‘Bring a pen and guard it well,’ I tell the two eager faces in front of me. This advice should rotate through on some sort of scrolling alert bracelet for new clinical students. The sort of wearable cheat sheet that would also beep to remind them to always close the door when leaving the doctors’ office, and give them daily reminders like: ‘No-one cares which high school you went to’ and ‘Avoid offering unsolicited advice to patients or their family members, especially when prefaced with as a future doctor’.
Clocking how annoying I must sound by the look on Bonnie and Jonathan’s faces, I tell myself to relax. My welcome-to-the- ward pep talk has to be cautionary yet supportive. New medical students, I remind myself, are more scared of me than I am of them, and in their heart of hearts they don’t intentionally want to aggravate the people they meet. Most of them anyway. My last student didn’t turn up for her five-week placement, so I am really looking forward to having a few extra hands on deck to carry stuff and do busy work. This isn’t mean because newbies just want to feel useful, and feeling useful is a key predictor of students returning for a second day of clinical placement, and while the medical students get to learn how to be junior doctors, I get to do less unpaid overtime. Win-win.
Bonnie is a postgraduate medical student who originally studied to be a pharmacist. This means I must know the therapeutic guidelines rote when speaking to her otherwise she is going to see me as a fraud. She is wearing pants and sensible shoes so maybe we can be friends.
Jonathan is an undergraduate medical student who appears to have entered university after a stint with a remote, bush-based fertility cult. He has Jesus hair, a landscaper’s tan and an armful of dirty old festival wristbands. Beneath his untucked plaid shirt he is wearing black ripped jeans, and he will not stop picking at his nose ring. He has remembered to bring his own pen so at least we have that.
I ask Jonathan if I can call him Jon. I cannot.
Today is one of our twice-weekly consultant ward rounds. This is a time for juggling folders and writing notes quickly as we try to competently assess our twenty patients in the two hours the hospital has excused the rehabilitation consultant from clinic. Also, for the consultant to talk with all the family members who do not believe that registrars and residents are real doctors.
I ask Jonathan if I can call him Jon. I cannot.
The registrar is madly clicking through pathology results on the off-chance something useful has come back positive. I’ve already packed the patient folders in a trolley, ready for us to round once the consultant arrives. Together we’ll decimate a task list that could otherwise be conquered by one junior doctor if they had a combination of an eidetic memory, a traumatic injury to the part of the brain that handles obsession, and a reliable method for obtaining drugs designed to treat childhood attention deficit disorders.
‘Bonnie, your job for the round is to check the observations chart for each patient then feed me the vital signs so I can write them in the progress notes. Can you also check each patient’s bowel chart to make sure that none of them are trawling for a gloved finger up the backside later today?’
Bonnie palms bed one’s chart and offers back a brisk nod. ‘Jonathan, you’ll be responsible for preparing the folders from the trolley so they’re open to the right page by the time we get to the bedside. Can you also make sure the curtains are shut before we start examining, please? And have the hand sanitiser ready – the infection control nurses are auditing this morning.’
Jonathan unscrews a bottle of alcohol rub from the wall mount and spills a third on the carpet just as the consultant walks in. She saves him the embarrassment by pretending not to notice. The registrar groans and throws a tissue box at the problem.
‘So yeah, with you guys helping, we should be able to get through the round a bit quicker so that we have more time for teaching,’ I say.
Two and a half hours later, we have only managed to see eleven of our twenty admitted patients.
‘Mrs Papadopoulos is a 71-year-old lady from home alone, admitted to rehab two weeks ago for ongoing chest physiotherapy and reconditioning following a prolonged acute admission for community-acquired pneumonia,’ says the registrar. ‘Her past medical history includes brittle asthma, insulin-dependent type two diabetes and osteoporosis secondary to long-term steroid use for her asthma. She is a non-smoker and usually ambulates independently on a four-wheel frame. Currently medically stable. The plan is to discharge her to an appropriate location in the next few days.’
The registrar is trying to be upbeat, but Mrs Papadopoulos looks like she is mostly pickled at this point and doesn’t seem to be mobilising on anything. Her nurse is spoonfeeding her pureed spaghetti bolognese for lunch because she can’t swallow anything solid. The few times Mrs Papadopoulos has tried to eat something with any discernible form – like the boiled strawberry lollies I know she still has hidden in her mattress – she has borderline asphyxiated. We discuss mobility goals, antibiotic goals, not-choking-to- death goals and discharge planning goals. Mrs Papadopoulos has seven children. Unfortunately, none of them are able to take her in, so Beth is paged to begin the social work hunt for a public nursing home bed.
The registrar is trying to be upbeat, but Mrs Papadopoulos looks like she is mostly pickled at this point
Two more patient reviews then the consultant decides she can’t ignore any more calls from the overbooked falls prevention clinic she was due at an hour ago. Vague instructions are left to call her with any problems. This is code for ‘I won’t be able to leave clinic but at least we can have a moan about medical administrators together.’
‘Divide and conquer, divide and conquer,’ the registrar and I chant as we divvy up the six remaining folders. The registrar takes the easy reviews because she looks closer to passing out from the combined effects of dehydration and low blood sugar than me, as evidenced by her defocused gaze and furniture walking.
I get the harder cases.
Our new overnight admission, Mr Roy, is a morbidly obese man with weeping pressure wounds and fungal infections invading his rolls of fat, and by rolls of fat, I mean huge dollops of loosely hanging tissue with no distinct anchor points to his body, which ebb and flow like flotsam on the incoming tide. He is also suffering from intermittent confusion secondary to a bladder infection kicked off by static, glucose-rich urine, which can barely leak out around the overhanging fat apron that has swallowed his groin.
‘Good morning, Mr Roy. It’s Amy, your doctor. I’ve got two student doctors here with me, Bonnie and Jonathan.’
Mr Roy does not acknowledge the students. He doesn’t acknowledge me. He just stares at my left hand and frowns.
‘Mr Roy, how are you feeling today? Are you getting any pain from your pressure areas?’
‘You don’t have a ring.’
I feel both sets of student eyes slide my way.
‘No, I don’t.’ I unthread the stethoscope from my neck. ‘So, do you have any pain?’
‘At your age, my wife was in the kitchen with a baby on her hip, and that’s where you should be too, before your eggs and whatnot shrivel up.’ Mr Roy snorts back a throatful of phlegm to emphasise his point.
I know I should be kind. He doesn’t know where he is, he doesn’t know what year it is, and he doesn’t know that the whole ward can see where his testicles used to be through the bottom of the bedsheet that he’s wearing as a hospital gown.
He doesn’t know where he is, he doesn’t know what year it is.
He also doesn’t know that, at this very moment, I would much prefer to be in a clean kitchen with a ring on my finger and a chubby-thighed baby on my hip, rather than discussing my fertility odds with a man who probably thinks I chose healthcare to attract a wealthy doctor husband.
I place my stethoscope on his bare chest hoping he will take it as a prompt to shut up and breathe deeply so I can assess how little oxygen is making its way into the bottom of his lungs. Instead, he coughs up a half-chewed, tomato-sauced meatball onto my chest. This wouldn’t have been a problem if we were allowed to wear white coats or scrubs on the ward. We would laugh about him scoring a three-pointer then I would go freshen up in another set of industrially laundered clinical wear. Unfortunately, this hospital’s professional dress policy clearly states that medical staff must look like globetrotting business executives at all times so that our clients don’t feel intimidated by doctor costumes. And, of course, it’s our duty to cover the cost of replacements every time a sick patient moves a body fluid in our direction, reinforcing the hospital’s clear commitment to improving doctor–patient contact. Bonnie magically produces a damp face washer and helps me sponge off my ruined blouse as we leave the room. Jonathan lags behind.
‘Word of advice, mate. Never trust something that bleeds for a week and doesn’t die.’ Mr Roy pats Jonathan on the arm and winks in my direction.
Jonathan laughs.
Jonathan is not a clever medical student.
This is an extract from A Little Unwell (Hachette Australia), available now at your local independent bookseller.
