Rookie Year

It’s been a long time between my last post and now, and wow, a lot has transpired since then. I have just finished my 10-week rotation in General Medicine last week, which honestly, has been the busiest rotation this year--but we’ll get to that soon.

Since my last post, I’ve rotated through General & Endocrine Surgery/Orthopaedics, Emergency Medicine, General Medicine and now Psychiatry, to finish off my internship year.

Where do I even start with how I found each of the above?

As you may or may not know, it is a requirement that all interns in Australia complete three compulsory terms in each of Surgery, Emergency Medicine, and General Medicine. For my 10-week surgery rotation, I got a 5-week split between General & Endocrine Surgery and Orthopaedics. I enjoyed this rotation. The first five weeks were spent on a relatively known “chilled” rotation in Endocrine Surgery. For a large majority of the time, the team did not have a heavy in-patient list, which meant that there were opportunities to head into theatre and see some endocrine surgeries. During one of those times, I was in a thyroidectomy surgery where surgeons remove the thyroid gland for a multitude of reasons. The most astonishing part of this surgery was seeing the carotid sheath so close to surgery site.

It was just there! The pulsating carotid artery in the flesh, just doing its thing and keeping the patient alive. I kept thinking to myself how there was very little room for error in such a minute area to work in. Subsequent moments of damage control would ensue if this carotid sheath was nicked and/or punctured in anyway. Quite the opposite to what endocrine surgery was, orthopaedics surgery was a lot busier and took some time to get settled in. There were some weeks of seven days straight of working, with some days starting at 6am to 8.30pm. Coupled with being in the middle of winter, it meant that sometimes I never got to be outside in semblance of Melbourne sun! Overall, the Orthopaedics rotation showcased to me how orthopaedics is not for me. I do like human anatomy, and have taught this subject previously, however, I don’t think I can do orthopaedics due to the other aspects that come with pursuing such a competitive surgical specialty.

Then it was off to Emergency Medicine, which surprisingly, I relished in. This rotation had a variety of patient presentations, and the best part, for me, was to work-up a patient that was undifferentiated. Despite this, at times, I had to be uncomfortable with not formulating a definitive diagnosis, but rather, provisional diagnoses, whilst importantly, ruling out the more emergent conditions that could harm the patient. The combination of teaching that was provided to the junior doctors, plus, the learning environment, was conducive to building up my clinical acumen. It made me think of why I want to order specific tests and radiology images, and how this exactly would help with taking steps towards the diagnosis.

Earlier this year, I thought that Orthopaedics was the busiest rotation all year, but damn, general medicine definitely came and took the crown of the busiest. The ward rounds were long, the cover shifts were stressful at times, especially when covering all the General Medicine patients between 8:00am to 8.30pm on the weekend! I’m glad I had General Medicine at this time of the year, as I was able to navigate diagnoses and continue to use my slowly establishing clinical acumen. My team of registrars and interns were good, and it makes sense when people say that your General Medicine team will determine what kind of experience you’ll have. I had a rotation that was well supported by the registrars, with learning from performing punch biopsies, to growing more confidence with inserting catheters, and using an ultrasound machine to insert cannulas. General Medicine taught me how to get things done, and also how to find things, hence ultimately troubleshooting. Oh, you need an echo report from 2018 from this hospital? This is the best way to get it. Oh, patient is planned for discharge, but not co-operating? Let’s go have a chat to them and see why that’s the case and assist them in discharging. Furthermore, compared to any other rotation, general medicine provided the opportunity to talk to patients’ families both in-person and over the phone. I learnt that some families only want the basics when it comes to medical diagnoses, whereas other families want every single details pertaining to their loved ones-- the trend of blood results, looking at radiology images, and wanting to understand every slight change to management. Luckily, I paid attention in medical school during the communication skills lectures and tutorials!

Getting through a large majority of internship would have not been possible with the help of the most important person in my life- the love of my life. She has been so instrumental in listening to my struggles and debriefing after the 12+ hour days. I would not be a quarter of the doctor I’m becoming if it wasn’t for her and for that, I am eternally grateful.

In other news, I still haven’t decided what I want to do, but next year, I’m pursuing a general clinical year and then we will go from there. Psychiatry is my final rotation of the year, and I’ve been seconded to a peripheral hospital site.

Also, if you haven’t already checked it out, have a listen to the podcast series “Medicine Through Our Eyes”: https://tinyurl.com/mvhy2y54

Lastly, I hope some of y’all can make on Thursday, 9th November at 7pm AEST, where I’ll be talking about all things medicine for prospective students- getting into medical school, thriving and surviving:

Zoom Link: http://tiny.cc/kircvz. P/w: 518123