Thought this was an interesting and informative piece. Hope you are enjoying
your summer! Mrs. Wood-Hill
 
  _____  


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 Title Image: So you want to be a doctor?
<http://www.abc.net.au/science/slab/doctor/img/slabtitl.gif> 

By  <http://www.abc.net.au/science/slab/doctor/biog.htm> Damon Shorter





We all need them at some point in our lives, but have you ever wondered what
it takes to become a doctor? Damon Shorter takes a personal look at the
confrontations and joys of his first year of graduate medical studies. 
 


 


doctor /'docta'/ n. & v. -n. 1a. a qualified practitioner of medicine. 3.
colloq. A person who carries out repairs. 
                                          - Australian Concise Oxford
Dictionary 

Two thirds of medical students faint on the job before they graduate. Our
tutor at Manly Hospital told us this, one of the many doctors who had
volunteered to introduce us to life in a busy city hospital, to help "ease
us in gently". From the way he told us you could tell he found the whole
thing amusing. He had been in our shoes, he knew how to scare us.

There were five of us in his group, including myself. On this particular
morning most of us still felt sheepish in our smart new hospital clothes,
trying not to look too out of place, bumping into trolleys and trying to
keep pace in the corridors as he strode from ward to ward. The format was
simple. Our tutor would introduce us to a patient, we would chat politely
and ask questions and later, in private, he would quiz us on what we knew
with pointed questions. We'd learn in subsequent months that this
interrogatory guessing game is universal to teaching doctors everywhere who
love to quiz each new generation of medical hopefuls.

"So, Katherine, what did you notice about Mrs U's ankles? A bit swollen.
yes, oedematous, and why would that be, do you think? Hmmm, yeeess. Anyone
else? That's right, and what about her lips?. a bit 'bluish'. yes, cyanosed,
and what would that be caused by.?"

This was the start of our clinical training. For the next four years in
hospital sessions like this one we would be expected to learn the skills
needed to become competent doctors. How to spot the difference between
indigestion and a heart attack, how to decompact a bowel with minimal fuss
and embarrassment, how to hear the heart of a squirming baby, push a
breathing tube down someone's windpipe without knocking out their teeth, or
how to explain to a relative stranger that they have just been diagnosed
with a horrible, progressive, debilitating disease. 

Medical students are expected to seize opportunities in the teaching
hospitals - queue up with stethescopes to listen to the crackling lungs of
the dear old lady in bed 8 with pneumonia who is slowly drowning, talk to
the quiet man with grey skin and downcast eyes who cries easily and ask
about how he's coping, watch as people bleed and scream on their way into
the emergency room. It's sometimes hard not to feel like a voyeur, an
intruder into the private misfortunes of strangers. At other times I've been
overwhelmed by the generosity of the terminally ill - patients who sit up in
bed, bravely let me poke their abdomens, cough on queue while I struggle to
hear their worn out lungs, answer my questions thoughtfully - and then
fumble to take my hand and wish me luck when I go. Such generosity from
people so sick is humbling, and common.

There is one man in particular who sticks in my mind. The supervisor in the
emergency ward that day had told me to listen to his lungs and report back
with my observations. It was a trick question - the man only had one lung,
the other had been removed two years previously, riddled with cancer, the
spot marked only by a long purple scar under his shoulder blade. That
morning he'd arrived back at hospital complaining of pain in his belly.

Neither of us mentioned it but we both knew his cancer might have returned,
perhaps at a different site, cloaking itself behind a new set of symptoms.
He was Scottish, humorous and talkative, in his mid-sixties, not yet an old
man. While I sat on his bed scribbling in my notepad he chatted about his
current complaint, his medical history, his working life, the lung
operation, the chemotherapy and his intervening good health. He told me he
was married to "a beautiful woman", had three grown-up children and a couple
of grandkids. 

He seemed to enjoy the distraction of talking and told me about his
emigration to Australia all those years ago, his business life before he had
retired. I listened to his heart and remaining lung, poked about in his
belly not quite knowing what I was looking for, I told him a little about my
studies. Throughout it all he seemed a little detached, on edge, as if a bit
of his mind was wrestling with something else. 

Eventually, quite unexpectedly, he broached what was troubling him. "I've
had a good life," he said matter-of-factly. "When the end comes, I hope it
comes quick. I've done most of what I hoped to do. I think I'll be okay with
it." 

He swallowed, gazing off at the wall behind me. "But then. there's the
wife," he said, his dear and beautiful wife. He told me how scared he was of
dying from cancer. "cancer's such a bloody horrible way to go". He was
crying openly without trying much to hide it, squarely sizing up his options
for the future, trying to anticipate the unknown. I couldn't think of
anything to say and just sat there on the edge of his bed, overwhelmed by
the enormity his situation and the frankness of his attitude.

Later, I went back to the supervisor and told him the clinical features I'd
observed. He was pleased I'd noticed the man only had one lung. I explained
that we'd had a long talk and he'd become a bit upset. The doctor confessed
he wasn't quite sure what was wrong with him - a complicated case. He'd be
kept in for more tests.

A month later we came across the same man in a different ward of the
hospital. Our tutor had arranged for him to be interviewed by one of us in
front of the group to assess us on our history-taking technique. Initially,
I was to conduct the interview but I recognised him when we arrived at his
bed and confessed I already knew a lot about his illness. He made a couple
of jokes but looked sicker than before, older, still scared, not as brave.
He told my tutor about our first encounter. His ill health was still
undiagnosed. 

I don't know what has happened to him since then, whether he has survived
for his beautiful wife and kids. I hope if he died that it was quick and
dignified, as was his wish.

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Another morning there was a young man in the intensive care unit, about my
age, regaining consciousness. He had tried to hang himself in his garage and
had been found by his neighbours. As he came around he was struggling with
the orderlies, trying to pull out his tubes and intravenous lines while they
kept doing their best to keep him calm.

"Take it easy, mate, we're trying to help you," they kept shouting at him
through his semiconscious daze. "You don't want to pull that tube out, it's
there to help you pee." He'd moan and thrash around. He was strong and at
one point about five people had to leap on his bed to hold him down.

His mother arrived shortly after we got there. The look on her face that
morning is still clear in my mind. Such a tortured combination of
conflicting expressions - horror, relief, shock, crippling guilt,
embarrassment - all hidden behind her brave attempt to smile when he saw
her. I can only begin to wonder what was going through that poor woman's
mind when she saw her son with the thick red welts around his neck and his
blood-shot eyes. Nobody at that stage knew whether he would suffer permanent
brain damage. I remember feeling utterly inappropriate alongside the other
students there in the ward, "accumulating clinical experience" on the
periphery of this woman's life tragedy.

Our tutors afterwards were philosophical about the experience. The young man
had schizophrenia, they said, a condition that can make your life a living
hell. Many do not live as long as he had. It was certainly tragic but not
unusual. More than anything, it was a hard situation, hard to ever reconcile
for the mother and son, hard to know what to do about it, hard for them to
explain to friends at their local bowling club when he had recovered, hard
to stop from happening again.

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I have not always wanted to be a doctor. As a school student, medicine for
me meant stale-breathed old people, runny noses, aches, moans and misery. It
was a profession for the sick that struck me as utterly depressing.
"Besides", I remember thinking with the wonderful clarity of a healthy
sixteen-year-old, "the world is overpopulated anyway".

By the time I'd finished my science degree at university a few years later
my negative opinion of the profession was even more firmly entrenched.
Medicine was cold, dehumanised and heartless, dominated by expensive
machines and multinational pharmaceutical companies that peddled sickness
and a quick-fix drug for every problem. Few doctors impressed me, most
seeming more interested in their careers and BMWs than the sickness and pain
of their patients - it was not a life I wanted.

It's hard to know when my opinion began to shift. By the end of university I
still wasn't sure what I wanted to do. I had always been a curious person
and found people intriguing, trying to understand what made them tick, how
bodies and minds worked, what made some sad, others happy, angry, depressed,
unreasonable. I've always talked easily with people, enjoyed hearing what
they have to say, negotiating. I was the one on the bus that the drunk
always sat down next to. I became a journalist. It didn't really occur to me
that doctors do these things too.

My skepticism about medicine has not disappeared but it has been tempered by
good experiences. There are certainly many puffed-up arrogant doctors
strutting around hospitals overwhelmed by their own importance who can
afford to act like kings because they have never ventured outside their own
blinkered medical world. However I have also met more than an equal number
of fine, humane people working in hospitals. People who are thoughtful,
compassionate, intelligent, capable - people I would want to look after me
if I was sick. Things are not as black and white for me as they once were.

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Not all of our experiences as med students are accrued in hospitals. One
Saturday I tagged along with an ambulance crew working the night shift in
inner-city Sydney. Most of the calls we attended were alcohol related -
party-goers passed out in gutters, one on the steps of an exclusive
five-star hotel, another woman who had been smashed in the face with a beer
bottle in a pub, breaking her nose. Others had symptoms that were far less
clear cut - a young woman who kept fainting in the casino and refused to go
to hospital, an hysterical nightclubber who was convinced her heart was
about to stop. 

One stunning nineteen year-old girl had swallowed a pile of pills in a city
dance club and injected more up her arm in the toilets to celebrate her last
night before going into detox. She kept sliding in and out of consciousness
during the trip to St Vincent's Hospital, slurring answers to our questions
as best she could. She looked like an angel on the stretcher in the back of
the ambulance; silken long black hair, smooth skin, not anything like what
an intravenous drug addict is supposed to look like. Her older sister had
come along with us in the ambulance. "I had no idea this was going to
happen," the sister kept saying, "I'm really sorry about this, I thought she
was clean." 

"Do you have any illnesses or allergies," the paramedic asked, ticking off
boxes in his patient chart? "Um. yes, HepC," she slurred. Christ! that may
well kill her eventually, I thought, stunned at the damage this beautiful
young girl had already sustained. "Thank you," she murmured demurely, as we
handed her over in emergency to the triage nurse.

Another call was for a diabetic woman who had been locked out of her unit
and needed food to restore her blood sugar levels. It seemed a routine case
to me. She was given something to eat, let into her unit and all was well.

"Did you notice her pupils?" the paramedic asked as we were driving away. I
hadn't. "Heroin, for sure" he said. The heroin had probably made her
diabetes worse, he explained, and also made her pupils shrink to tiny black
dots in the centre of her eyes.

I missed the chance to see heroin pupils on that occasion, but another
opportunity presented itself later that night. A young man had passed out
from a suspected heroin OD on a back street in Newtown. The treatment for an
opiate overdose is a drug called naloxone which, within seconds, completely
reverses the effects of heroin on the body. Only paramedic ambulance
officers are allowed to administer it, so the less-qualified officers from
the first ambulance on the scene simply kept him alive until we got there.

A few police were standing around when we pulled up, sharing the odd joke
with the "ambos". One of the ambulance officers had a mask on the bloke's
face and was bagging air into his lungs as he lay on the road. He was
dressed conservatively, had a neat hair cut, was in his early 20s and looked
like your average student out for a big Saturday night. His pupils were pin
pricks, just like the paramedic had said.

He came around about 20 seconds after the naloxone was injected into his
blood, a bit groggy but cold sober. He sat up on the road and looked around
at the two ambulances, police cars and the assembled group of people. "Where
am I?" he asked nobody in particular. One of the policemen told him in which
street and suburb we were. "You've just had an overdose," the paramedic
explained.

"Mate, could you give me a lift home? I just live round the corner from
here," he said to one of the ambos from his hard seat in the middle of the
road. "Sorry mate, we can't really do that," he was told. "I think we should
have a bit of a chat before you go anyway," one of the policemen suggested,
sounding sympathetic rather than intimidating.

The bloke stood up, noticed his wallet was gone, started looking around for
it, saw a couple of coins on the road, picked them up and popped them in his
jeans pocket. He looked a bit confused and scruffy but hardly like he'd just
been brought back from the brink of death. Had I watched the scene in a
movie, I would have laughed at the bad scripting.

The ambos packed up their bags, said goodnight and drove off, leaving the
cops to drop home the man with no wallet after his big night in Newtown.

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<http://www.abc.net.au/science/slab/doctor/img/linesp.gif> 

Looking back, the first six months of studying medicine have been more
confronting than I'd expected them to be, perhaps reflecting the style of
the course in which I'm enrolled. Sydney University no longer accepts
undergraduates into medicine, instead preferring students who already have a
degree in something else. Traditional lectures are supplemented by group
learning sessions and hospital experience is an intrinsic component of the
curriculum from day one. Similar courses have been adopted by Flinders
University in Adelaide and Queensland University in Brisbane, following the
success of a pioneering problem-based medical degree initiated at Newcastle
University in the early 1980s.

The new Sydney course began in 1997 and is radically different from the old
one. For instance, the first formal exams aren't set till the end of the
second year, although mock exams are written for us to help monitor our
progress. Students' backgrounds vary from degrees in music to nursing, vet
science, drama and physics, so everyone is expected to identify their own
weaknesses and address them. What we don't cover in class, we're expected to
learn in the wards.

On the day of our enrollment the Dean of Medicine at Sydney University,
Professor Stephen Leeder, gave us a welcoming speech. I was expecting the
standard drivel about striving to be the best, praise for being the smartest
of the smart, to be told that these would (again) be the best years of our
lives. I was pleasantly surprised.

He told us that his Faculty's job was not to teach us how to be doctors.
"Ninety per cent of the doctors you will be, you already are," he said.
Instead, the role of the Faculty was to give us the skills we would need to
practice competently and to encourage us to act morally and ethically. The
attitude impressed me.

I wonder now how my attitudes will have further shifted by the time I
graduate in 2002, or after having practiced in the real world for a few
years. Many doctors are obviously unhappy in their chosen career - something
reflected not only by what they say, but by alcoholism and drug abuse
statistics which are amongst the highest of any profession. Suicide rates
are also frighteningly common for young interns; every doctor has a story of
an intern they knew who didn't cope - and doctors more than anyone else know
how to suicide effectively. I wonder whether I'll become callous and
hardened to normal emotions as monotony and routine take over from zeal and
enthusiasm - whether working as a young doctor somehow forces you to forfeit
your empathy as a human being. 

Perhaps more than anything else I dread the day that I make a mistake, as
every doctor inevitably does, which harms a patient, and pray desperately I
never make an error that kills someone. It can happen so easily - a
mismatched blood transfusion, a drug label misread at the end of a long
shift, over-looking a crucial sign on examination and sending a
critically-ill person home from emergency. My stomach churns just thinking
about it and how such an event would leave you feeling.

I wonder too how my life might be shaped by the lifestyle, the hours spent
in hospital wards at night, and whether I will grow to resent the profession
like other medical students have before me. I muse whether I could ever find
golf an attractive leisure activity, whether one day I might suddenly wake
up and decide to wear a bow-tie to work or that I might begin to see value
in a BMW convertible sports car. I look at my friends studying alongside me
and wonder which of them I would want to see if I became sick.

Everyone has questions about their future. These are mine. 


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Original source: http://abc.net.au/science/slab/doctor/default.htm