On being a doctor.

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I worked 12.5 hours yesterday, then 3.5 hours today, starting at 0800. I slept 3 hours afterward; my stamina for long shifts has dwindled!

I should count myself lucky though, I used to have to do 14 hour shifts every 3 weeks, plus the whole week. This is the first I have done all year.

It was actually quite a hard day. I had to deal with 2 fracas (fracases? fricasees?). I was reminded that I really don’t like conflict very much. One of them was an old fella who was doing his best to destroy hospital property, without going into too much detail. It was quite a dangerous situation, because I had to sedate the fella, who was trying to assault all of us.

anywho – can’t go into too much detail but needless to say I had a headache at the end of the shift and I needed quite a large glass of wine.

I do enjoy having residents (junior staff) to work with – they bring out my protective instincts and I make sure they get lunch. Plus I like to teach. Which brought me to thinking about some of the lessons I have learned – “rules”, if you like. I thought I would share them here. Some of them apply to a lot of jobs.

  • Most people are alright. They can be snippy under stress, but underneath they are alright and it usually is obvious with a bit of empathy. Perhaps 98% of them are alright. The other 2% of people are arseholes. There is nothing you can do about it other than pick it up early (early diagnosis being the key) and deal with it.
  • More people, maybe another 15%, are stupid. Sorry, this sounds cruel, but I am probably talking to the converted here. Again, realise this and deal with it.
  • Bearing in mind the above, try to never get angry with the patients or families. If I get angry, I walk away. Most of the time. Very rarely I lose my cool. Which brings me to the next point.
  • We are only human. In fact, you realise just how human you are, sometimes.
  • At the beginning of my career, I used to be very upset when people were angry with me. Now I realise that, whatever I do, I can’t control the way people think of me. They will think what they like, and they will talk. Especially when you get a whole bunch of females together – case in point, Nurses. I have learned, since I am friends with a few, that they like to talk. And bitch. And there is sweet fanny adams I can do about it. Best to keep the head held high, and be super nice, because it will make them feel guilty.
  • On that note, I have learned that, to get people to do what you want, it is much more effective to make them feel guilty than to make them feel angry. This particularly applies when dealing with doctors.
  • Plus, honey attracts more flies than vinegar.
  • Empathy and forebearance are good, and I try to have them, but they run out at the end of a hard day. Best to talk to people between 10 and 2. Or if you can’t see the rule above.
  • Murphy’s law: when you do 100 things a day, you probably get thanked for very few of them. You get one of them wrong (that is a 99% hit rate) and that is the thing you focus on. It just helps to remember this. Important to reflect critically on the work you have done eg. ‘how can I have done this better?’ but important to also pat yourself on the back.
  • Because it is such a thankless job we do, as much as I can, I try to thank people and tell them they did a good job, especially after a difficult situation, of which there are many. Case in point; the cops, security guards and nurses that pinned down the fella going apeshit yesterday.
  • The gut. The vibe. The intuition. Whatever one calls it, always good to follow it. It is usually backed up by skill and experience.
  • I don’t have a magic wand or a crystal ball, nor am I withholding any treatment that would be of benefit out of spite or any other thing. This I tell people sometimes, gently. This is usually quite effective.

Those are the philosophical ones. Now are the medical ones.

  • An elderly person with wheeze has pulmonary oedema until proven otherwise. This I taught to an intern over the phone yesterday, who then went on to fix the patient without me having to go to them. Which was lucky, because I was dealing with the apeshit guy, plus another thing.
  • If a person cultures a bug that I have never heard of, their mortality rate is 100%. This is based on my trial with n=3.
  • For an older person, aim to have haemoglobin greater than the person’s age; this gem was taught to me by a colleague.
  • The line between severe agitation and profound obtundation is much, much smaller than I once thought (this is the rule I was thinking of when sedating the apeshit guy)
  • If in doubt, give the smaller dose, because you can always add but never take away – see rule above.

That is all I can think of for now.

Many thanks to youse all for your comments for the previous entry. I am better now.

I have done some therapeutic cooking – I made a beautiful spaghetti bolognese – the ingredients: organic beef mince, tin crushed tomatoes, little tin tomato paste, oregano, salt, pepper, 1 diced carrot, 1 diced onion, 2 diced stalks of celery, a glug of olive oil and the secret ingredient – a spoon of brown sugar. It is not a quick dinner; it needs at least 1 hour on the stove. Plus the other secret ingredient which is a whole lotta love. Plus I also made a bircher muesli for brekky, with frozen raspberries.

I learned a good rule – try and spend as much time eating the food as you did preparing it. I often get hiccups and heartburn from demolishing rather than savouring food. This is a good one for me.

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3 responses »

  1. Working in IT is a little bit the same, never any thanks for the 364 days, 23 hours and 30 minutes of the year that everything is working just fine, but for the 30 minutes when it isn’t, boy then do people make a noise!

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