I Got Next...

To think I started this blog as a third-year medical student, and now I just started my PGY3 year. It’s been a while since my last blog post. I have been in the trenches with some of the rotations during PGY2: rotations in anaesthetics, orthopaedics, and ED. 

I have seen considerable growth in the way I practice the art and science of medicine. I can sense the cogwheels of being a clinician slowly but surely coming together. My ED rotation provided an environment to bask in this growth. At the beginning of this rotation, I still had the mindset of an intern, where I would find myself talking about every single patient to the senior registrars. It wasn’t until I got further into the rotation that I was expected to not talk about each patient and instead feel confident in the management decisions I was making.

I started managing more category 1 and 2 ED patients, which means patients that needed to be seen within 10 to 30 minutes of presentation. The level of independence can be daunting at times; however, I think it’s important to extend yourself within the limitations of your clinical acumen.

There was paediatric patient that came to the ED in the last 45 minutes of one ofmy shifts. I thought it would be a quick hello and good-bye, but the patient turned out to be a diabetic ketoacidosis. This is when the blood sugar levels are high, but your cells are not able to utilise any of that for a variety of reasons. Your body then tries to make energy in other forms, which sounds like a good thing, right? Wrong! These other forms can make your blood more acidic and causes all kinds of issues, as your body tries to rapidly breathe to clear out the acid. For those of you that know, and don’t know, there is a whole process for managing diabetic ketoacidosis, which requires contacting the endocrinology team and starting intravenous fluids and electrolytes. 

I was grateful because my ED registrar, who at that point had seen a plethora of diabetic ketoacidosis cases, gave me the reins of managing this patient with close assistance. I started the fluids, gave the appropriate electrolytes, monitored the patient, and referred them to another hospital. The steps and management made sense to me, and it was about actioning these things in a timely manner. By the end of the night, which was now hours after I was meant to finish, the patient was more stable for transfer and well-looking. Having the continuous repetitions of managing conditions adds to the growing muscles of clinical acumen. I can now manage diabetic ketoacidosis more comfortably, compared with the beginning of my ED rotation.

Speaking of repetitions, this ED rotation also meant I got more exposure. I cannot even count the number of hand and limbs lacerations I have sutured; the number of casts I have moulded. It has been a great rotation for building these essential skills that can be used anywhere. Another lesson I took away is looking for the complications of conditions, as opposed to just going through an examination, which is what medical school teaches. This mental model is what experts and seasoned consultants exhibit with their clinical acumen.

Let's use heart failure as an example. Your examination would include looking at complications of heart failure. This could mean listening to the lungs for fluid build up or looking at the feet for swelling. Essentially it means tailoring your examination to what you expect the most vital signs of that condition are.

I’ve recently started a new resident job. This year I am doing a Critical Care HMO job, which is a stepping stone into anaesthetics accredited training. Yes, you heard right: anaesthetics. I want to be an anaesthetist, and this current job has a proven track-record for getting HMOs onto training. Critical Care resident jobs are quite competitive. At my hospital there were more than 250 applicants for only 6 anaesthetics critical care jobs – only 6! It only makes sense because it is one of the few ways to get expose to anaesthetics, and therefore, acquire references to support you in your application to the program. 

Prior to applying for this new job, I had been chipping away and working on my CV; augmenting it with courses, teaching, as well as research and audits. 

I would not been in the position today without the unyielding support of my wife, Prisca, throughout this entire application cycle for critical care. Her wisdom, meticulous reviews of my CV and cover letter, and her overall feedback, packaged in a parcel of love and wanting to see me get the job, meant that I was able to present myself in a competitive way when it came to submitting my application and for interviews. I am eternally grateful for her invaluable contribution! 

I also got the help from consultants and registrars, who had been in a similar position to me, to offer feedback and interview practice for such a competitive field. Each person had a different take when it came to CVs. It was interesting to see what people picked out and offered feedback on. I approached it by looking at the commonalities of the feedback, as it made it pertinent to fix something that stood out so much. Prisca jokes that too many cooks can spoil the broth, with all the different people I have had look at my resume. Well...Too many cooks add flavour and different tastes, and I’m glad to say that my current hospital loved the meal!  

In other news, I have released some new podcast episodes for “Medicine Through Our Eyes”, with an Obstetrician/Gynaecologist, Anaesthetists and many others. Check it out here: https://tinyurl.com/2jxw7vmf

Don’t forget to eat your pancakes!