Monday, September 6, 2010

Internship: Term 1 – Relief/Nights

So I guess it's been a while since I wrote about medicine here. Oops.

My first term as an intern was relief/nights. This means that you fill in for other interns and residents who are on holidays, and you do anything from 1 to 3 blocks of night shift, covering half the wards in the hospital.

It's not really an ideal first term, because there's no continuity and little supervision. But many had done it before me, and there was no point whinging about it - I just had to get on with it.

I started with 3 weeks on a Geriatrics ward at a small peripheral hospital. It was a great way to ease me into the workings of the hospital system, eMR, procedures, etc. And one of my closest friends from uni was allocated to the same ward as me - bonus!

After that, I did a week with a very busy General Medicine team back at the main hospital. Gen Med is the dumping ground for most non-surgical/non-chest pain patients who present to the Emergency Department, and therefore a lot of my time was spent arranging consults with the subspecialties (e.g. Respiratory, Gastroenterology, etc.), hoping that they'd agree to take over care. I also wrote LOTS of discharge letters.

Next up was 2 weeks at another small peripheral hospital, this time doing Rehabilitation Medicine. It was really dull. Not much happening. Although I did get a chance to practise my venepuncture skills, because the vampires blood collectors don't service that hospital each morning.

I then had another week in Gen Med back at the main hospital, with 1 day of Paediatrics thrown in to confuse me! The Paeds day was very quiet - they didn't really need me. I did a few new baby checks, wrote 2 discharge letters and some medication charts, and that was about it.

To finish off the term, I had 2 blocks of nights - 7 nights in a row, with several days off before, in between, and after. The nights sucked about as much as you'd think they would. Basically you work, come home, have breakfast, sleep, get up, have dinner, and work. I lost a few kilos by skipping lunch for seven days! (I did have some - mostly healthy - snacks each night of course.)

I covered 7 wards:
  • 4 medical - Gen Med, Neurology, Cardiology, and Coronary Care Unit
  • 3 surgical - Orthopaedics, Urology, and Vascular.

A resident covered the other wards, and there were medical and surgical registrars on call too.

Each night, after handover from the evening team, I did a round of the 7 wards - depending on the night, this could take from 2 hours to 5 hours or more! Then I'd aim to do another round closer to the morning. On weekdays, the surgical teams arrive from about 6:30am, which cuts my workload in half. Most PACE calls (see below) were received around 6am, when the first observations (vital signs) of the day were taken.

The intern is first on call for theatre, so that means I had to assist on Caesareans. I don't normally have any problem with blood, but seeing and touching that much blood in the wee small hours made me a little bit woozy.

I couldn't believe how busy the nights were. Not all of them, but most of them. I think my longest break was about 2 hours. I hated my pager. Common pages were for people with hypotension or low urinary output. Medication pages were for pain relief and sleeping tablets. The most common things listed on the whiteboards on each ward were requests for fluid orders or cannulas. I'm not a fan of waking a patient at 3am to do a cannula, so I always asked the nurses why the patient was having fluids and whether we could let them sleep a bit longer. Many of the jobs on the whiteboards can be left until daylight, or even for the day team to do.

And then there were PACE calls, which means that a patient has breached specific parameters (e.g. high/low blood pressure, high/low heart rate, high/low resp rate, etc.), and you have half an hour to review them.

Finally, there were arrest calls. I attended several arrests, and did CPR for the first time, and then many more times after that. There was one particular arrest that really rattled me, and I was pleased that the nurses on the next ward I visited were happy to talk through it with me.

There's not as much support at night, but I found the nurses to be mostly wonderful. I was on great terms with a lot of them by the end of my 14 nights - to the point where one nurse paged me at 3am to see if I wanted something on her Maccas run! The medical registrars were very helpful too, and understood that I might call them about seemingly trivial things, because I was so new and still learning how everything worked. That said, there were a couple of nights where I didn't need to call the registrar at all. Amazing!

I actually had an incredible 'circle of life' experience one night - about an hour after a patient died following CPR, I helped deliver a baby. Quite a privelege.

I handled the fatigue fairly well. I'm lucky that the place I'm living in is an old unit block, so the walls are solid. I can't hear a thing from the apartments either side of me. I wore earplugs and an eye mask, and managed to get a decent amount of sleep most days. The weekends were the hardest.

So I managed to get through the first term mostly unscathed. I feel like more of a doctor now, but still a total newbie. A lot of my medical knowledge came back to me, but I still think I need to be doing a bit of study here and there. I'm really thankful for the access to online resources such as UpToDate and Therapeutic Guidelines. I've made good use of those during every single shift, I think. Not to mention MIMS and AMH.

Best things about my first term as an intern? A regular pay packet, and days off.

My second term is in Emergency, and I'll have more to say about that in early November.

Sunday, August 8, 2010

Budapest, Hungary

I loved Budapest! It was easy to get around, there was so much to see, and I finally had some great weather.

Fisherman's Bastion and statue of Stephen I on Castle Hill, Buda

Looking from Fisherman's Bastion, Buda across the Danube to the Parliament Building, Pest

Fisherman's Bastion and Stephen I

Fisherman's Bastion

Matthias Church, Buda

Raven, symbol of King Matthias

Széchenyi Chain Bridge, viewed from the Royal Palace

Parliament, viewed from the Royal Palace

Liberty Bridge and the Danube, viewed from Gellért Hill

Looking towards Castle Hill from Gellért Hill

Liberty statue at the top of Gellért Hill

St Stephen's Basilica, Pest

St Stephen's Basilica

St Stephen

St Margaret

Statue near the Parliament Building, Pest

Another statue near the Parliament Building

Interior, Great Market Hall

Did you notice the undead doll staring back at me?

Széchenyi Baths

Next: Prague, Czech Republic...

Tuesday, July 27, 2010

Auschwitz-Birkenau and Kraków, Poland

I specifically visited Kraków so that I could go to Auschwitz-Birkenau (it was as depressing as you'd expect), and was pleased to find the city thoroughly charming, and quite busy at the end of winter.

The Auschwitz concentration camp entrance gate with the sign "Arbeit macht frei" or "Work makes you free" (a replica of the original sign, which was stolen in December 2009, and since recovered, cut into three pieces)

Auschwitz electric fence

Birkenau extermination camp: end of the line (I could not believe how many tourists were getting their photos taken, draped across these train tracks)

Birkenau memorial

Birkenau memorial

Birkenau gas chamber destroyed by German troops as the Soviet forces approached in November 1944

Guard tower with Birkenau camp buildings in the background

Wawel Hill featuring Wawel Castle, Kraków

Wawel Cathedral

Dominican Church, Kraków old town

Church of SS Peter and Paul, Kraków old town

Town Hall tower, Rynek Główny (Main Market Square), Kraków old town

Rynek Główny

St Mary's Basilica, Rynek Główny

Florian Gate, Kraków old town

Old city walls extending from Florian Gate

Courtyard of Collegium Maius, the oldest university building in Poland

Next: Budapest, Hungary...

Wednesday, July 21, 2010

State Hermitage, St Petersburg, Russia

Think of every famous artist you've heard of. Michaelangelo, da Vinci, Raphael (only 3 of the 4 TMNTs - Donatello was missing), Renoir, Monet, Cézanne, van Gogh, Rodin, Gauguin, Picasso, Matisse, Kandinsky, Rubens, Rembrandt...

Now place their artwork in rooms of incredible beauty, rooms that are works of art themselves. Add crown jewels, ancient treasures, and Egyptian mummies, and you'll begin to imagine the scope of the State Hermitage.

My jaw dropped when I walked into each room. I didn't know what to look at first - the floor, the ceiling, the artworks on display? Some rooms were overwhelming, and required several viewings.

The collection is housed in the Winter Palace and Small, Large, and New Hermitages. I spent 2 full days there and still didn't see everything.

Detail of mosaic on the floor of the Pavilion Hall

The Raphael Loggias (copies of the frescoes done by Raphael at the Vatican)

Detail, the Raphael Loggias

Large Italian Skylight Hall

My favourite room: The Gallery of the History of Ancient Painting

Detail, the Gallery of the History of Ancient Painting

Detail, the Gallery of the History of Ancient Painting

The Boudoir

"The Eternal Spring" by Auguste Rodin

"Dance" by Henri Matisse

"Music" by Henri Matisse

"Absinthe" by Pablo Picasso


The Twenty-Column Hall

Next: Kraków, Poland (including Auschwitz-Birkenau)...