 April 2011

Easter Weekend

My sisters gave me the little sheep above for my birthday, almost a week ago. I can't bear to eat it, just look at those eyes!

This morning we had Easter breakfast; (with a few Beacon marshmallow eggs, from the two boxes my dad imported this week... what the hell do you do with two boxes of Beacon eggs??) and yesterday was just mellow. Went for a run with my sister, watched some TV, went to church with my family (and had the entire church queue up to talk to me)...

So, that was Easter Weekend.

And I'm starting work in a week!

Saturday, 23 April 2011

So, what did you do today?

It's a chilled, relaxed, sunny Saturday somewhere between, well, Good Friday and Easter Sunday. Apart from chilling in our (kiddie) pool on one of those floaty beds (what, if you close your eyes it's almost like floating in a real pool!), I decided it was a good day to reveal the following picture of my belly: 

Friday, 22 April 2011

Signed, sealed, delivered

There. I signed my contract and am on my way to mail it. (Once the floor is dried up, Grandma did the floors). Along with it, I'll be mailing the MRSA kit. This means the job hunt is officially over... for this year.

If I'm MRSA positive, I might have to get treated and then find another job. Because I can't start work at this hospital if I'm MRSA positive.

I have a contract for 38h/week, plus 10h 'training and supervision', which comes down to 48h a week (EU norm). In the beginning it will probably take me longer to do the work I'm supposed to do in 48h; but essentially my work day is from 8:00 - 18:00/18:30; not taking into account shifts. When doing night shifts, I get to sleep during the day. When doing evening shifts, well, I forgot how this hospital did it, but either I work 'doubles' and get days off in return, or I just work evenings. I'll be earning enough to have to pay around 30% in taxes (we have a stepped tax system: the more you earn, the higher% you pay), and I'll be earning more than my friends who started work 2 years ago and who smilingly always had money when I had none. I also have 116.82 hours of vacation for 2011. If I worked a full year, I'd have 175.23 hours of vacation, which is just over 4 weeks. Mind you, that 0.23h is very important. I just don't know what I am going to do with 14 1/2 minutes of vacation.

That just to give you an idea, since my stats page says most of the people who actually read this are American.

Thursday, 21 April 2011

At the dentist

Me: No, sorry, I can't make appointments half a year in advance, I work in shifts. But can I get an e-mail reminder instead of the card you sent me like I requested last time? (Yes, we like to save the trees...but more importantly, I receive e-mail on my phone, which, coincidentally, I also use to phone them for the appointment)

Receptionist: Oh, sure, sorry, we must not have your e-mail address.
*checks my info*
Oh, right, something is wrong with your adress, please look at it.

Me (peeking at screen): Yes, there's no @.

Receptionist: Oh, right! No idea what egg did that!

(apart from the missing essential, I found it amusing that she called her colleague an egg!)

Work out details: tuesday run/walk workout 35min plus an hour cycling, yesterday none specifically, today 50min cycling and a zumba class. I need to work on my bicycle fitness, simply because I'm tired of struggling to get places!

Sunday, 17 April 2011

500km of my running history.

I've just logged my 501th km on my nike+ system. That's something, right? Despite 3 injuries in the last year, I've made it to 500k.

Total, that is. 

I 'seriously' started running on September 12, 2009, apparently. There were a few runs on there from before that, which I deleted. (I also have an estimated 50km which I haven't logged.)
Then, just as I was getting somewhere, the winter happened. Three months of subzero temperatures and crazy snow... and I couldn't face that. I went to the gym instead, but I hate treadmills.
Then I injured my lateral collateral ligament during a street dance class...
Then I injured it sort of again late last year...probably doing nothing in particular.
Then I finally got going, and then I hurt my IT band. 

Then we got to now, but 500k over and done with. 

Let's just make the next 500k more productive?

Today I went out for about 35 mins, starting with 2 mins walking, then 3 mins running, then 2 mins walking etc. I tried to actually run during the running bits but my cardio fitness dropped so fast while I was out. Nonetheless, I've managed to keep a pace of well below 6'00/km during the running bits, even below 5'30 on the first four runs, then about 5'30 for two runs and then 6'00 on the last one. I don't know if I'm being particularly smart. I just know that I can do this. 

Saturday, 16 April 2011

Very long dead fellow countrymen

Today another holiday tale.

We also went to visit the historical Stellenbosch in South-Africa. It's really a gorgeous town, idyllic almost, set in South-Africa's wine country.

I think maybe my memory of this part of the trip is slightly blurred by the fever I had, and the murderous sore throat, and maybe the horse-dosages of pain killers I took... but I do remember that it's a fascinating place to go and home to Stellenbosch University, one of the country's best uni's.

A few years ago, I was an elective student at Stellenbosch University's Tygerberg campus. Tygerberg is in Cape Town, technically, but it's Stellies' medical faculty. That's my teeny tiny history with the Cape; in reality I'm from Gauteng. Originally, that is, I've spent half my life abroad and the result is that I'm not really from anywhere in particular anymore.

At the Mother Church in Stellenbosch I found this:

Tombs of dead, well, fellow countrymen. They're dead Dutchmen from the 1700's; which makes me unsure if they're dead old or new fellow countrymen. As a white South-African, I have Dutch ancestors, probably not the ones buried here, but still. Some of these buried here would be first-generation South-Africans, from before the Afrikaans were the Afrikaans and before the English discovered how much fun South-Africa is. I'm an expat in Holland, but I'm a Dutch citizen since I think 2008. These tombs made me aware of an odd cycle I'm running (or cycling) around the Dutch: I'm not a 'real' Dutchwoman, but yet, these dead Dutchmen are double fellow countrymen.

Exercise: Pilates work out DVD.

Friday, 15 April 2011

My Legs

Second work out of my 'getting back to running after IT band syndrome' plan.
Run-walk-run in 2min intervals for 30 minutes. I took my sisters with me. They're seasonal runners; and the weather is improving. The work out is by no means challenging, but I think my IT band begs to differ but doesn't say too much.
I'm faster than they are, but they are fitter than I am. They describe us as the soldiers and the floating alien, I'm the alien.

The only problem with my plan is that it's not really a plan. It's just something I came up with after my 2 runs in South-Africa, and the plan was to make a plan.
Part of the plan was to count Zumba as 'running' for now.
The plan might be to see if I can do part of the 'Nike Walk To Run schedule.

Maastrichts Mooiste is in 2 months. I'm considering doing the 5k run; well, mainly because it would be a good excuse to hang with a friend. All I need to be able to do is run for 30 minutes straight, right? I'll have to see what my work schedule is like first; I've decided that races are no priority for me now.


In terms of not-so-recent weight gain I realised that I have one pair of black trousers to wear to work; that's it. Actually, come to think of it, this not-so-recent weight gain trouser problem goes a bit further back than the cardiology kilo's: I own two pairs of jeans and one pair of black trousers fitted to my post-recovery body. For the record: I went through weight restoration in 2008.

Don't ask me what I've been wearing for the past 2.5 years. I don't know.

I decided to find myself a pair of trousers suitable for work today, and preferably a light brown or beige pair. I did buy two pairs of jeans before going to South-Africa because I sort of just grew out of my old ones; a light grey pair and just blue jeans, forgot the latter in SA. Not relevant. Relevant maybe, is that I lost a minimal amount of weight in SA. I was sick for a few days.

I aimed for something less than 30 euro's. I'm low on cash. In the H&M it turned out that that minimal amount of weight was enough for me to need the same size I needed last year, before the whole cardiology-weight-gain thing. I'm pretty close to my set point weight. I found the size thing very amusing. Even more amusing was that I forgot that H&M trousers are too short for me, and only realised that after pair nr 4. I can't remember the last time I tried on trousers there. I had better luck in the Zara, where I found a pair for 26 euros.

The most amusing thing of all maybe, considering my past, was my legs. I'm pretty thin, and I think my legs are pretty thin too. Not too thin, just, well, like they should be. I don't look in the mirror thinking my thighs are fat or big. (I do look in the mirror thinking that running actually works for cellulite though! I have less of it now than I had at my lowest weight!) My thighs are right-sized in my humble opinion, and I love that I finally have calves. Thank you, running.
However, whoever sets the standards for confection clothing seems to disagree with me about my thighs. I either have too much thigh for my bum or too little bum for my thigh, either way: it doesn't fit right. And apart from having handed my sister a pair of annoying jeans (too loose at the top, meaning it got pulled down by the sheer force of my gigantic thighs...), I find this extremely amusing. My thighs don't even touch. Maybe the proportions are correct in the sample size. Maybe other women my size have booties but never exercise.

I don't care. I'm proud of my legs.

And I suppose the good news is that my new beige trousers (slightly tighter over the thighs than over the rest) will still fit at my personal, healthy set point.

And maybe the best part is that I have seemed to 'reset' my attitudes towards food, leading to something closer to my normal pattern of intuitive eating. It feels so much better.

Cheers to my legs.

Good night.

Thursday, 14 April 2011

Today is not my day

Allright, because I promised Africa stories:
One of the ironies of South-Africa is: new cars are programmed to automatically lock when you drive. I suppose too many people have been hijacked or robbed at traffic lights: South-Africans lock their car doors when driving, it's safer.
Yet, the back of a bakkie is considered a completely legit place to transport people and stuff. (I deliberately looked for a white-people shot, because foreigners seem to believe that only black people ride there)

Anyway. Woke up with a headache and a fight with my mum (at least, it feels like it, but I probably woke up with just the headache). Took two paracetamol and went to a big market with my grandma and sisters, paracetamol wasn't doing it's job. Yes, they sold cheap clothes there, but I didn't like it. I like cheap clothes if they don't look cheap, you know? I don't want to look cheap.
So really, not much more sensible to say.

Work out: apart from walking around the market, none. 

Tuesday, 12 April 2011

HR interview

I had my appointment with HR today. You know, the guys who do the paperwork and so forth when you get hired.

This morning, I woke up more or less fresh and fruity and ready to go. I had my day planned out, but it turned out to be one of those days that don't go entirely to plan.

I sorted out the remaining paperwork, signing all the forms and making photocopies of documents. Then I got dressed and put on some make up. Getting dressed turned out to be a bit of a challenge as I don't have much to wear, literally. I wore my floral blouse (very trendy) with a black waistbelt and a black lacy skirt and ballerina-pink ballerina pumps. I calculated that I'd need about 20 minutes to get to the train station, as I didn't have to buy a ticket because my public transport card had money on it.


I forgot to plan in idiot time, which I needed for the following:
- somehow between 11:30 last night and 11:30 this morning some family member had managed to move my bike in such a way that I can't get it out easily
- I have forgotten that getting said bike requires 5 whole minutes of locking and unlocking
- I could not find my watch between someone else's laundry, which was conveniently placed on top of my stuff
- Naturally, my public transport card would be blocked. Naturally, all my attempts to get rid of the student-free-travel tag were in vain, with the result that 'they' found out it's still on there post graduation and apparently blocked my card. 'They' were supposed to have it untagged on the 1st of March after I requested them to do so.

The result: I missed my train. Not in the acceptable way, where you'd be 5 whole minutes late, but in the frustrating way where the train is still standing there but you can't get the door to open any more. Then it stands there for another half a minute without letting you in, before leaving.

I planned to take a relatively early train, to make sure I was on time. I ended up being there at 1 precisely...
after which the lady at the reception (the correct reception) sent me to another building, where I found out, at 9 past 1, that I had to be in the first building and the man with whom I had the appointment was waiting for me. So I sort of missed out on the interview with him, and went straight to the formalities with another lady. Which I find frustrating, because apart from not leaving a sharp impression, I don't know exactly when and where I start.

Plus, I have to take time off almost immediately for the driving test (the medical one, not the one that will get me my licence, well, ok, that one too) because OF COURSE it could not be done in these last few weeks I'm off. I really don't want to take time off immediately.

Workout: total of 1,5h cycling just to get places, and a 55min zumba class. Legs still sore from my 15x2min work out alternating running and walking... or maybe it has something to do with the cycling. I'm not used to it anymore. 

Monday, 11 April 2011

In the Land of the Zulu

As we drove towards the luxurious Cathedral Peak Hotel, the scenery was breathtaking. We turned off the main road, and drove through a really rural area. The shrill contrast between the sheer beauty of the country and the harsh poverty of the people in the small towns didn't seem to make sense. There were hundreds of school children walking home at the time. Hundreds of school children in an area with no jobs. Children with goats; a few cattle, some thin. Most of the colourful houses were brick, that's a good thing.

The hotel itself was gorgeous; I've never been in such luxury. But then again, I've only been in a hotel maybe twice before. There was a small wedding party present; and a few other guests. We had buffet breakfasts and dinners, and while we were off to dinner the housekeeping staff would open our beds for us, and leave a story and a chocolate on our night tables.

The next day we went for a guided walk. Our guide was Wise Man; a local Zulu. He was a tall, skinny man with upside-down tear shaped scars all over one cheek. They didn't look like accidental scars.

Wise Man was in his early 30's and unmarried. He's unmarried because he can't pay the lobola (bride price) of 11 cows for his girlfriend of 7 years. He doesn't earn much but he tries to save up for the cows, but it's hard because his parents died and as the first born child it's his duty to take care of his younger siblings. There are six of them, and three have finished school but can't find jobs.

When my dad said he should marry a city girl because then he wouldn't need to pay lobola for her, he replied:
"No man, city girls are lazy. They don't want to carry firewood or 20litres of water on their heads"
and under his breath he valued them at 5 cows. (The irony is: these city girls are important for the development of the country!)
He didn't have any children because he's not married. Sadly, I doubt the girl would still be able to conceive when he saved up for those 11 cows.

Wise Man grew up in a small village with no electricity and no running water in a place with no future for the few thousand who live there.
I grew up in the suburbs in relative luxury and had the opportunity to study and had three jobs to choose from.

Underseas Adventures

Right. Part one.

I've already half posted about this, but it was fun.

I spent my first week at the seaside in KwaZulu Natal, getting my diver's licence and enjoying family time. Apart from my right hand, I also managed to get my ears sunburnt. Human Anatomy 101: ears are covered with skin too, remember when applying sunscreen. Apart from that I only got a mild tan; wetsuits don't let through much UV light.

Diving is fun. The course is interesting, and I've learnt interesting things. Among other things: it's complicated to breathe through your mouth underwater without a mask on, water gets in your nose. This might be slightly terrifying when there's 12 metres of water above your head. I've also learned that, despite being a strong swimmer and not weighing that much, I don't float. You have to be able to swim 200m and keep yourself afloat for 10 minutes in order to do the course. The Swedes who did the course with me floated, I had to tread water.

We went for a total of 4 ocean dives; which included practising skills. Aliwal Shaw is a gorgeous place to dive, and apart from the already mentioned white tip reef shark I saw thousands of fish which I can't identify... and a giant potato bass, and two stingrays. One of the stingrays had take-away dinner in it's mouth. It was really gorgeous!

On the last morning I went for a run on the beach with my dad. OK, maybe I overdid it a tiny bit, but it was good. Nothing better than barefoot running on the beach... and it's good for my calves and feet too. I might do a bit more of that when the weather gets better here in the Underworld; after all, the beach is just a tram ride away.
It was incredibly humid though.

Sunday, 10 April 2011

I am back

Hello, I am back from South-Africa.
Right now I don't have time for blogging, but I'll catch up soon.


Travel stories, all the way from Africa...
Running, yes, I started again!

and of course, I'll be starting work as a real doctor in less than 3 weeks!

Speaking of which... I had a bit of a fright on the plane last night when they called for a medical doctor. Fortunately there were 3 medical doctors and my services were not needed.....

Wednesday, 23 March 2011

Greetings from...

...the bottom of the ocean!

And thanks for all the congratulation messages!

Ok, fair enough, I'm not exactly on the bottom of the ocean, but I was earlier. I'm doing a dive course and we had our first two open water dives today. Great fun! Even saw a white tipped reef shark!

I also somehow managed to burn my right hand in the sun. It's pretty funny. My right hand, and nothing else.

Thursday, 17 March 2011

Graduation Day!

And, an actual picture of me. See? I'm blonde. That's me, being congratulated by the president of the exam board of our medical faculty.

On the way to Maastricht I phoned the hospital and accepted job nr 3. Yes, I'll be working hard, but at this stage I need to learn a lot, and this seemed to be the best learning opportunity. Yes, I love cardiology, and I love psych, but I need more than either one. Plus, this job includes cardiology and pulmonology and A&E on top of just medical wards; I think any UK FY2 can be jealous of me.

We arrived early, parked our car and then went to the church. It was a bit weird at first, turns out there were only about 20 of us. Then time for the group picture, and also time to discover that one of my classmates is already working at the hospital where I'm going to start working in May.

For all those who wonder how such a ceremony works: I live in Holland. We don't do robes and hats. We do pretty dresses and high heels. Or not, in some cases.
The chairman opened the 'special meeting of the Exam Board'. After the short opening speech, he read the Oath, and then we had to reply with the last sentence (This I promise/ So help me God Almighty). My sister said I did my oath too quickly for her to take a picture! I went with the God Almighty one, stammered on the Almighty, because it was a church and because it seemed safer from my agnostic point of view.
After that we were handed our certificates after somebody gave a little speech for us. In my case it was my father. Some were funny, some embarrassing, some down to the point. Some fathers made a point out of saying that their children were now their colleagues, mine joked about always having to do the speech for his own students and now for his daughter. The Exam Board enjoyed the speeches; I suppose it's fun to learn about the anonymous students.
Then it was time for a final speech, and, an hour and a half after it began it was time to wrap it up again. Drinks were served, but no refreshments. A bit disappointing, really, but it doesn't matter. A friend of mine couldn't make it, but she came to the drinks bit to congratulate me.

We drove back, and then went out for dinner.

I sat up straight like a lady all day long. The dress was beautiful, but only comfortable when my spine was straight.

I'm flying to South-Africa this Saturday, so I'm not going to be writing much in the meantime.

Job Interviews nr 2 and 3

*This post was intended to be posted 2 days ago, but due to lack of time did not happen*

Apparently it's not extremely hard, once you're through the bit of sending out applications, to get a job as a doctor. Not taking into account the ones that turned to be for non-existent jobs, I got invited to half of my applications; the others just didn't respond.

Interview nr 2 was at a psych institution. Yes, I like psych, and no, I do not wish to become a psychiatrist. I'm also a good one for this particular job: I know a lot of psych compared to most fresh graduates, and I also know a lot of somatics compared to most fresh graduates who aspire to go into psych. They offered me the job. It was tempting: 4 days work, and I wouldn't have to stay there when on call. The lady was very nice; the other doctors were enthusiastic, the psychiatrist was... well, a psychiatrist. But getting another job after a year of psych would be slightly challenging.

Interview nr 3 was at a general hospital not far from here. It felt a lot like Hospital to me; hard work... but also a good learning opportunity. It was very much down to business: this is our hospital, this is what we offer, and when can you start? Afterwards I got a grand tour of the hospital. Lots of young doctors, which is good.

Which left me with a very difficult decision, really.

A nice hospital
Good working hours
something where I could learn.

Friday, 11 March 2011

Job Interview nr 1

...of 3.

I never applied to cardiology; I applied to internal medicine. My application got sent through to cardio, because they had no opening in internal medicine. I loved that about this hospital; others don't bother.

I got a job interview at cardio.
I love cardio, for the record, but when I applied at this particular hospital, I had to pick one, and I picked the most obvious one.

I had my sister drop me off (of course, I could have used the tram, but she was driving in more or less that direction anyway) and I found the OP clinic quite easily. The receptionist immediately asked me if I were here for the job interview, I said yes. She went off and told him I was here. (And, since I was 15mins early, the good impression started early)

Between my charm, my cultural background and apparently a more impressive resume than I thought I had, it took him less than 10 minutes to decide he wanted me. Having done cardio research, and being a BLS/AED instructor did help too.

I have a job, though I have 2 more interviews. He was happy for me to let him know Tuesday.

Sunday, 6 March 2011

Staccato Update.

As I once more remove Louis the Rat from underneath the shower curtain I use as a pee-guard for wherever they free-range. (My bed, in this case). And, it works better when they're on it, not under it. At least they have fresh breath. They've been bugging me for peppermints.

Yes, I'm still alive.

No, I haven't forgotten about this. I just am sick and tired of my boring life.

Yes, I'm still selling Hugo Boss, and no, I'm not selling much. I always thought I had high requirements for my clothing. These people make me look like I dress with no more discretion than those on

I suppose the greatest news is that, yes, I've actually graduated in the meantime. With 367/360 ECT credits, and no, I have no clue what I did to earn the extra 7 credits. Ceremony is next week, but in the meantime I'm no longer enrolled, no longer a student.

I've sort of decided to do the traditional pledge if I pass for my driving test. That would be this Friday, and with a regional first pass chance of 33% and a driving school with a first pass rate of 50%... I'm not extremely confident.


I also have a job interview next week; the first one. Most of the applications turned out to be for non-existing jobs, which is quite interesting, as I did react to existing advertisements. The interview I did get was not for something I applied to. They had no available position in Internal Medicine, but they are looking for somebody on Cardiology. I like Cardio, and I've done cardio research. I liked the Cardio bit, but not the research bit. I'm trying to get into a place where I don't know anyone. I've borrowed a suit and I'll put in my best charm... and really, it might be a good idea to start there. Get my first experience with being a doctor in a familiar, less broad specialty. Besides, they have the option to switch to General Internal after 6months, if there is place.

I'm also not going to run the race. My leg is more busted than I initially thought.

That's it for now.

Thursday, 24 February 2011

I want to run...

I can't.

I'm injured, once again, still... and it's frustrating.
Here I was, thinking I did everything right.

Here I am, with my overuse injury. This is a bitch. I was finally getting somewhere....

I tried to run today, it has been a week. I didn't get far, turned around and jogged back.

I think my race is screwed.

I'm looking at a MINIMUM recovery time of 2-4 weeks. 1 week done.

Monday, 21 February 2011


I just can't wait to get my life together. I am utterly frustrated. I'm sitting at home, sometimes doing the odd temp job. I am also volunteering once a week, btw. My social life is a mess, my body is a mess, and I'm broke.
I'm not getting anything done. This weekend, I was supposed to write two applications and send them. Not done. Also, the money-time balance is way off: loads of time, no money. In a year I'll have money, but no time.

Saterday's temp gig was slightly better than promoting toilet paper. I got to put on my 'suit' (10 pound Marks&Spencers trousers combined with a white longsleeve tee and my black blazer -Elle, so it's sort of designer- which I bought at a going-out-of-business sale) to sell Hugo Boss at De Bijenkorf, a posh warehouse which I absolutely love. It's odd, seeing teens wearing clothes that cost  much more than I made in a month with my job at that age. I was fascinated by the people who bought the clothes. Maybe one day I'll marry rich? If required, I wouldn't mind learning to play tennis, but I sort of draw the line at hockey.

To add to my frustration, I haven't gotten very far with my 11 projects for '11.
Almost two months gone, and here's the status quo:
1) Find and start first job as a doctor: Well, 3 applications sent, one turned out for a job that doesn't exist. Another 2 will be sent out in due time. Tuesday?

2) Get a drivers' licence: Well, in all fairness, this one is going OK. Test on March 11.

3) Running: The first aim was to run a 10k race. Am still working on that, and I am at 9k, but I also have a bit of an ITband problem. After gait analysis by my physister I have learned that I am indeed a midfoot striker (much to her amusement) but I also use my right (affected) leg less and I need to work on my strength. The shoe is not the problem. Good, because I want to do other things with the little money I have.

4) Get my diving licence: The course is booked.

5) Join a club: is proving difficult: no money. Also, with no job I still can't guarantee I'll be near here for the rest. Stability is the biggest issue here!

6) The food and weight situation: is, if possible, even worse. Much to my frustration. Am working on it, but I'm going to look awful for a while. It's just fairly impossible to do it right while living here. Yes, it's almost march, and I'm heavier than I was with New Years. And even more uncomfortable. No, I am not going to buy fat jeans. The thing is, boredom leads to eating more than usual. Boredom plus hunger is catastrophic, but I don't have the resources to handle the hunger in a healthy way. Extremely frustrating!!!

7) Keep up cross- and strength training.I am still cross-training, but strength training isn't happening. I find it rather boring. And today I spent half an hour trying to get the pilates DVD to work, it didn't. I did a better job at uni: the gym was close by. I get bored, and I can't do it in front of the TV in my room. (Because there's a bed, and then some mess because there's nowhere to put my stuff, and then the rat's pen and that was my entire room)

8)Learn to cook new dishes: Well, I did one...does it count that I made mash for the first time?

9) Creativity time: Well, apart from writing, no and this is frustrating. I'd love to work on my ratbook project, but it's such a hassle to dig out my stuff in the garage... as I have nowhere to put it and nowhere to work.

10) Being organised: Well, I tried with the room. It doesn't work It's depressing. And I'm not getting anything else done... Literally, there's a bed, and part of a closet and a desk that is mine. I can't put anything anywhere. And it's driving me nuts.

11) Learn new things. Well?

Friday, 18 February 2011


Yes, crap, it's true.... Remember my thigh pain?

Though not your typical IT band syndrome. The bit that's normally affected is remarkably unaffected in my leg. Also fairly atypical is the sudden onset. I have pain in mid-upper thigh, only sometimes radiating to my knee.

I also have a physiotherapist sister who didn't mind giving me a rub. A very painful rub, I might add. Turns out there band is a bit thickened/swollen with a lump in it. Even I felt the lump....

The frustrating bit? Never once have I been forcing myself.


Rest for now, will do short runs now and go swimming just a bit more often. I still want to race. Not fair. What now???

The next planned run was 5k, after that I was going to be at 10K, with about 2-3 weeks to work on that.

And, for future reference, the IT band lies roughly in the L5 dermatome:

Ah. The Importance of Hydration.

This was bound to happen.
I still haven't figured out exactly how I want to take my liquids with me on longer runs. I don't feel much for running with a bottle in my hands, and I'm not sure those belts actually work.

Meanwhile, I'm running close to 9km.

Up till now I've managed with pre and post run hydration. Drink half a litre slowly in the 45 mins before running. It worked.

But today (nice and sunny), I found myself thirsty after 15 mins. After 25 mins I was parched. and after 34 mins the Man with the Hammer hit... and I didn't get very far.

Interesting how, if you're really really thirsty, you start considering drinking the water from the pond.

I trespassed onto restaurant property trying to find a tap. No luck. I decided to drastically decrease my tempo and add more walking...

And finally, went to the MacDonalds to drink water from the tap in the loo. A manager greeted me, I said 'Hi' back. (Look, I have no money on me! Besides, what does MacDonalds possibly sell that won't interfere with my run?) Then I walked out. (They're pretty strict about the loos being for customers only.).

Unfortunately I started getting sharp pains in my right outer leg (but NOT in an iliotibial tract pattern) right after that so running didn't go so well afterwards either. In the meantime I've been having these weird pains on and off, especially when going downstairs. Almost like a nerve got a hit somewhere. I'm too young for this shit!

I suppose the good news is that I ran the first 5km of my 5mi which turned to 9.3km run in 29:something minutes.

Wednesday, 16 February 2011

Job Applications

Yes, I'm writing them. I need to start working at some point, don't I?

Slight problem though. Apparently, I can't take my driving test, which means I'm a bit limited when it comes to job appliacations?
Don't believe me?

Found a nice psych job. Requirements: own transport, due to lack of sleep-in calls.
GP training: requirements: driver's licence.
Anything too far to cycle and too complicated to reach with public transport: idem ditto.

I'm pissed off about the whole driving test situation. It's not like I wasn't extremely clear about the situation.
Now it's overbooked.

Writing letters is complicated. I'm nervous.

Tuesday, 15 February 2011

Me and my GP

Yes, another side-post on when the doctor gets ill. I also wrote about the vetinary dilemma. And now, I'd like to talk about my own doctors.

The thing is: I love my current GP. Not in the wrong kind of way... just in the way that she's really good. I don't want to be with her, I want to watch her and learn. (That, of course, won't work). In my time as a medical student I've witnessed and experienced enough GP's to know that you have bad ones, average ones, and good ones. A good GP is worth their weight in round brilliant cut diamonds. Patients often see their GP as 'their' doctor, and trust them, often more than they trust the specialists. (Statement may not apply in all countries) Specialists often complain about GP's, usually about 'daft' referrals. The thing is: on average, a GP refers 10% of their patients. Specialists forget that the GP handles the remaining 90% themselves. A reason for referral could be: I don't know what to do with this. Yes, that does sound daft on a referral letter.

(But, honestly, still, if you can't read an ECG, don't make one, dear GPs who refer to cardio unit)

Dr G1 was my GP when we first moved here. I had to switch GPs when I went to university, and registered with dr W. I never saw him/her. Then I moved out of their 'service area' (GP has to be able to get to you in 15mins in case of emergency), and registered with dr G2 and her colleague dr M. Recently I moved back, and was re-registered with dr G1. Because the rest of the family are registered with her.

Dr G2 is an older GP. She went to medical school in the days when it was a big deal for a woman to go to medical school, and trained before my university even existed. I liked her. She knew I was a med student. I think she probably had a few med students in her practice. She also was really good about my eating disorder; without judging me. I read my notes when I switched GP's recently, including a rather enthusiastic bit about me finally gaining weight. Dr M doesn't know about my status as a medical student, and she seemed to have a bit of an edge about her. One day, when the surgery was really quiet, I ended up chatting about shoes with her. Human after all. Quite a contrast with the time I ended up in a discussion with her about what's in Nexium. (Esomeprazole, for those who wondered, and for those who think it's the same as omeprazole, go review secondary school chemistry)

Dr G1 is probably slightly younger than my parents, although she looks ageless. She has a sort of energy around her. Interestingly enough, she still knew who I was, 7 years after I last saw her. It's in the little things, really. The way she takes into account individual things; such as my cultural background. The way she obviously loves her job. Her attention to detail, and the fact that she's on top of things. Or at least, the things I came to her with. She knew that the Nuvaring could cause the problems I had, for example, but maybe just because her patients are on average 20 years younger than Dr M's. She also quickly revisited the entire situation around my lactose intolerance and stomach problems, and did not just write me a prescription like the other 2 did. Suggested I see a nutritionist after my holiday.
She recently started training new GP's. Good thing. You want the good ones to teach.

None of my doctors were ever annoyed with me being a medical student, thus a notoriously difficult patient. I'm not a difficult patient, I respect their seniority. Also, I'm not one for medical student hypochondria. I've suffered enough real drama, don't need the pretend.

Gynaecologist (I wanted a mirena for period pain, ended up not getting one): Have you done your rotations yet?
Me: Yes
Gynae: So what do YOU think about this pain?
Me: Probably just primary dysmennorhoea...
Gynae: What about endometriosis?
Me: Well, I hope not....
Gynae: laughs. 

Anyway. The only other doctor I've seen was my psychiatrist. I used to be a little nutty, remember? I was severely depressed a few years ago, and basically this man made a huge difference for me. I wouldn't know how he is with other patients. All I know is that he took me seriously when others didn't. He didn't get lost on labels like 'chronic'. I'm also forever grateful that he didn't admit me to the psych institution when I was at my lowest. He said that specific place would not be a good place for me. Later on, when I got to know that place, I had to agree. He really contributed to the fact that I am where I am today, against all odds. I owe him a picture of my graduation.

Look, mental illness can happen to anyone. Thinking that it might not happen to you, or that you are above such mushy mushy things, might only make you more susceptible and less treatable. That means those around you suffer too. I'm pretty honest about my past.

And I don't think having that past makes me less of a doctor. On the contrary; I have life experience which I can use to be a better doctor (than I would otherwise have been). Statistically I have a higher recurrence risk than somebody who never suffered from anything. (For instance, statistically, I have a 70% depression relapse risk. I also have a 30% chance of remaining healthy... I tend to focus more on that bit). On the other hand, having learned to take care of myself both mentally and physically is proving invaluable in a demanding career with a rather high suicide rate. I am not the only one. I personally know a few doctors who have dealt with depression and told me about it.

I do think the relationship between you and your own doctor changes when you're in medical school; particularly towards the end. It's neither good nor bad, it just is. It's such a marvellous profession though: everybody needs doctors at some point in their lives; even the doctors themselves.