I'd like to preface this by explaining that I was living with three productivity-prioritising boys, who recorded voice memos in order to collect 'anecdotes' come our interviews at the conclusion of medical school. The whole idea is calculated, inorganic, and also quite smart. I too attempted to record a voice memo while cruise-controlling my way through rural northern New South Wales, but unfortunately I speak in jumbles - not that my writing is much better, stream-of-consciousness and all - and the majority of the recording consists my commentary regarding a small yellow spider dangling from the rearview mirror.
Instead I am here, attempting to convey what it is I learned from a month-long placement in the countryside before the experience slips my mind entirely. Before I left I honestly thought I'd be writing a manifesto overlooking lush green fields and orange sunsets (trust that I'd romanticise a small town filled with cows and pubs). The picture was actually true to my imagination, except instead of manifesto-writing I was reciting flash cards. While the quiet repetitive nature of the place was subtly always present, I felt I was floating through this space over this time, unaware that anything was different. It's as if my life was put on pause and I have returned as if nothing happened. I can feel that I am different, but at the same time slot right back into my life before. This can be my version of a countryside-inspired piece, except with the overall intention of communicating medicine-related lessons to my future self in a digestible way.
***
I'll start by describing a few patients I found interesting.
Mrs. K was a 52 year old woman who had been in hospital for 92 days when we first encountered. She had two broken tibias, and was majorly depressed in COVID isolation at the time of my arrival. This woman was immobilised in bed for the entire four weeks I was in town, plus the 92 days before, plus however many days she might have to go - probably a lot. She had broken both bones following a fall, and was left lying on the floor for 24 hours by her husband and son before an ambulance was eventually contacted. Mrs. K was not considered a surgical candidate due to her many co-morbidities, and instead the dice was rolled to see if her bones would heal on their own. Spoiler alert, they weren't healing and this woman has been bed-bound for over 100 days now. I wondered what kind of solution this was, to condemn a woman to months - if not a whole life - in bed. Would physiotherapy ever be enough to solve the problem? Would she be better off if an orthopaedic surgeon took their chances? Would an orthopaedic surgeon ever bother to take a chance?
Although, surprisingly, as I came to talk to this woman day-in-day-out once she had overcome isolation, she seemed to be adjusting quite nicely. She had finished all 15 seasons of Criminal Minds and was joking with the staff. I wonder if humans truly can overcome and learn to love any situation if they have endured it for long enough.
Mr. R was admitted to the hospital from a nursing home due to aggressive behaviour. The man had a history of a traumatic brain injury, with half his frontal lobe excised, leaving a visible dent the size of a golf ball in his forehead. His aggression was the product of paranoia - a real fear that everybody was out to kidnap him. The frightened patient held a finger gun to the door, hands shaking, hair crazy like Einstein. His antipsychotics and antidepressants had to be crushed into his food. His referral letter from the nursing home read, "Mr. R has had four wives, wishing he could go back to the second," which I found only very random and endearing. As the days passed, Mr. R calmed down and could be seen sleeping peacefully or dopily eating his breakfast and whispering to his favourite nurse in a childlike manner. "Honestly, all this man needs is a single room," explained the nurse. "If you leave him alone and close the door he's perfectly happy. He's just scared of people coming and going in the nursing home and that's why he becomes aggressive."
Mr. B was a 92 year old man with a humeral head fracture and a sour mood. He really hated the hospital. Mr. B lived alone in a caravan and broke his arm by crashing his motor wheelchair into the side of the van, without his glasses on. Having explored these caravan parks and isolated beaches that stretched for miles, I could finally appreciate what people meant when they said they enjoyed camping. A friend I was hiking with marvelled at a woman serenely sitting in the back of her van, covered in Turkish blankets overlooking the ocean. I tried to picture Mr. B independently mobilising through the tiny amenities and long extension cords, and couldn't see that going well.
To be honest, the patient interactions on the north coast were not dissimilar to those I've observed in the city. Albeit, I have spent my last few placements in the West, where health literacy is much poorer and immigrants make the majority of the population. Differences in healthcare were due to the limited services available, with considerations made regarding the logistics of patient transfers to larger hospitals for specific procedures.
I was also told that the town had the second-highest population of Indigenous people in the state, and spoke with the Aboriginal-liaison officer who made two important points: 1) that a transfer to a different hospital is a much bigger deal to an Aboriginal person than to you or I, because they are travelling onto land that does not belong to their tribe, and 2) that family comes first. I recall a patient of ours who disappeared from the ward to go on a drive with her sister, missing an iron infusion. Any healthcare procedure or investigation was a commitment that went straight over her head, and if a family member wanted to hang out, she would waltz out of the hospital. As soon as she was told she could go home during ward rounds she left, before a discharge summary could even be written.
***
To comment on the doctors employed at the hospital, the consultants were overqualified immigrants attempting to re-climb the hierarchal ladder in a new country, and the single registrar and junior doctors were locum workers.
At the head of our team was a fellow who played the role of the consultant - an incredibly intelligent Pakistani woman who previously worked as an internal medicine consultant at a tertiary hospital. She treated each patient as a problem to solve, asking questions as if ticking blank boxes in a game of Cluedo, and concluding each consult with an answer narrated to the patient. Once the answer was an endearingly direct, "If you ask me, honestly, I don't know, but here are the possibilities..." Her method of teaching was to make up a scenario as if she were writing a long question for a math test. She was mechanical and graceful. This was the first time I had seen medicine performed so clearly and logically.
If anything, the male consultants paled in comparison, coming off as both less competent and more self-entitled. I watched as a male consultant became upset when his name was not present on the progress note, or argued with a nurse for interrupting him, or childishly yelled "WRONG" when I gave him an incorrect answer. He was not handling his demotion in this country with grace, but instead saw the unfairness as a direct insult to his manhood or something. And yet, he still asked for help in a small voice when called to a patient's family meeting, acknowledging the difficulty of explaining concepts of life and death when using a second language. Perhaps this was a reflection of male versus female roles in foreign countries, or perhaps men simply have bigger egos and less consideration than women in all countries.
The two junior doctors on our team were reflections of a role I would play in the near future. However, both were post-graduate medicine graduates who, as has been a recurring attitude of my superiors on previous placements, were somewhat put off by my flippancy toward this whole medical school ordeal. Of course I am not flippant, but neither have I prioritised my degree much until now. Medical school is just something I sort of do in the background of my life as a silly girl in her early twenties. The perspective I achieved from this is that undergraduate medicine thrusts children into an educational journey they are not ready to prioritise. 18 year olds simply could not care less about how the kidneys work. As these 18 year olds progress into 22 year olds they have won an easy ticket into being final phase medical students, having spent the last four years scraping through exams and partying and finding love interests and, most importantly, finding themselves. They never had to sit that big GAMSAT exam, or worry about their WAM, or make an executive decision about their career as they came out of one degree and willingly thrust themselves into another. I've been taking my learning much less seriously than these junior doctors had, and I'm behind.
The hospital itself was a textbook come to life, with bread and butter cases from all specialties of medicine. As the registrar grilled me regarding heart failure and elderly falls, the amalgamation of knowledge we call medicine became more cohesive and revealed the many gaps in my basic knowledge; and for the first time, I was actually excited to fill them. I wouldn't say my knowledge was destitute, but would instead admit that portraying your smartness to somebody is a gift in itself. My general flawed life philosophy has always been that the show doesn't matter. I'd never been one for aesthetics. I'd never understood the need for a clean room with nicely arranged furniture, or the romance of a candlelit dinner, or the purpose of nice-smelling perfume, or the problem with wearing pyjamas in public. In medicine, I never understood the need for jargon. I'd always thought big words were a mechanism of gatekeeping, and I may not be wrong. However, the one piece of feedback I have often received is that I must expand my vocabulary. I honestly think I am a little linguistically challenged, but the medical language is one I think I should learn.
On our last night in town, I made the boys watch Clueless. Their stream of commentary consisted complaints about Cher's stupidity - unable to see that she is endearing, and actually quite smart. Her intelligence is portrayed through pop culture and hot-girl anecdotes, rather than some elitist string of monologues. While I definitely think these boys are wrong, their perspective provided evidence that not everybody can see past the elitist or non-elitist surface. Sometimes the show means everything.
***
Living with these boys day by day taught me that planning is an advantage. I've always naturally been a planner, as most medical students are, but throughout the last few years have suppressed this urge in favour of the romance and chaos of spontaneity. Deep down, I am also aware that the suppression of calculated moves comes from a fear of an unexpected outcome despite meticulous planning. I am afraid of failure and disappointment in a way my naive younger self never was. Watching these boys sincerely try their best and blatantly move the pieces in their favour, I realised that I can do the same.
***
The countryside was really more of the muchness of muchness of life. They all said it was a 'city-girl goes to the country' situation, but I never really saw it that way.
Love,
M
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