What to Do When… #1 (A cheat sheet to residency)

Forgive the incoherent title, it’s late and I’m tired.  But now that the new juniors have started, I thought I’d share some tips to not letting the shit get you down.  So for my inaugural what to do when, I thought I’d talk about….

What to Do When Someone is an Arsehole to you on the Phone.

(Yeah I can’t capitalise, I’m so tired I can barely see).

Okay so you’re calling for a consult or your calling the radiology reg.  These are the most likely two circumstances in which someone is going to be a complete prick to you.  Some hospitals give out awards for blocking consults or reviews.  Down the phone their tone is dripping in sarcasm, they ask if you’ve considered this clearly obvious thing which had never even occurred to you, your self esteem is in your shoes and you’re trying not to cry because you’re so stupid you should never have done medicine right?

Wrong.

You never considered that thing because you’ve just finished medical school in the last one or two years.  Or maybe you never learned that thing.  And also you’re not psychic.  And also you’re calling for their expertise, they’re not calling you for yours.

So #1, you’re not psychic, and you’re not stupid, they’re just being an arsehole.

Then they say “what’s your name, I’m going to have to tell my boss about this”.  That’s it. You should quit right now right?  You’ve been found out.  You shouldn’t be there.  You’ve been an impostor all along right?  Wrong.  Wait for it, waaaait for it – they’re just being an arsehole.

#2.  They don’t know you.  No really.  They’ve never bloody met you.  They have no idea who you are, what makes you tick or what you eat for breakfast.  So threats to tell your boss and eat your firstborn because you’re clearly incompetent are just hot air.  They literally don’t know you.  Anyone who tries to judge your performance from a 30 second phone call is demonstrating their own incompetence.  Assessment takes time and repetition, you need to demonstrate progression – it is not what happens in a phone call the first time you speak to someone.

Then you inevitably get some set of demands about how they can’t believe you don’t know xyz, what their cat ate for breakfast 6 years ago, and the knife through the heart…you should know that.  The most useless phrase in medicine.  People who say this are simmering angry, they’ve got so much shit going on that they have no insight into that it comes out in this ridiculous way.  No you shouldn’t know that.  You’re ringing them for their help.  You might not be serving up what they need on a plate, but you’re ringing someone for help.  And when someone in a position of power gaslights, intimidates and says ‘you should know that’ to a person in a much more junior position, not only is it an abuse of power, but wait for it….they’re an arsehole.

#3 You’re ringing for their help and expertise in the care of a patient.  Don’t be afraid to remind them of that but don’t take it as a moral failing that you didn’t have all the information.  And if it was something simple, like maybe you forgot to get the HBa1c for an endo consult – don’t beat yourself up.  Apologise and say you’ll have it for them and move on.  If they go on about it – they’re an arsehole.  And they will.  But if you’re the sort of person who learns from their mistakes (like, you know, most people), you will have it ready for next time and that’s how you know you’re good at your job.

And then you get to ‘well I’m not coming to see the patient until xyz is done’.  Alright there champ, commit to having to take two phone calls.  One of my biggest lessons as a registrar is just see the patient.  You don’t need all the information, just a good clinical question and some background and a request to the caller to find out some more for you.  That’s it.  Anything beyond that is just mucking around.

#4 Get the info and call them back.  You’ll have learned something and they’ll have just created more work for themselves.

And finally, you get off the phone feeling really crappy.  You feel like a failure, you feel down in the dumps, you can’t even articulate all the thoughts behind your feelings.  It affects your work and everything seems to slow down while you battle with your unconscious brain and all the feelings it’s having in the background.

#5 Phone a friend.  Find a trusted person (not the competitive person who will also gaslight you and tell you they have no problem getting consults).  You will inevitably find that the person who gave you a hard time over the phone, gives everyone a hard time over the phone and is reknowned for their behaviour.  Bullies never operate in isolation.  If your workplace has an anti-bullying reporting service I highly recommend using it.  Nothing will get done off a single complaint and that protects people from spurious complaints (some people think getting feedback is the same as being bullied – it isn’t), but slowly and over time, as complaints collect, those slow grinding wheels of medicine move into place and the person either gets the help they need or get moved along.

But just know that when these things happen – it’s not you.  No one deserves to be treated with disdain at work, no one deserves to be barked at for not having all the details – even if it’s a recurrent problem, it needs to be dealt with in a formal way via a supervisor meeting, not belittled down a phone.  Expect better from your workplace.  This isn’t about whoever is the smartest wins.  This is about who cares the most about their patients and colleagues wins.  That’s what gets you the job you want ultimately.  People trusting you to look after their mother.  If they see a complete arsehole to a junior, they’re going to assume that’s how they behave to everyone – including patients.  So don’t accept that behaviour, and don’t ever engage in that behaviour.

I hope that’s not too heavy handed and angry, and I hope even more that it cheers a few of you up.  💖

Mojo.

Last night after writing that, I sat there and read over the last near-10 years of posts.  What hit me was how obviously hard-working I was, and the other thing that hit me was the gaps, and all the things left unsaid.  Reader, deep down I always thought I was useless.  My self-esteem has been so poor going through all of this, that I truly thought of myself as borderline-remedial.  And while it’s done a lot of growing up (because what else is low self-esteem really, than a small frightened child?), looking back over my posts broke my heart a little.  The enthusiasm, the genuine concern for her patients.  I always wanted to be that ‘star’ resident, that ‘star’ registrar.  And my career choice (not that I have regrets), has been very shaped by that poor self esteem.  I truly believed I would have no hope in certain specialties, and now I realise I would have been great in them, and would have been welcomed, if only I’d posessed a little more self-belief.  What makes you get hired?  Caring about your patients.  Being personable.  Not bringing your personal shit to work.  Clicking with the right team.  Not being so wound up and twisted-in-yourself-anxious that you can barely form sentences because when you’re like that, people can’t get to know you.

And then there’s the gaps.  2013, where the workload, the bullying, a miscarriage, and all the stuff that has made its way into the news now was my reality, where I truly fell apart.  2014, where I failed the written but had a baby which put everything in perspective.  2015 where I passed the written and the clinical with a tiny baby, but still so broken from 2013 I didn’t think any training program would take me because there was something inherently wrong with me.  I did no pre-interviews, no meet and greats and there but for the grace of whatever deity there is, I was offered a job in geriatric medicine.  2016, where I moved interstate with a baby, got no time off work and suddenly found myself in a new state with new systems, and a constantly daycare-sick kid broke me in a new way.  2017, another miscarriage.  2018, another baby, maternity leave.  And here we are now, 2019, two kids, full time work. So. much. change.

My new job feels like I’ve been hit over the head repeatedly like a hammer.  I am stunned.  Stunned by the flow of information coming at me, the meetings, the workload.  Slowly I find myself coming to, but at the same time slipping into that I’m-not-good-enough mentality.  It’s always hard when you start a new term.  You have to forge new relationships while remembering that everyone there has just lost a relationship with the last doctor, who mostly, they’ve grown to appreciate.  You can’t possibly fill their shoes.  They talk about your predecessory fondly while looking at you suspiciously, and by the time you’ve earned their trust and their love, it’s time to move on, only to do it all again.  And every little slip that I make, I feel like a knife.  Coupled with the fatigue that two small non-sleeping children bring, I find myself thinking ‘how can I possibly measure up?’.

When it comes to having a good short term memory and an excellent recall of exam-level knowledge, I don’t think I can.  I can be just good enough I think.  But I make up for it in other ways.  I make myself freely available to my patients and their families.  I tell them I don’t have the answer and that we can find it together.  I hold hands with unconscious patients.  I sit with crying adult children.  I’m painfully honest about what I haven’t done or don’t know to my boss because it’s the fastest way to trust when you can’t be that star.  But oh to be a star!  Oh to have that endless mojo of my resident youth that lent me the energy to walk 13km a night and do endless cannulas and want to change the world of medicine.  I hope it comes back soon.  I feel the weight of the years, of the impossible juggernaut that is the public hospital system in which it’s so difficult to enact change in the face of that endless historical resistance.  And the older and more established the hospital, the harder it is.  But I still hope.  I hope for a bit more sleep, for the motivation to exercise, to read studies, to be better.  I hope for my mojo back.  Hey two posts in two days – something has definitely changed, and I think for the better.

I am so tired.

Well it’s not quite a year since I last posted so I must be winning at something right!  This blog has been running since 2010 – I can’t believe it!  Pity it’s not more frequent but eh, you can only do what you can do.  So, 2010 was final year of medical school, 2019 is second last year of advanced training.  Can you believe it?  I know, I probably should be done by now but there’s two babies and two mat leaves and some part time training in there, so I’m not doing too badly.

When I look back over the last 9 years, it’s like looking over a series of mountains.  I can’t see the starting line anymore.  I’m not the same person by any stretch.  I’m harder in some places, softer in others, I’m pretty sure I’m much stupider than I was but I make up for it with lots and lots (and lots) of hospital experience.  And I’m also pretty tired of hospitals.  Some people never get over the merry-go-round and just love the acuity, the intensity, the perpetual high-functioning anxiety of it all.

But oh, I am so tired.  I haven’t slept since 2014 when my first was born.  I churn through patients and patients and patients and never quite get enough time with them because I’m drowning in paperwork and meetings and projects.  Every single little thought I have, every email I get, every meeting request gets scheduled, reminder-added, double reminder, or added to a task list with another reminder.  I get home from work and jump straight into my beautiful, relentless, children.  The evening routine of play-feed-bath-put to bed gets me to 9pm.  We wrangle dinner.  No time to make lunch if I want to sleep.  And my nights are filled with rocking my non-sleeping baby and breaking all the sleep-rules.  And then back to work, with it’s dizzying array of people, requests, and frightened, vulnerable patients and families.  I never, ever, thought it would be like this.  I had no idea.  It is just push-push-push all the time.

But less than two years to go now.  You sort of think after exams it will quieten down but it’s just a different kind of intense.  So many more competing demands.  And today I was sitting in meeting #92034783297892 and I started daydreaming about getting my letters.  Letters!!  FRACP!! I daydreamed about standing up at the lectern wearing a cap and a gown and shaking some dudes hand and getting a certificate, but really what it means is that I’m shaking that hand and walking through to my freedom from changing jobs every 3-4 months.  It will be ten years of a new job, every few months by that point.  When you think about it, it’s fucking ridiculous.  But that’s medicine.  So much of it is a level of ridiculous, delivered with full seriousness, gaslighting you into believing it’s normal.

So much is coming out into the media now, so much of my old normal which I never realised until later was overt bullying, sexual harassment, discrimination, abusive work hours.  I’m glad I’m out of all of that (mostly).  Junior doctor life, depending on where you land, is like Lord of the Flies.  It’s awful.  And maybe one day when I have my letters, I’ll have more perspective on it and maybe I can help.  But I’m so tired, I’m out of fights.  My former indignant, and usefully outraged self has been replaced by this pleasantly comatosed and somewhat zombie-like human who pastes on a smile and tells herself and everyone around her that it will be okay, that this too shall pass.  Less than two years to go.  My secret inner-catastrophising mind whispers “what if something bad happens and you never get to finish?!” Things that keep me up at night.  I have thrown myself at this wall over and over and over and the thought of that makes me feel ill.  But hey, they’re just thoughts, not realities.

I’m so tired.  And I can’t wait to be done.