Di stress / Distress / De-stress

Please enjoy this post I wrote 2 years ago while struggling to survive my intern year. The level of optimism is truly remarkable considering I was on my Paediatric rotation at the time.

The shift from medical school to internship is the shift from dipping one’s toes in the swimming pool to diving in the deep end. When you’re a medical student, duty ends at 10pm. If you can’t get an intravenous access, you call the intern. 12 o’clock is always lunchtime.

Suddenly, it’s July 1 and the minutes don’t roll over. Free paper has been burnt. You have passed the dreaded MBBS and received, in return for your labours, more hard work. Harder work, in fact. Your duties extend for 24 and 48 and 56 hours. Sleep becomes a concept. Lunchtime, a luxury. You become the person the medical student calls when they’ve destroyed all the veins in their quest for an IV access.

Why am I here again?

If you haven’t asked yourself that question at least once in the last six months, consider yourself lucky. You might actually want to try your hand at the Lotto.

If there was a buzzword for internship, disillusionment would be it. When asked what lessons have been gleaned from the “Internship Experience”, one intern from a hospital which shall remain nameless (we’ll call it the Really Tall One) responded with an outburst,

“Old doctors want our experience to be as frustrating as theirs to ‘build character’.”

You know it’s time for a paradigm shift when you point out workplace inadequacies and your boss responds with,

“You merely adopted high patient loads and low resources. I was born in it, molded by it. I didn’t have the luxury of readily available investigations until I was already a SR and by then it was an insult to my clinical acumen.”

It’s admirable to want your interns to be the best they can be but there are practices in medicine that in any other profession would spark the ire of an entire HR department. But I digress. This isn’t meant to be a call to arms.

Sometimes the answer to that ever-present question is positive. Real life patient care (as opposed to the dabbling that’s done in medical school) can be and has been rewarding and invigorating. The General Surgery rotation is particularly satisfying in this regard: patients enter the hospital bleeding, broken, dying and with the flick of a scalpel, the swish of a stitch (and some strong pain meds) they survive to maim themselves (or someone else) another day.

Lest this turn into a clichéd trope about the satisfaction of a job well done, I do have some misgivings about the surgical field. Once a patient expressed their profuse gratitude for having their infected digit amputated. You’re . . . welcome?

As uplifting as those moments are, they seem to be outweighed by the downsides of working in the public system. Like McGyver and Miss Lou, you has to tun yuh hand mek fashion. Whether it’s performing an entire sepsis screen (including lumbar puncture) on a neonate without assistance or manoeuvring a 250lb patient with bilateral skeletal traction off their stretcher and onto the CT machine, provided the CT machine is working. One disadvantage faced by every public hospital is inadequate funding, but necessity is the mother of invention. If you haven’t made an IV drip stand out of a curtain hook or a chest tube out of a Foley catheter, you haven’t really lived.

There is a certain satisfaction to seeing patients managed conscientiously despite low resource settings, but can medicine be equally reward and punishment? Ours is the lot of sleepless nights, thankless hours and the constant threat of occupational exposure (latent TB, anyone?). Is the smile of a mother when you tell her yes her baby can go home really worth the stress of q4hrly bilirubins?

As the most junior member of the medical team that stress of ‘getting it done’ rests squarely on the intern’s shoulders. It often feels like we’ve been left in the deep end of the pool to sink or swim, complete with Yoda-like figure declaring “do or do not, there is no try”. Coping mechanisms become currency as we try to stay afloat despite the setbacks. Periodic nervous breakdowns, the impenetrable veneer of cynicism and a strong tendency toward smoking and alcohol are only a few of the methods employed.

If you are stranded amidst the sea of disillusionment, clinging to the battered lifeboat of responsibility it helps, I think, to remember the reason you started out on this journey in the first place. Sankofa, my friends. It is okay to look back for that which you have forgotten. Whether it was the personal fulfilment you get from helping other people or the determination to be consultant someday, internship is decidedly BYOM. Bring Your Own Motivation.

At six months in we’ve already committed to this gestation period, for better or for worse. And when we are delivered in another six months, freshly registered and happy to be out of the frying pan of internship, we’ll look back from the fires of Senior House Officer year with the same clouded nostalgia as the consultants who believe that their internship experience was the only one worthwhile.

The more things change, the more they remain the same.

 

Coming in Live through Your Stethoscope

I like to think my shenanigans on the blog are useful to other people, that it’s not just Jamaican-accented self-gratifying chatter amidst all the other self-gratifying chatter that clogs up the internet. So in the same vein as my posts on medical school and UWI, I’m transitioning into something a little more adult. Still PG-13. Well, depends. Some internship stories are pretty out there.

Mic test.

Internship will probably be the worst year of your medical career. Scratch that. It will be the worst year of your medical career, unless further down the line you end up with a horrible boss who treats you like an incompetent intern. That would probably be worse.

But it’s also supposed to be the most liberal year of your career. The level of responsibility is much higher than medical school (for obvious reasons) but much lower than it will be once you get fully registered as a doctor. Internship is the test the waters year. Dip your toes in all the specialties and a few sub-specialties. See what you like and what you don’t. Free time is limited because you’re first call and therefore can never leave the hospital, but just like med school – doctors work hard and party harder. And sleep even less.

Between the working and the partying (notice how no one cares about the sleeping) it’s important to learn as much as you can. There are aspects of patient management that only become apparent once you start working. Add to your skill set and exposure – minor amputations, sutures, chest tubes, thoracocentesis, paracentesis and neonatal resuscitation (among others) are all the forte of the medical intern. If you show interest, people are almost always willing to teach (because some people are dicks, and there’s nothing you can do about that) and there’s a lot to learn.

While you’re busy learning, take everything with a grain of salt. Always, always be cognizant of the complacency of third world medicine, and the fact that sometimes the things we routinely do are not the internationally acceptable things. Double check your management with evidence-based guidelines (and be up to date), Youtube your procedures to see how it’s being done in more resource-rich centres. Keep your standards high, even if you don’t live up to them.

One inescapable downside to intern year is that people will be mean. People will be mean and cranky and at some points downright bitchy. They will take their frustrations out on you; you will end up being blamed for the incompetence (and sometimes sheer slacking off) of other people. Patients will yell and cuss. Staff will grumble and talk about you behind your back. Work environments (as I have discovered) are rarely if ever rose gardens. And even if it smells pretty, there are usually thorns.

So, keep the faith. Remember why you started doing medicine in the first place. If that doesn’t work, remember that you won’t be at the bottom of the food chain forever. If that doesn’t work, remember that at least you have a job that pays more than most in this country. And even though sometimes I feel the urge to be just as mean back to them, I have found time and time again that it pays to be nice (even if you have to fake it til you make it). Also that having friends in every department is pretty much the only way to get things done for your patients in an overwhelmed, understaffed system (as I have mentioned before).

 In my last seven months, I’ve developed some words to live by to help me keep my sanity.

Don’t be a hero, is what I learnt from Paediatrics.

Surgery taught me that responsibility is informing your seniors.

And on Internal Medicine, I am learning that you catch more flies with honey than with vinegar.

Somewhere in these ramblings, I hope you find a truth you can apply to your own internship. Or maybe it’s enough to know you’re not in the struggle alone.

6 Reasons I’d Never Live on Rex Nettleford and 1 Reason I Would

Disclaimer: This was written back when I used to live on campus; I dug it out of my drafts folder for posting at the time of year when people are thinking about where to live.

Rex Nettleford Hall of Residence on the UWI Mona campus was once the crème de la crème. Everyone who was anyone wanted to live there and everyone who was someone did. But Rex celebrated their tenth anniversary last year with flagging spirits and waning enthusiasm. The torch of hypeness has been passed on to the newcomers Towers (Elsa Leo Rhynie Hall) and New Postgrad (Marlene Hamilton Hall).

But even in the heyday of Rexan fortitude, I still wouldn’t have wanted to stay there. Here are six reasons why.

1. The hall fees are not the most economical. Last year, the 9 month stay on the 900 strong hall costed $214,120. (Seacole’s single room fees by comparison: $180,200).

hallfees
Hall fees 2013-2014 by Hall and Room Type

2. Hot water depends on the weather. Rex’s water heaters are solar powered, meaning no hot water if the sun don’t shine. I live and breathe hot water. Maslov left it off his hierarchy by accident. Seacole’s hot water is like the U.S. Postal Service: sun, rain, sleet or snow, I will always be toasty in the shower.

3. The rooms are SO TINY. A Rex room holds a single bed, a closet, a desk and a tiny shelf, all touching edges. It’s about half the size of my room on Seacole, and I’m not even exaggerating for the purposes of this list.

4. The laundry has opening and closing hours. How do you beat the crowd? You don’t. The freedom to do laundry at 2AM is on the Bill of Human Rights. In the fine print. Trust me on this. I’ll be making an independent inquiry.

5. The walls are paper thin. Privacy is a concept. On a flat, everyone always knows what everyone else is doing. Listening to Vibes Kartel? I can sing along with the lyrics. Using the bathroom? I can hear you pooping. That kind of intimacy is. . . undesirable.

6. 900 strong. Rex has always boasted the largest residence of any other hall on campus – claiming to be able to house 900 students. I’m pretty sure this number has dwindled over the years because their milkshake no longer brings all the boys to the yard, but they still house an impressive number of people. Which makes me distinctly uncomfortable. I’m not the biggest fan of large crowds so the 200 or so girls that live on Seacole feel more like a family than anything else.

Despite all the negatives (which I suppose could be positives to someone somewhere), there is one thing Rex has over Seacole*:

1. You only share amenities with 7 other people. I would gladly give up the 30 girls to a kitchen/bathroom aspect of Seacole life for Rex’s controlled 8-person chaos.

*The fact that my boyfriend lives on Rex almost made the list, but I realized that wouldn’t have been a plus to anyone else but me.

For Shari, who asked about WJC

What are some other things you liked that Mona Western had to offer, that Mona didn’t? (pro/cons of both campuses).

You guys, this is my absolute favourite topic (barring Doctor Who, Jane Austen, The Bloggess, and also right now Hozier).

The Western Jamaica Campus was like a second home to me. I loved the people, the campus and the atmosphere; I am hopelessly biased. But I will try to give you some amount of objective information (don’t take my word as gospel, guys).

Starfish
That time we found a starfish at the beach.

Disclaimer: This post is written based on my rose-coloured memories of life at WJC some 3+ years ago. The Todd just reminded me that life at WJC was actually not all that awesome.

We had to fight for some basic requirements (good sized classroom, proper streaming, actual anatomy specimens), and a lot of the time we were doing the best we could with what we had. What made it easier to bear was the relaxed, ready-to-help atmosphere of the western campus and the gorgeous, gorgeous surroundings.

wave goodbye

Additionally, things might have changed for better or for worse. You can get up to date information on WJC happenings from their Facebook page or on their blog, The WJC Insider.

Let’s get into that pro/con list.

WJC vs Mona

WJC Mona
Class sizes small – 20-30 people Class sizes HUGE – 200-400 people
Student:specimen and student:teacher ratio relatively good Brand new anatomy lab with lots of space and small group sessions
Tutors are (usually) readily available Lecturers have dedicated office hours, more students to compete with
Lectures are all streamed via network that might not work Lectures live or streamed depending on lecture theatre
Consultants teach anatomy Mostly residents and anatomists teach anatomy
Have to travel to Kingston for major labs No travelling required
Small, close-knit group of people Sprawling campus; easy to disappear
Breathtaking view of the Bay/beach/airport Mountains. Sometimes cold.
Hall of residence has a pool Campus pool that is currently out of service
Some clubs, some diversity of students Wide variety of clubs, wide range of nationalities etc.
The beach is RIGHT THERE. Liguanea is right there?
Less social events, almost no night life (except Hip Strip) Everything happens in Kingston. No, seriously.

WJC actually seems to come off worse in the comparison (sadface) but again I’m not exactly a valid or reliable judge (I’m actually a notoriously unreliable judge – ask anyone). If there are other specific concerns you have about either campus, feel free to post them in the comments or even call the campus of interest (I don’t have all the answers, guys, sorry) and share their response here.

Much love,

Robyn

For Christiane, who asked a Really Big Question

Dear Robyn,

I am from Trinidad and I got accepted into medical school at Mona. Could you tell me all that I need to know concerning medical school and how to care for myself while I am in Jamaica? Tell me how you managed because this is a new experience for me and I could use all the help and advice I can get.

Dear Christiane,

First off, congratulations on getting into medical school! (Or condolences, depending on how long you’ve been following this blog).

I want you to know that there is no simple answer to your questions. Five years into medical school and twenty-odd years of living in Jamaica and I’m still figuring most of this stuff out. A lot of your experiences here will be trial- and trial- and trial-and-error because they will likely be very unique experiences. (It is best to embrace this fact from now).

The best I can do is give you a few sweeping generalizations. (If you would like more specific answers, please leave specific questions in the comments)

I don’t know where to begin so I’m giving you your very own blog post (yay!) for people to comment on and share their own bits of advice. My hope is that this will turn into a giant crowd-sourced repository of advice for surviving and thriving medical school at UWI Mona (your place to shine!) much like my other (massively supported, I love you guys) post on medical school. (I will love you guys even if there is no support on this post).

I’ll kick-start the discussion with what I’m hoping are the starts of answers to your very valid, questions and share the links to some posts where I’ve gone in depth on a few topics.

New experiences are scary! And exciting! There’s so much potential, so much could go wrong; you want to run towards it with your arms wide open or hide with your teddy bear in a blanket fort (the teddy does not judge). I understand your need to feel prepared, but there’s no possible way to prepare for everything. What follows is my (hopeful) guide to keeping you alive and reasonably sane.

Medical School

See my (mostly) comprehensive post here: What is UWI medical school like?

Generally speaking, medical school = university + dead bodies and loads of studying.

Aside from the dead bodies, it’s pretty much like any other science major. Get used to the smell of formalin, and studying all the time. If studying all the time is your bag, congrats! If not, you will need to do some degree of adjusting.

First year med students hit the ground running with the sheer volume of information they’re expected to absorb and regurgitate, and the sad part is you will forget most of it. Later on in your 4th and final years some of it will actually start to make sense. Accept this fact from now.

Keep yourself healthy. This means physically, emotionally and mentally. Eat right and get some kind of exercise – foster the good habits early, or you will end up being the intern with a stomach ulcer who collapses on the job (true story).

Have appropriate outlets for your emotions; suicide is a very real danger for people in this career. Some/most med students study hard and party harder as a way of stress-relief. Find your stress-reliever and hold on to it with both hands (and feet, and your teeth too. Don’t let that fucker go).

Medical school is very self-directed; what you put in is what you get out. You should have a reasonable idea of what you want and what kind of doctor you want to be. The guiding light in med school is not passing exams, it’s being a clinician. You’re going to need to prioritize your activities (academic and co-curricular) according to the type of person you want to be when you graduate.

That sounds a little heavy.

My point is, when you’re confronted with decisions that seem hard or information that seems pointless (a lot of it will seem pointless in first and second year, it’s hard to tell the difference) the choices you make now will influence what kind of doctor you are five years down the line.

I’m not telling you to stay in the anatomy lab until midnight every night (unless that’s what you want to do – no judgment there), just be aware of the difference between your short-term wants and your long-term wants.

And make friends. Making friends in medical school is awesome. You need people to get your weird med school jokes, and to commiserate about how horrible this all is and why didn’t you just do business.

Taking Care in Jamaica

Jamaica is pretty much the same as everywhere else, except slightly scary and dirty and people harass you if you’re not from here. So, pretty much the same as everywhere else.

Stay clean, keep hydrated and don’t be an obvious target*. If you need to eat, bear in mind that food is expensive here (blame the IMF and our sliding dollar). If you need somewhere to live, you can read my post on student housing.

Hang out with people who don’t do medicine (you will need the break). Living on hall is a good way to meet those people. Get involved! University is a much more fulfilling experience when you’re involved in things you’re passionate about with people who are similarly passionate.

Something I wish I had known – you can do whatever you want as a medical student, especially in first and second year. Med school is not an amputation of your life outside of medicine. You can write songs, start a charity, go to Literature classes, join a professional dance company. If it’s your passion – go for it!

I hope I managed to answer at least some small part of your questions.

Much love,

Robyn

**

*Not being an obvious target = keep your wits about you, read all the campus security bulletins/advice, trust your instincts (unless you have bad instincts, in which case I would suggest not trusting your instincts). 

**

Advice from my classmates include:

First, would be not to worry about getting all the books that are required. The library is reliable and you will meet fellow students that will help you, so travel light if you can. Always have a working phone with credit. Take time to enjoy what the island has to offer, and be balanced with work, family and friends.

And of course. . .

Don’t. Go. 

Run as far away as possible.

Advice Across the Board

(No more classes, no more books / No more teacher’s dirty looks. In celebration of the end of my training, I’m sharing tidbits of advice from the last six years of my life. Because there’s no advice like unsolicited advice).

What I Wish Someone had Told Me

Before I started Medicine . . .

Stay in the Arts, create yourself, establish boundaries and priorities, travel, push through the fear and conquer the unknown. Own the unknowable. Get advice from as many people as possible about how to do what you want to do, not just about the best thing for you to do. Stick to your guns.

In first and second year . . .

Pay more attention in Anatomy class. Actually, forget that. You were probably better off break dancing at the back of the room when no one was paying attention. Study just enough to pass your exams, real medicine won’t start for another two years. Anatomists and physiologists are not real doctors, but they can still fail you. It gets better. It does.

In third year . . .

Read the small books and commit them to memory – the OHCM is going to follow you for the rest of your life. Do not ever trust the administration to get things right. Have at least five white jackets to start with, add more as necessary. Spend your time on Paediatrics learning Paediatrics, not feeding and consoling fussy babies. Switch consultants if you have to. Don’t lose your enthusiasm for participating in clinical duties; pace yourself. Don’t assume it’s always going to be this exciting because it. won’t. be.

In fourth year . . .

Leave UHWI every chance you get. Deliver your elective assessment to the Dean’s office yourself; no one is going to do it for you. Give up on ENT classes from early (you’ll only sleep through them); spend all your time reading instead. Pay more attention to ECGs on Emergency Medicine. Pick the rural places for community health; the people are nicer. Do not start the habit of calling ‘Empathy point!’ every time a student says something supportive during a history/counselling station. Read more Radiology than you think is necessary.

Start MBBS prep from now – find a study group you’re comfortable with, who moves at your pace. Get organized with PPQs and lectures and notes from the graduating class. Do it now so you don’t have so much to do later.

In fifth year . . .

Prepare for each clerkship like it’s the final exam. Take really good notes on everything – that way you can revise your notes and not the whole textbook. Ignore the consultant who tells the third years not to end up like you. No guilt-tripping about your study habits. As early as possible, ensure the Dean’s office has all your elective forms. Spend less time in the classroom and more time assisting at procedures or reading on your own.  Keep a tight hold on the small books (Surgical Recall, OHCM, Toronto Notes).

Medical school drags its feet when you’re stuck in the middle or at the beginning, but when you look back from the end of the road you fully appreciate the whirlwind/ thunderstorm/ cacophony of experiences you’ve lived through. It is a lot to live through but you can survive it; you can even do it well, if you try hard enough.

Well Read Robin’s Anti-Medicine Tips Issue #2

People who can’t stand to see people suffering shouldn’t do medicine. This sounds counter-intuitive, but you’ll come to understand that everyone suffers and sometimes you can’t do anything about it.

People with sob stories shouldn’t do medicine. Your sob story ceases to matter once you get to the hospital. No one ever feels sorry for doctors.

People who are easily offended shouldn’t do medicine. Everything is offensive here: the patients, your colleagues, the smell of surgical wards. . .

People who are narrow-minded shouldn’t do medicine. The ability to think outside the box is indispensable to practicing in a third-world, limited-resource setting. The ability to treat all patients equally and without discrimination is also a useful asset.

People who are in it for the money shouldn’t do medicine. Seriously? Go do business. Who wants to spend 10+ years studying and then another 10+ years building your private practice so you can finally afford the house of your dreams? No one.

People with an aversion to normal social interactions should do medicine. From the awkward to the downright bizarre, medicine is chock-full of strange people discussing stranger things.