Facing death

When you're a doctor, dealing with death is inevitable. When you're a baby doctor, the prospect of having to deal with death fills you with dread.

I've had to grow up big time in the last 2 weeks and deal with what I've always looked at as a "grown-up doctor" topic.

Thursday 2 weeks ago:
Was paged to sign a death certificate for a patient I didn't even realise had died. We'd given this man 6 months to live from diagnosis. He died after a week. He just stopped breathing. Just like that. This man thought he had just come in for gallstones. We diagnosed him with pancreatic cancer, one of the few we just have no treatment for but palliation.

I didn't realise how much emotion I had invested into this patient. I felt sorry for him and his family, and went out of my way to make sure his stay in hospital was as pleasant as it could be. He was my first patient to die. I was shattered.

Friday last week:
A nurse came running into my office: "Anna, you have to come now, your patient in bed 8 is crashing." My patient in bed 8 was this little 84 year old lady who was not for resuscitation and not for active treatment. I went in, saw that she was in pain and distress. She had difficulty breathing -- it was pneumonia and some heart failure. She was drowning in her own lung fluid. Now, I know how to treat this. What was exceedingly difficult about this patient was that I wasn't allowed to treat her. All I was allowed to do was make sure she was comfortable.

It's really hard to not do what you've been trained to do. Doctors are taught to save lives. The difficulty arises when the ethics of quality of life intervenes. When should someone use heroic measures? And when a doctor doesn't do anything, how is that not giving up.

I had to stand back and wait for my patient die, knowing I could do something to stop her death, but also knowing that any measures I employed would be against her wishes.

A post-Valentine’s Day thought

I know that it’s considered mushy. I know that females of my generation outwardly deplore the commercialism of the day.

But it was my first ever Valentine’s day to celebrate with a significant someone. So I hope I will be forgiven for being caught up in the romance of the day.

A red rose. A picnic basket. Moonlight Cinema’s showing of Breakfast at Tiffany’s in the Botanic Gardens with a guy who is watching it only because he remembered me saying “ooh, I love that movie” about 4 months previously.

I know that it’s important to feel romanced everyday, but sometimes, just an outpouring of affection and romance on one day, even a commercially dictated one, makes me melt. And fills me with the warm fuzzies.

So I wish a belated happy valentine's day to all the hopeless romantics out there. Even if you won't admit it :).

The second paycheck

I picked up my second payslip yesterday. My second pay. And since we get paid by the fortnight, it means that I've been a doctor for a month. (Well, more than a month, since it took me a while to get to my pigeon hole to pick it up.)

Don't laugh, I need to be more aware of these links now, since my tired, sleep deprived, caffeine overloaded brain no longer functions on a normal level.

It scares me how quickly this month has gone by. In the past month:

1. I've parked in the doctor's carpark.
Yes, ladies and gentlemen, I have gotten over the fear of the title and have claimed a proper parking slot.

2. I've saved someone's life.
In my second week, I was paged to critical care, where a little old lady was acutely short of breath. I managed to conquer my panic, order the right tests, and prescribe the right medications. This despite her gasps of "Are .... you.... old..... enough..... to..... treat..... me.... dear?" After she got her breath and I realised she was going to live another day, she patted me on the hand and told me that I would grow up to be a good doctor.

3. I acquired students.
Or, as they're known on the ward, my little ducklings. Who follow me around and hang on my every word. A scary position to be in. They're 4th year students, it's their first week on any hospital ward, and I do feel for them. I remember what it was like to be so scared and so in awe of the intern, but, at the same time, I can't believe that they look up to me so much.

A highlight: yesterday, I assigned one of them to take a history from a patient and present him to me, just for practice. I went off to clinic, and when I came back, my student was copying my admission note. I wasn't too hard on him, after all, every med student cheats off the intern's admission note. But I still can't get over the fact that my notes are now worth copying from!

4. I've broken bad news.
Today, I had to tell a patient and his family that, no, his problems were not gallstone related, but that he had a nasty form of cancer that, unfortunately, is not curable, and has already spread.

All in all, I'd say it was a hectic month.

And now I've just gotten paged to put a drip in. Sigh.