Saturday, May 24, 2014

on circuses

first call of my life. 

wow what can i say. a) i was incredibly lucky b) i was also incredibly slow and stupid

my mo really did so much for me - clerked 2 cases and ALL THE BLOODS. its not that i didnt want to do the bloods its just that i could hardly get thru clerking one case without the phone ringing a zillion times so hence i never got round to the bloods. or the million passive changes. and also why is one ward so far away from the rest?? oh yeah my mo also cleared aforementioned tons of passive changes for me. and then she bought me breakfast and coffee. and answered all the difficult qns during handover [ive heard that this depends greatly on the niceness of ur mo]

plus only 8 admissions in a night cos the hospital was super full. plus two sleep studies plus one in the private ward plus one in the haem ward. so that's 12. but only needed to present 8 at handover thank goodness.

HANDOVER. scariest thing alive. thankfully i was so high on adrenaline and numbed and humbled at my inefficiency that i had no space in my brain to think of what would happen if it didnt go well - just typed out two patients and photocopied the rest and WENT FOR IT. we rehearsed 2 patients and after the rehearsal i think my mo must have really felt like running far, far away into the mountains. but again thankfully for my debate training that somehow kicked in. if only that could kick in during ward rounds as well, i wonder why it doesn't. so we survived handover. except for the fact that there were a million qns about management which my mo tackled and sometimes we literally didnt know why the reg did that.

how to improve for the next call:
1. buy a huge bag to stuff all my things and sustenance thruout the night [oh but then wkend call sometimes the reg buys dinner. hm well see how. coffee never ever hurts]. put my bag of sustenance IN THE WARD not in the call room. i didnt even sit down for one minute on the bed in my call room.

2. haem onc patients tend to be sicker. so when faced with a haem onc pt who is spiking a temp and a gen ward patient with one day of urti, i think i know where to go. [in my defense on call the other day once the nurse called about the pt and i realised i didnt know what to do coz the primary team had said hold off abx - i just escalated right away to my mo. good choice, and SO LUCKY she didnt scold me. sometimes when u escalate too fast pple get annoyed. she actually told me that was a good move coz even if i walked all the way there to see it would delay and i wouldnt know what to do and wld have to call her anyway. BUT it would have been a good idea to open up the flowsheets to look at the T spikes. yup].

anyway this call im gonna try and prioritize the haem onc pts. i feel more confident abt the gen ward clerking thingy after trying it once and also i know i dont have to be SO THOROUGH and clerk for like 1 hr per case, just make sure pt stable and ok. the rest morning team can do. and no need to chitchat with the parents for too long when on call, can do that in the daytime...

3. clerk new cases faster!!! just whip through it. i'm gonna time myself, 30 mins for each case esp easy cases. honestly the reg is gonna see soon anyway. and they are pretty detailed. u just need to not miss anything big.

4. go back and check the cases for changes after reg rounds. i resolve to do at least 3 bloods. my mo cannot keep doing alll the bloods for me! and anyway, most mos wouldnt.

5. do small changes (like paracet) fast coz if not, they KEEP CALLING and it really disrupts anything u are doing. not least clerking new cases.

6. pre-sleep

7. highlight URGENT changes.

8. bring chocolates to the nurses in the wards im covering on sunday. and tell them its only my 2nd call and please take care of me. haha the nurses in my own home ward are so awesome. when they call me they'll be like "elizabeth, this is su su, you have a puff review in bed 2, come soon ok?"

ending off with a quote from a navy seal dude on my fav topic: HOW TO CHANGE THE WORLD. well i dunno about you but medical training (HO yr included) sounds pretty much like this.
But an interesting thing happened to those who were constantly on the list. Overtime those students—who did two hours of extra calisthenics—got stronger and stronger.The pain of the circuses built inner strength-built physical resiliency.Life is filled with circuses.You will fail. You will likely fail often. It will be painful. It will be discouraging. At times it will test you to your very core.But if you want to change the world, don’t be afraid of the circuses.
i also like this:
Every SEAL knows that under the keel, at the darkest moment of the mission—is the time when you must be calm, composed—when all your tactical skills, your physical power and all your inner strength must be brought to bear.If you want to change the world, you must be your very best in the darkest moment. 
let's go! :)

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