Sunday, 29 May 2011

Perfection.

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

Time...

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."
Eh...

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.