I can stand people suffering, especially when they come to me for help. That’s what I do, and I have tools to help. My attending said to me in supervision a few weeks ago that it’s fun to do the supervision because I see my work as centred on the patient, as opposed to colleagues whose work is centred on the organisation of the hospital, on politics. As long as I can work with my patients, I can take a lot of organisational crap.

Now I’ve been doing my last rotation for about five weeks. Internal medicine, neurological unit. I’m supposed to learn more about the differential diagnoses between neurology and psychiatry, so I’m normally taking care of the half of the unit who’s not suffering from stroke.

Meaning a lot of, as Bouncy Haired Girl calls it, MultiGlyo-whatnot, aka glioblastoma multiforme (GBM), aka unoperable-6-months-to-live-braintumors. These things are so bloody malignant that at the point in time you find most of them, there’s not a lot of treatment left to do, and what there is is palliative.

It might have something to do with my new Chemo Angel assignment (an organisation you should check out if you don’t know it, it’s fantastic) which is a woman my age with GBM and a 12 weeks old baby.

It’s odd. I don’t have such huge problems with death normally, but somehow, things seem to have been adding up. I don’t know. Bouncy Haired Girl says I’ve seemed sad the last few days. I’m glad she’ll be here this weekend – there’ll be So You Think You Can Dance and Torchwood to watch which makes for a good weekend, naturally. Also, three weeks until vacation, yay!

When I was an intern in my last year of med school, I did my voluntary assignment, naturally, in psychiatry. I was placed on an open unit dealing with patients with affective disorders.

There was a resident there, a woman called A – maybe in her mid-thirties or early fourties. She was specialising in Childrens’ psychiatry, and as such had to work a year in adult psychiatry.

I disliked her from the start. She was distanced and gave me the feeling I was stupid when I asked questions. At that point I was still seeing a therapist (who is also a psychiatrist) weekly while recovering from a severe depression I got about a year before.

I had two patients of my own. I still remember them, even though I can’t remember their names. (I’m bad with names. It’s annoying.) One was a depressive patient who was scared of being at home and later on of riding the bus. The other woman had what we thought might be bipolar disease and came in with a depressive episode.

Since she was bipolar and I always had the feeling I had to know things instead of asking on rounds with the chief attending, I I thought I’d try to find out what to do when someone had a manic eopisode, in case one of the other doctors would ask. Doc A was sitting in the conference room, and I asked her.

Lil Doc Fae: I was wondering, how would you treat a manic patient?

Doc A: Why do you want to know?

Lil Doc Fae: I have this patient with bipolar disease and thought they might ask during rounds. I know what to do about depression, but I’ve never seen a manic patient before.

Doc A *points*: There’s a bookshelf over there. Read it up.

I was mortally embarrassed. I read it up.

I told my therapist the week after and she chuckled and said, “Honestly – she’s a childrens’ psychiatrist and won’t have seen much of bipolar disease or mania. Have you not had the thought yet that maybe she doesn’t know either?”

And I boggled. Honestly. The idea that someone could know as little or less than me had never crossed my mind. That’s how confident I was at that point, haha! And somehow, instinctively, I knew she had to be right.

I never talked to Doc A about it. I didn’t even think about it myself, at that point I just thought, oh! and that was about it.

What I will never forget though is how things changed from that point on. Because suddenly it was easy to work with her. We got along very well. We played to each other’s strengths, and at the end she was my favourite doc there.

And all of this because I thought differently. Because that was the only thing that had changed, the way I perceived her. My behaviour to her must have changed, and that made her change hers. I have no idea that I did anything differently, but I believe knowledge of any kind makes you behave differently automatically.

It taught me to a degree to question others’ motives, especially when I assign them negative ones. I think it also meant that I was born to love cognitive therapy

But, anyway. Another thing. I’ve always seen my mother as an incredibly disciplined and tidy person. She used to have everything tidied, and cleaned and whatnot. And I could never do it. Cue tons of teenager-mother-conflicts. I’ve always had problems keeping order, I’ve always had waaaay too much stuff, never been able to keep sensible routines. At the same time it’s always been a big thing for me. While I’ll never be a neatfreak, I don’t like it when it’s too cluttered. I somehow always cross the line between comfortable and cluttered without noticing. Honestly, it just happens!

I remember very well the only day I’ve been truly suicidal, about nine years ago now. I woke with the thought, “I will clean now. At least they won’t be able to say that the apartment was a mess.”

And I wondered what the hell was wrong with me when obviously my mother had it all down, and how could I not have learnt this from her?

When I was visiting last week I got my answer – she isn’t too good at it, either. She really hates it as much as I do. She could force herself when she was home with me and my brother, but now that she’s working part time again, stuff doesn’t get done the way it did before. She told me how she didn’t clean the bathroom because my brother was staying and would shower that day, so it wouldn’t pay off to clean the shower just before that – sheesh, I so recognise that line of reasoning.

It was good, to see that she isn’t perfect, so I’m not too imperfect either.

She still remembers me, tells me where I sat during that conversation. I didn’t think she would, she seemed so closed off at the time, wrapped up in unhappiness, wishing she would have succeeded with taking her life.

She seems different now. Talkative, enthusiastic, open. We talk about a lot of things. She’s glad I’ll be able to see my grandmother on her birthday. She talks about her own grandchildren, and her eyes sparkle.

I ask her about what happened when she tried to take her life. “Oh, when I went to take a bath?” she giggles. She took pills and went to drown herself in the lake, in the middle of winter. Luckily, because otherwise her family wouldn’t have been able to find her. There wouldn’t have been any tracks, no snow.

I’m taken aback and I tell her. She becomes serious and tells me, I still sometimes wish it had worked. Being like this, it doesn’t mean I’m well. It doesn’t mean I want to live.

She has nightmares about promising her doctor not to hurt herself, the day before.

He shakes my hand and makes a little bow. Both he and his son have this adorable accent that makes me smile and tells me they’re from Finland originally.

He walks into the room and stops in front of the two visitor chairs.

“Please, sit down.” I tell them.

He looks from one chair to the other. “Which one?” He looks up nervously, then looks down again, touching first the one chair, then the other. “Which one? Which one should I sit on? Which one?” he murmurs. He seems lost and tortured.

“Take this one, dad,” his son helps, and he sits down on the right one.

This won’t be fixed with just pills, goes through my head.

We talk about how he normally has no problems taking care of himself. He lives in a house by himself, but lately his son has been staying overnight more often or he has been staying with the son’s family.

“A beautiful house, yesyes, I have to springclean, there’s so much to do!”

He’s wringing his hands and the torture is back in his eyes again, this hunted look that always shows up sooner or later when you have to live with a constant nagging anxiety.

He is like this almost all the time now, worrying, thinking in circles, never a calm minute. He gets scared at night and won’t calm down until everyone there is awake so he knows all are accounted for. 

He has had these problems before, they tell me, and he was treated with ECT and had done well for years afterwards.

“Oh, that was a great treatment,” he says. “Please, I just want this to go away. I just want to get better.”

I tell him he will be fine.  I call psychiatry and get him an appointment at two p.m.

When I tell him, the haunted look is back. “Oh, at two. Downstairs? Downstairs. At two? It’s eleven. What are we going to do?”

“It’s okay, Dad, we’ll go have lunch”, the son says.

“Oh, all right,” he says and stops wringing his hands.

“I hope all goes well later,” I say, and hold out my hand. He shakes it and gives another correct little bow. “Thank you very much,” he says. “And good luck with my case!”

 

Got an adorable older couple. Guy has heart problems. He’s also had pain in his calf and foot for a few days, so I can’t rule out thrombosis.

Normally, I would send him to radiology. If all’s good, they send him back to me. If something’s wrong, they send him to surgery.

Today, surgery’s on strike. They only take prio 1 patients (equalling Take care of me NOW or I die!) which adorable older guy clearly wasn’t.  

That just meant they could have sent him back to me though even if there was anything on the x-rays. Problem was, it was past four and we close at five, so he wouldn’t have made it back. Normally in that case he would have been seen by the surgery doc on call, but alas, strike.

So I tell him I’d be right back after clearling the logistics and go to Boss Nurse, who knows just about everything.

Me: Blahblah guy leg radiology blahblah surgery blah what now?

She: Hmmmm. That’s a very good question.

Oh God. 

She: I don’t have a clue. You should call radiology.

 

Okay.

Me: Hi, radiology nurse! Blahblah guy leg radiology blahblah surgery blah what now?

Radiology Nurse: Hmmmm. That’s a very good question.

…

Radiology Nurse: Wait a sec, I will go and ask someone.

*cue waiting on the phone for ten minutes, wondering if poor patient has fallen asleep in my office yet*

Radiology Nurse: Um, I really don’t have a clue. How about we do the exam first thing tomorrow morning, and surgery will be open then too!

 

I’m really glad I didn’t get any real emergencies today.

 

Nurses here study for four years. They’re generally very well educated and do an amazing job. They’re also mainly female, and have two employers to choose from – in other words, they’re screwed. I’m all for them getting more money.

The only “but” there is that I wish they wouldn’t have to strike for it. It should just be bloody obvious to people that you should pay them according to the quality of their work, which they’re not right now. So they’re striking.

The thing is of course, that without them, nothing works. So even though the doctors, secretaries, assistant nurses and so on are working, the units in which the nurses are striking are still closing down.

In our hospitals it’s basically surgery, medicine and the ER. Of course they’re always taking real emergencies (meaning, if you have a heart attack, no one will send you home, but if you come in with a sore throat you’re out of luck) and the hospitals here and in Slightly-Bigger-Town are working together, so that the ER is open in one of the two.

Since I’m working in GP right now, for me this means that lots of the patients who would have gone to the ER during the night or weekend (the sore throat variety) will now be calling us in the morning instead.

The nurses’ union has asked for neutrality from the doctors’ union which has been granted. Meaning, we are not supposed to do any additional work that would normally done by nurses, so as not to dilute the effects of the strike.

Our nurses in GP won’t strike, and we have received a note that while we are to be neutral, our employer has the right to revoke free days and to prolong working hours. Which they promptly did, and I don’t especially like having ten minute appointments – mostly because I think my patients don’t really like having those, there’s not too much time to get any kind of talk, trust or relationship going. And of course they’re saying, this is neutrality because you’re not doing the nurses’ work, you’re doing the work the doctors in the ER would normally do! Which to me doesn’t really fly, and I feel like a strike breaker.

It makes me feel uneasy. There’s nothing I can do about it, really, and I can see on the other hand how it’s better the patient get a short appointment than not getting any, but – well, it’s making me uneasy. I remember when I was five, six years old and my grandfather was the president of Germany’s textile union, and how I would walk with him on the May 1st demonstrations, being proud of my red carnation broche. I have been thinking a lot about him these last days. He was an interesting man, managing to combine his work with being a conservative Christian (and voting as one). It has always fascinated me, even though I see myself neither as socialistic or conservative.

All that’s just to say, hey, work’s been a bit strange.

Friday our Diabetes nurse (who is awesome by the way, and one of the prime examples why they should really get 15% more pay – she knows more about diabetes than any doctor I know) took my bloodpressure. And, yikes. My mom has high bloodpressure, and I know that she found out when she was my age. I have been taking it just to see because of that in the past, but then I remembered I hadn’t checked in a long time.

Anyway, she was alarmed enough to give me the 24 hours – erm, thingo? You know, you fix the cuff on your arm and have a cable around your shoulder, and a little box on a belt that you’re carrying for 24 hours. It checks every 30 minutes, and every hour at night.

Yes, that does mean I didn’t sleep tonight, because every hour the damn thing made BZZZZZZZZZZZZ and blew up until I thought my arm would fall off. ARGH.

And just in case I will deny it later, if I’m lying over 140/90 average, I shall do the exercise thing till the end of the year to see if it makes a difference. Because I would so love to not have meds for the rest of my life. At least not yet

On the light side, I’ve been stitching and I’ve finished the Hinzeit Doctor block today, YAY! I’m so very proud of it. While I was working at it I had to keep thinking about how I’m so glad I made it through med school, and thankful that my parents put me through it. I’m happy that I have a job that lets me feel that I sometimes make a difference. It’s the best feeling I know. And while I know that there should be other things in my life that make me happier than my job – well, maybe sometime there will be, but right now I’m just glad I’ve got that. It’s a great thing to have. I feel like I’m doing a good thing, and like I’m doing something I’m good at.

Sentimental blah-blah aside, here you go:

This is it without all the charms attached, because they will be hiding a big part of the caducei:

And this is it with the charms:

And two close ups that show the charms better. They’re adorable, I will definitely do more Hinzeit designs in the future.

This design does mean a lot to me, and I definitely want to buy a frame for it. I don’t know if I should get the frame that’s meant for it and shown in the picture (see in the last post or on Webshots) because I used such different colours, and I would love to have something in another colour. Right now I don’t have the money anyway, but it’s definitely something I want to save for.

I hate it when the administrative stuff at work takes over patient work. I stayed more than an hour late today and am still not finished with the bloody paperwork.

I HATE PAPERWORK.

In case you hadn’t noticed.

Then I had to go shopping, but didn’t. Heh. And then I went home and got all my cables and stuff from the Home PC program together. It’s a thing where you get a pc from work and pay a little every month. After three years you can either pay it off and keep it or give it back. I decided to give mine back mostly because it went poof. Colourfu lines all across the screen, and it kept crashing. It’s a laptop and overheats every other minute even when it’s standing on the table.

So I kept all night deleting stuff from it – because, you know, official people from work. Eeeeeek

Tomorrow I’m off work early to bring back the pc, which would be great if I hadn’t Wednesday and Thursday off – which is great don’t get me wrong – but it means that I have to somehow finishe all the BLOODY PAPERWORK before. Which seems just a tiny bit impossible right now.

I will have delicious cheese sandwiches now.

I had a nice conversation with a colleague today. She’s German too, but I don’t know her apart from work. I like her, she has a dry humour that cracks me up.

I was walking home in the sunshine (it’s spring, finally, and I’m starting to believe the snow is done with till winter) with my ipod as usual, and met her. She was waiting for her husband who’s currently working in medicine. During my internship, I was truly miserable when I had to do medicine. It was the only clinic where I really felt the division of “you interns over there” and “us regular docs over here”. They had this thing going on where all attendings would go home early on Fridays, shortly after lunch.

Meaning there’s literally one attending who has their hands full with emergency patients, and a bunch of interns and residents, when they have any. All the people who actually know their stuff and have some experience go home.

Not to mention how much it sucks to be left there on a Friday afternoon with tons of work to do, knowing that if they’d stay, everyone could go home a bit early, but because they have to rush out after lunch, you’ll be there till seven. With no one to ask in case anything goes wrong, and things on ICU’s have a tendency to do just that.

It seriously sucks big time, to be sitting there thinking “PLEASE no one try to die now, because I don’t have much of a clue.” Not because the interns/residents are bad at their job, but because they’re supposed to have supervision and aren’t ready to handle all these cases.

Anyway, German Colleague will do her rotation there soon and asked me if it really was as awful as it sounded, and I kinda had to say, yeah, it was. She’s scared, which made me feel a bit weird – I still thought that I was only scared because I didn’t have a clue, but it seems I’m really not the only one.

When her husband was sitting there with work coming out of his ears, the attending bounced in and announced, “Anything more to do? I’m going golfing now!” I mean, come ooooon, how much more cliché can you get?

Anyway, long story short, it was good to see that it wasn’t just me who was scared of all that crap. I always thought of it as a personal weakness, and it was freeing to realise that it wasn’t, it’s really them who are nasty.

Also, German Colleague thinks I always seem calm and as though I have everything under control and know my stuff. Might be she’s certifiably insane and I have to take back everything I just said

Yes, I’ve been stitching, pics will come later this week. 

 

 

 

 

 

Yesterday was strange. I woke up at three in the morning because the phone was ringing. Some prank caller.

‘Hi, how old are you?’

I ended the call right away, but the moron kept calling.

I put the phone on occupied, checked that the clock was on, and fell asleep after a long while.

Only to wake at 9:30 to my chief nurse calling me, ‘Where are you? You’ve got appointments, you’re supposed to be here NOW!’

EEEK. Talk about embarrassing. I couldn’t have slept through the clock ringing, so I must have turned it off by mistake when I was checking it during the night.

I scrambled and got there in 20 minutes. Thankfully, my colleagues had taken care of my first two patients.

I looked for a hole in the wall non-stop and felt off all day. Plus when I got home, I noticed I had left the door open.

I’m in serious need of a non-strange day, let me tell you!

I had a good day at work, on Friday no less. (Fridays are almost as annoying as Mondays, heh.) It made me think.

If someone would ask me what my greatest weakness is, work-wise, I would say that I have a very hard time with being manipulated. Thus I have a very hard time working with patients where manipulation happens more often – addicts, certain personality disordered patients. I would say that this is one of the things that I’m worst at in real life even. It hurts me very badly and it has been the only reason that I’ve ever shut people out completely, more or less.

My biggest strength goes hand in hand with that. It’s my way of being there and making the other person feel that I care about them and take them seriously. Which isn’t hard, because I do. And I have a hard time combining the two sometimes - for me, to be that open and warm, I have to believe in the best in people, and then it hurts twice as much when I notice I’m being taken advantage of.

Anyway, all that’s to say that I think I’m good at my job not mainly because of medical knowledge (not that I don’t have any) but because I’m able to make my patients feel safe in my care. They trust me. I try to never downplay any concerns, I never tell anyone it’s just in their head or that they just have to lose the weight. (Talk about pet peeves here.)

I realise that they’re sick and not at their best, because God knows I know how I am when I’m sick. So even if they might start out snippy or just plain tired, that’s no reason for me to react anything but friendly and civil (to a certain limit, of course).

And most of the time, that’s just how I do my work. I honestly don’t know how people can do it any differently. It’s “Dienst am Menschen”, and I don’t understand certain colleagues who seem to put the patient last – the reason I learnt all this stuff and crammed things into my head that I’ll probably never need is to be in contact with people, and, yes, cliche ahoi, to help them. Really. So mostly, I don’t notice what I do because that’s the way I always do it. I think it’s the way it should be done.

So sometimes, I’m a bit thrown off kilter when I do the normal thing, and people get all overwhelmed with gratefulness. The sweet old lady who gripped my hand tightly and thanked me because she hadn’t thought she would be treated this well. The woman with severe muscle pains who didn’t think anyone would believe her. An elderly lady with pain in her back and legs who got ridiculed by a colleague because she wanted to *gasp* see a chiropractor, and how she relaxed when she noticed I wasn’t laughing. And last Friday, a sweet Hungarian couple I joked with for about half an hour, and it was so obvious that they felt comfortable, even though they were scared when they went in.

When they went out of the door I got this wonderful feeling I don’t have too often, that I’ve done really good work. Not because of some fancy diagnosis – we’re not there yet – but in that they know they can trust me, and they will be back. The whole warm and fuzzy thing. And I felt a bit silly too, because I thought, well, that’s really just an intrinsic part of the job, and I shouldn’t be feeling this good about it, it’s nothing special.

But listening to my patients every day, I hear more and more often that sadly, it seems to be special. And I just don’t get how that can be. I’m no oldtimer, but I have been working for a few years now, and even though the job can be tough and I sometimes don’t especially like going to work – I love meeting the people I meet. I just don’t know why you would want to do this job if you don’t.

Still with me? Wow, you’re good. I’m hesitant to post this because it might sound incredibly arrogant. It’s not like I don’t have bad days, but I do think my job is cutomer service related to say the least, and I would never get uncivil or laugh at people. I just don’t get how people can think that would be okay.

End diatribe. Patient waiting outside