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.