Geriatrician or Social Worker?

It’s the second week of geriatrics. And my first impression of this specialty is – it’s a lot of social work! In fact, I would say it accounts for the majority of the work by everyone from the resident up to the consultant. The ward I am attached to is mainly for elderly amputees to go through rehabilitation after their amputation so they can go home with the skills to live as normally as possible.

Although the patients are mostly elderly people who have multiple co-mobidities like diabetes, heart failure, COPD, peripheral vascular diseases, etc., which make them very interesting patients as far as pathology is concerned, their conditions have largely stabilized by the time they are ready to go to the geriatric and rehab ward. So the main focus on the ward is their rehabilitation; their medical conditions have almost become a secondary issue. As they go through the process of going to the gym to gain their strength back and learn to use the wheelchair with help from physiotherapists, the doctors are busy coordinating the allied health team to work on their discharge – home visits to assess access issues in and around their houses, arranging Meals on Wheels for them, booking the Blue Nurses to care for them post-discharge, arranging house-cleaning, and for those not fit enough to live in their own homes, plan for discharge to nursing homes. A meeting is held weekly for doctors and allied health professional to discuss each patient on the ward and to assess their progress and the progress of the work being done to address the patient’s living situation.

While it’s great to see that patients get such thorough treatment to make sure their transition from hospital to home go as smoothly as possible, it appears that this specialty involves more social work than the practice of medicine. Is this the result of the break down in the social fabric of Western societies? Traditionally, people go to the hospital when they are sick; and when they go home, their immediate or extended families take on the role of care takers. Now that role has been assumed by the health care system and, at least in Australia, largely by the government. From a rational point of view, it makes sense – the patients’ family, now unburdened with the work of caring for them, is free to devote their time on work and, by extension, contribute to the national economy. But from the humanistic point of view, the care the patients receive from the various government agencies and professionals, however great, cannot make up for the feeling of being cared for by someone close to them. Of course, many of these patients are fortunately enough to get the best of both worlds: they are under the care of a family member, with help and subsidies from the government. Their main carers can get various benefits like pensions from the government and carer respite to prevent burn-outs. It is reassuring to see that, under the generous welfare state and the social safety net in Australia, people can age with dignity, even with debilitating illnesses.

In Retrospect: Zion National Park

In July, 2004, I did a cross-country drive from California to Washington, DC. Along the way, I stopped and visited a number of national parks in the western states. Southern Utah consists of a number of national parks, national monuments, and national forests – a great place to be if you like the outdoors.

Map of the US with location of Zion National Park marked

The road leading to Springdale nestled among the mesas

The red-tinged road inside Zion

Angels Landing, the tall rock formation on the left, forms part of the canyon wall

The shuttle bus is just a dot at the bottom of the canyon when surrounded by the massive cliffs

View of Zion Canyon from Observation Point, 670 meters from the canyon floor

The sheer drop off of the cliff offers spectacular views and gives you sweaty palms

Pine trees and cacti coexist here

Rainwater has carved out their preferred course through the sandstone canyon over the years

The layers of the soft Navajo sandstone is revealed after years of the polishing action from raging floods

The canyon comes to a point at The Narrows along the Virgin River

Rock formation and pine tree

The Zion-Mount Carmel Highway winds its way up the canyon wall

Thumb-Twiddling Time

It’s almost noon. I’m standing next to the team of doctors on ward round, fighting the urge to shake my legs or do fifty jumping jacks or do a sprint down the hallway, anything to keep me from falling asleep and crashing on top of the patient. No, I am not sleep-deprived, I am just incredibly bored. It seems that in this rotation, the student’s role is to stand back and watch. I am but a mere observer on ward rounds, at clinics, and on consults. It is really hard to stay focused when I know I am not expected to contribute anything more than getting the patient’s charts. So I stand back, twiddle my thumbs, smile at the patient, and watch the team in action. Occasionally I find myself dragging my mind back from outer space when the team is ready to move on to the next patient.

Perhaps this rotation isn’t really that different from any other ones, but it feels especially jejune from the stark contrast to my elective, where the excitement of being in a new and exotic place and being able to do so much made it a joy to go through each day. So it was inevitable that the crash back down to earth hit me hard as I returned to the daily grind. I have found myself, on more than one occasion while ward rounds start to drag on, taking my mind ten thousand kilometers away and replaying images and episodes of my time in Zambia. Good times…

In Retrospect: Namtso Lake

I was going through my back up hard drive the other day and realized I have taken over sixteen thousand photos over the last six years, most of them travel-related. So I went through each folder and looked at all the photos. Each one of them brought back great memories: traveling solo, setting my own itineraries, making decisions on the fly, meeting great people, sampling exotic foods… And then before I knew it, hours were gone. What a great way to procrastinate!

So I am going to choose photos from random locations – photos I took before I started this blog – and post them, along with any relevant stories.

First up is Namtso Lake, one of the sacred lakes in Tibet.

I spent a month in Tibet in October, 2003. Four Swiss backpackers I’d met in Lhasa and I hired a four-wheel-drive and went around to different monasteries for a week. We spent one freezing night by the lake at a “guesthouse” set up by the locals, sleeping in a drafty canvas tent on creaky cots under heavy cotton blankets that had never been washed. The wind howled throughout the night. But it was worth it, the place was very spiritual and the scenery was amazing.

Namtso Lake, in relation to Lhasa, Tibet's capital

The dirt road threads between mountains, leading to Namtso Lake.

The weak morning sun shines on nomadic yak herders camping by the lake at 4700 meters in elevation.

Yaks and horses graze on the grass at the foothill of the mountains surrounding the lake.

A Tibetan takes water from the lake in the morning.

Prayer flags are strung from the top of the hill to the edge of the lake.

View from the top of the hill of pilgrims walking along the kora next to the lake.

Two pilgrims on their way around the kora, with the snow-capped Nyenchen Tanghla Mountain in the distance.

Pilgrims walk past the khata-covered rocky outcrop.

Prayer flags flutter in the wind, carrying the prayers to the gods.

Prayers written in the Tibetan script

Tents belonging to the nomads dot the landscape along the shores of the lake.

Two nuns contemplating? Or are they just chatting about the weather?

Pilgrims make offerings at a prayer point.

Silhouette of pilgrims making their way toward the end of the kora in the fading light after sunset.

I am wearing everything I own. The sun is blindingly bright, but it is not working very well at giving warmth at the moment.

First Class, Cattle Class

After ward round, the consultant brings us into the doctors’ lounge for a break.

With a wave of the doctor’s badge, the translucent glass door slides open, Star Trek-style. With one step, we enter a different universe that is the brand-spanking new multi-million-dollar doctors’ lounge. The décor is ultra-modern and looks straight out of an IKEA catalog: light wood-paneled ceiling with spotlights beaming down on streamlined couches, abstract metal sculptures seem to float effortlessly over the minimalist coffee table resting on the slate floor, next to the restaurant-grade refrigerator with glass doors, a professional espresso machine spits out fine coffee made from freshly ground premium beans at the push of a button, you can even froth your own milk. While enjoying your cup of coffee, you can flick through every channel available on cable on one of the Giant LCD TVs. Down the other end of the room, beech-veneered lunch tables and translucent lunch counters are impeccably paired with ergonomic stools and chairs. The whole room overlooks the hospital’s courtyard through tinted wall-sized windows. In another room, computer workstations are set up with comfortable chairs and soft lighting. I stand there like a farm boy in the big city, marveling at everything; the setting, more suited to a fancy private hospital, is rather incongruous in this public hospital.

After the break, we walk out of the lounge and back into the utilitarian hospital hallway. I slip back into the med student common room directly across the hall. Compared to the doctors’ lounge, the student common room is downright proletarian: mismatched and well-worn chairs and couches in green and brown and every other shade in between haphazardly arranged around tables with dull laminated tops and wobbly legs, harsh florescent lights fill the room, and the industrial linoleum floor ties everything together, giving it that institutional feel only a hospital can. An old TV sits forlornly in one corner of the room; the five free-to-air local channels are your choices. Before the new doctors’ lounge was completed a year ago, the junior doctors shared the common room with us students. When they moved to their new digs, the free instant coffee and tea left with them. But to show their pity and generosity toward us, they left behind the warped pool table with ripped felt.

Maybe it was a way for the hospital to let us know, ever so subtly, what they think of med students. Or maybe it was to show med students what we can look forward to and, to make us appreciate the new lounge, a bit of contrast can be useful. Of course, making the doctors’ lounge “absolutely forbidden” to med students unless accompanied by a doctor isn’t exactly an ego booster for us who are not even on the bottom rung of the ladder yet. Just think, at the end of November, we will still be lowly med students who don’t even warrant a flicker of the eye; but by next January, those of us lucky enough to be an intern at this hospital will have unrestricted access to the lounge and the right to sit in the same room as the most senior consultant.

Unless there’s an ultra-luxurious, ultra-secret senior doctors’ lounge somewhere else in the hospital that only the very privileged would know about.

Warholic Culture

Quick, who do you think of when you see panels of technicolored Marilyn Monroe or Mao? Of course, it’s none other than Andy Warhol, that weird dude who also brought us paintings of giant Campbell soup cans and all things previously thought to be un-art worthy. He is either enthusiastically embraced as the cultural icon who elevated the lowest common denominator and made art accessible to the general public or passionately loathed as a fraud who shamelessly presented advertisement and crass commercialism as art.

I tend to agree with the former. I love Warhol, whose work is on exhibit at Brisbane’s brand new Gallery of Modern Art. This is the last weekend for it, so of course I am making a day of going to see it. Not that I haven’t seen his work before, I had visited the Andy Warhol Museum seven or eight years ago when I went to Pittsburgh, Warhol’s hometown, to see a friend. But it’s good to revisit great art like this.

As I walk through the exhibit, it suddenly strikes me that the material on exhibit is very American. The exhibit shows a snapshot of the American pop and underground cultures of the sixties and seventies. Does the Australian audience get the cultural references and know the subjects of the artwork? I think most of them do – the Coca-Cola bottle is universally understood, international superstars in their days like Liz Taylor and Elvis are instantly recognizable, even the series with Jackie Kennedy wouldn’t be too foreign to Aussies; pieces like the Oxidation Painting where squares of copper-coated canvas were urinated on and then allowed to oxidize to immortalize the patterns of urine splatter are both base and sublime – the main determinant is probably generational rather than national. Of course, this exhibit would probably feel infinitely more foreign in some parts of the US than the cosmopolitan city of Brisbane.

I spend the rest of the afternoon sitting, with coffee in hand, with my friend Pedram at the open-air café overlooking the river.

After a year out in the cultural desert that is Hervey Bay, it is good to be back in Brisbane again.

Free Food!

Back in college, wherever there was free food, there was I. The event, the organization, the place were all irrelevant. And it is still the same ten years later. Tonight, the local organization of general practitioners is hosting a dinner for fourth-year medical students at a golf club. Needless to say, I am there. Oh yeah, I am considering GP as a possible career option in the future.

Thinking showing up to a doctors’ gathering at a golf club on a bike may be a bit weird, I decide to drive. I pull into the parking lot, pass all the fancy and shiny cars, and find a space to park my little hatchback next to a late model BMW. Walking into the club house, I am handed a name tag and am immediately presented with a tray of beer and wine for my choosing. Free booze, trays of hors d’oeuvres floating around, and people standing around exchanging witty remarks – it’s time for schmoozing. I hate schmoozing under any circumstances, even when I don’t need to be selling myself. I scan the room, looking for cover. Spotting a group of other fourth-years nearby, I shuffle up to them to find safety in numbers and familiarity.

After a half hour, we sit down at the tables for dinner. The rest of the night consists of great food and interesting talks from two of the GPs about their work. It appears that the emphasis of the night is on rural GP work, as both GPs recount their experience while working and living in a small town in far western Queensland. Seeing that Australia needs a lot more GPs, especially in rural and remote parts of the country, it behooves GP organizations like this to recruit soon-to-be doctors into their ranks.

As far as GP is concerned as a career option, I am actually putting it fairly high on my list at this point. I know, GP is not as sexy as, say, cardiac surgery or emergency medicine, or even any of the other hospital-based specialties, except maybe microbiology. But the lifestyle appeals to me and the general nature of the work – you never know what’s going to walk in the door next – makes it interesting. The training is short: only four years. As a GP, you’d get to build up a patient base and get to know them quite well over the years, especially in a smaller place where the population is not transient. Yes, to some specialists, you’d be “just a GP.” But if the choices are either to be the jack of all trades but master of none or to be the master of one thing and forgetting everything else, then the jack of all trades sounds pretty good to me.

At the end of the night, I don’t think my feeling about GP work has changed. But I do have to say the food was great. Sadly, we med students probably won’t be wined and dined like this by other specialties. Sigh…

Specialties Galore

“What do you want to do when you grow up?” is a question we all have to think about from time to time as we are in the process of growing up. I knew I wanted to become a doctor even when I was in elementary school. Now that I’m at the cusp of becoming one, I find myself pondering that same question again. What do I really want to do when I grow up? Saying “doctor” is not going to cut it anymore. The question now is what kind – as in which specialty I want to go into. Unlike some people who already knew what specialty they wanted to go into even before applying to med school, I really can’t say for sure which type of doctor I want to become.

To help us decide or, rather, to try to sell us the specialties in need of more applicants, the med school has put out a miniseries of sessions where specialists from a few different fields come and talk to us about the ins and outs in their field. Tonight’s session includes such exciting specialties as emergency, obstetrics and gynecology, anesthetics, and psychiatry.

I had already ruled out psychiatry last year after the mental health rotation. It takes one with a certain personality to go into that specialty, and I am not it.

OB/GYN – nine years of training?! Isn’t that how long people doing neurosurgery have to suffer through? Anyway, I’ll be doing that rotation later this year. I’ll have a better idea after the rotation.

Anesthetics sounds interesting. It’s pretty cool to be able to suspend someone somewhere between deep sleep and death and bring him back at your command, but a good anesthetist means a really bored anesthetist. A busy one generally means trouble. As the saying goes, the job of anesthesiology means being “bored shitless 95% of the time and scared shitless the other 5% of the time.” At this point, I am pretty ambivalent about this specialty.

Emergency actually sounds cool – four ten-hour shifts per week, no calls, no overtime if you don’t want it. It’s completely unpredictable; you never know who’s walking through those doors next. The training isn’t too long – “only” six years – definitely worth considering.

I’ll see what specialties the next session will bring us.