Pethidine Pleasure

Far out. How can words possibly describe the first few days as a House Officer. The whole experience is so freakishly overwhelming. Honestly, I was so scared on my first day. Everything I did made me shake - especially if nobody was checking what I was doing. The first time I charted a drug, and it was only maxalon, made me shake like crazy!

I'm just so scared of making a serious mistake. It's a horrible feeling because you want to know everything about a patient before you do something for them, but if you sit down and think about every single minor point, each job would take hours and you'll never get home! However if you do things too quickly, you get burned. For example I charted maxalon in an elderly patient and the next day a bright yellow sticker was left waiting for me by pharmacy saying that I shouldn't chart it due to extrapyramidal side effects! I also got burned badly by an AT&R reg for a crappy referral. She wrote with big font and asterixes telling me to rewrite the referral with clearer information... I was definitely feeling small after that...

One of the weirdest things has been getting used to having a pager! Sometimes it goes off and I hear it but don't respond to it! It just doesn't click in my brain that I have a pager, it's going off, and it's my job to respond to it! Several times it's been going on and on and on and it's only when somebody near me says, "is that your pager??" that I actually realise what's happening! I guess it's all those years of just ignoring pager sounds as a student.

Ward calls on Monday night was the most freaky thing. My very first call was for a painful red eye. On my way, I was trying to remember all I could about ophthalmology. Painful red eye... infection... glaucoma... exploding eyeball... when I got there, the eye was not painful or red. After asking a few questions, I soon found out that the problem was that he couldn't move his arms and just needed his eyes wiped! So I got a tissue and wiped his eyes for him. YAY! First ward call problem solved!

The rest of the night wasn't too traumatic. Mostly charting fluids and pain relief. Although there wasn't all that much to do, I managed to spend most of it running around like a bunny. In fact, the whole week so far has pretty much been like that. Not many jobs but I fill the day walking between wards, doing jobs in an illogical order, taking ages to figure out simple problems and generally flapping around. Like this morning it took me until 11.30 before I actually achieved something. It would be really interesting to track my movements around the hospital. It would look something like a bowl of instant noodles.

Actually I've been relatively lucky that the work load hasn't been too large. I've also had heaps of help from the other house officer on the team, the house officer buddies around the hospital and all of the other more senior doctors. I know things will get worse, but at least I've had a relatively gentle introduction compared with what I know it could have been. I'm just waiting for the $*** to hit the fan... lots has been coming my way, but none has hit the fan yet. It's just a matter of time... I just know it...

Just finished 3 days of orientation and I'm exhausted!! Partly because of the early starts and non stop talks all day, but also because for once I've actually tried to pay attention!!! For uni lectures I just drift in and out of reality as I please, but I thought I should try to remember what I'm being told!

I sorta regret listening now. The more they told me, the more terrified I got about starting work! Oh my giddy aunt!! It's going to be horrible!! I'm so terrified!!! I have no idea what I'm doing!!!!!! I've done new scary stuff before, such as trying to go 1 week without internet, but this is totally different because if I stuff up, it has very real and serious consequences! This ain't fun and games anymore!

It's the attention to detail which really gets me. As a student I could just pick and choose the fun bits to keep me entertained and when it got hard I could just give up and wait for someone else to pick up the pieces. I can't do that anymore!!! The fun bits, the crap bits, the medium bits, I have to do them all!

This is what my programme looks like:

Monday: Ward calls (15 hr day)
Tuesday: Acutes day

Wednesday: Post-acutes day
Thursday: All day clinic
Friday: Mental health day

Mental health day is when I cry by the sushi fridge in the caf. Anyone else who wants to join me is free to do so. BYO kleenex please!

Sorry, I've gotten a bit behind in my blogging. There's been so much happening in the last week, it's unbelievable! The main problem is that while I've been recovering physically from my appendicitis, I've also had to get through the qualifying ceremony and ball!

The qualifying ceremony was a nice little occasion. A good chance for us to pat each other on the back and reflect on the last 6 years of life. It was a really strange feeling for me. It seemed like everyone else around me was much more excited than I was. I also had to self medicate with paracetamol+ibuprofen+omeprazole to get myself through the evening and get up on the stage with something that resembled a normal looking gait.

After the ceremony everyone came out saying to each other, "Hello Doctor (place surname here)!" and then giggling like crazy. I don't get it. Seriously. Perhaps I am just grumpy and cyinical but it just seems like a really cheesy thing to do. Afterall we're supposed to be mature adults and the best we can do is get a cheap thrill out of calling each other Doctor? Did we all really go through medical school just so that other people can rub our egos by addressing us with a this title that is suppoed to give us status and authority in our society? I certainly didn't and in fact the title doesn't sit comfortably with me at all. To me the title implies expertise in our chosen field, and I am by no means an expert in medicine. The real doctors are those who have gained their college fellowship, or in the world of academia those who have completed a PhD. That's what being a doctor is really about.

The strangest feeling was losing a sense of identity. For the last 6 years I have called myself a medical student and suddenly the safety of this disguise was being taken away from me! It means I'll soon be exposed to the real world of the work place, beeping pagers, responsibility, signing my name next to my work, and all that crud that only seemed theoretical a few days earlier.

The ball was also a nice fun event and it was really nice to catch up with classmates for one last time before we split into different directions. Again I felt really flat physically which kinda stopped me from being as sociable as I would have liked. I tried really hard but I just couldn't lift myself.

In a way, I feel kinda cheated. After all that hard work I finally had a chance to celebrate and I couldn't because of my stupid appendix! On the other hand, I guess I could look in the brighter side - at least I made it rather than being stuck on the surgical ward. It would have been even worse if I was sick while away on my elective. I was still surrounded with great friends even though I probably wasn't the best of company to be around.

Now that I've had a couple of days to let the dust settle and rest up properly I can look back now, and despite my whinging in this post, I feel that it was a really nice way to finish a major chapter in my life. Farewell student life! I've loved every moment of it, but now it's time to move on and face the real world. A new chapter in my life begins next week. Stay tuned folks!

Far out! It was my appendix that caused me the problems in Melbourne! I started having similar symptoms but not nearly as bad on Tuesday night, but I also had this twinge on my right side. I thought I had giardia or something.

I just cruised along still going to radiology teaching on Weds and Thurs and then it got really freaky! I saw my GP at around 3pm and even then she wasn't convinced it was appendicitis so she gave me a letter to go into hospital if it got worse. Even on the drive home, I was starting to feel pain in the car everytime I went over a bump and I got the feeling something sinister was going on.... by 7pm I was chucking up all over again and I suspected my appendix was past its due by date. I then initiated ondansetron seeking behaviours and got Mum to take me to Auckland Hospital.

Good grief the agony. The nausea and vomiting made me want to roll around, but the pain was forcing me to lie still. No escape from the torture!! Then it was time for another 20g IV cannula! More stinging and this time they took bloods so it kept stinging as they sucked the blood out of my antecubital fossa!

I said that maxalon has been useless in the past and asked for my beloved ondanstron, but I only got cyclizine! NO GOOD! After a few more minutes of agony, I begged for my ondansetron and finally got it, but to my surprise it didn't help at all!!!! Oh no!! I'm in this stupid vomiting state for ever! The nurse then got some maxalon and surprisingly enough it actually worked!! OMG the drug that's supposed to be useless actually worked! Oh well, at least I got my taxes back in anti-emetics.

After being sufficiently poked and prodded by a House Officer and Registrar the diagnosis of appendicitis was confirmed. Apart from behaving from an excellent patient giving a good history, other evidence included spiking temps, WCC 15 and ESR 8. Also had K+ 2.9 due to the vomiting. I signed the consent for the execution of my appendix.

Due to an emergency case taking up most of the night, I wasn't operated on until first thing on Friday morning. My gosh it was a weird experience. Just a week earlier I was in Melbourne seeing other patients given the talk about the risk of post-op nausea/vomiting/confusion, heart attacks, strokes, death... or even worse... the dreadded chipped front teeth!!! Suddenly I found I was in Auckland operating theatre admissions bay receiving exactly the same talk from an SHO. There was even a 4th yr medical student to complete the picture!

I get wheeled into theatre, slide myself on to the table and in the process of being connected up to the montoring. Then I'm told that my parents are coming in! W T F!?!?!??! Somehow someone decided it would be cool for them to get changed into the hat and shoes and gown and come in to see me before the operation!!! Of all the time I've spent in theatre, that has to be the weirdest thing ever!!!! Like in paeds, I can understand that parents go in and stuff, but this was just absolutely bonkers!!! I'm just having my appendix out!!! It's not like I'm having a chunk of my brain removed!! (even tho some of you might think that's a good idea)

So anyway, with that ordeal over, it's time to get preoxygenated by the medical student. Then I had the fentanyl followed by the propofol went in which didn't sting at all! OMG that was such an awesome feeling those split seconds before my eyes closed. The experience was quite surreal. I felt so perfectly relaxed and happy. Wow....

My next memory is in recovery which is a shame because I wanted to know what it felt like having the tube pulled out just for the sake of curiosity. I had 16mg of morphine on board so I was pretty drowsy. I have vague memories of the PACU nurse handing back to my ward nurse but my next real memory is seeing my classmates visit me on the ward. Thanks for coming!! I really appreciate it! Sorry I wasn't very good for conversation!! Later that afternoon I also had a visit from mi² which was really nice although I still had a lot of morphine on board and probably looked absolutely terrible.

Part of the reason why I probably looked absolutely terrible was that I couldn't pee! OMG that was the weirdest experience. I was fairly sure that my bladder was full, especially because I hadn't been for almost 10 hrs and received tons of IV fluids, but it was quite hard to tell because of the pain. When I went to the loo, nothing happened! Absoultely nothing! It was quite bizzare! The intetion was there, but there wasn't any cooperation from down below. I even tried walking around... different positions.... ok, so you don't need to know all the details, but basically I just couldn't pee. Fortunately, the nurse threatened me with a catheter and after a couple of hours the water works kicked back into action again.... phew!!

The next couple of days were pretty dull. Every few hours the nurses would come and bug me for my "pain score", often waking me up in the process. This is supposed to be a number between 1 and 10 which represents a range from almost no pain to the worst pain imaginable. This "pain score" really started to irritate me! How on earth am I supposed to know what the worst pain imaginable!! This is the worst pain I've ever had, but I'm sure being in the middle of a nuclear explosion is much more painful! Even more stupidly, it seemed to be used to indicate what pain meds I was given, so I ended up trying to second guess what number I had to say in order to get the drugs I wanted. They also asked what my pain score was when I moved, but I often felt like saying, "I have no freakin idea but I was pain free while I was sleeping!!! Now give me morphine so I can go back to my blissful slumber!!!"

Over the weekend, I also had problems with nausea. Man that tramadol is really nasty stuff. I hated it!!! I'm sure the IV metronidazole didn't help either cos I always felt much worse after it had gone in. The other thing that didn't help was the food! YUCK stupid lite diet!!! Every time I lifted the lid off the plate, I had to suppress the gag reflex. What's with the melted vanilla ice cream! It tasted like chilled animal fat!! So disgusting!!! The beans were boiled to a mush and the bread had been stale for at least 2 days. Even the jelly tasted yuck!! Like how can you mess up jelly!!!

By Monday morning I was well and truly sick of being in hospital. I was still really really sore and quite nauseous but all I wanted to do was go home. I felt I could cope with regular panadol and I had stopped spiking temps for 24 hrs so I could take oral antibiotics. So even though I was still nauseous and not really eating properly, I felt there was nothing much more the hospital could do and I might as well be miserable at home than in the hospital.

Once I got home, I felt immediately better. It's funny how the hospital promotes sickness behaviours. Just being in a more normal environment made me feel more human. Having Mum's food also helped a lot.

So that's my hospital experience!! So many words I could use to describe it... unexpected... scary... interesting... educational... I wouldn't say it was fun, but since it had to happen, I'm glad to have experienced being a patient for once. I have a whole new respect for what patients have to go through. Even for a "simple" appendicitis I found it a pretty hair raising adventure. Imagine what it's like for patients with really serious conditions and have no idea what's going on!

One last comment before I finish this extremely long post - a huge thank you to all of the visitors and people who sent cards and txt messages. I really did appreciate it all even if I wasn't able to reply or say thank you properly!!!

Well, after 3 months on the road, I've finally returned home to Auckland. It's been such an amazing journey and I just can't believe it's all over. From those nervous first moments leaving Auckland airport, to the beaches of Honolulu, to finding my accommodation via the Toronto Subway, to Times Square in New York, to Niagara Falls, to the mountins at Whistler, to Federation Square in Melbourne, to arriving back in Auckland feeling like a totally different person... gosh what an amazing feeling!

The time away really was like a dream. In a way I wish it could last for ever, but probably part of what made the time special was that in the back of my mind, I knew it would only last for a finite time.

Unfortunately I've had to come back to reality rather quickly with a whole week of radiology teaching. It isn't quite as bad as I expected and I think the tutors know that we're all still in holiday mode so they don't drill us too hard. Honestly, I suck so badly at radiology! Everything looks the same to me. Blood, fat, fluid, bones... who cares!?!??! You don't have to worry about me overordering radiological tests because I will avoid looking at them at all costs!!! I think my psychic powers have more chance of reaching a diagnosis than my brain trying to interpret a T2 weighted MRI or whatever it's called...

I had my elective interview yesterday - the chance of the med school to make sure that I've actually come back. They asked me all sorts of questions, such as what my most memorable moment was... but I wasn't really sure what to say because I felt like talking about my encounters with celebrities, or travelling to New York, or the week I spent in Vancouver... but I couldn't think of anything medically related! Anyway, it's all in my elective report! Just read it and save me from having to think!!!!