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.

One last time.

I told a man he was dying today.  He wasn’t old.  His life had been written for him by his parents and his circumstances, and as we sat there, in his room, in a nursing home, even though he was too young and too cognitively intact for a nursing home, I watched the sun filtering in the window and I wondered why.

How did I come to be sitting here, and him there?  How had I been born to two parents who in spite of their mistakes, didn’t put me in danger, kept me safe, and warm and fed?  How had he been born into the opposite?  What had happened to his parents?

When I told him, he nodded, announced he was tired, then told me I should have worn more makeup to deliver news like that.  It was no surprise to him.  We both had a chuckle.  His writing had been on the wall for a while, and today, more than he was out of time, he was out of fight.  “No hospital” he told me, when I offered a last-ditch attempt to turn things around, “no more”.  I helped him into bed, he intermittently shouted at me, followed by intermittent sheepish silence.  We talked about palliative care, he signed the form with his wishes, not for transfer to hospital, call his social worker when he died, he wanted a funeral in a big church.

I wanted to hear everything.  I wanted to hear all his stories.  Why his bedroom was decorated the way it was.  Who he’d been.  There was no time.  Earlier in the week when I’d met him, he didn’t know me, he shouted at me for the entire visit.  I tried everything I could to try and turn the ship around, but decades of hard living, multiple diseases all conspiring against us, won against my feeble attempts.  When I discussed him with my consultant, she gently suggested it was his time.  There’s always a part of me that wants to fight and she saw this, she let me try.  When I saw him again today it was on his face and in my heart.

I’ve never told a person they were dying before.  On a normal ward job, by the time they get to you, they’re unable to talk or they’re already gone and you’re having that discussion with devastated family.  Today was a long and private discussion, met by my patient with quiet acceptance, with courage, and with peace, in spite of his young age.  There was a both a stillness and a rawness in our words, he was not the sort you could mince words and I’m not the kind to try.

At the time I was focused on making sure he would be comfortable and not be taken into a hospital system that at his stage, would do more harm than good.  We planned a goodbye party.  The chaplain brought him fruit.  Afterwards the nurse and I got in the car and drove to our next appointment.  And it wasn’t for a long time later that the seriousness, the specialness, and the immense privilege of that discussion hit me.

I feel both sad for my patient and happy to know him if only briefly,  immensely humbled to be a part of his final journey, overawed at his bravery and courage in facing it the way he does.  This is why I did medicine.

Something happens to you in medical school.  You forget about why you did it in the first place, you forget you wanted to help people.  You get stunned by bright lights, start trying for the impressive specialties, ditch the touchy-feely stuff in case people don’t think you’re serious about the scientific side of medicine.  You use all the jargon, no lay terms, you pride yourself on it, you assume that those who prioritise caring over the science of it must be covering for their lack of knowledge.  And then if you come to your senses and return to those values, you wake up inside that dream.  When I was done chasing the bright lights and found Geriatric Medicine, I told one of my bosses from a different specialty what I had chosen.  He pursed his lips and shook his head.  ‘What a waste’ he retorted.  I looked him squarely in the eye and loudly disagreed.  I wanted my resident to hear how wrong he was.

When I left my patient today, I said I’d see him again next week.  “If I’m still alive!” he shouted with the sort of cheer that is half joking and half sad.  He is why I did medicine.  I am humbled and rewarded to be his doctor, even for just a few days of his life.

At the end of the day, our team went through our list of patients.  Someone announced he was now discharged from our service, he’d been referred onto our palliative care colleagues.

“He’s not discharged yet” I said out of nowhere.  It’s my first week in this job by the way.   “I can’t.  Not yet.  I need to see him one more time next week, I need to make sure he’s comfortable”.

There is silence.

“So do I” says one of my nursing colleagues.

“Me too” says another.

We keep him on our list so we can see him just once more, and try to help just one last time.

Goodbye 2016.

Sometimes you have years that have so much change in them that personal growth is minimal and everything feels insensible.  That was my 2016.  Interstate move, four new hospitals, new hospital system, buying a house, another move, a new daycare – I’ll be honest and say I drowned in it somewhat.  Sometimes you look around you and wonder how other people do it.  Tidy houses, tidy children, stability everywhere.  And then you realise that most people live in the same place for most of their lives, sometimes even the same suburb.  For the last 10 years we have moved and moved and moved and moved.  Never mind that in medicine for the first 5-10 years of your career you change job every 3 months.  You can go crazy trying to be the person who lives a life of no change, or you can raise your tolerance to mess and hope that other people raise their tolerance for your temporary scattiness and disorganisation.

I’ve been late to lodge forms for so many things this year, bills, training stuff, other vagaries of life and I’ve also been very lucky in that for the most part, people have been more patient than exasperated with me, and that in spite of this, my current network gave me a job for next year.  Sometimes you want to scream at people “I swear this isn’t me!  The form is in a box somewhere but I’ve moved so much that it’s not in the box it was in, it’s in another box which has the wrong label crossed out and the right one written on it and…” and so on.  No one has an attention span that long so I just apologise profusely and say I’ll get onto it and inevitably do.  I mean I just posted my work contract a month and a half late.

Don’t even get me started on keeping a house tidy!  A house!  Aren’t I lucky!  I have my own house and a patch of grass and honestly, this makes me feel like a king.  Watch The Castle if you haven’t already.  But I’ve lived in apartments for ten years.  Houses are big.  And drafty.  And you can’t just leave the window open and go out, and you have to worry about homes security because there aren’t 3 locked doors and a building manager between you and the outside world anymore.  And I seem to get one room tidy but the others get all messed up in the interim.  And you have to sweep.  You know, just like your parents did.  There’s a driveway and it needs to be swept.  And mowing the grass!  Anyway, all this little, new things that houses require on top of all that change, I’m afraid I’m not very good at that either.  I get one ball in the air and all the others are shattering on the ground – that’s been my 2016, but at the same time I feel so lucky and grateful for it all.

If there’s one thing I’ve learned from going through those exams, is that you have to be shit before you can be good.  All those people, living in the same places, doing the same things forever – they’ve had years to become that way.  Years to develop systems of living, and it does take years.  The exam also taught me that it’s okay to be a beginner and what it really really taught me is that it simply does not matter what people think of the way you do things, nor is there a ‘right’ way.  The best way is the ‘get it done’ way, whatever that looks like.  I’m afraid I’m not great at that either because oh, there’s just so many things to get done all of the time, and that’s just the ones you know about it.  Inevitably there turns out to be ones you don’t know about as well.

Anyway, 2016 has been a very very very hard year for me, but not an awful year.  No one I loved died (Carrie Fisher, David Bowie, and Prince notwithstanding!), my family is healthy, and we got our castle.  I stopped making resolutions a long time ago and have instead come up with themes to try and live by and improve on, and the theme for 2017 is ‘stay ahead’, which is kind of a testament to being more organised.  2017!!  Can you believe it?  We’re almost a decade into the 21st century.  There’s been modern science fiction movies made about times BEFORE now.

At any rate, I wish all of you lovely readers a wonderful 2017.  I can’t name a single person who hasn’t had a hard year, and this is the nature of things from time to time.  And to end my post, here are some photos of my structurally unstable 2016 gingerbread house I made for Christmas, and the Pinterest fruit salad I made that is held together by toothpicks, a large carrot, and half an apple.  Enjoy!

See how the side is bowing?

Funny story (not). The whole thing slid apart when I put it together and the roof collapsed so the whole thing had to be fixed with skewers and terrifying amounts of royal icing.

How good is Pinterest? It taught me how to make this!

Here’s a photo of some more gingerbread I made. It’s lemon icing and some FF-inspired gingerbread glamour.  The recipe is from the Barossa Vallery Cookery Book circa 1912 with a 16th century German gingerbread recipe renamed to ‘honey biscuits’ because everyone hated the Germans then and were very awful to German immigrants.  Sound familiar?

This is a platter that I wrapped after watching this video on Japanese gift wrapping. I modified the technique because it’s a circle (and it’s not as easy as it looks) but this technique is LIFE CHANGING.

Goodbye Christmas. I got this decoration-organizer from Aldi in the spirit of my new years resolution.

Goodbye Carrie. You were the first female superhero I ever knew. Your Leia was magnificent. And no one but you could have done The Blues Brothers. I’m sure when you got up there, John Belushi was all ‘well what took ya so long?”

Goodbye 2016, it’s been real.

Perfect motion.

9 years ago my husband and I got in an old Magna and moved our entire lives to this state so I could go to medical school.  That day, driving away from my childhood home is forever etched in my memory.  It was burning hot, and as we drove away I cried and told him to turn the car around.  I couldn’t imagine a world without my whole life in it.

How do I put 9 years of my life into a blog?  How do you even begin?  All I know is that the pace of my life increased a thousand percent and didn’t stop until now, 9 years later.  Years and years of the most amazing journey that’s shaped the person I am today, so profoundly different from the one that arrived.  9 years of the most solid friendships I’ve ever made.  Transitioning from terrified arts grad through the incredibly rigorous physician training program to the mostly self-assured doctor that I am today.  I have my moments.  I have a million photos of the things I’ve done.  I have the scars from the tragedies that have fallen in the duration, and the strengthening of those friendships as a result.  The beliefs I entered with are not the same as the ones I exited with.  That breathtaking naivety that you enter medical school and internship with, that you have to enter with otherwise you would never survive, replaced with a gravitas that comes from the things you have seen and a gentle patience for that breathtaking naivety in your juniors that you cultivate for as long as humanly possible.

How do I describe that life in which I had a baby, the one that came at the end of a rainbow, who irrevocably took my heart and put it outside of me in the form of fat little arms and legs?  Who slept while I studied and cried while I slept?  Who broke my heart with every 15 hour shift, endless weekend and evening teaching, and those single days off where I was torn between wanting to sleep so hard and being with her?

How do you put a decade into a single post?  I don’t think you can.

And here I am, in my final 15 hour shift as a basic physician trainee, in my last ever shift at this hospital that I’ve been at for 3 years, the hospital that broke me and reshaped me over and over.  The residents are buzzing about the wards, I’ve got some downtime after seeing some very sick patients.  That panic that used to consume me at arrest calls replaced with that sense of calm that comes with experience.  That knowledge that there’s always someone you can call, and the sense of achievement you get when you lose the fear of calling anyone!  I feel no fear about starting advanced training.  I should.  But after everything, god, after everything that has happened, I have no fear left.  I’m here to learn my craft.  I’m here because I want to be.

Right now I’m wrapping up my last ever med reg job.  I’m moving interstate.  I’m sorting out daycare.  Reading my orientation timetable.  And I’m saying goodbye to this wonderful state that has given me so very very much.  There are no better friends than the friends I have.  No better job.  No better husband and no better child.  I’m exhausted from a sick daycare petri dish baby, I’m not sure when I last washed my hair, and my husband and I haven’t had a moment alone since before she was born and my house would almost qualify as squalor but, here I am, okay with it all.

Through it all, like golden threads woven through my time, shine my incandescent friends with whom we have laughed and cried every step of the way.  Thankyou so very very much.

Dust, the regular kind.

I sat down tonight, hair wet from the shower I had time to have, after playing with my baby all evening.  I realised that it’s been a month exactly since I posted, and it’s probably taken that long to start feeling like me again.  The person I was before medicine deconstructed me.  The dust is finally settling, and here I am, nearly 8 years on from starting medical schools, with all exams finally, finally behind me.  I can be who I want and learn what I want when I want.  In the past few weeks I baked a birthday cake for my one year old, I sewed a ton of quilt blocks for a quilt for her, I hung out with friends, drunk champagne, read books, did a yoga course – all things normal people do.  I still go to work and see terrible things from time to time, but it’s different now.  I get to have hobbies again.

And at work I’m clearheaded than I’ve ever been.  I see the problems, I investigate the problems, and I have plans for the problems.  I’m not perfect but that loud voice of self-doubt has evaporated and been replaced with a ‘you passed the Royal Australian College of Physicians exams!” voice whenever self doubt appears.  I will say this about education – once you’ve got it, no one can take it from you.  No matter what happens in life, it will always be yours, no matter what you choose to learn.

My blog is probably going to get less personal and more fun from hereon, but I’m so looking forward to the little things.

Stardust.

3 months.  3 months I saw patients with varying degrees of attention and quality.  3 months I walked those corridors, struggled through them, cried in them.  I cried every. single. day.  In cupboards, to my friends, and into my lunch.  I left evening teaching early because my breasts were like rocks and leaking but I couldn’t stop breastfeeding because it’s all I felt like I had for her as a mother.  I had nothing else to give her.

3 months I froze and practiced and froze and practiced and froze and froze until I didn’t anymore.  The words started to come, not perfectly, but there they were.  A semblage of structure, something approaching sense coming out of my mouth.  I was struggling and behind right up until the last two days, two days before, it suddenly started to click.  I have lived my life to varying degrees of raw and burnt out and never before have I been so raw and burnt out.

3 months I sat in teaching, feeling like an outsider, feeling like I shouldn’t be there.  Mother’s don’t do this.  My colleagues were already in study groups, they didn’t know me nor I them and I was alone.  Mother’s on TV were doing washing and not letting their babies watch television and steaming sweet potatoes.  Mother’s don’t do this.  They don’t become mothers and sit both specialty training exams in the same year. I cried.  I can’t repeat how much I cried.

And for 3 months my husband, not without his own challenges, got the baby up and fed the baby and changed the baby and played with the baby, rinse and repeat for 12 hours a day.  That precious hour I got with her was a shadow.  I could barely look at his drawn and haggard face, the guilt nearly killed me.  3 months of the most crushing guilt and escalating burnout.

I showed up on the day, exhausted, in something resembling a suit that I’d cobbled together to fit my new odd-shaped body.  My hair has all fallen out from breastfeeding and stress and it was barely passable.  My tights felt uncomfortable.  I walked in there and did my thing.  I forgot to do so many things.  I said stupid stuff.  I ran away in the lunch break and cried some more, somehow there were still tears left.  I listened to the other candidates bang on at each other with nervous excitement.  I sat on hard plastic chairs in a 1970s hospital lunch cafeteria and ate a bad sandwich.  After lunch I did embarrassingly badly, I can hardly think about it.

Afterwards I went and sat in my hotel bar and bought myself a glass of champagne because everyone who’d sat it sent lots of messages to our group about how happy they felt that it was done.  I drank that glass and cried some more.  I didn’t feel happy.  I felt broken and defeated.  And stupid.  Really really stupid.  Only a stupid person would attempt this with a baby and no extra family support.  For the next two weeks I was so sure I’d failed.

And there it was, like stardust.

In my inbox, there it was.  For whatever reason, uncomfortable stockings, imperfect skills and hair and motherhood, I passed.  In spite of it all, I passed.

No one I worked with could ever really understand the self-doubt I felt.  From the outside I seem to have it more-or-less together except for the corridor-tears with my inner circle.  So much has happened since I started this journey in 2013.  More than I want to recount or even think about.  I’m a different person than the one who started.

The further down the rabbit-hole I go the less I feel like I know.  But I know that for what it’s worth, I did this.  I really really did this.  I got into medical school, survived it, and did the physician exams and passed them.   Whatever happened long ago, who I might have been and the things that might have happened just don’t matter anymore, because I did this.  And I can’t wait to get on with my life.

Thought for the day…

‘Le mieux c’est l’ennemi du bien’. (The best is the enemy of the good) – Voltaire.

How I Cured My Bald Patch.

In my previous post I mentioned all my hair fell out from stress.  It was thin and breaking and terrible and when I finally fronted up to my horrified hairdresser, she loaded me up with such good advice, none of which involved buying overpriced products from her salon.  I originally thought about titling this ‘How to cure a bald patch’ but seeing as this only worked for me, and to prove that something works you have to prove it in well over a hundred people, get it peer-reviewed and then published, I thought I’d give you my anecdote instead.

First – exercise, food, vitamins.  Everyone needs these.

My hairdresser told me to take silica and fish oil, or alternatively, eat fish.  So I did.

Then she told me to put organic coconut oil through my hair before washing it and leave it in for a while.  I don’t think there’s a hard and fast rule about how long.

It smells amazing!  I use it as a moisturiser, instead of butter in cooking (if you don’t mind the coconut flavour) and for frying.

She also told me to keep putting treatments in my hair.  She didn’t care which ones, and didn’t try to sell me any.  I got a sample of Terax Crema from Adore Beauty and haven’t looked back.

I think they’ve changed the packaging now, I hope the product itself hasn’t changed.  I only wash my hair twice a week because all of that is such an ordeal but it’s looking a million trillion times better and I love my hairdresser all the more for giving me a half hour long lecture on looking after myself and eating right.  I wish healthcare was more focused on wellbeing.  I’ve always said that if I don’t make it through my physician exams, then I’m becoming a GP that incentivises good health.

The most important thing to get my hair back though, was relieving stress.  Some stressors I couldn’t change (like my job or location) but some exercise here, some good food there, and the knowledge that ‘this too shall pass’ got me there.

As did my Yoga Studio App!  If you’re like me and would like to fall out of poses in private, then this one’s for you.

It is hands down the best Yoga app out there – I even took it to the park and fell out of poses in public I love it so much.  Great to do right after a run.

I’m happy to report that with all that on board, my hair started growing back, and my bald patch is now covered in hair.  Short and cowlicked hair, but I don’t mind at all.

Phew, enough posting for one day I think, time for some more study >__<.

And while I’m procrastinating…

Did I really not post since last September? Let me catch you up on the last year:

• I started physician training.  (For those not familiar with the system, when you finish your internship and residency, you often then thinking about the pathway you want to do: surgery/physician training/obstetrics/general practice/anaesthetics and so on.  Physician training is what you do to become a medical specialist something, don’t ask me what yet!)
• I spent six months at The Regional Hospital From Hell.  It wasn’t all that bad, but it was really really hard.  Like, you pick up the phone 24 hours a day for 7 days a week, every three weeks, for four hospitals spanning a large country region.  And you deal with questions like, chopper or ambulance?  And you keep your cool when people call you at 3am for a medical issue not even remotely related to your specialty because they don’t want to wake up the right person who is known to not keep their cool and figure since you’re so junior, you’ll just say yes.  You come into work for all seven of those days too.  The sleep deprivation was a bitch.  As was seeing my husband once a week (when I wasn’t on call).
• Lots of my hair fell out from the stress and I discovered a bald patch! I have the best hairdresser ever though, and it all grew back.
• I made some new friends in my new network, and started working at my new home hospital which is great! I found a lovely study group…now to just err, study (more).
• I stopped being vegan because it was too hard, I realised that the population examined in Forks Over Knives (i.e. I’m not an overweight type 2 diabetic who required bypass surgery) and there’s some great evidence for The Mediterranean Diet.  So rather than treat myself for something I don’t have, I switched over to preventing something that I may easily develop.

In short, life has been boring for a blog, but exciting for me.  Interesting election huh?  I wasn’t surprised by Tony Abbott winning it, and I got a sausage AND a cake at my local voting station.  What have you been up to?

Tears in Rain

It’s after hours. I’m doing one of those famed fifteen hour shifts where you don’t sit down. The cardiology fellow is on the phone telling me he’s sending someone up from the cath lab, they’ve just had emergency intervention for their massive heart attack. ‘We couldn’t get access,” he’s telling me, with that calm sense of urgency, “and that femoral sheath can’t stay in – can you have a go when he hits the ward? Otherwise call anaesthetics to do it”.

I tell him I’ll have a go, and wander up. Something about the impossible lights my fire, it doesn’t matter if I can’t do it. I wander into the patients room, his family are all there, I ask them if they wouldn’t mind stepping out. I happily go about setting up, cheerfully miss my first attempt, tell him I’ll have one more go then I’ll get the anaesthetist…and then I notice the tears streaming down his cheeks.

“I don’t know what happened”, he’s saying, “one minute I was mowing the lawn…”

He stops and looks at me. “I nearly died didn’t I?”

I nod, pull up a chair, and hand him a tissue.

“You’re here now” I tell him, “that’s all that matters really”.

“Life is so short”, more tears stream down his cheek “so short”

We talk. I could almost see his whole world changing before his eyes. Everything he held true evaporating. I repeat that all that matters is that he is here, and that he gets to keep going. I tell his family to come back in. More tears. The cardiology nurse comes in and tells him that his kind of heart attack is known as the widowmaker (yes, we really do refer to it like that!) His family looked stunned, they don’t know what to say. After all, it was like any other day – Dad was just mowing the lawn.

The guy has lots of risk factors. A little bit overweight, drinks on the weekends, smokes a bit, all seemingly benign enough, all completely insidious. I don’t need to point this out. He’s already talking about never smoking again. Watching people come to realise that how their body works is so much more important than how it looks is one of the best parts of my job. No one ever really listens to their doctor. I can tell people how to live and they’ll smoke, drink, and eat too much fat. You have to realise what’s bad for you for yourself.

I get the line into his foot. Less than ideal but it’s a big one and I know the cardiology fellow will be happy. And I know this guy will live. Watching people get to live is the best.