emergencyregistrar

I realised I have paid probably about $120 a year to keep this blog up and running.

Goes to show what procrastination or neglect can do…

It is now 5 years since my last post; 7 years as a consultant; 13 years since a junior ED Registrar.

Whilst I think I lead a reasnoable comfortable and privileged life, a voice in me sings :
is this the real life; is this just fantasy

anywhere the wind blows; does it really matter to meeee….

I have tried :

a. educational roles : whilst I continue to work in some capacity in this role

I actually lost a DEMT position to a junior colleague who interviewed better despite me holding onto a college role (that still occasionally burns)

b. attempted leadership roles – twice turned away at interviews (yes burns)

c. research – I don’t think I like research apart from the occasional poster I publish or rare case report (with an educational slang)

what else is there ?

Private ?

Slog away.

Sell insurance.

Pivot.

Where I am currently living, there is a partial lockdown.

No more meals outside; just take-away food.

Much angst about job losses and income security amongst some people; I guess we are fortunate to be employed. I echo a phrase from my old mentor “without patients; we would be out of a job…”

It has been > 1 year since I have updated this blog.

I chose to keep this blog open as a source / repository for my future trainees / children.

I do wonder at times ; is there more to life than medicine itself ?

Should I embrace this wellness concept ? …

ON a more serious note; I have been watching lots of Radiopaedia lectures (subscribed) to some of them. GOLD !

-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=

I reminisce when life was slightly simpler when I was a registrar…

I remember 2013; I was a freshly minted registrar at a place called Ipswich. Literally felt like I was thrown in a deep end. Fantastic acute medicine; and very steep learning curve.

I struggled to pass the primary exams then (I still hold resentment at a previous workplace in 2012 where I was not given enough leave)

But my struggle came down to focus.

I was fortunate enough to pass these exams by the skin of my teeth thanks to the amazing tutelage and assistance from the people then.

Ipswich has a very fond place in my heart.

My transfer of an intubated patient with multi-organ failure (on inotropes and all that jazz) to a tertiary centre… (which then became many…)

My first diagnosis of a ruptured ectopic pregnancy !

My foray into lung ultrasound.

My few neonatal resuscitations !

Now as a consultant I wonder how to pass on the wonder and expectations I have on the trainees… is it too much to expect a higher standard or enthusiasm ?

Most of us would be excited that SMACC is next week !

It is the last SMACC after all !

I have now been working as a consultant for the last 1 year !

Impostor syndrome occasionally prevails and pervades my ability to perform.

Sometimes I fumble upon describing a pelvis Xray accurately – fumbling the words “sacro-iliac” or “sub-trochanteric”

In moments of stress or high tension ; I would often default to :

a. the ZERO Point survey – espoused by the famous Dr Cliff Reid at Resus.me

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166036/

I am now a FACEM. This is a long journey which started in the corridors of an emergency department.

I am now doing WBAs fr trainees instead of doing them with with other consultants.

I credit influential mentors and a great hospital system for influencing me.

The whole idea that I am now a specialist…is scary.

Sometimes I wonder, whether my behaviour and leadership example is appropriate for a  consultant. I can only continue to strive for my best. every day.

For the patients.

a lysed inferoposterior stemi…

an MTP joint aspiration…

4th MCP fracture > POSI

droperidol x3….

haemarthrosis knee

superior articular facet fracture of c7….

i thought i was okay; until someone asked whether “are you okay”

and reminded me that “i am awesome”

maybe i display a flat face when it comes to feedback

but deep deep down i feel guilty and stupid

and always blame myself for not being good enough

not failing to be a patient advocate

on another gripe

i have a theory that registrars of similar ethnic backgrounds treat each other like shit. just an observation. “can’t be accused of racism” right

Passed the osces !

this empty feeling remains….. I wonder why.

it is 14 hours to the OSCEs.

I sit here in this nice, sparkly clean apartment with my laptop on my thighs. Notes / books scattered on tables/floors.

The shirt/scrubs are ironed / hung on hangers….

The shoes ready. Next to the door.

People tell me that I am ready. I don’t. I really am not.

I had a rough few weeks. Personal matters.

For the first time in my life, I have actually thought about suicide. It is real. What if ?

Don’t worry (I have more reasons to live)

Just goes to show that even myself am not immune to these thoughts. Suicide is real. Depression is real. I used to think that people on anti-depressants don’t necessary need to be on them …..

I had few encouraging emails from old bosses :

the most encouraging one was “good luck” but the truth is “you don’t need any more luck”
“you are a FACEM”

now….to try and remember that we actually measure thrombin time for dabigatran and now Xa levels….

or which is Neer’s test again. or Hawkins. or Mcmurrays…

Look. Feel . MRI !

It is 9 days… to the 3 day extravaganza they call the “ACEM Fellowship OSCE Exam”

I have 2 more work days ; so that makes is to 7 days.

7 days to practice :

101 ways of taking various history and exam i.e. headaches/abdo pain/chest pain/syncope

dozens of various physical exams e.g. cardiovascular exam / knee exam

dozens of data interpretation

Hundreds of variants of Simulation scenarios

Dozens of communication practices

Hang..on..I should have practiced them for the last 4 years !

Phew.

The nerves are getting to me. Silently.

I just realised it has been 4 years since my last post !

In 2 weeks time I will be sitting my Emergency Medicine specialist exams.

I had some practice OSCE sessions with a colleague and gems from the consultants today were :

“Don’t do a core basic thing poorly – heavy weighting ”

“That stuff needs to come out – you know this”

“Knowledge needs to come out in a structural way”

“Show an overview of a big picture”

“Get all the ducks lined up”

“You do not get marks for what you are thinking only what you are saying”

“Make a consultant handover concise and precise”

“YOU ARE A Beacon of calm for prioritized actions”

“Deconstruct each step for procedures”

==================================================

I just finished a shift with 4 procedural sedations / 1 intubation :

a. Assisted in washing a middle aged man’s compound tib-fib fracture

b. Sedated an 85 year old female to wash a medial malleolus wound ; she had rib fractures and was recently in AF 2 weeks ago (she is on Apixaban)

c. Sedated a 40 year old 120kg lady’s tibio-talar dislocation

d. Intubated a young male with a GCS of 5

e. Sedated a middle aged lady to reduce a Colles fracture