Friday, 29 January 2010

I feel pretty useless right now. Mary Harney should feel the same.

As the title says, I feel pretty useless at the moment.

I've been contacted by a friend of a friend in Ireland. Her baby has an agonising condition, and needs to see an Ear, Nose and Throat surgeon to have it treated. It's an easily fixable condition. Science has seen to that.

But science hasn't found a way to shorten hospital waiting lists for children in my home country. Sadly, we depend on our politicians for that, and they've been found wanting.
This family have been told their 10 month old baby will have to wait roughly 2 years just for an initial appointment.

Then they'll have to get scheduled for any procedure that the child needs, which will take another few moths.

This baby will be a 3 year old child by the time he gets sorted out.

They've contacted me in the hope I can do something. I'm a paediatrician, and I'm from Ireland. Surely I can do something to help...can't I?
They can't go private, as they're on social welfare. It costs almost 200 euros for each private visit, and that's before any surgery has to be paid for. Private care is not an option for these people. They rely on the state.
But there's nothing I can do. I don't know anyone at their local hospital. I've told them I'll have a think about it. But I know I'm just delaying the conversation where i tell them I can't help.

As well as feeling pretty low about the plight of this baby, I feel somewhat embarrassed to be associated (albeit pretty distantly) to a service where babies are given worse healthcare than many animals would receive. I'm reasonably sure that a pet owner or a farmer would find themselves in trouble with the law if they left an animal in pain for 2 years.

Mary Harney is the Minister for health in ireland. Rather ironically, when we consider how many cutbacks have been foisted upon the sick children of Ireland, she is actually the Minister for Health and Children.

I wonder if she feels embarrassed like me. I wonder if she's had trouble sleeping, thinking about these kids in pain, like I have.

Or will she continue to claim that Irish hospitals are failing because of the inefficiency of the staff?

I suspect we all know the answer.

Working in Australia, I'd forgotten about these problems. I'm amazed at the third world healthcare available to those without health insurance in ireland. I'm doubly amazed that the current minister has kept her job for the last 6 years.

I guess this blog entry is just a rant because I feel useless. I don't have answers right now. I don't know how to help this kid. I don't know how to help the hordes of other children in the same situation

I'm not paid to have the answers, though. But I guess I wouldn't be as worried if I thought our political masters genuinely cared. Because anyone who gives a damn about people would do everything in their power to make sure nothing like this happens on their watch.

I'm sorry this isn't well written. I'm sorry it's all over the place. I'm sorry it doesn't flow well.

But mostly I'm sorry I can't do anything to help this kid.

Dr. Thunder.

Friday, 22 January 2010

Before considering medicine as a career......

......have a look at this anonymous post from an Irish junior doctor:

The link is to a post in the health sciences section of a popular Irish discussion forum.

While I think the doc in question has it worse than most, it's an interesting read for those thinking of going down the medical career path. Note the number of responses from other doctors, sharing stories of bullying. I think this is one of medicine's most shameful secrets.

One piece of advice I would give prospective medical students is that you need very very thick skin to be a doctor. I've never had the problems with consultants that the poster in the link had. I've had my share of bollockings, and I worked with a surgeon for 6 months who did, by all industry standards :P, bully me for the duration of the job.

I think I've been lucky, insofar as paeds attracts a type of doctor who's usually patient and caring. But bullying and abuse are most definitely part of the junior doctor package. Senior docs can give quite a lot of abuse (Ireland seems to be worse than anywhere for this...I didn't notice much bullying in Oz or New Zealand), nurses can be very harsh on junior docs (I found Australia and the UK pretty bad for this). Even admin have screamed at me in my time. It might be controversial to say this, but if you are female and from an ethnic minority, you are likely to get it in the neck more often than most (In my experience). But very few juniors get spared.

The standard response from prospective students when you tell them about this issue is:

A) But I know I'll love medicine, so I don't care about the other stuff.

B) I'm going to find it hard to hold my tongue.

Well, I've never met a doc who doesn't care about their working conditions. You spend most of your life in the hospital, and it's important to have a nice atmosphere. All the idealistic stuff doesn't play such a big part in your thinking once you're used to it. But how you spend up tp 14 hours of your day will always be important.
As for holding your's not that hard actually, wen you're embarrassed in front of a crowd of people, and your competence (which most junior docs have doubts about at the best of times) is called into question.

I found that, until I was a registrar, it was open season on me. Anyone in the hospital would speak to me in any manner they choose. I remember what it was like. So, when the nurses on my ward ganged up on a young resident recently, I took them aside and told them to leave her alone or I'd report them all. Just like when my consultant heard about a consultant radiologist who tore up my request form in a rage, and threw it at me..he rang the guy there and then, and told him never to treat me like that again.

I think we all need to stick together. I think senior docs have to watch the backs of the juniors more than they do. If I was advising the guy in the post above, I'd tell him to come to Oz or New Zealand until he's senior enough to defend himself.

Though the fact that I'm even writing this post is a sad reflection on how we treat our juniors.

Feel free to share your thoughts/experiences in the comments section.

Dr. Thunder

Thursday, 7 January 2010

Dr. Ima Toilet

So, what's the worst thing that's happened to you on the wards?

A few of my non-medical friends were remarking recently how nothing can turn my stomach. No matter what we're wathing on TV, or what dead animal we see on the roads, I can just carry on eating, and acting like nothing has happened. I'd never given it much thought, but I was very squeamish as a youngster. Anything gross would have had me dry retching, regardless of where I was or who I was with.

But I guess medicine and medical school gives you an iron stomach.

I guess we are exposed to experiences that a lot of people would regard as abhorrent very early in our careers.
Within days of starting medical school, we were cutting cadavers open. Not many 19 year olds operating within the boundaries of the law have had that experience.

A particularly disturbing moment has stayed with me since the second year of medical school.

We were dissecting an abdomen, which was filled with fatty tissue. To get through fat, you basically have to just pull it out with a massive tweezer and a scalpel. I was busily dissecting through the huge adipose layer, with the enthusiasm of a first year medical student. One of my colleagues was hanging over my left shoulder to try and get a glance. He was quite a keen student, but he hadn't mustered up the courage to get stuck in yet.

So, I worked fervently, and was getting through to the prize that was the adominal peritoneum. As I got closer, I worked quicker. A small piece of fat flew from my tweezers. I watched in horror as it shot towards the guy who was standing behind me, with his mouth open.

I can remember the huge hunk of human fat entering his mouth like it happened in slow motion. I still remember him swallowing reflexly as it landed in his mouth.


And down it went. Jesus H Chist. I had just witnessed a colleague swallowing human fat. He turned white. Then yellow. Then green. Then he ran to the toilets to vomit violently for the next hour.

Poor guy. It didn't help his anatomy phobia. But, bizarrely, he is now a surgeon. So, he must have learned to use a scalpel at some stage.

There have been other moments that would make you grimmace. I remember being an intern on-call in a general medical ward in the UK. I was standing at the nurses' desk writing in a set of notes. Suddenly the back of my leg started to feel warm. I jolted and turned around to see a very elderly man standing behind me, urinating on my leg!!!!

I jumped out of the way and he finished off on the floor, undeterred. But that's life, and I have to say it didn't phase me too much. I just pottered off, and got some scrubs. I was back on-call 5 minutes later.

Paediatrics is full of things that would be gross if adults did them, but are considered cute when kids do them.

I was resuscitating a baby at a delivery a while back, and he came around very quickly. So, as I was leaning in palpating the arteries in his upper thighs, he decided to have a pee. Straight into my eyeball. I was so stunned, it took me a second or 2 to jump out of the way. Like I said, disgusting if an adult did it, but because this was a baby, everyone just went "Awwwwwwwww".

But I had to draw the line, when working in New Zealand, and classify a paediatric toilet incident as "gross". I was in A+E and saw a litte person who was constipated. I asked the nurses to put half a little dissolvable tablet into his bottom to shift the impacted poo. They weren't sure how to do this, as it wasn't a paeds emergency department. So, I said I'd show them.

I leaned in and put the tablet into his bottom. Within a millisecond his bowels decided that A) They were going to work and B) They were going to make up for lost time.

I was drenched in liquid poo. I mean DRENCHED. My whole face was covered in a stinking layer. I wiped my eyes, to see this baby laughing like crazy at his handywork.

I guess you have to laugh. And you're pretty much guaranteed to develop an iron stomach after those experiences.

I can't wait until I'm old so I can exact my revenge. Bring it on!!!!

Dr. Thunder.