Saturday, August 20, 2005

The Night of the Long Stockings

Well, back from a weekend shift and a lot going on.

I started at seven in the morning today. I dragged myself out of bed (not entirely hungover, but neurons still crackling from the glorious football) and hunched my way through the rain to the ED. I sortof shuffled past the waiting room (only a few people waiting), grabbed one of those coffees I advise other people to cut down on and sat down next to Dr Longstocking.

"Screen looks good" I said. "How's it been?"

And she burst into tears. And the next half an hour (I wasn't there for all of it) she explained to the senior consultant Dr Van (via sobbing, and gesturing, and wringing of hands around imaginary necks), what overnight had been like.

She'd been on with three others. One was a GP trainee. General practice trainees are good at seeing everyday problems ("This lump on my ear..."), and that's often all they do overnight in the ED. This one didn't do a lot of that, because he was basically disinclined to work. And I can understand him being nervous about his capabilities to do what must have been a very challenging job, but presumably he was less nervous spenidng the money.

One of the others was Wmbesa, a doctor who appears to have evolved on another world where the gravity is much weaker. He moves with almost treacle-like slowness. The first night he was on I remember watching him flow from one cubicle to another like the Blob. In ten hours he sees two ro three patients. He does buggerall.

And lastly she had Dr Rookswen. Dr Rookswen is not like the others - it cannot be said that he does not see patients that he should see. Rather he sees ones that he should not, because he is dangerously, frighteningly, almost "slapstick comedy if it wasn't real life" bad.

No words, no hyperbole, can adequately illustrate this. One example - he's the guy who saw a kid having a seizure and turned out the light to help it relax. So it could choke and convulse in the dark.

No, none of us believed it either.

He is meant to be working under one-on-one supervision. He has been sent down here because he is too fucked (my boss's term) for any other branch of medicine. He keeps trying to escape and see people independently, but normally we can track him down and stop him.

But last night Pippi's there with three imbeciles and more than ten priority twos (really sick people who have to be seen within ten minutes) and a priority one (someone who is dying and has to be seen now) and a waiting room full of people and basically did 90% of it herself.

And first she was seeing them because they were human beings in pain and then she was seeing thembecause they had to be seen and by four in the morning she was seeing them out of fear of them dying (all nobler feelings having fled) and by seven thirty she was seeing them out of whatever spinal reflexes move you around when compassion and fear and conscious thought are gone, but still not far enough gone to let Rookswen moved about unobserved - she sent a nurse to watch over him, much to his chagrin. And nobody died on Pippi's shift, but by God it was a near run thing.

Anyway, this morning Pippi melted, and said she will not be here in a few months if significant changes are not made, and that she does not believe they will be, so she's looking around now for other jobs.

And she is the best doctors we have amongst the juniors.

I don't know. Sometimes I feel my whole profession is imploding.

That sounds stupid, but emergency medicine - I don't know. I believe at some level that we have to do it, that a society or a community or whatever the fuck we are meant to be has some duty to do this. Provide basic medical care for those who cannot provide it themselves.

But in the last few years it's gone horribly awry. The local GPs (that's the family doctors), they all charge now. Twnety five dollars minimum to see a doctor. A lot of people in the greater Mordor-Slytheryn area can't pay that. And I don't give a rats arse whether it's "can't" or "won't", in the end if you're old or you're a baby and you have pneumonia and you don't go get antibiotics, you die.

So the sick, in increasing numbers, come here, where there are decreasing numbers of us to look after them. And it's starting to show - we have more junior doctors, more foreign trained doctors... I worry that we have more questionable doctors. Because we're desperate, and if you're desperate, you'll take anyone.

I don't know. Of the junior registrars I started out with, several have gone. One is definitely still in the training programme, she's that kind of person, emergency medicine material. Another is deeply unhappy, looking to transfer to cardiology or something - and smart enough to. Dr Maad is not really in training. Dr Iskandar has resigned and gone to Queensland and will never return. Pippi has children who want to see her and a husband who almost left last year - she knows there are other positions, places that offer forty thousand dollars a year more for easier work.

And me. I'm part time. I'm not one of the common ED personality types - my boss did a bit of research, got the consultants and seniors to do that Myers Briggs personality test. A disproportionate number of ED doctors are thinkers rather than feelers, extraverts rather than introverts, sensers rather than intuitors, judgers rather than perceivers. When they did the study they published the results on the ED noticeboard. I went and looked it up and my personality type (I think it's INFP) is represented by a smallish proportion of the general population but precisely no other ED doctors.

And I have a wife and children too, and stuff I want to do.

I know it's stupid, but that baby still gets to me. You know, the one that wouldn't breathe, the one I thought was a doll. And I don't know what I'm doing, typing all of this out to a doubtless rapidly diminishing number of readers, maintaining an online record of what is likely to be some kind of breakdown, but I keep thinking about it.

I am a thirty eight year old Australian man, I have more degrees than a thermometer, a father and a doctor and allegedly one of life's winners, and I am ALWAYS at some level afraid.

Is this what it's like for everyone else?

Anyhow. No-one has died yet on "my" shift, no-one has died who wasn't going to die. And no complaints against me personally, and no legal action.

Deep breath, calm down. Truth is, I don't know how much longer I will do this. I feel selfish saying it, but I don't know if I am going to keep doing this. I love doing the job, a few days ago I saw this guy brought in with acute heart failure, pale, labouring, so sweaty we couldn't get an ECG on him... and it all went bloody well. We kept him out of ICU, he ended up being able to talk and eat instead of being intubated or resuscitated... and it felt good and it worked well.

And I love the staff, nurses, doctors, everyone. I love the community, the cameraderie, the sense that we share a common understanding, that despite ER and Chicago Hope and all that we are a closed circle. And I really love seeing patients, and I love it more as I get better at it.

But I don't know. I have to do a year non-ED, that's next year. Maybe it's for the best. Next year will be Hogarth House and Something Else - psych, paeds, drugs-and-alcohol. Nine to five, good pay, easy money. And an option to stay as long as I like.

It's hard now to imagine not doing ED. But I reckon next year it'll be hard to go back.

Thanks for listening, too.



Blogger Chade said...

Fear is a normal part of life. What is worse, in my opinion, is the inability to feel joy when not soing something. Unless I am being interactive (work, socialising) I can't lift my spirits. Now that's bad. I'd rather fear.

5:41 PM  
Anonymous Go_Freo said...

The day you lose your fear in emergency medicine is the day you should start doing something else...

10:32 PM  
Anonymous Camilla said...

I am a thirty eight year old Australian man, I have more degrees than a thermometer, a father and a doctor and allegedly one of life's winners, and I am ALWAYS at some level afraid.

Is this what it's like for everyone else?

'Tis for me. Except that I'm not male, a parent, or a doctor. I think it's one of the reasons I haven't gone in the direction of psychotherapy practice yet. So much less terrifying to read about it than actually deal with unhappy people. In that respect, I think you've got more guts than me. And I agree with go_freo. I think some degree of fear is necessary in a good doctor. Just so long as you don't let it paralyse you.

11:01 PM  
Blogger Benedict 16th said...

if you didn't have that fear, you would be just like one of those speed addled antisocial personality types that present to the ED about 3AM Saturday mornings for a broken fist about the same time as the cause of the broken fist gets wheeled in.

- Benny

From another reader too shy to post themselves:
"... think about doing a Paed Reg job
I thought of this after seeing his blog about the baby.
It certainly helped me lots esp. Paed Reg and Neonates - you learn LOTS.
Just let him know it reduced my fears as I felt a bit more skilled afterwards"
- Caro

11:51 PM  
Blogger Foilwoman said...

BJ (actually, I am going to call you that unless you protest): I'm always afraid about my competence etc (with some evidence, this last year, that those fears were well founded). I think anyone who isn't a narcissist or psychopath who does challenging and responsible work feels some real level of fear. The trick is finding a way to live with it, and not have it eat you alive. Of course, easy for me to say. I work with paper, not people.

Oh, and you're only 6 years my junior! I thought I was your Mom's age. For some reason, that makes me very happy. Go figure.

4:19 AM  
Blogger Bronze John said...

Hail Chade,
Does sound serious. Free advice being worth what you pay for it, but talk to someone, serious.

In times like this, I find a good idea is to ask yourself "How would (currently written) Matt Murdoch handle this?". Then you do whatever it is he didn't do, and your life doesn't get as fucked up.

12:27 PM  
Blogger Bronze John said...

Thanks go-freo,
I think to a certain degree you're right. But too much fear is as unhelpful as too little. I'm just going to work out if I'm one of the people who can do it and have that acceptable amount of fear.

Port look dispiritingly good this weekend, but we'll see.

12:30 PM  
Blogger Bronze John said...

And thanks Milly. They have this idea called "vicarious traumatisation" which you probably know more about than I do. Some of that is probably some of what's going on.

We are meant to have doctors we can talk to, but it's difficult to get the time/the anonymity/the humility necessary to tell one of the priesthood you are a sinner.

Rather than that, I have a blog.

12:35 PM  
Blogger Bronze John said...

Benedict (deeply weird calling you that), maybe what we need is an ED polymorph (can't do those hypertext linkup things here, but it's an emotions-sucking extraterrestrial from Red Dwarf, for those unlucky few who don't know).

I will leave the procurement up to you. It could "cure" our psych patients too. I might write about this later.

Apparently "Caro" means "darling" or something in Italian or some other language. See what a precise recall of facts you need as an ED doctor?

12:43 PM  
Blogger Bronze John said...

This comment has been removed by a blog administrator.

12:44 PM  
Blogger Bronze John said...

This comment has been removed by a blog administrator.

12:44 PM  
Blogger Bronze John said...

This comment has been removed by a blog administrator.

12:44 PM  
Blogger Bronze John said...

And thanks Foilwoman,

When you look at junior doctors (and I'm sure the same goes for most professeions) there is a strong correlation between how good the junior thinks s/he is compared to the average and how good they truly are.

Unfortunately it's a strong negative correlation. Good doctors/whatever think they have far to go and much to learn, bad ones reckon they've got the game sussed. You (and I) may be better than we think.

And about the age, I read a line in a book once about someone who acted more childlike than she was because she "had learned the advantages of prolonging her adolescence".

I suppose that's what you get when you keep people at school most of their life.

12:53 PM  
Blogger Chade said...

Personally I think it's this town. Ever sice I got to the Dead Heart I've watched my girlfriend spiral out of control emotionally. I now spend more time dealing with her problems that I just don't have anything left for me. I need to RETURN to the city. I need more than this degenerate hick town can provide. I need a good beer, in a good pub, with good company. Come on November...

7:03 PM  
Anonymous Anonymous said...

Does being an INFP ED physician make it more difficult to do the job?

3:22 AM  

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