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.

 

Zoom zoom? Pressure! Pressure!

The last ten weeks have been some of the most intense weeks of my 21 years, and the last few days have been some of the hardest. For the first time in my life there was hardly a moment when I wasn’t studying – by choice. I wasn’t even being forced to study; I was motivated to out of sheer necessity. There’s nothing like feeling stupid in front of your residents to make a girl want to go home and apply herself. Nothing in pre-clinical years motivated me this much, probably because none of the styles of presentation captured my attention enough.

See, my learning style has always hovered somewhere between audio-visual, where it works really well if I can hear the words being spoken and have a mental picture at the same time but doesn’t work at all if it’s only one or the other, which means I learnt a lot on clinical rotations because of all the talking that went on about patients we were actually seeing.

I also learn better in small groups, like three or less people, where I can get individual attention from the tutor. Luckily, even though most of our groups were allotted six people my group ended up with four students (including one guy who rarely showed up). Plus our very, very dedicated senior residents were determined to make sure we learnt something on this rotation. God bless them but they tried hard for us.

But as the weeks wound down, the pressure of exams wound us up. It was our first practical clinical examination (fondly termed an OSCE, pronounced “OS-ki”) and everyone was freaking out all over the place. People who were confident in their examination technique were panicking over differentials, or at speaking aloud to a stern-faced consultant. Most of our consultants are of the sarcastic, dry-wit variety. We had good reason to be paranoid.

And yet somehow, we managed to emerge relatively unscathed (at least until results come out). I’ve yet to hear reports of anyone breaking down into tears during the exam, though I actually came close once, and all the other complaints are along the expected lines of “I can’t believe I forgot to do that!”.

If Medicine was the frying pan of our Junior Clerkship, I can’t wait to see if Surgery is the fire or a respite from the kitchen altogether.

In other news, I auditioned on Saturday for the University Dance Society’s upcoming Season. Crossing fingers I get in a piece; (crossing toes that I can handle it).