Thursday, 28 November 2013

YAY!

Just for the record. I got accepted into the GP training course! And I got really really really busy somehow lately.

Saturday, 26 October 2013

Nerves!

Belated, but here's the update about my interview. I was nervous! I am never nervous, so I don't know how to deal with being nervous. Ok, true, I do get nervous: I'm the stage fright type: freaking out behind the scenes but rocking on stage. And this was the other way round. So I don't know. I didn't manage to show them who I was, and I worry. But, now we wait, nothing I can do anymore.

Thursday, 17 October 2013

Tomorrow is interview day!

So much has happened the last few weeks!! I don't remember if I've blogged or not... guess not then. I have my interview tomorrow. Am I nervous? Well, surprisingly not very much. I prepped for the interview this morning in the train at 7:30 AM, decided once again I'm ready. This evening I read through some stuff, laughed at some responses on a forum about what people expect from a GP and checked the train schedules. That left me with the rest of the day to fret about the rest. Seriously, I've thought longer and harder about my outfit than about why I want to be a GP. (The answer to that is simple: that's the only doctor I really see myself becoming. Of course, there's more to that, but... spoilers...) Turns out my closet full doesn't contain a single combination suitable for this chore, also turns out that close-fitting berry/jewel coloured tops aren't in fashion in Holland to go with my black trousers and tweed-like vest/blazer cross and my ruby lucky jewellery. After a few hours I've found a simple wine coloured top. (Seriously, everything looks like the colours have been washed either too much or with new black jeans. And it's wide. I don't want to go to the interview wearing a tent!! Or something that's absolutely too large... Now I remember why I hate shopping!! I don't understand retail.) Had my hair cut because this seemed a better moment than next week, spent some time pondering on wether or not to wear nail polish. Did my nails in the end, simply because that red nail polish last week wasn't a great idea, and yellow nails don't look too fresh. Am pretty impressed with my manicuring skills. I've finally figured out, at age 27, how to do nail polish without making a mess. Got my documents sorted. Couldn't find passport photos, but I had handed them in digitally. I have no idea where they went, last time I had them I was scanning them for the application. Photocopied diplomas. Including my secondary school diploma, but I really need the bit with my marks on it, which I couldn't find. Why do you need it, you may ask. Well...I'm South-African. I need to prove I speak my languages. (As a native English speaker, I still need to take an IELTS if I want to work in England, for example, because I have no papers to prove it. I do have the papers to prove that I am proficient in Dutch: my secondary school diploma. I never took the Dutch version of the IELTS. I suppose I'll have to prove I speak Afrikaans as well...) Got my proof of registration as a doctor too. Everything. My Dutch passport. And now I need to get my beauty sleep!!

Thursday, 19 September 2013

The All-in-one human.

Somehow, in the Western world, the worst offence to a patient seems to be to ask about their mental well being when they present with physical complaints. We live in a disembodied, beheaded society, I think. Patients are more likely to understand your untranslated explanation of the pathophysiology of shistosomiasis than they are to understand you if you explain to them in plain simple English that their mindset and the amount of stress they're under has a negative impact on their bowel symptoms, but they're not physically ill. Rats experience bowel discomfort when stressed too. The one enjoying his bath doesn't poop in it (unless you manage to put him in there right as he was going to poop anyway). It's not just 'patients'. Just look at the massive gap between mental health and other specialisms. Doctors don't get it either. Funny, because the 1 in 4 prevalence of psychiatric illness affects them too. Sad, because if doctors don't understand it, how will others? And why? Fear? Fear of what? Being human? A result of the Enlightenment? Culture? Belief systems, usually the beliefs of those who insist they don't believe? Science? I've noticed that psychiatric patients are treated differently sometimes. I've noticed that people think I have some kind of superpower, just because I landed myself a psych job. I've also notice that I am somewhat disqualified in the eyes of somatic health care providers because I work in a 'soft' specialism. Sometimes, they even go as far as to assume I know nothing about the Holy Body, forgetting about the M.D. behind my name. A few examples: Dispatch: Ambulance services, how can I help you? Me: Hi, this is dr Blondie, doctor with the acute psych unit. I'd like an ambulance to send in mrs Pams, who turns out to be in the process of an overdose w... Dispatch, irritated: riight... with what? Is she conscious? Me (half interrupting): with diazepam and risperidone in unknown quantities, possibly up to 60 tablets of diazepam and around 20 risperidone between yesterday and just now. She's haemodynamically stable and her consciousness is slowly deteriorating, she's becoming somnolent. I have already informed the emergency department and will be staying here but I have no equipment at hand Dispatch: OK, so that's orange triage then, they're on their way. I'll also note there's a psychiatric nurse present. me: I am a doctor.... (Thinking: what part of the above made you think I'm a psych nurse?) Or,upon noticing that the patient with a psych history acting funny, who has been seen by the GP out of hours service and referred to us due to acting funny with a psych history being the main finding, actually is suffering from advanced liver disease and needs to get to hospital TONIGHT: Dispatch: but does she WANT to go? me: No, but she doesn't really have a say in this right now dispatch: Does she have a mental health act order then? me: No, she doesn't need one...she is unable to make any decision dispatch: But I need a mental health act order to transport her me: No, you don't. I am sending in a physically ill patient to the Emergency department, this has nothing to do with mental health. dispatch: I'm not sure I'm allowed to transport her, I'm going to discuss this with my manager Apparently all symptoms in psychiatric patients are due to their psychiatric illness? Apparently working for the acute psych unit renders me incapable? Our team has had multiple clashes with two different GP's over this patient, and I had the long version of the above discussion with the dispatch for a patient who went on to spend weeks in the hospital with an hepatic encephalitis. This is not intended to bash other health care professionals; but had this woman not been in the same house with an alcoholic and had she not had any psych history, she would have been in hospital days earlier. People get thrown off by 'psych'. Luckily the Emergency department had no issues with me. This is sometimes different. The following situation is more likely to happen if you're dealing with a junior doctor. Them: ... and they're medically ready for discharge.. me: What were your findings? Did you check this-or-this? Nothing special, and no, I needn't check this-or-this. me: May I see your discharge letter please? We need that info. them: -giving me that you-won't-understand-it-anyway look- I already told you, but here me: -glancing over labs and results- Look, I still need to know this-and-this This-and-this usually refers to something related to neurology, specific lab results such as CK or delirium related information. The worst was when I had to have my supervisor intervene in order to get a neuro consult for an elderly gent with a recent head trauma. I don't think it's about hating psychiatry. I think it's about fear. It's also very much about the mainstream Western belief system. Secular individualists who have faith in science and rationality, believing that they are -or should be- in control of their own lives. Physical illness is easier to deal with, because it's something that 'happens' to you. This type of control is seen as 'strong'. 'Strong' is the surgeon, not the psychiatrist. Health and happiness above all, and success is important. Strong people have their shit together, mental health issues mean you're 'weak'. And stress causing physical symptoms threatens this 'control'. They immediately assume I am not taking them seriously if I am asking about 'stress', and in their minds it's a weakness. This is another interesting example of how the body gets blamed for doing what it does when it gets pushed past it's limits in terms of stress: Adrenal Fatigue. Essentially it comes down to this: you are so in control of everything and can do so much and can handle stress so well that you start having symptoms of exhaustion. You then kick up a fuss and let everyone know you suffer from adrenal fatigue. Victim. You even get angry because the medical world doesn't take you seriously. And I know this way of putting it isn't fair. Dr Wilson's adrenal fatigue really comes down to a medicalised explanation of what is bound to happen when a person is just plain overstressed. And he then wants to make money out of it, but all in all: there's nothing medically wrong with explaining what happens when a person has had more than they can handle. In fact, I too 'suffer' from 'adrenal fatigue'. The thing is, this is what happens when you name it a 'condition'. I would not be taking myself seriously if I were to blame 'adrenal fatigue', or even call it that. I would not take my patient seriously if I were to go along with their wish to treat the body, blame the body and such, without even exploring who they are and what they're dealing with. There is also a drive towards 'balance'; mindfullness and and the like. Balancing your chakras, living mindfully, becoming a buddhist, etc. The above image really brings out the associations we have with the 'Connection between body, mind and soul'. More associations: alternative medicine, holistic approach (such as sticking needles in your foot?), yoga, whole foods, energies, certain types of schooling, detoxing (not talking about an admission to rehab here) and the like. I think you get the picture. I also know many 'logic' people who do not want to be associated with that. Neither do I, actually, because I see just another way of trying to control, trying to find health and happiness for oneself. See, I don't get it. Why is it so hard to find an in-between? Where has common sense gone? Why the all-and-nothingness? Why this obsession with health and happiness? I see people as multi-dimensional creatures, IN their surroundings. Mind, body, soul are all connected, of course. Mental health is health just like any other, after all, the brain is an organ, and your psyche did influence that heart attack. You can't control everything, but you should take responsibility for what you can. I won't prevent myself from getting sick if I do everything I can to stay healthy, and statistics are statistics. But it would be pretty stupid to not take care of myself (body, mind, soul AND spirit), and then feel sorry for myself if something happens. I can't prevent getting cancer, but I can refrain from increasing my risk to a certain degree. The clue being: balance. It will never be perfect, and happiness can not be found, only experienced. Being human is an all-in-one experience. It's not that floaty, and actually pretty simple if you think about it. And now, I am going beyond, for those who DARE. Body, mind, soul... and spirit. I believe there is more to being human than what we can grasp. No, I KNOW this. I am a believer, a Christian, in a secular world which looks down on believers. Because faith is for those who are weak, cannot think for themselves, the unenlightened, the lazy, the broken. Religion limits, humanity has evolved past religion. How can any self-respecting, intelligent person be a Christian? Simple. Really simple. Faith is for the weak, the thinking-disabled, the broken, too. Faith IS enlightenment. The lazy? Not so much. Religion does limit, and is not the same as faith. Humanity apparently has not evolved past ego, but God takes you past ego, and I don't even have words to describe that. It allows me to fully understand self respect and I am intelligent enough and educated enough to know we're not as smart as we think we are. I don't understand how anyone, after discovering Christ, can NOT believe. I can not understand how anyone can be satisfied with a secular life. But, that's up to them. We can agree to disagree, in all respect.

Really Psyched!

So, things are rolling still. I should be hearing about my application next week. The University Medical Centre (UMC) was kind enough to inform me that I can expect a letter in week 39, but receiving and envelope with the UMC logo a week after the closing date almost put me in cardiac arrest. I mean, that could NOT be a good sign. I am still just doing my job and it still is a lot less fun or safe to write about. Remember the Paracetamol Girls? Three years on, and they've become the run-of-the-mill of my daily (nightly, weekendly, eveningly) job. Three years on, and I do not view them any differently than back then. I know more about them, it hasn't changed my view. Interesting. To be honest, 'I want to die' becomes less impressive after hearing it a few times. You learn to listen to what they really want... and some really want to die. Not the Paracetamol Girls, mind you. The ones that chill your spine are the really sick ones: severe depression, booming psychoses... roughly in that line. On this job I've been called 'names I can not identify myself with'. I've been threatened... and I've had someone who threatened to kill me come up to me and apologise... and thank me. I've phoned 112 for acute police assistance. I've had to pull a police officer off a patient who was faking coma to prevent him from resuscitating her... (of course, only to figure out she was faking and then regretting not being able to witness the resus... she wouldn't let him!) I've had to deal with the snake pit of gossip. I've dealt with other doctors and the ambulance service who don't take psych seriously. According to some at work, I would be able to become a psychiatrist. Thanks. Really. I just don't want to. I am really psyched about the prospect of becoming a GP!

Friday, 6 September 2013

Starting night shifts again

Due to -in short- me having been emotionally and physically exhausted due to stress in any imaginable way possible in the 2 years since graduation I was taken off nights. This exhaustion went far beyond what normal doctors experience. The goal was to prevent me slipping into another major depression; and that goal was reached. I am fine. So I am to try night shifts again. I don't have the same resilience I once had, and I won't be able to handle the 'standard' 4 a month. Risk is too high, especially now that my asthma is another factor to take into account. I can't afford any 'post night shift colds' because the common cold triggers my asthma too much. And I am nervous. The first will be on Monday. I live in the city centre, there's no way I'll be catching a good day's sleep. I know I'll be fine really. It's just that nighs are so long. I get so much more done during daytime if there are no patients, and I am less focused during the nights when there are patients. When I mention that I don't like nights, I usually get a response 'but... isn't it kind of cool, the city sleeping, the atmosphere of the night, feeling like superheroes?'. Well, if I want that feeling, I can set my alarm at 3:30AM and go for a bike ride, and then go back to bed. We'll see. I'm still trying to recover from the hours spent laying awake because of noise problems this week; last night was the second night I had a good nights sleep. It's kind of like having a baby, living in this house, you never know when it will keep you awake. But then without the oxytocin release, without the cuddles, and without the option of kicking Daddy out of bed because it's his turn to make the noise stop. Oh, and without the noise actually stopping. (I WILL be kicking Daddy out because it's his turn if I have a baby).

Thursday, 29 August 2013

Application!

I handed in my GP training application form. On time. I don't think I've ever spent so much time and attention to ANY application. First, I tried to find as much information as possible. How, what, where, experiences, advice... Luckily it's not too hard to find either a GP or one in training to chat with. Google helped me a long way. I even studied a 95-page report on differences between the universities. Then, I used a list of aspects Leiden University pays attention to -to be found on their website- to start my mind. I know why I want this, the only trouble is that I can't find words to describe it. The limitations of the Dutch language doesn't really help there either. Then, I sorted out the 6-page application form. Those questions are hard! What was my exact graduation date? Is my cardio research relevant? What about child and adolescent psych? I mean, MOST things are relevant for general practice, just maybe not equally relevant. Religious studies turned out to be more relevant for medicine than you'd think, for example. At some point I decided to write the letter. I spent many very focused hours, without the blinking stripe on my screen actually being chased by very many letters. How. Do. I. Explain. This. Draft 1 got reviewed by 3 people, as did draft 2 and in the end the only difference between draft 2 and the final result was a few spelling corrections and one sentence. I decided that I was capable of writing a sentence. The Sentence was rather important I think. It's about the 'context' in which a patient/person experience whatever troubles they're facing. I talked to our GP trainee, she mentioned that... and when I re-read my letter I noticed that I did not express it. It's that thing where I paint a mental picture of someone's world. I've always done that, I've always found that really fascinating. Even as a child. I suppose growing up in a multi-cultural country inspired that. It took me a while to realise that not everybody does that. I still don't understand how you work as a doctor without considering this 'context'; well, unless of course in certain acute situations where you need to treat first what kills first. But, even THEN: Do they have an NTBR, do they want to be saved, do they refuse blood? I tweaked my resume, mostly the lay-out. I only realised that my summer jobs may have been relevant, but, oh well. Not extremely relevant. And then I handed it in. And now, we wait.

Friday, 9 August 2013

Take my Breath away!

Well, I suppose this is both a problem of trying to be your own doctor, and having ADHD. Seriously. ADHD won’t prevent you from becoming a good doctor (Ok, this I hope). For other people. Being a doctor makes you a shitty patient. Having ADHD makes you a shitty patient. Combine the two and well Not all visits to out-of-hours medical services are completely unpreventable. (In this city -like in many Dutch cities- GP out of hours services are right next to the hospital Emergency Department. It’s wisest to phone the GP out of hours services unless you need to phone 112, because the ED will likely bounce you back to the GP if you just drop by. GP’s also do home visits. In most cases this system will work best. Human error is as present in GP’s as it is in ED docs. Well. Hi! I’m Blondie and I am an asthmatic. I’ve been in denial. I’ve had light asthma for a few years, after being symptom free from age 8 to roughly 20. Bronchial hyperreactivity more like. I had an inhaler, which was usually lost. At some point I’ve managed to find 3 inhalers. I had some exercise induced wheezing, I had some bronchial problems whenever I had a cold. Nothing much to worry about, just annoying. I had minor attacks when cleaning out rabbit cages but not the cages of any animal that didn’t sit on hay. Then last winter I had severe bronchitis, probably with a secondary budding pneumonia because I’m not buying the rapid response to antibiotics that this ‘viral bronchitis’ had. It landed me -accompanied by a worried TDH- at the GP out of hours service. Me: unable to speak full sentences or remain standing for a few minutes. The GP: convinced that I was a very weird lady. ‘I’m sure there’s something else going on’. Me, racking my half-functioning mind: ‘Nothing I can think of…’. TDH almost forcing the first dose of antibiotics down my throat as soon as the pharmacist handed it to me. A friend of mine, who is also a doc, pointed out that she thought the GP should have sent me in, she would have admitted me to Pulmonology or the Acute medical ward.. Later on, I realised that I would have admitted me to Pulmonology as well had I been on the ED, and had I been on the GP services I’d send in a 26-year-old female with an acute worsening of an already long-standing bronchitis who is obviously lethargic, short of breath and doesn’t seem to make enough sense. I wonder if my mental health history -hinted by methylphenidate as medication- influenced him. Anyway. I recovered. I don’t remember much, apart from being unable to provide basic self care. I don’t remember ever being so ill in my life. But the antibiotics worked. And I had another bout of viral bronchitis, this time it was nicely self-limiting like a good viral bronchitis should be. All fine and dandy. Then came hay fever season, and asthma was a problem for the first time in my life. There have been a few minor attacks in the meantime. But allergy season revealed allergic asthma. I had anti-allergy meds, I had salmeterol, I had salbutamol. At some point I was quite limited: pollen get everywhere. But, yeah. Whatever. It will be ok soon, right? Wrong, of course. I have a cold. I had a cold, actually. It’s all better now, apart from the chest bit. Yesterday morning I noticed a slight roughness in my upper chest, and tossed my inhaler in my bag at the last moment. Good, because I started having an attack 5 minutes into my normally 20 min ride to work. Not that my inhaler did much. Went better after a while at work. Got worse again in the afternoon. It did not get better again. At 8:30PM I phoned the out-of-hours service. They saw me within an hour. The irony being that of course, it just started feeling a tad better right before they saw me, in the waiting room and in the office I had a few minutes of compensatory hyperventilating I think, got my saturation up to 100%. I wasn’t wheezing anymore and while I was there I started thinking clearer. Really, I walked out of the tram (see, I push myself…) and I thought: hey, wow, that’s the best breath I had all evening and afternoon. It wasn’t GONE, it was just slightly better. I went because I started panicking a bit: what if this gets worse and I’m here alone? I wanted to cry for some reason I can’t remember. Panicking and crying of course doesn’t work too well if you’re having trouble breathing, noticing that it made it even harder snapped me right into logic mode. Ok, so, let’s go then. Asked TDH to go with me. Went home with Seretide, the combination of salmeterol and the steroid I should have picked up months ago. I knew that. This time the GP was less judgmental, took me more seriously and gave me advice. I didn’t have the coherence to explain that I kind of knew that, and that the doctor managing my asthma so horribly was in fact… me. I could have played the ‘psych’ card; but that’s bull. I know perfectly well how to manage asthma. Sometimes doctors are hypochondriacs. Med student hypochondria is a real thing. Sometimes doctors are the opposite. I’m one of them. I’ve never been good at being ill anyway. I tend to ignore things, thinking it’s no big deal. It wll pass. This is fuelled by others who tend to dismiss it if I mention anything. Mostly my family I think. I’ve internalised the ‘Busy can’t possibly have anything seriously wrong with her and shouldn’t whine’ concept. It’s based on nothing to do with the actual me. I don’t whine. On the contrary. I keep going too long. And, in this particular case, I had irrational fears about steroids. And it landed me somewhere I didn’t want to be. I hate going to doctors. And that, ladies and gentlemen, is why you shouldn’t try to be your own doctor.

Sunday, 4 August 2013

So, here we go!

Kind of 'scary' really, to think that I'm doing the 'career' thing now. It's August, I'm at work, and I am working towards a future. A grown-up future. I'm busy with the preparation for GP training, well, the application for it. The boy and me are talking future dreams, he's joking too enthousiastically about getting me pregnant to not take it seriously. Some men are father-types, he's one of them. I'd have to pry my theoretical child from his arms just to give it a kiss. I'm also realising that I'm very likely going to be the breadwinner one day... All very grown-up and very responsible! (Isn't it wonderful that we live in an era where, albeit sometimes somewhat reluctantly, men can be carers if that's what they want to be and women can be providers if that's what they're best at?) Not that any of this is really new. I knew I'd be facing these things when I was 18 and decided that it was a brilliant idea to go to med school. I'd never seen myself as a housewife. (Let's just say that I'm a little domestically challenged). Motherhood always was a future possiblity, and I've been shouting things about it ever since I arrived in Holland as a South-African teen and people started asking me 'but what about the children?' when my answer to the question 'what do you want to be when you grow up' didn't involve being a (part time) SAHM. (What do you mean, what about the children? You don't ask the boys that, do you?). I've thought out the whole GP thing in my final year, and even planned it out. Then things happened, and I started regretting not being a fashion designer... And now it's all very real and very close. And that's kind of scary.

Wednesday, 24 July 2013

Oh My.

So... I have been sort of MIA for a while. Just, randomly, I had nothing to say. I also had survived, somehow, my first year as a doctor, and after that it just sort of becomes a given thing.

My world has changed. I have moved, I have fallen in love, I have learned so much about life. Important, too. In fact, I am only marginally blonde these days. Perhaps I should change my user name? Turns out my 'natural' blonde hair is actually dark ash, growing out light thanks to the Pill. THAT explains why my hair never seemed to suit my face!

My current job is filled with fantastic stories. The problem is, I can't write about them without risking compromising patient confidentiality: my job is uncommon, my patients are uncommon. I work in acute psych, still, differentiating plain crazy from playing crazy and figuring out the perpetual puzzle of How To Get Through Today.

It is, however, time for a new chapter in my career. Specialist training.

Or...

Generalist training.

I still find it odd that training to be a General Practitioner is called 'specialist training'.

"A general practitioner is a doctor who keeps knowing less and less about more and more areas until (s)he knows nothing about everything. A specialist, on the other hand, knows more and more about less and less until he knows everything about nothing"
-quote taken from 'Rude Health' by Adrian Besley-

And now I'm looking forward to reading about some people I haven't read about in a while!