Inspired

It's Tuesday evening on my last day off after a run of evening shifts last week that included the weekend. This week I am back on night shifts starting from tomorrow night. This means that I must try to stay awake tonight and sleep for a good portion of tomorrow day so that I can stay awake tomorrow night, etc (you get the drift). Once this week is over, I will be half-way through my first internship rotation (yay!). Onwards and upwards people!

I wanted to post about how restless and unsettled I have been since returning from Fiji. Basically, for reasons I can't quite put my finger on, I just have this overwhelming desire to travel; and in particular, to be out at sea or settled on a little tropical island. It's crazy I know, but that's where I am right now. A few years back, before I had been anywhere (except for Jordan and here), I was desperate to just travel. This feels different though: less arbitrary and random... more focused. In short, I don't want to "just travel" anymore - I want to go to specific places, spend longer periods of time there, and (at the risk of sounding pretensious) somehow be involved or useful.

This time I risk sounding completely ungrateful - for the blessing of a stable income and the opportunity to further myself academically with this great internship program that I am undertaking - but the sad and inescapable truth is that it binds me here to quiet suburban Sydney life, for the next couple of years at least. Regardless, I am young, restless and hate nothing more than feeling powerless... so I map out plans instead. And this is not a bad time for it either. My last life plan ended last year with the completion of med school. I made a hasty one towards the end of the year (that of doing Anaesthetics training) to get me into the new year and starting internship with some degree of focus. Now it's time to go back to the drawing board.

"Why Anaesthetics?" was the first question I had to ask myself. Because it's scientifically interesting, well-paid, flexible and with a relatively low out-of-hours commitment load. These are all traits that make for a good speciality to practice in if you have plans for serious extra-curricular travel.

"Why not Anaesthetics then?" was the obvious second question to pose. The primary and fellowship exams are soul-destroying. I have had a look at the curriculum and at past papers. We're taking about an intimate, biochemical- and molecular-level-depth of understanding of human physiology and pharmacology here. It's important to know this stuff obviously - afterall, if you're going to be manipulating human physiology, you'd like to be well familiar on what you're dealing with. Here's the thing - every speciality has a set of exams that need to completed at some point in the training. Anaesthetics happens to be one of those specialities that has primary and exit exams. I would need to start studying for the primary exams in the next 6 months to stand any chance of passing. At the end of the day, it's been done before; but, personally, I don't think I have it in me to commit to rigorous study of such a dry nature anytime soon. At first, I was making other trivial excuses for wanting to switch to another speciality (like, wanting to leave the hospital system) but the bottom line is - as much as I would still love to actually do Anaesthetics, I just simply cannot commit to the academic requirements.

"So, now what?" Well, fortunately, in Australia, regardless of what medical training program one decides to do - that first year of training (this internship that I'm currently doing) is the same. So the door remains open for a little while yet, to decide on what happens next.

My objectives in life when I decided on Anaesthetics have changed somewhat. Back then, I was still set on the mode of wanting to "just travel". Inspired by my recent travels however, and with the added desire of wanting to be more purposeful and involved wherever I go; I've been considering medical specialities that allow for a broader spectrum in practice, geographically speaking. The founder of the Australian Royal Flying Doctor Service, Dr John Flynn, once asked, "What would it mean, if, wherever a little band of men advanced to try their fortune in the middle of nowhere, a Nursing Home, were it only of canvas, could be floated down among them?". This is a neat little clue as to where I'm heading. It makes perfect sense. I want to practice medicine, I want to travel, and I want to be purposeful in doing so - why not combine these? I live in a country with some of most beautiful and remote places on earth; a country that also happens to have a critical shortage of doctors in these areas. It really does make perfect sense! I'm not saying it's set in concrete or that it won't change (because I'm going through a crazy transition phase right now, so anything's possible) but I'm thinking about becoming... a Rural and Remote General Practitioner!

It would be an amazing journey just getting there, let alone pursuing it for life. Of course there are many challenges to be considered too - remoteness is not an element to be taken lightly and I will have to think long and hard about the social and family implications of this choice. But I need something to hold onto for now, or else my restless mind will continue to ruminate aimlessly.

I have spent the last few days browsing through the different regional training centres where I could undertake my training. I like the idea of moving to a tropical, coastal area so Tropical North Queensland and the Torres Strait Islands are high on my list. Like I said, lots to think about still, and much ground to cover.

So, what happens next? In April I will need to apply with the training college to register as a GP trainee. Then, later on in the year (not sure when exactly) I will have to select rotations for next year. The first year of training as a GP (after internship) has to be completed at a hospital-level; with compulsory rotations in Paediatrics, Obstetrics and Gynae, General Medicine, General Surgery, Anaesthetics and Emergency Medicine. After that, I can stay on in the hospital system for an extra year doing specific special-skills training (e.g. in Paediatrics, or O&G, etc) to gain some more experience in an area that would useful for someone who is going to practice in remote and rural settings. Or I can just start rural and remote GP training and return to a hospital setting to do the extra year of special-skills training at the end of the training. I'll describe the program in more detail later on because it's a bit confusing, but for now I'm quite happy that I have some direction in life!!

Inspiration, I am coming to learn, can come from all manner of sources around us. I leave you with a picture of one of the beautiful beaches I visited in Fiji. Seemingly a mere photo of a happy me on a pristine beach - lazy indulgence that is far from noble and far from heroeic. Why not post a picture instead of doctor helping out victims in a war zone or refugee camp? This picture means more than that. On that trip, we visited remote Fijian communities and I started to understand the value of a health care worker in these settings. Health care is so much more than about stepping up in the last minute and saving someone's life... I'll leave you to think about that for a bit.

Here, in the real world...

Thursday morning, 1:30 am. Just returned home from an evening shift. Too awake to go to sleep; to tired to do anything productive... so I reflect.

I've been meaning to post earlier but couldn't get in the right mood at any point before the present time. Week One of internship seems like it was forever ago and I specifically held off going on a blogging rampage under the influence of all the stress and emotion. Afterall, as with revenge, reflection is a dish best served cold. Week Two - the week just gone past - I was reduced to a zombie, working the graveyard night shifts, with little time/energy to do anything but go to work, fall into a deep coma between shifts, wake-up, and return to work on the evening of the same morning that I was just at work! This week I'm on evenings and the dust of novelty is settling; so it seems like a good a time as any other to reflect on the weeks that have been.

So, as I have alluded to, we work on a rotating roster - doing a run of Day (7.30am-6.00pm), Evening (2.00pm-12midnight) or Night (10.30pm-8.30am) shifts. Typically we will do about four of these shifts in a row, then have about three days off before rotating to a different time slot. While it has its advantages (like random days off midweek and the occasional long weekend), I can't say that I'm much a fan of shift work. There is a tendency to become so consumed in your own schedule that making social plans becomes too much of an effort, logistically. Night shift, in particular, is going to take me a while to adjust to. I always considered myself somewhat of a night owl - but I now appreciate the difference between staying up all night watching DVDs or reading a good book; and staying up all night with the expectation that actual work needs to be done and to the same standards/efficiency as if you were working during daylight hours. The fluoro lights help.. a bit.

The Emergency Department (or ED as we call it) at my hospital is a VERY busy place. I did my Emergency Medicine rotation in a small district hospital, with a low admission rate, frequented by the "worried well" who really should have presented to their GP/family doctor instead of coming to the ED. So my preparation for a term in a busy Tertiary Hospital ED was somewhat inadequate. It's growing on me and every shift is less overwhelming than the previous one was. There is a lot of support for the junior doctors of course, at all times, which I am very grateful for. The registrars, consultants, nurses... but mostly from each other. You end up being best buddies with your fellow intern who is on the same run of shifts with you for that week - like you survived war together, or something.

My buddy Daniel and I at about 4.30am on a night shift, trying to keep our spirits up

The work itself depends on where you're placed within the ED. I have only ever been assigned to the Acute Care area thus far, so I can't comment on other areas yet. Acute Care is where all the seriously ill patients are placed for review, assessment and initial management. Most of the patients in this area end up being admitted to the wards so there is a tendency to spend longer taking a thorough medical history, examining, investigating, and really getting to know these patients in anticipation of what will be required criteria by the admitting team in order for them to accept the patient. It's a bit bureaucratic - but you basically have to prove to another medical or surgical team that your patient in ED is sick or interesting enough for them to want to accept them under their care on the wards, because obviously the ED is not an endpoint in itself (despite how it's portrayed on ER!). This is the part that I have found most challenging. I have dealt with just about the entire spectrum of human personalities on trying to refer patients to other teams. Some teams are exceptionally open and inclusive - basically happy to take anyone whom the ED (at our discretion) think needs to be under their care. Other teams refuse to even talk to interns. So you have to be adaptable to whatever response awaits you at the other end of the telephone line. Thick skin and remembering that it's not personal also helps.. a lot. Enough said.

"So, what's the verdict doc?" I hear you asking.. Do I love it, do I hate it? Hmm.. hard to tell. Certainly, even as a distant memory, I wouldn't recall that first week as the happiest in my life. It's tough being the new kid in a new playground - that much I was sort of expecting. One morning I came home after a particularly harsh night shift and, despite being completely and utterly knackered, started frantically researching different medical specialty training programs that allowed for an early exit from the hospital system. I'm going to leave posting on that for a different day because this musing has gone on for long enough. I will admit though that switching to General Practice/Family Medicine was looking very attractive at one point. On the same account, three weeks in, things seem better than they did on Day One. The other thing, I work with doctors and nurses who have been there for years, decades even. That's something to hold onto for now.

Love and Peace until next time...