Gen Med - A brief reflection

Four weeks had past since I finished my Gen Med rotation. Not intending to be boastful, I knew I would survive the rotation. However, I was surprised that I had not suffered a mental breakdown (thankfully) from the busy rotation. To be honest, I was at the brink of it:

It was a Monday - we had loads of new patients - ward round ended late - it was my reg's half day - she had to leave early - I was left to manage a sick patient who was actively bleeding - I had to reverse the warfarin effect which I had never done before - that took me a while to organise - my pager kept buzzing the whole day - blah blah blah!

To keep it short, it was crazy. I wanted to scream and run away. But, I kept reminding myself to maintain calm and keep things under control. Eventually, the day past by without significant issues. After all, it was a learning experience.

Each day at work, I would never fail to receive a new patient who presented with either dementia, delirium, falls or (near) syncope. Yet, I am by no means an expert in managing them. Almost all would have long significant past medical histories, and hence thick medical files - one even with almost 20 volumes of medical history!!! Imagine needing to make referrals for these patients and you are bombarded with lots of questions from the other end of the line. It is still a challenging and nerve-wracking task, but I certainly believe that I'm making some improvements.

I still vividly remember the day I had to call a Code Blue during my weekend cover shift. It was a 70+ year old patient who came in with rapid AF and developed some fluid overload. She was given an increased dose of metoprolol and frusemide in the morning. Just before dinner, I was called to see her as she was quite sick - she was quite pale and peripherally cool/shut down. Her HR and BP kept dropping (to the point that the BP was not measurable) despite giving fluid boluses. It was harrowing to see the patient deteriorate in front of my eyes and I decided that Code Blue was the most appropriate thing to do.

Perhaps, my experience in managing sick patients may not be as bad as dealing with families. I can't forget the day I was reproached by a patient's daughter. The patient suffered a rapid decline in her function and cognition for the last six months; its cause unknown and hence she was admitted on a Friday for investigations. An urgent MRI was organised by the admitting unit, but for some unknown reasons, was not performed over the weekend. She was then transferred to my unit on the following Monday and before I knew anything about the patient, her daughter called and vented her anger at me for not doing anything. I understood that she was in distress (who wouldn't), but I found it difficult to accept that she directed her resentment at me. I wanted to tell her off, but did not see any point in doing so as it would only escalate the problem. I must admit that I was a little upset after the phone call. I did my best to hasten things, all which eventually occurred. At the end of the day, it was satisfying to see that the patient's daughter was appreciative.

Overall, Gen Med was a challenging but valuable experience, which many of my colleagues agree. Some despised it but I enjoyed it very much.

As you can see, I ramble a lot about my work. I like speaking to and listening to my friends/colleagues for they are excellent ways for us to learn, to share our experiences, to provide support and also to de-stress from our ever demanding jobs.