what is it about being a medical registrar that still fills me with unease? im into my fifth year out of med school; spent a couple years as a relatively competent resident (at least i think so); managed patients on my own pretty much since day one; admitted hundreds more; ran codes by myself; done a stint in icu and even worked as a locum "registrar" for a few weeks. lots of my colleages are doing it / have done it / are over it. and yet i dread that first day in mildura and a part of me wants to put it off forever.
i think it's mostly the responsibility of the job, or my idea of it anyway. the sense that the buck stops with me. im supposed to be making the calls, running the show, supervising my interns and only occasionally "consulting" with my bosses. if something goes wrong, then im the one whos stuffed up, not done enough, let the patient down. i know it's not exactly like that, but thats how it feels.
i love being a resident when i have an easy-going registrar. i get to do whatever i want, but if things aren't working out, i handball the problem into his/her court, and demand a solution. it's that simple. now i will be on the receiving end. serves me right.
the last run of nights was insane. six transfers and two code blues. it's difficult when all ive got on my side are one div one nurse, whose probably been working in subacute for twenty years either side of her pregnancies, and a non-medication-endorsed div two nurse, and me all on my lonesome. it feels like the day teams dont know and dont care about their patients medical issues (but the stump looks alright: what are they, surgeons?) and when the person on the other end of the phone is half asleep, or questioning your judgement, or telling you they're on bypass, well... that doesn't help either.
im starting to understand why xiu keeps moaning about not knowing enough. its this... panic. it freezes me. and then the endless replays in my mind (the "i could have done this... i should have done this... maybe it would have made a difference..."). the guilt. the gaps in my knowledge seem enormous. didn't i learn anything in medical school? it spurs me on for a moment, until im lost in the overwhelming amount of information in harrison's or uptodate. then i despair.
not that im into acute medicine or anything. but sometimes its great just being lost in the heat of the moment, doing thing, thinking that you know what is going on and what to do, and not having to worry about the consequences.
3 comments:
It is rubbish. It is terrifying. The sense of responsibility that you take on, for being the one who makes the decisions.. I find I swing between wanting to wildly over-investigate people for worry of what could be missed (we're constantly stuck with thinking about the worst-case scenario), and underestimating just how bad their condition really is.. At least by the time they get to you they're some semblance of sorted. We're stuck with trying to make sense of the unknown...
and thats why i hate ed most of all. the daily battle with the unknown. but shouldn't it be getting better for you? doesn't experience make you more chilled out? most ed consultants i know seem to be pretty cool calm collected... (or is it all an act?)
as to "some semblance of sorted", you and i know that both depends on the reg / consultant that's on and the number of hours the patient has been in ed / how close the hospital is to going on bypass. sometimes there is barely any resemblance between the story you were told over the phone and the patient thats in front of you!
brumbles passed, btw.
chi
Experience doesn't make me more relaxed at all.. The more you see, the more you realise how badly things can go wrong.. You learn from other peoples' mistakes, as much as anything else, and there's so very much potential badness.. You learn that abdo pain can be a triple A getting ready to rupture, or ischaemic gut, that a seemingly simple cellulitis can infact be spreading rapidly through deep compartments and need to be taken to theatre for opening up...
I think you just perfect the act of outer calm as you get more senior.
Well, it happened to us when we were med students, and it still happens to residents.. The patient tells different stories to different people. :P
Bravo to Catherine! Where is she these days?
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