Life in the Emergency Lane

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This talk was brought to you as part of the biannual When I Grew Up series hosted by the Australian National University Medical Student Society. Our guest speaker is Professor Caldicott, who is an Emergency Department Consultant at the Calvary Hospital ACT. It is one of the most heartfelt and genuine talks that we believe all medical students and junior doctors should hear. There are so many pearls of wisdom about living and surviving as a doctor that we can all learn from. This is a raw, honest and entertaining reflection from a senior clinician practicing in one of the most challenging and exciting fields in medicine.

Our Guest Speakers Bio

Professor David Caldicott who is an Emergency Consultant at the Calvary Hospital and a Clinical Senior Lecturer in the Faculty of Medicine at the ANU. He is a spokesperson for the Australian Science Media Centre on issues of illicit drug use and the medical response to terrorism and disasters.

Professor Caldicott designed and piloted the Welsh Emergency Department Investigation of Novel Substances (WEDINOS) project in the UK, a unique program using regional emergency departments as sentinel monitoring hubs for the emergence and spread of novel illicit products. He is currently replicating this work in Australia with the ACT Investigation of Novel Substances (ACTINOS) Group.

What do you listen to when you study?

Some students like to listen to soothing music, others like a good up beat song to keep the mood pumping.

Myself? I tend to study in silence. But it doesn’t hurt for some soothing background music every now and then. Just no lyrics please! I’m trying to concentrate!
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What helps you study?

AH

Are You Empathetic or Sympathetic?

“After all these years, I’ve realised I’ve been sympathetic and not empathetic towards my patients!” exclaimed our clinical tutor.

Even before day one of med school, the word empathy is drilled into the applicants. Myself included.

But what does it mean to be empathetic? I know it’s an important quality to a doctor. Everyone tells me that. But how do you be empathetic?

According to our tutor and a dictionary, one has to have suffered the same pain, gone through a similar experience, understand the nature of the pain, to be empathetic to the patient.

Thus, by this definition, he said that he’s only been sympathetic to patients and never empathetic.

I don’t agree. Because from this definition, I’ll never be able to empathise to the majority of my future patients! What are the odds of me catching Parkinson’s, Alzheimer’s, colon cancers, melanomas and GORD in my lifetime? (touch wood)

To me, empathy stems from being able to relate yourself to someone’s suffering. Bringing yourself from your place of comfort and down to the level of the patient’s pain. Not just sitting in the shade as the patient is standing in the rain. Mentally going into the rain and standing with them.

Sympathy on the other hand is seeing other’s suffering, recognising it and saying: “Oh man, you’ve got that rough there!” while thinking thank God that’s not me!

I’d have to admit. Sympathy is a lot easier to practice, and empathy sounds emotionally draining. I don’t think it’d be strategically smart to emotionally empathise with each one of the patients you see. Sometimes even once can drain you dry for the day. This then leads to the question, how do you distance yourself and keep a professional distance while still caring for the patient. I don’t have that answer yet. I’ll leave it for another day to find out.

If you’re a visual/audio person, this video may help to give you a conceptual understanding of the difference between sympathy and empathy.

Enjoy

Caught between two minds

As a second year medical student, we rarely get clinical experiences into the real world. When the chance came to watch a gastroenterologist perform endoscopies, I jumped at the opportunity.

Here I was, all gowned up in the theatre. Lying in front of me was Mrs Jones (not her real name of course). She was an elderly woman referred to the clinic for both a gastroscopy as well as a colonoscopy.  Previously she had went to a small hospital to receive transfusions for iron deficiency anemia. The hospital doctors then referred her to the clinic to investigate the possible cause. From her history, she didn’t have any symptoms.

After a perfectly normal gastroscopy, “What could be causing the anaemia?” the doctor asked me as she prepared for Mrs Jone’s colonoscopy.

“If we’re talking about the lower GI, I’m think that polyps and possibly colon cancers can cause anaemia.”

“Exactly. Now where would you expect to find this tumour?”

I stared blankly back at the doctor. I tried to dig through my limited pool of knowledge. After all, I was just taught about colon cancers less than 24 hours ago.

The specialist must have seen the blank look on my face and answered her own question.

“In an asymptomatic patient, it would likely be the right side.”

By now the scope was prepared and plenty of lubrication was applied. We were ready.

During the colonoscopy, I found identifying the segments of the colon quite hard compared to the upper GI as it all looked the same to me. Hmm… round tunnel with semilunar folds… round pink tunnel.. 

A normal colon

“Sorry doctor, could you please tell me where we are again?”

“Near the splenic flexure”

“Thank you”

Hmm… pink round tube with… what the?!

On the monitor, the smooth round tubes of the colon disappeared. Replaced instead with a sea of small raised lumps and bumps. Polyps… and a lot of them.

Clarification: Not the real patient’s colonoscopy. I just found this online to show a close approximation of what I saw.

I was surprised. I expected polyps, but not 30 of them at once. The specialist quickly took multiple biopsies of the region, and while further investigating found a hard cancerous mass further down the colon. The scope was then withdrawn after another biopsy was made.

As I watched the procedure, I was ecstatic! I felt like the luckiest med student alive! It is unbelievably satisfying to physically see a disease that you’ve only heard other people describe. However, I also felt… uneasy.

As I watched Mrs Jones gradually recover from the anaesthetic, I realised the source of my unease. Guilt… I felt guilty!

While I was feeling excited seeing pathology come to life from textbooks, I also just witnessing a life changing moment for Mrs Jones. In those 30 minutes, we have discovered a tumour in her colon!

While the doctor continued to type reports and organise a follow up with a surgeon. I had a chance to talk to Mrs Jones in the recovery room.

“Hi, I’m a medical student”

Mrs Jones smiled and nodded “The doctor told me before the procedure. Sorry you had to see such an unpleasant thing”

I presume she meant the procedure and looking at her bowels. “No, not at all!” I replied quickly, “At this stage in my degree, I don’t see much at all. I’m deeply grateful for just the chance to be here today! Thank YOU so much for allowing me to watch.”

We then looked at each other for a few seconds in silence. All I could think of was the tumor in her colon.

“I think I’ll need to go back in. Once again, thank you!”

“Take care”

“You too!” and with that, I rushed back to the doctor.

***

As I left for the day, I happened walk by Mrs Jone’s bed. She lay there wiping tears from her eyes. The doctor must have told her the news. Although I don’t know how severe her diagnosis is, I could see how upset she was.

I didn’t know what to say to her, so I hastened my pace and left the hospital.

Of the many things I learnt that day, I realized that I’m caught between two mindsets, a clinical mind and a human mind.  One that feels excited to see rare diseases and terminal illnesses in person, and another one imagining the possible pain and sadness the patient would feel when they find out the diagnosis.

These mindsets are conflicting. It makes me feel guilty for feeling joy from someone’s suffering. However I don’t want to sacrifice either. Ten years later I don’t to be a doctor who only sees patient’s suffering and forget the joy of learning and identifying diseases. Neither do I want to become a doctor who only sees patients by their disease.

I guess I’ll need to live with both… for now.

AH

Goodbye my friend

Yesterday I found out a friend from university passed away. For someone my age at 23, death is one of the last things you think about. For heavens sake! I’ll even considered getting married, settling down or buying a house before I consider that my friends will die.

And yet, he’s gone.

To be honest, I didn’t know him that well when we were at university. But I remember him as a pretty cool guy to have around. Last time I saw him was at a Christmas party playing board games two years ago. That guy was way to drunk that time to play Cranium.

Embarking on the journey of medicine, I’ve readied myself to deal with death at work. After all, I expect that I’ll be encountering him (or her). But I was not at all prepared to deal with death among my friends and family.

I always assumed I would have another chance to see my friend. I don’t know when, where nor was I making plans to. I just thought that we would run into each other some time in the next 10 years at least. The news was just so sudden and unexpected. It might have been unexpected even for him! I found out that a few days before he died, he just purchased a new car. A NEW CAR! I heard that he was so excited.

And yet, he’s gone.

I don’t know what exactly I’m feeling, and I don’t know how to articulate it. All I know is that I wanted to say something.

This makes me realize that I taken every day for granted. I always expect to see the sun rise tomorrow. His death showed me that death can come any day to any one of us, despite any upcoming exams, assignments or whatever troubles are going on in life.

From today on, I’ll try to live everyday with a sense of appreciation. Death brings a certain perspectives that make all those woes and worries seem not worth stressing about.

Dear friend, I hope you find joy and comfort wherever you are. I’m really sad that you’re gone. From what I can see, you will be sorely missed.

I’ll leave you with this comment from your closest friends:

You know I don’t drink but it’s one of the bottles you left behind last year. You were supposed to come back with the others and help finish it. Now that won’t happen. We were just talking yesterday and suddenly you’re gone. Here’s toast to you. Farewell my good friend.

Farewell my friend

Goodbye… dear friend.

A