How to be a good registrar, part 1.

I know a few people starting this job next year and this is for them.  For those who don’t work in a hospital, a registrar is part of the clinical management structure.  The most junior is the intern (fairly universal in any place of work), a person who is two years out of medical school is a resident, and a registrar can be anyone who is in their third year or beyond.  It varies a bit between states, sometimes a third year out of medical school can be called a senior resident or senior house officer.  A registrar is someone who is embarking on a training program to become a certain sort of doctor – i.e. a surgical registrar will one day be a surgeon, an obstetrics registrar an obstetrician, a GP registrar a GP, and a medical registrar, a physician.  A physician then becomes any of the internal medicine specialties, i.e. a cardiologist, gastroenterologist, geriatrician, endocrinologist etc.  All of the specialties training programs are another 4-6 years after medical school.  It’s a long and quite stressful process!

So for those halfway through, here’s my take on what makes a good registrar.

1.  Know your drugs.  Learn the classes of the most commonly used drugs and the important interactions with other drugs and diseases, i.e. thiazides and gout.  They’re easy to learn, easy to remember and for some reason, it really impresses the boss when you rattle off a list of dopamine antagonists and rage about all the haloperidol that person who is being investigated for Parkinson’s disease is getting.
2. Write an issues list, twice a week if you can.  Not at the expense of efficiency though!  Bosses love your issues list and where you’re at for each issue.  Name the issue, the reason (if relevant), what the tests have shown, what tests are pending, and what the plan is.  No longer than a couple of lines though.
3. Make DVT prophylaxis and resuscitation status their own separate issues.  This reminds you to write up DVT prophylaxis and NFR forms and again, the bosses think you are golden.
4. Be certain about things as much as you can.  In residency they don’t like it when you’re overly decisive and opinionated.  Ask me how I know this!  But when you’re a registrar, if you have a good sense of what’s going on and sound certain when you say it, they love it.  Say it from the get go, instead of, ‘this lady presents with shortness of breath” and go into her history of symptoms etc, say “This 89 year old lady from home alone presents with pneumonia or likely pneumonia”.  It’s your job as the registrar to make an assessment.  It’s okay to be wrong too, that’s why you’re calling your boss – to offer your assessment, explain why you’ve assessed it that way and see if they agree or not.  If they don’t agree, that’s great!  It’s good learning for you, and they get to offer the benefit of their experience to you.
5. Be honest, even if it humiliates you.  No, we don’t all do a perfect top-to-toe assessment of our patients.  We get busy, we skip a step, it happens.  If you’re boss asks you ‘what was their JVP, their corneal reflex, their Pemberton’s sign, their lid lag etc’ and you didn’t do it, say so.  Say “I didn’t do that but I can run back and do it now/re-examine them later”.  Even if they’re a bit annoyed, it develops trust.  It means that when they ask if you did something and you say you did, that you’re actually telling the truth.  Trust is hugely important in this game.  So man up and own up.
6. Look after your junior but  do not do their job for them.  I have run the full gamut of interns and residents from the best to the very failing-internship worst.  Everyone has a different management style, if it’s halfway through the year or beyond I tend to give them just enough rope to hang themselves with.  I don’t offer to do anything for them, I tell them what needs to be done and when it should be done by, and I will suggest how to prioritise their tasks.  If they’re absolutely shockingly drowning I will sneakily do half of their jobs for them if I’ve got the time just to see the look of relief on their face.  I don’t do it too often, and most of the time they’re pretty good.  Make sure you tell them they’re doing a good job when they are, for some weird reason there’s not a lot of praise in medicine but I like to buck this trend by justifiably telling people when they are doing well!
7. Don’t get too emotionally involved in your patients lives.  I am still learning this.  You do not have the emotional capacity to get involved with the lives of 15-30 patients a day or 4000-8000 people’s lives per year.  You will burn out if you try.  You’re not responsible for their disease or their situation – all you can do is help them as much as you can at this single timepoint in their lives, be caring and empathetic about it, and point them in a direction that is better for their health.  Lots of people complain about doctors being uncaring or the medical profession being evil, it’s not, it’s just too busy.   We all care, it’s why we did medicine, but there’s one of you and 4000-8000 people per year.  You can’t spread yourself that thin.
8. Be nice to the emergency department.  Don’t be that doctor that bags out the ‘terrible ED’.  It’s low hanging fruit and pretty unfair.  I wouldn’t be an ED boss or a registrar for the world, their job is so difficult.  They have 50,000 people coming through their doors, unsorted, undifferentiated, and it’s their job to make an initial assessment, do some workup, and pass it on to you, all within about 3 hours. The higher up they are, the more people they have to supervise, and the juniors are always so variable.   It’s fine to ask for more workup if you don’t think it’s adequate – my baseline workup for a patient is basic bloods plus a CRP (not usually done but they’re always happy to add it on), a urinalysis, ECG and chest x-ray, plus or minus a head CT or blood cultures if it’s relevant.  If that’s all done or coming, don’t refuse to see the patient because some weird vasculitis test hasn’t been done.  DO refuse if the patient is in kidney failure and they haven’t imaged the ureters because that will be the difference between a medical and a surgical admission!
9. We are all terrified of pregnant patients.  All of us.  Admit them if necessary, get O&G involved immediately, and make the midwives do dopplers/CTG/anything else that makes you worried.  Know about pre-eclampsia.  Don’t mind the midwives laughing at you because you’re anxious and terrified of Hurting The Baby.  And again, know your drugs, and check that they’re safe in pregnancy, and if they ARE safe, make sure the patient consents because not all pregnant women will consent to safe pregnancy drugs anyway.  Which is their right.
10. Don’t diagnose a psychogenic disorder without specialist input, and ruling out absolutely every other disease it could possibly be.  And once you have ruled it out, don’t dismiss the patient as ‘putting it on’.  Psychogenic symptoms are real – the patient has no idea that they’re not.  For whatever reason they are unable to communicate their internal distress so their bodies are communicating it for them.  This does not happen on a conscious level and takes a lot of specialist psychiatric input, time, and trust from the patient to be cured or managed.  Be patient.

That’s it for now – I could write a book on this!

Temperley I am actually dying.

I am not a cool person when it comes to fashion.  I wish I could be that all-grey and black monochrome person with the fringe hanging off my Alexander Wang handbag, flicking in the air along with my gorgeous bayalaged hair that doesn’t snap and is shiny but I’m like a magpie.  I love colour and white and shiny things.  And I never get to the hairdresser because I’m always on rotation somewhere new and when I do get to a hairdresser, my grown-out hair reeks of hairdresser-disloyalty.  Anyway, I have all my favourite designers and mainly it’s because they use colour in fun and uncool ways that look cool on hungry Amazonian women in a ‘oh this old thing, I just threw it on because I’m totally ironic and I hardened it up with some chain mail/bondage gear/leather’.  Currently I’m at home tired and I load up my Style.com app because lets face it, we all had that app for the high res photos of New York and Parisian eurotrash parties that random celebrities and fashionista’s showed up at and were often caught mid-drink in unflattering lighting and we could sigh with relief and say “oh thank god, they’re just like the rest of us”.  Except billionaires.  The app understandably got rid of it’s party section so now I just flick through the fashion shows of all my favourite designers (DVF, BCBG Max Azria, Valentino, Red Valentino, Temperley, Kate Spade and so on).  Today I caught up with the Temperley show and OH WOW.  Here are some of my favourites but really, I loved the whole damn collection.

Note the fedora for extra cred.  You mustn’t look too sweet or people wont trust you, or worse, they’ll think you’re stupid.  I wouldn’t wear the fedora and would just cop the weird judgment.

I just have no words for the amazing perfection of this whole get up.  The intricate embroidery, the symmetry, the matching scarf, gladiator sandals that don’t look you’re going to beat someone up.

Again they’ve reduced the sweetness of this one by using what looks like metal grommets.  Again, the attention to detail is off the friggin’ hook.

I can just see myself wearing this at the resort mentioned in the previous post, swanning around in my oversize weird rattan tub chair, ridiculous cocktail in hand pretending I’m there like, all the time dahling.

There are literally no words.  I am actually dying looking at this amazing thing.  Where the hell would you even wear this?  Somewhere amazing.  You’d have to be Cate Blanchett or getting married or something.

This dress is basically who I want to be.  Glittering, supercool, brown, taller.  Basically amazing yet gliding with ease through life with my attention to detail and simultaneous brilliant grasp of the big picture.

Goddamn you Temperley London, I love you.

Full collection Temperley London SS 2016 here.  Pictures also from there.

I am a really lazy person.

I had an annoying conversation with a random person the other, I can’t even remember how it came up but they irritatingly said “I can never not be busy, I have to be doing something every minute of the day.” and then degenerated into some smug “idle hands make light work” kind of arrangement that one of those women in the 1950s might have said to themselves as they chugged down their 3 packets of Bex mixed down to a paste with some whisky in order to keep their mind off the drudgery.  I made some polite excuse about having to go and do something and was out of there.*

At work I’m a powerhouse, I don’t stop, I make sure everything is done, every patient is sorted, right down to making sure they’re warm enough and fed (you would not believe how long patients get left without food sometimes), I feel like this matters more to me since having a baby, I’m not sure why. I will stay back late if I need to and make sure everything is sorted. But I am driven by the motivating factor of rest.  Everything I do is so I can hit the couch and binge watch The Mindy Project while shopping on Asos and come up with plans to the most brilliant home-manicure ever which I will then inevitably wreck because I get bored waiting for the polish to dry and decide to do something manly like fix the door hinges.

Nothing irritates me more than people who tell me that when they go on holidays they have to do something with every minute and see every sight and go wakeboarding then paddleboarding then jetskiing then grab a bite to eat before partying the night away because who goes on holiday to stay in their room?  Um, me.  There is nothing better than going on holiday, wrapping yourself in five star sheets and going to town on their on-demand service.  Or sitting in the balcony bathtub for an hour.  Or lying on those pool/beach lounges/cabana pretending to read the paper but actually falling asleep for a good two hours, and then start ordering cocktails.  And not moving.  People bring you things!  How is this treated with such contempt?

Or people who proudly proclaim they never nap.  I actually hate you.  I am jealous of you.  Moreso when you tell me you don’t need sleep either.  Who doesn’t need sleep?!  If I could go to bed at 9.30pm every night, get up at 8am and have a 2 hour sleep every day I would be in heaven.  There is nothing more awesome than having a three hour nap on a Saturday, slamming a long black, then going for a run along the beach.  The endorphin rush is insane!

Mostly I get very little sleep, work very long hours, and spend a lot of my weekends trying to nap, and binge watch TV, or catch up with my exceptionally amazing and fabulous 3 closest girlfriends to eat cake and talk about how much we love relaxing.  I really hate going to the hairdresser/any women’s clothing store because they’re like “GOT PLANS TONIGHT BABE? HECTIC SATURDAY NIGHT FOR YOU?!!?!!”  Also what is with the use of the word hectic?!  Why is everything hectic?  I want to say to them “well actually, after a week of really sick patients and having to do CPR, worrying about where my 102 year old patient is going to live after we’ve discovered her home is falling down around her, worrying about if my intern is bored on his/her rotation, whether or not my boss thinks I’m a complete idiot, whether or not that patient’s family is going to lodge a complaint because I was half an hour late to the family meeting, worrying if my incredibly poor knowledge of statistics came across in my journal club presentation or whether or not I look enough like a doctor in the way I dress because my patients keep calling me nurse, I’m actually really looking forward to spending the night on my couch with my fabulous hair in my fabulous dress thanks!” But I don’t.  Sometimes I shrug ruefully and say “not really” then watch the knowing looks of sympathy between them.  I don’t even feel bad about it.  They can have their exciting Saturday night.  I have 60 hours a week of exciting.

So the minute I am not at work I am either napping, eating, watching TV, or eating with my friends.  I used to have hobbies I’m sure but now I’m just really really lazy.  It’s probably because in my job I don’t ever sit down.  Like ever.  On TV doctors all sit in gorgeous offices with fresh flowers and amazing modern art.  In reality, hospital doctors share a computer with the physios, the nurses, the OT, the junior doctors, and sometimes the boss when he needs help working his email and his secretary isn’t around.  True, boss doctors get offices but no one ever gets to be a boss doctor.  I’ve seen one person get to be a boss ever, the rest are all in fellowship and pHd hell because there’s not enough jobs at the top or the bottom of the chain.  And you don’t really use the computer that much.  You come to work, see all your patients (standing up), then you go and see other teams patients, or the emergency department patients.  Your intern uses the computer or writes in the notes for you, kind of like a really overtrained PA.  If you do use a computer, half the time it’s a stand up one on wheels, aptly named a COW (Computer On Wheels – so very 90s), or if you do sit down at one, people stare at you maniacally until you give it up for them to use.  There is no sitting, ever.  Okay maybe at lunch for twenty minutes in the staff cafeteria because it’s not worth the barrage of pages you get if you leave the hospital to go to the cool coffee place.  It’s like they know you’ve gone off the grounds and start freaking out.  A bit like high school.  Anyway, all you lazy people out there, I salute you.  Don’t be ashamed of the way you are.  Work hard, but relax harder.  If you get to go on holiday and some guy in a fancy suit just brings you elaborate drink after elaborate drink, you’ll know you’ve won.

*I feel like the only person who legitimately gets to say they have to be busy all the time is Faux Fuchsia and this is because so much beauty and good and cake comes out of being busy and she is generally pretty happy. The people who say this crap to me are usually really angry manic sorts who in spite of always having to be busy and never napping, get very little done.  I just want to give them a hug and tell them if they learned how to relax and slow down, they might get more done than ever before.

**Yep this whole piece of writing was essentially to justify my own laziness.

How to be a good intern on nightshift.

I am a cranky cranky person on nightshift.  I don’t sleep well during the day (even less now with a baby), I take ages to wake up during the night and my notes can be very thought disordered.  My saving grace is that I care.  Nothing makes me more annoyed than people who show up to work to write notes and tick boxes and order tests and completely forget about the person in the bed.  And since I’m on nightshift and so far it’s been a week of rage and things left unsorted, I thought I’d write this list for the next generation of interns.

How to be a good intern on night/evening/any after hours shift.

1. If you order a test you chase a test.  If you order a test but your shift finishes prior to its return, you tell the incoming person to chase the test and tell the medical registrar the result.  Always tell the medical registrar the result.  Even when it’s normal.
2. You do not diagnose anxiety or heartburn on an evening/weekend/night shift.  Ever.  The med reg is allowed, the boss is allowed, you are not allowed.  Ever.  If you suspect heartburn, you have to prove to me it’s not a heart attack.  If you suspect anxiety, and do no blood tests, no chest xray, basically nothing to show me there’s not pneumonia, a pulmonary embolis, a heart attack, or something else bad, you’re in big trouble and not just from me.
3. You do not prescribe valium, or any other benzodiazepines without checking with the medical registrar first.  Ever.
4. If you say to me “I don’t know what’s wrong with them but I think they’re sick”, you get a gold star.  Thankyou for having the courage to recognise the limitations of you knowledge, and the clinical judgment to recognise something is wrong.  This is all I need from you.
5. None of us like doing lumbar punctures.  If you don’t know how to do one or don’t feel comfortable, tell someone.  Don’t try and get out of doing it. The patient needs it.  End of story.
6. If you say to me “I don’t know what’s wrong with them but I think it’s nothing” or “the patient was admitted with x, but I don’t think they have x” and have no basis for either of these statements other than your own reluctance to collect blood/put in a cannula, then you’re in trouble.  Big trouble.
7. You don’t need to diagnose anything.  You need to come up with a differential diagnosis in order of most scary disease to least, do the appropriate investigations, and tell me about it.
8. Tell me if you’re drowning.  Gold star if you recognise you’re drowning.  Double gold star if you ring me up and say “the nurses keep calling me and all this work is piling up but I have so many clinical reviews to do and I’m not going to get to it all”.  I will manage your workload for you if you let me.  If you tell me nothing and I have every ward in the hospital telling me that you’re not answering your page and I ring you up and you tell me you’re fine, again, you’re in big trouble.
9. “I feel uncomfortable doing this thing you/a boss/some other doctor told me to do and here’s why” = gold star.  Trust your gut.  Don’t let anyone give you shit about it.  Don’t worry about angry doctors – remember why you’re here and ask yourself “what does this patient need and how do I achieve it for them?”
10. Split up your workload.  When I was an intern I’d do a round when I got to work, then at 1am, then at 5am.  The first round I’d do any outstanding cannulas.  The second I’d do all the morning insulins and drug charts.  The third I’d do any cannulas that popped up during the night that were needed for the morning drugs.  On every ward I would write “Board/book cleared at 0100am, will return at 0500am, please call if anything urgently required”.  That way you wouldn’t get a million phone calls.  Of course things get busy and people get sick and it’s not always that straightforward but if the nurses know you’ve been and are coming back, they feel a lot more confident in your abilities.
11. As always, your registrar always appreciates chocolate.  Always.

How to be a good intern.

I feel like I’m qualified to make this post now, having run the full gamut of medical interns from so-barely-there-I-don’t-your-name to here-take-my-job-you-awesome-machine.  When I was an intern I really really wanted to be that star intern that was just basically awesome in every domain that everyone raved about.  The only problem was that I had no idea how to achieve it, or really even how to define it.  I was pretty good, sometimes great, but never the full package the perfectionist in me wanted to be.  And Googling it was NOT helpful unless you’re an American intern where you’re actually expected to know stuff.  As an Australian medical intern, you’re expected to do more and know less.  Only you don’t know how to do more because you know less.  It’s a tough year, and I wanted to write my list on how to be a good intern.  As usual, a big chunk of it is tongue-in-cheek and not be taken seriously, but could be, and if you did that would be AWESOME.

How to be a good THE BEST intern.

1. Your registrar needs coffee whenever you think of coffee.
2. Don’t bake.  I bake.  I have to bake.  It’s procrastibaketion for exams.  If you bake then what will I do?  You can however, bring coffee.  All the coffee.  You may also bring chocolate.
3. If you could have my patient list and all the blood & imaging results written out on them and a photocopy for yourself done before I get to work, then you’re a little bit awesome and a little bit frightening in equal measure.
4. Telling the nurse/NUM/physio/OT/social worker our plan right after we’ve made the plan shoots you to the top of the list for star intern.  Bonus points if I see it.  Full winning points if the boss sees it.
5. When I come to work and find new patients on our list and you say “yeah I’ve read the plans they wrote down in Emergency and I’ve done the plans” then I will hug you.  And again, full winning points if the boss is there when you say it.
6. Say “I haven’t done that yet, I’ll get right on it” when I ask if x has been done, rather than “I dunno…”
7. Your gut instinct is key.  If I or my boss or anyone asks you to do something you don’t feel comfortable with, whether that reason is real or just a lack of knowledge on your part, saying “I don’t feel comfortable” is actually really appreciated.  The swiss cheese model of error lines up when this doesn’t happen.
8. Be cheerful.  Yes the job stinks some days.  Yes you get asked to do stupid administrative things or call for consults when you think it’s pointless.  There is actually a point I promise.  It takes years to see that point.  If I have to pull out the “if this were your mother…” argument, you are not heading towards a good evaluation.  A friendly attitude is everything and remember, the boss often has 30 years of experience.  You have months.
9. Hurry me up.  Tell me to go faster.  Tell me to finish the round so I can study.  When the round is done, get my mobile number, kick me out and tell me to go study and call me while I’m studying with any questions you like.  Please don’t ask me to sit next to you to keep you company while you do all your jobs and check everyone’s results.
10. Did I mention coffee?  Now is a good time for coffee.  Feel free to suggest it.
11. If the ward clerk loves you then I know you’re good. Ditto the NUM, and the nurse named Dazzle whose been there for 30 years.

Reasons why I am late sometimes.

I was on Facebook the other day and watching a bunch of people complain about their doctor being late.  I started wondering about all the things that made me late to see patients so I thought I’d write them down in the hope it would make everyone in the SMH comments section hate doctors a bit less.  Possibly more if they see this but hopefully not

Reasons why doctors I am late sometimes.

1.  I have lots and lots of patients.  This one seems obvious but in a hospital you can never see a new patient quickly.  It comes back to bite you if you do.  And most of the patients in hospital are of an older vintage and can’t be expected to remember the bits of their medical history I want them to remember so I have to ring their GP, their other hospitals, and their kids and their neighbours to piece together enough of a history that helps me understand why they’ve come to the emergency department unconscious, and what of their medical history is likely to slow them down getting home.
2. Figuring out what medication my patients are on.  I know this should be in 1 but it deserves it’s whole own category.  Working this out is a bit like India Jones with those Roman numerals in The Last Crusade sometimes.  The amount of medications that some people are on and who has changed them and when is mind boggling.
3. I am hiding in the toilet from the boss that was really mean to me a year ago and I don’t want him to see me and be mean to me again and I have to text my intern and find out if he’s gone even though he probably has no idea who I am but he might.
4. I need a coffee and have in fact slowed to a standstill while my panicked intern runs downstairs and comes back and puts a coffee in my hand so I can drink it and we can keep moving.  Also I’m not allowed to drink my coffee on the ward/in front of you so I have to finish it before I keep moving or hide it in convenient places where it can’t hurt anyone.
5. I am eating lunch.  We get half an hour for lunch.  I take 9 minutes exactly with an extra 2 minutes staring into space/groaning about having to stand up again.  It still counts as a delay because I could be seeing patients in that time.
6. I already came to see you but you were asleep/getting a test/told me to piss off.  I always come back!
7. I am chasing a delirious person.  This a common and unseen job of hospital doctors/nurses/cleaners/security/random hallway guy.  Delirious people have no idea where they are or how they got there so it’s only natural they would try to leave, and only natural they would get very upset, nay violent, when it is suggested to them that they can’t leave.  Chasing a delirious person means walking after them, but not too close, trying to join them in whatever delirious place they’re in and trying to reason with them into returning to that strange bed with the strange other people in the other 3 beds in the room because it’s good for their health.  No, I wouldn’t believe me either.
8. Ranting at the ward clerk because my patient keeps calling me nurse.  I have been seeing them daily, every day, for two weeks and introducing myself as their doctor and it. does. not. compute.  So then I inevitably rant at the sympathetic ward clerk about #everydaysexism before my intern comes out and tells me the orthopaedic surgeon is here to have a chat about our patient and ask which guy he is in the group over there.  Naturally, it’s a woman.  This rant always makes me late but it needs to be had.
9. I am hungry and my blood sugar is -5 and there are no patient biscuits in the cupboard so I have to go upstairs to the vending machine and eat something delicious but disgusting so I can make the words English good.
10. I am blogging.  Haha just kidding, I wish.  Hospitals have the strictest firewalls ever.  They even block reputable medical websites.  But curiously not Youtube.

Delayed gratification.

After you pass your specialty exams and that initial “I’m so elated I can literally not feel pain or heat or cold or anything other than epic joy” feeling wears off, you inevitably go through the stages of post-examhood.  There’s the part where you promise yourself you’re always going to have this amazing level of knowledge and spout facts to anyone who’ll listen – your boss, your intern, the ward clerk, the nice coffee lady and sometimes the endlessly giving patient fridge.  Then there’s the part where you make up for all the time lost not-exercising, so you sign up to a gym and start working out maniacally as if there’s some way you can cram all that lost time into a week.  Then you overhaul your hair, your makeup, start wearing nice dresses and heels to work to prove to everyone you were only just a thrown-together massive slob while you were going through exams.  You stuff your fridge full of healthy stuff and start banging on about how much energy you have now that you exercise and eat well and brush your hair…

And then you crash.  You crash so hard you can barely drag yourself to work, your clothes look like you’ve been travelling for weeks, and your hair, it just can’t be spoken about.  That awesome amazing flawless human that you became for oh, about a week evaporates and you start lurking in the corners, hoping no one will notice how terrible you look and feel only you don’t know why because you should be feeling great right?  You’re through!  Through all the exams forever!  So you keep schlepping to work hoping that whatever this is, hormones?, not enough food? wears off only it doesn’t.  It doesn’t because for two years you haven’t stopped.  Exams are over but the job where you don’t sit down and walk all day and people fight over getting to sit in a chair (actually it’s a polite “no you sit in the chair!” type of argument) and some days it’s sad story after sad story, or worse, death after death, and those 15 hour weekend shifts are still there.  They are still there and you haven’t stopped.  And suddenly you’ve called in sick, feeling horribly guilty at the scared tone in your interns voice despite all your reassurances that the bosses wont eat them if they call them, with horrible bronchitis.

And then you do what any sane rational person feeling completely out of control does.  You spend way too much money online. “Bras? I haven’t bought any how long? CLICK! Ooh Philosophy does a peppermint body wash? I need body wash!  CLICK! ” and suddenly you’re stacking coupon codes and having a big box of Benefit products with more free samples than there is product coming your way.  Then you go and do all these pop psychology quizzes about what makes you feel out of control and then you think that if you just ate better then you wouldn’t get sick so much, so back onto overhauling your diet it is and suddenly your grocery cart is full of raw cacao, which as far as I can tell is a higher calorie version of cocoa, chia seeds, and Medjool dates because in some way, these must be superior since all the raw/Paleo/wholefoods people use them in everything.

No matter how many times you sit an exam in medicine, this happens every single time.  You cannot prepare for it, and you forget about it every single time.  The worst or best part, I can’t tell, is that it feels great.  And then you crash from that and get your credit card bill.  Mainly it’s that the whole wide world, that you’ve been denying yourself for two years is suddenly wide open and you want it all.  Now.  And at once.  This is probably why doctors wind up in the media doing stupid stuff sometimes.  That juggernaut of delayed gratification gets us in the end.