Saturday, September 17, 2011

Residency: Term 1 – Emergency

Internship was over, and I returned to Emergency for my first term as a resident.

I was correct in my prediction at the end of this post: I felt much more confident heading into this term. I really enjoyed myself.

I don't have any particularly exciting stories to share. I didn't get as much experience in Resus as I would have liked - I asked to be on the trauma team whenever I worked in the acute area, but there were no major traumas on those days.

I was pleased to find that many of the nurses remembered me from my previous term last year, and seemed happy to have me back. To be honest, the fact that I speak English without an incomprehensible accent and am not a complete muppet got me major points with the nurses.

The shiftwork still sucked, but I coped with it better this time around. I also never had any days like I described during internship, where I got upset with myself. My general coping skills appear to be much improved.

I was happy with my case presentations to whichever staff specialist was on duty, and was pleased that they seemed confident in my ability to manage my patients. When working in Fast Track, I moved much...faster (haha) and was able to work independently - I could work up patients and send them home without having to discuss them with someone senior to me (but there was always someone senior to talk to if necessary).

The most frustrating feature of the term was bed block: the hospital was full, ED was full of admitted patients waiting for beds on the wards, and the ED corridors and waiting room were full of patients waiting for beds in ED. Often, I would complete a patient's treatment and discharge without them ever getting to a bed. I would bring them into a temporary room (in very high demand; it helps to be nice to the nurses managing these rooms), take a history, examine them, take bloods (if necessary), commence treatment (e.g. medication or IV fluids if necessary), and send them back to the waiting room. If necessary, I'd order scans, and the patient would come into the department for an X-ray/CT scan/ultrasound, and then return to the waiting room. Patients were very frustrated, obviously, but for the most part they were nice to me. I got annoyed with GPs who sent patients in to ED, without warning them that they may have a long wait. Patients seem to think that if they have a letter from their GP, they'll be seen sooner, but it doesn't work that way.

I did several shifts in Paediatric ED during this term - I requested additional shifts there because I was enjoying it so much. Paediatrics is now at the top of my list of future careers (my current term is actually in Paediatrics, on the ward). It had been in the back of my mind for a while, and my experiences in ED and on the ward, as well as conversations with the Paediatric registrars, cemented Paediatrics as a good career choice for me. More on that later, when I summarise my Paediatrics term sometime in November.

Internship: Term 5 – General Medicine (Geriatrics)

My fifth term was at a peripheral hospital doing General Medicine (Geriatrics).

I'd already spent 3 weeks doing the same placement during my Relief/Nights term, so I knew what to expect - boredom, long multidisciplinary team meetings, and lots of paperwork. And that's what I got! It was a chilled-out term; just what I needed to finish off internship. I found myself missing the pace of my surgical term, though! Crazy.

I had 4 weeks off at the end of the term - the last 2 weeks of this term and the first 2 weeks of my next term (Emergency). It was great to finally have a break, though I hadn't saved up to travel anywhere. I spent a lot of time training for a half marathon (I ran it in July), catching up with friends and family, seeing movies, cooking, and relaxing.

As I mentioned, term 1 of residency was Emergency. More on that shortly (I promise!).