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It appears that I now only blog once in every 4 months, when I complete a posting. Fun. So, I was in Paediatrics for the past 4 months. How quaint right, from O&G to Paediatrics, with a sense of order to things. Initially I thought O&G was bad with it’s medicolegal repercussions, but it appears Paediatrics is worse off.

Prior to going to the department, everyone said that you will enjoy your Paediatric posting, and everyone is one happy team. I shrugged it off as misplaced optimism. I was wrong, initially. The paediatric department is an awesome place to be in, barring a few annoying things, which I’ll get to shortly. As one who prescribes to the importance of optimism, I shall start out with the cons of the department.

The Not So Fun Stuff

Incident Reporting -  There is a significantly high chance that you will be filling up an incident reporting, or writing an explanation letter for shit that happens in the department. When I started, I was told, if you accumulate 2-3 of those under your name, your name is up for extension. I still don’t know if it’s a fact, but I’d not worry about that too much.

Blood Taking – Have you ever tried taking blood from a neonate that weighs 800 grams? Yes, 800 grams. It’s a bitch, but with a bit of effort, skill and patience, it can be done, and I’m not talking about using an arterial line that has already been preset! Although not everybody will be trusted to acquire blood from a baby that weighs 800 grams, the bigger babies weighing around 2-3kg can pose a challenge, especially if your colleagues have had fun raping every visible vein.

Neonates – Neonates by themselves are cute and cuddly, and fun to trick. However, if you have to cover 110-120 of neonates, especially when you’re working on a weekend or a public holiday, that’s where things start getting messy. On top of reviewing each and every one of them, some of them require repeated blood taking, if they are under phototherapy or ventilation. Impossible? Not really, tedious; – quite so.

Gossip – One thing that I have noticed in Paediatrics is that, everyone gossips! I once complemented a colleague on her haircut, and she said suspiciously, “Oh shit, what have you heard?!” Naturally I was confused and she said that this is paediatrics, and since we can’t talk to our patients, we end up gossiping.  Fun. It’s not really a bad thing, but sometimes it gets ridiculous! Once, there was talk amongst the housemen that one particular MO is a Para 1 so she is taking leave to take care of her child! Ironically, said MO is unmarried, and still nulliparous.

Infection – Every housemen that works in wards 7D and 6B WILL  get sick. Be it acute tonsilopharyngitis, or severe AGE, it will happen, there is no escaping it. I usually work through it, once with a fever spike of 40*C, but it isn’t a pretty picture. I don’t know what these kids have, but, Jesus Christ it’s powerful.

The Good Shit

Safety Net – The department is great for first posters, as the safety net is huge. The MO counter checks everything you do and answers to all calls with immediate effect. In the beginning it’s quite annoying because you are shadowed completely, but once you mature in the department, and they start trusting your management, it gets better. So naturally, it’s nice to for once have that initial, “So guys, this is how we manage xyz” instead of the “Aiya, this one also you dunno ar?”.

Teaching-Orientated Department – The department takes pride in being one that expects all the housemen under them to be educated. Teaching – Compulsory, MO covers the ward while you go. Before you off tag, you must undergo several CPG teaching with senior MO’s. Journal club where we discuss relevant research papers and attempt to apply it in our scope. It’s not about getting the work done, it’s about learning and knowing why you’re doing what you’re doing and how it works.

Awesome Specialists – Every…single….one of them. All the specialists in Paediatrics (at least those who are currently in Paediatrics) are awesome. All of them are dedicated (in their own way) and make every effort to teach any houseman that is willing to learn. Rounds in the morning isn’t just regurgitating the case, it’s about discussing everything that is wrong with the baby, why it is happening, what we should do, and how we should do it. This means rounds end later than usual, but it’s worth it! Once had a 30 minute discussion (note discussion and not grilling session) on premature baby and LBW babies, and introducing supplements. The specialist finished rounds with just me at 10 a.m. before she went on to the next nursery to cover the cases there. She started rounds at 8 with me.

Procedure Galore – Anyone who knows me, knows that I believe in attempting everything the department has to offer. This department has tonnes of it. Of course not really surgical in nature but as with every department, I try to get full exposure by doing everything. Lumbar Punctures, UAC, UVC Insertion, Long Line (under HEAVY MO scrutinization – he insisted on holding my hands as I pushed in the guide wire!), SPA, Cardiac blood, Intubating neonates, and several others. The only procedure that I couldn’t do was chest tube (Specialist only) and intraosseus as there was no case 😛

Colleagues – Team Work is awesome in Paediatrics. In Medical, it was, save your own ass first (I hated people who did that, and always took time to assist colleagues), in O&G the buck ended with you, and moved on to your MO, but in Paediatrics, sweet Jesus. Once I was working in the neonatal ward on a weekend with 120 babies to see. My colleague who was supposed to join that day turned ill and had to EL. I was doing morning rounds with the MO and word got out that I was alone. Without being asked, colleagues from other wards that had completed their work, came to assist. I shed a man tear seeing that. I don’t know how the situation is with the newer people, but I tremendously enjoyed working with all my colleagues. If you needed help, all it took was a phone call and no matter what people were up to, if possible, they’d attend to your need.

So, I will, God willing be finishing Paediatrics on the 17th! Just have to chug it out for a few more days. My specialist came to the labour room yesterday and hinted to me that I have flare for paediatrics and I should consider it. I don’t know if this is my calling. I’ll wait till I’m done with surgery to decide.

Here’s to looking forward to the next step;

Joyfully yours,

-Karthik

It’s finally over. 4 months of O&G comes to an end this Sunday. With my end posting leave in effect, today is my official last day. Honestly, this department was a bitter sweet experience.

When I first started, I was extremely ticked off that you had to inform your seniors over every damn thing. Even on things that you obviously knew what to do. However, as I matured in the department, I realized the medicolegality of things, especially when shit hits the fan, and I understood the need to get someone senior to collaborate your findings. Anyways, coming from Medical, this was obviously a difficult change, because in Medical, you’re the first line, and you start treating the patient. In O&G, you’re quite often made to think you’re a clerk, but seriously, I just wouldn’t go with that.

As with all postings, it is my utmost desire to expose myself to all the procedures. I feel, to establish a good footing in any posting, it is first vital to observe, and if possible attempt all the relevant procedures. I must say that in O&G, theres always a procedure you’re gonna need, but luckily, colleagues are more than happy to switch the ward/OT/LR they are covering with you should you need a procedure from somewhere specific.

O&G started out exciting for me, but I was kept in the antenatal ward for 5 weeks. It was brutal, but I am thankful for it. I can honestly say, I became confident with my VE’s, S&S, Prostin Insertions because of the long stay in antenatal ward. I also learnt how to manage chicks and their labour. In HTAR, the general consensus is, 4 cm – ARM. 8 CM/9CM/Fully, then push to labour room. Sometimes, when you just observe the progress of a chick you’d know for sure if you are too generous with her os finding, go ahead with an ARM, that she is going to be diagnosed as prolonged labour and an unnecessary c-section would be done on her. I know it’s a cliché thing to say, but honestly, it does come with experience. As you go, you’ll just know how you should manage a specific patient, and can tailor the management, specifically for her.

Towards my last month, I was chucked in the Gynae/Onco ward. Whilst not as exciting as the other wards, It sure did give me a new outlook to life. Whilst here, I was given the opportunity to assist two great men. One specialist, who is the most humble man I’ve ever met. The first day I am meeting him, in the OT, I greet him and introduce myself, and he offers me his hands, shakes mine, and says, okay, lets get this TAHBSO done. After we’re done, he says, thank you very much for helping me, I appreciate it. When I heard a specialist speak like that, my heart figuratively sank. Wow. Another Consultant, was the nicest man you’d ever meet. He’s in charge of the Onco section of the gynae ward, and all his patients love him. He’s now in the private sector, but still makes time to come see his patients, and even goes as far as performing op on them. The best part about him is that he is extremely tall, in fact taller than me, which means I don’t have to end the day with a sore back after a 5 hour surgery.

All in all, O&G was a great experience. I must honestly say I now have new found respect for all women. I used to be really chauvinistic, but seriously, these 4 months has seriously changed me. I’ve seen what kind of assholes men can be towards their wives, I’ve seen how these women don’t have an ounce of independence, and how they are completely subservient to their husbands. I’ve seen women refuse oral contraception because the husband doesn’t allow it, because she’d gain weight. I’ve seen a woman dare not even talk about contraception without first asking the husband for “permission”. Seriously, are we still in the stone ages? If you get pregnant again, it’s not him who is going to face all the risks! These are just the tip of the iceberg, you’ll see it all later when you go through O&G.

In finishing, as I said earlier, to ensure that you get a holistic exposure to any department, you must observe, and at least attempt every procedure allowed. I’m happy I did.

Looks like the next department to go to is Paediatrics. Hopefully it will be a good journey into the unknown.

Cheers,

God bless.