Tuesday, November 30, 2010

Electives Part I - Madness in Dermatology

I look out the office window and admire the beautiful vista of the Opera House, Sydney Harbour, State Parliament House and Library. It is my last day of a fast-paced 2 week placement and I want to commit this view to memory.

When I turned my back on a Law degree, I never imagined a doctor could have office views like this. The offices I was accustomed to so far were the dungeons of the hospital, 4 walls and a measly window if you were lucky to get one.

But alas, such beautiful and therapeutic views were but a deceptive illusion to the action that occurred within its walls.

I find myself sitting in this office after being picked up daily by my elective supervisor, a dermatologist. Seeing we live only streets apart he insisted, it wasn’t hard to refuse…Sydney public transport or a 7 series Bimmer; a tough choice indeed. He has a post-it note to remind himself to pick me up, 715am each morning. He is a mad dermatologist (other dermatologists being more sane with 9am-5pm days) and he happily confesses this to me day 1.

The list is packed 8am to 6pm sometimes 7pm appointments, 10 minutes apart. Within the first hour we already run an hour behind and he manages to shift into a higher gear. I blink and he has re-appeared in another room (I accuse him of taking ninja lessons whilst still an undergraduate). CEOs, barristers and priests from St Mary’s come and strip down to their knickers for annual skin checks, flinch and yelp at Botox injections. The phone rings during each and every consultation. At one point he is juggling 6 people all wanting to talk to him. He jokes with his patients, discusses business, argues with them, attacks them right left and centre with the liquid nitrogen. I think he is superhuman, I find it embarrassing that a girl like me half his age is mentally and physically exhausted yet he still goes on sharp as a nail diagnosing, managing and getting through patients.

We finish an hour later than we should and make a quick exit to the hospital outpatient clinic where 3 dermatology registrars are seeing patients. He whizzes in and out dictating treatment plans. By magic we wrap up the clinic at a reasonable time. On other days instead of rushing to the hospital we make an equally speedy drive across the bridge to “God’s country”. Another consulting list awaits, with the added challenge of his cosmetic clinic upstairs which he simultaneously juggles and where I bear witness to many laser and botox treatments.

He is a brilliant doctor. He genuinely cares for his patients; he waives his fee for those who have difficult financial and social circumstances or only bulk bills. For each excision, he takes the time to do subcuticular and vertical mattress sutures; making sure the edges are aligned and everted to achieve the best cosmetic and functional results (by the end of it I think they are seriously the prettiest stitches any patient could ever want!). He genuinely cares for his staff and also a lowly medical student - imagine your chairman or boss picking you up from home and dropping you off everyday AND buying you lunch everyday! (Though lunch is really a race to see who can finish first without choking).

But my favourite times are the ride home at 9pm. We act like big kids and binge on jelly snakes. He reminisces and tells me crazy and downright hilarious stories of his time in training. The winner by a long shot is the story of legendary Dr X, the obstetrician/gynaecologist. Cut short, this gynaecologist was found by the anaesthetist to have passed away whilst performing a hysterectomy with his head slumped such that his face was in direct contact with what we call the "gynaecologist's landscape"! Sounds like something straight out from Gray's Anatomy, but he reassures me this truly occurred during his days as a medical student.

There is never a dull moment - take for example his introductions for me: as a random patient sitting in for fun or maybe a member of the Dermatology Board here to make sure he is in line; worse a girl he's picked up from the beach that morning after a boat has delivered me from China. (We tell the truth afterwards of course).

He reveals on the last day that he was terrified to take me for a fortnight placement - he has taken medical students, registrars and doctors at maximum for a few days but never as long as a fortnight - and he didn't quite know what exactly he was going to do! I can't help but laugh out loud. I realise that I've never laughed this much during any placement in my 5 years of Medicine nor had this much fun. I tell him that I haven't only taken away general dermatology learning but life lessons as well. Most importantly though, relief that there are mad (but brilliant) doctors around like him; the knowledge that you can deliver high standards of medical care while still being your crazy mad self and have roaring fun with your patients.

Friday, November 19, 2010

The Top 10 Trials and Tribulations of a Medical Student


Hello Spring! The glorious poppies in bloom at Wagga Botanic Gardens.

Exams are done! Let the celebrations begin :D


It is a fact not universally acknowledged but acknowledged somewhat that prior to exams, some of us put our lives on hold.

(Self-inflicted lockdown.)

And so it was goodbye to aimless rolling on my bed, to sunshine and Spring, to fun and frivolity... hello to a paper jungle of a bedroom, to daily dosing of vitamin D supplements and the occasional stress-induced palpitations/feelings of impending doom. We've shared tears, sleepless nights, the "baby" (I guess exams can incite feelings of cluckiness?)... and of course that pesky psychosomatic diarrhoea come D-day. Yes, it was times like these that I/we asked ourselves what we were thinking to put ourselves through this?

But in the space of an hour, 4 stations, facing 4 pairs of examiners testing what 'knowledge' we had accumulated over the last 5 years, all the hard work has paid off - 5 years of Medicine down, 1 more to go baby! :)

Actually I have to admit I had a pseudo-Slumdog-Millionaire-turn-of-events!

For my pharmacology station, the case presented was of a lady 3 weeks post-partum who was suspected to have a pulmonary embolus. Just the week before, the Wagga crew had to do a series of non-assessable case presentations... I had decided to present a case on a pregnant woman who had a recurrent PE during pregnancy (amongst many other things) and focused on anticoagulation in pregnancy. What's more, for the anatomy station, the topic was on chronic pancreatitis. During my surgery rotation earlier this year, the case presentation I gave was actually on chronic pancreatitis. I guess someone up there was really listening when I was imploring to whoever would listen to help get me by!

And after the exams, we had over to Lake Albert for some post-exam shenanigans and a good old BBQ...


Lake Albert by dusk.


With Psychopathwitch, MissLovelyP and MrProjectRunway and an amazing backdrop of a sunset.


Caught: a Fat Duck!
But hopefully we won't be eating this fat duck at THE Fat Duck ;)


So the top 10 trials of being a medical student?

(Warning: possibly ranty post to come...this was scribbled during those times cramming which I really did question why I was doing med in the first place...that's right being a trophy wife is actually quite difficult - just kidding! =p). Anyways here's the list:

1. Spending six whole years at uni. Yes we might get to make the most of the concession travel cards but that's because we're poor. We get to watch all our friends graduate, work and place a deposit on their first property and still find ourselves being a full-time student at uni. There are better chances being an electrician or plumber and probably a lot more sanity by the time we graduate as well.

2. Nurses and midwives. Being a medical student is the only chance it seems midwives and nurses can get back for all the times doctors write up "patient needs enema". (This however does not apply to country nurses and midwives who sometimes have been too good to be true!)

3. Exams that test you on six years worth of assumed knowledge. Law peeps get open book exams, not us. Plus no more spoon-feeding days means six worth of assumed knowledge = pretty much self-directed knowledge = Wikipedia.

4. Becoming a hermit / dubbed anti-social by your non-med friends (aka the rest of the world).

5. Getting shafted to places via an 8 word email. Point being me. A 2 line email delivering a 2 year sentence. And no it doesn't matter if you don't have the finances to support yourself during this time, nor if you just got engaged, nor if you find out your grandmother is in hospital with end-stage renal failure and might not get dialysis and you just want to spend your next 2 month rotation back in Sydney (as I found out a fortnight before exams)...nope these are not valid reasons for you to get out of your rural secondment.

6. B-blockers, anti-depressants and Temazepam. Doctors apparently have the second highest rate of depression / suicide (behind dentists). But as Quality Use of Medicine dictates, consider an appropriate medicine when a medicine is considered necessary. For the timebeing I'm sticking to my non-pharmacologic option...chocolate.

7. 100% employment... wait that was yesterday's news. So the government has doubled medical student places without facilitating an equal increase in the number of internship places available. International students have been notified that they might not be able to secure an intern placement after investing $40000p.a. to study here. That's nearly a quarter of a million dollars by the time you graduate...

8. When you realise it's only the start....and know that ahead of you are: 100hr+ weeks, sleepless nights being on-call and yes nearly another decade of study before you get to the end of all exams...

9 and 10: So I kindof stopped at no. 8 since I thought 8 points were quite depressing already, but if anyone has anything else to contribute - feel free to comment.

Of course having written all that, I do consider doing Medicine a privilege and that yes when you put your hand up for Medicine you are ready to accept the above. People enter Medicine for different reasons, I wanted to live a comfortable life (not too extravagant and not difficult, just comfortable and content) doing something that would give me reason to get out of bed every day (the ability to alleviate pain and suffering) as well as being able to have a family life and my priorities in check (GP, part-time consultant? we will see). The hope is that the hard work and sacrifice to get there will be worth it in the end*


*And my fortune-telling skills predict that it will be a yes. As long as you have a roof over your head, clothes on your back, family and friends you love, then that's all you need to be simply happy. Like I am now. It also helps that I'm post-exam and know I've passed ;) (Hang in there for Sydney medstudents less than a week to go!).