Saturday, 16 April 2011
I love being out early in the morning, even when I'd rather be in bed. The other people who are awake with me always seem the happiest. The fittest. Running and walking and glorying in experiencing as much daylight as possible. Often I'm still feeling slight pangs of regret about not still being in bed, but driving into the sunrise perks me up every single morning. I love seeing the beginning of a day, and not wasting any of it.
I have perfect eyebrows tonight. I had them waxed and tweezed this afternoon by a girl at a cheap walk in place at our local megamall. I am wary of these places, as I have had some odd experiences with sperm brows or accidentally removing far too much hair. But these current brows are perfect. And cost me $15. They are a bargain, and if only I was not curled up under the doona in my pyjamas, I could take them out on the town and show them off.
I was at work today, and it was mostly dull. I have had enough of rude patients on weekends. I dislike it immensely. I recognise that pain and fear and suddenly being weaned from cigarettes and alcohol and having to depend on others is traumatic. I understand that some people cope better than others and I understand that sometimes you catch people at bad times. But truly, clicking your fingers at me, asking for a "real doctor", shouting obscenities at me or being rude and abrasive when I ask you politely if you have any specific worries on a Saturday when most people are at home with their kids is not fun for either of us. Ignoring me will not make either one of our lives easier either.
The life of a junior doctor is not glamorous. Scrubs is true. All of it. I grimaced to myself the other day as I stood by the lift balancing coffees (I don't drink coffee) for the morning meeting. 10 years of university education and I'm fetching coffee. I have had consultants that don't know my name, who have ignored direct questions and speak directly over my head, issuing orders for me to my registrar when I'm standing right in front of them.
I have stood in semi darkness with a single bulb over me, sweating profusely as I try and poke a cannula into a vein from someone that has been "handed back" from IV services. IV services put cannulas in all day. That is their job. I'm lucky if I do one a week at present. You do the math. And often aside from the cranky and already jabbed patient looking at you witheringly you will have a nurse, and maybe if you're lucky a student, huddled in your bay as you flush deep red, sweat running in rivulets down your back as you attempt. If you succeed, the accolades and the sheer achievement will put you on a high for hours. Right up until the point that you are paged to the ward, as the patient has pulled it out.
I dream about veins. After one particularly brutal run of ward call, I started noticing the veins of every person I met. I would be carrying on a conversation with people, while thinking about which vein I'd cannulate. The juicy one right there? Or the smaller straighter one? I stood on a train once, and as we all gripped the overhead bar as the train lurched out of the station I had already triaged the people around me based on their vasculature. Subtly when someone shakes my hand, I will be feeling for the plumbing under my hand, and it takes all my concentration sometimes not to rub my thumb across to check the calibre. I could get a grey in that one.
I have been chastised by patients for having "no idea" how to treat diabetes as we look at their massively swinging BSLs. I have been harrassed by nurses who are concerned by the HI reading on the glucorometer 1 hour after a massive dose of novorapid. And I've wandered down to the ward and looked at the box of chocolates next to the bed, the cup of tea with 4 sugars and the empty Hungry Jacks bag in the bin and wondered what miracle I'm supposed to work.
I notice who all the people are who drink too much now. In the shops, at the theatre, when out to dinner. I can pick them on sight now. Not the alcos you're thinking of, the ones lying in the park with a silver cask. No, the people who work with you. The people who work with your friends. The people who work with me. Your body gives away so many signs if someone is willing to read them.
I feel the barrier start to come up slowly now. The one that means that I am no longer as affected as I was in my first year of medicine. In my first year there was so much humanity on display. I struggled to look at people objectively, I struggled often with what it was necessary to do to people. I shuddered at the cynicism of many of my superiors, while also quaking at their vast knowledge. I was the slime on the bottom rung of the ladder of the medical career, and the deference and the rungs poking up above me were well and truly out of reach. I felt overwhelmed often, but I felt cheated too. Medicine is not some mystical science. It's mostly simple patterns and a lot of paperwork. There are no magic wands, there are no crystal balls. It's just synthesising information and making sure that you don't miss pieces when trying to solve the puzzle.
I can still remember certifying my first dead body. I was terrified. Not by death, not by the peculiar rigidity or the scent of death. The man in front of me was quite clearly not alive, but I didn't know how I was supposed to prove it. It was like some of the Maths problems that I'd been given in my extension class where I had to come up with an answer and the proof of it. Often I arrived at the answer in seconds, but actually explaining how I got there was difficult.
I stood there fondling my stethoscope, remembering the signs of life I was supposed to check for and fumbling my way through it while the family stood back reverently. It's a very easy thing, to certify someone as not living, and yet to that family it had some significance. And it was for them that I stumbled through some sort of cliched message of sympathy and confirmed the obvious. Then left as fast as I could.
I've had to look at so many anuses (anii?) that they no longer hold any sort of grossness for me. The PR (per rectum) exam is still one of the most feared practices that medical students are supposed to become proficient at, but so rarely do. As a student, finding willing patients to allow you to practice your technique with someone competent overseeing the process is rarer than rocking horse pooh. And the ironic thing is, that the people that refuse to let the medical student have a go, will next week be having to deal with a junior doctor who may never have performed it under supervision having a go in the middle of the night. There is no dignity in hospitals. For all the hands I've held and all the apologies I've made, when it comes to it, your privacy will be as stripped as surely as your chest will be to stick on the ECG leads. Though luckily if you have me, I'll remember to close the curtains first.
I'm feeling tired at present, but satisfied as well. I'm getting home most days now when it's light and I'm getting enough sleep. I'm hungry again too, which is good for my health, but oddly disappointing from a shrinking point of view. I am less snappish, and I'm feeling warmer, after months of radiating cool. But I still get grumpy working on weekends, and I'm not sure if that will ever change. Especially on a snugly one like this one.