365

At the end of every 12 months on the rotation we are forced to sit down and produce some vague attempt at self-reflection. 
This is what I came up with 3 months after that deadline...

            A year is nothing anymore. Months are swallowed up by call rosters and weekend rounds. When time is measured in 3 month rotations it doesn’t take that long for 4 of them to fly past.

Self reflection sounds easy enough when you say it – in reality, putting these words on paper has been trickier than sedating a ‘Downsie’.

But ok, here goes.

I swear a lot more – if you spent 60 minutes with me you’d probably never say it, but it’s true.  In my head mostly, but occasionally under my breath when I’m running to a resus, or I’m struggling to intubate the 800g prem. Almost always when I put down the phone after the lab has called with a potassium result and pretty much after every phonecall from Hanover Park MOU.

It’s been an education in people.

 In how they wear their insecurities - interns and consultants alike. Some cowering behind them and some disguising them as impatience or condescension.

 Also, in how some people have no willingness or capacity to give beyond what is expected to the detriment of the group,  and equally so, how others struggle with the ability to say no to the detriment of themselves.

The most interesting skill I’ve had to acquire is the ability to work quickly and thoroughly and under pressure. Interesting, because it is completely contrary to my slow metabolism.

In my comfort zone I like to work at a pace that enables me to be thorough and thoughtful, and beyond a certain pace my brain starts missing things.

In reality though the workload is mostly too overwhelming for slow, but the kids are sick enough to demand thorough and thoughtful. At the same time they’re sick at 3 in the afternoon when you’re relatively fresh on a shift, but they're no less sick at 3 in the morning, when you’ve sat down for maybe 30 minutes in the day and your brain is running on cortisol and red bull.

I’ve had to start treating calls like a series of short sprints and less like long marathons.

The second is negotiating a healthy balance between me time, work, friends, God, fiction and non-fiction reading. I get the feeling this is a learning curve your whole life – and different seasons lend themselves to the waxing and waning of different demands. Some days the balls are miraculously being juggled in the air. Most days they are all over the floor.

Do I feel smarter…

            Mostly no.

I don’t fee l any more skilled in telling the difference between a pansystolic murmer and an ejection systolic. What I know about intropes is embarrassing. I’ve worked in ICU for 3 month and I don’t think I could find the Newport Ventilator on switch if I had a manual. That being said – I’ve spotted a DKA on the triage bench, clerked in a kid with hippus and a ‘milkmaids grasp’ and recently even a congenital rubella.

Baby steps.

Do I still love this?

I think so.

I mean at least once a month I dream about leaving it all to go run a well baby clinic in a Karoo town and bake cupcakes in my spare time.

But I work with some of my all time favorite people.

I get to go on ward rounds with some of the most respected names in Paediatrics in the country.

And the little people – they never stop amazing me.

Take home Teddy

Thursday morning after Wednesday OPD chaos - the folders in the box are remnants of the previous afternoon, told to rather come back in the morning than sit on the uncomfortable passage bench, to be seen somewhere in the vicinity of midnight.
None of my follow-ups have arrived yet so I pulled the first folder - green triage sticker, complaint - 'sores in the mouth'.
So typical of MOPD, the real reason for coming is not always well captured by the triage nurses, and in this case it was a complete red herring.

A very cute little 3 year old girl comes into the room with her mom. A pleasant little pair.
Her mom speaks a slightly broken, Eastern Cape version of English; her grammar giving it away more than her pronunciation. Her daughter is a sweet little poppet who barely says a word the whole consultation, just sits quietly next to her mom and wanders around the room with her eyes.

Sores in her mouth - not so much. Sores on her hands and feet - yes. More alarming is the blood in her urine and then very nonchalantly she tucks in this statement...
"The other thing doctor, I almost forgot... she was raped last year."
No, not how I like to start my Thursdays.

So we stumble through the story which is a good year old and sadly, probably the story of a thousand other little people.
Mom can't actually tell me what happened, at the time her daughter was too small to talk for herself. The only real clue may have been that she was suddenly reluctant to go play next door with the neighbors kids. The clinic had done a courtesy examination and said nothing was wrong and left it at that. The police had said a case wasn't necessary as there was already one opened by the first victim.
And so the system let her down.

For most of the examination she is a honey. She sits quietly, not a peep. Only right at the end when the consultant joins the examination do the tears come, and our promise that nothing is going to hurt fall on deaf ears. Surprisingly, we get through it with very little kicking and screaming and as a bit of a lackluster consolation prize the kids get to pick a take-home-teddy
What happens next is a moment I want to burn into my memory forever.
A little face, with big, sad, uncertain eyes slowly melts into a smile when the teddies are presented and she is allowed to choose one. She spots one in a pink dress, plucks it out of the bag without a moments hesitation and hugs it close to her little heart. By the time my notes are finished and social workers have been called, the teddy has been inspected from every angle, wrapped up in a blanket and rocked to sleep.
It is in those moments that she melts back into the shape of a normal three year old girl, and the reality of the morning is a deep contrast to this innocence.

In Her Shoes

Edit: I would just like to say that having worked with the person in this post for more then a year now I have to say there is nothing wrong with her work ethic. She is one of my favourite people around and has never shot me down or not been obliging when I've had to phone for help or advise. Perhaps the first conclusion is more appropriate. 

You could spot them from a mile away - so out of place at seven-forty-five-ish on the cardiac morning round. Surrounded by Trainers and Crocs and the occasional cheeky sandal, they looked as at home as a slinky catwalk model in the middle of a 'Vroue Federasie' AGM.

The female obsession with footwear is not poorly documented. Most of us dream of a shoe-closest like Carrie in 'Sex In The City'. I love having a reason to slip on a pair of heels (not just because they add a few centimeters to my shortness) but because they make you feel more ... I don't know...stylish and grown-up. It's the way they finish an outfit, the way they sound when you walk in them, the way they show off a pretty pedicure and most importantly, make legs look skinnier. No one pulls off a power suit in pumps.
But they are made for women who do a fair amount of sitting. After a few hours they start pinching, and feet start burning and muscles start aching. That's why they come off when the party gets going, why they are work shoes and occasion shoes, not holiday shoes, or weekend shoes.
They certainly aren't intern shoes, or ICU shoes, or call shoes. In fact, they aren't hospital shoes.
This is not a job where you get to sit a lot. This is a job where you do a lot of standing, and walking, and every now and then when people stop breathing, occasional running. These are not 8 hour days, they are sometimes 12, sometimes 18, sometimes 28 hour days.
It just concerns me when someone has been around in the profession long enough to have an MBChB and a Fellowship Qualification, and then doesn't choose their shoes with the same wisdom they apply in choosing antibiotics and inotropes.

I know they say you shouldn't judge a book by it's cover, and probably in the same vein a doctor by her shoes - but I cannot help but wonder about the person who willingly chooses heals over flats in this profession.
I have to assume that

1. They have no idea what is about to hit them, in which case shame for them, or  

2. Their work ethic is going to be a problem, in which case shame for the rest of us.