In this part I would share with you some of the ways I coped with the stress of house job.
It was a tasking experience and I was overwhelmed multiple times. I coped because of some factors and that is what I would be sharing here with you.
I was able to cope because God helped me.
I was able to cope because I had people in my corner that were around for me. I was able to decompress and share my struggles, get consolation and advice to continue.
I was unable to be frequent at church but I tried to still keep up with my relationship with God. I still attended and participated in bible studies, and fellowships.
I did not neglect my love for art and writing and even though my writing suffered a bit, I was able to still share some of my works with you.
Remember I told you that I wished to do many episorrhaphies.
I was able to do until my hearts content.
This was my first attempt: The registrar on ground was handling other emergencies and a mother had gotten an episiotomy (a surgical cut to help deliver a baby), and she need to have an episorrhapy (the repair of an episiotomy using sutures). He saw my eagerness and after showing me the steps he had taken, he allowed me to tie the knot.
Now, I had assisted twice in the past not with episorrhapies but with other suturing procedures.
On my next call, after a long night of staying awake, I had an opportunity to do another. I was unable to complete it because I got stuck at a point due to the pool of blood at the site, so I waited for my registrar to come before I handed over and watched him complete it.
The next two times, I did it confidently and I was proud of my final look. It was neat and well done.
The next time I sutured, I did three within the same day and the last two I did were done when I was quite exhausted but gratefully they all went well.
Now, this was what I did during my surgical procedure, after explaining to the patient and getting their consent, I administered local anesthesia to help with the pain then I maintained a friendly rapport with them to distract them from the procedure. I could understand that it was uncomfortable and I wanted them to feel at ease as possible. With some patients, I discussed different topics and even got ourselves laughing at some parts discussed. They were patient with me and after I was done, they were grateful. I was never in a haste and made sure that I did not leave any surface to be sutured open.
I was happy that my seniors were confident allowing me suture without supervision and at the end of my posting, I got the highest grade in that section for the procedure.
C.S ASSISTANT
Caesarean section is a surgical procedure that is aimed at helping a pregnant woman deliver a baby. It is not the recommended way to deliver a child, however it is a life saving procedure for a pregnant woman who is at risk of complications with vaginal delivery. For some women, it is safer to have a caesarean section than to go into labour.
It was my dream to assist during this rotation. I had assisted in the past but not in this facility I was in. It was an opportunity that was not easily accessible in my unit as a house officer.
The first opportunity I thought I got was lost die to a misunderstanding with my senior and the next came and I was almost not going to do it.
Like I was the one who prepped patient and to get the opportunity to still assist was not easy to have. Finally, I was given the opportunity and it was one of the most breathtaking experience I had. I loved that I assisted for this particular caesarean section was unique and it was not as smooth as the other ones I had observed. The baby was in an abnormal position and we had to employ our hands to deliver him safely. I loved that I assisted and that it turned out successful. The patient who was initially afraid to have the procedure went home happy and sound.
The remaining opportunities I would have had were halted by a strike.
THE END OF THE ROTATION
I did not have any other exciting experience afterwards and the strike dragged until I was done.
I was still coming to work but the patients to be seen were few until they were no longer coming. The strike was held by the medical professionals that were neither doctors or nurses and then by the non-medical professionals. Aside from the extra procedures I missed, I was satisfied by my experience. It had been bearable and I was able to learn the things I wanted to learn.
Last dayTo celebrate, a fiend sent me this
THE END?
Nah….
I will share one more part with you and then I’ll wrap up this series.
If you’ve been enjoying this then you’ll like the next thing I’ll share to wrap up this series.
We are gradually getting to the end of this series.
If you have ben following, thank you. If you recently joined, thank you for entering this bus.
Let’s ride in…..
CHILLING UNITS
Unlike, what I heard I was not going through the same stress I had gone through in the previous unit.
The units I had been placed in for the first 4 weeks of my stay in this department were bearable and I had enough time to rest, think and plan.
I was learning as well but nothing felt rushed or overwhelming, I was finding myself bearing the difficulties of the unit.
Some of my colleagues were like “You are lucky” and I would respond with “It is a reward for the difficulties I faced in Cardio”.
For the first time in a long time, I was able to go home at reasonable hours and sometimes have free time to mentally clear up.
ON THY FEET
My calls were different.
I did more labour ward calls and they were busy.
We were handling more than one life at the same time and that meant our attention were divided.
Because of limited hands, we had to attend to multiple needs and still make sure we did not lose track of what we were doing. Lives were on the line and they depended on the decisions that we made.
N.B: I use we because it is a team work.
Also, due to limited materials and supply we basically had to make use of what was available, or use our own stock especially for patients that came unprepared or referred from other health centres.
I could be handling an emergency in the labour room and get a complaint from the wards and then the decision to pick the more life threatening situation would have to be made instead.
One incident I remember vividly was one where I was attending to a patient around 1 am, listening to her complaint and write the specifics of her complain to come to a presumptive diagnosis when a woman was carried inside. She was heavy and could not walk on her own neither was she carried well. She was half dragged as gently as possible. Her companions had come in first “Doctor Doctor!” their voices were loud. I was sleepy and tired and I was not excited to see them. I raised my head slowly for my attention had been distracted from the patient I was attending to.
I saw her and I knew she was not a simple case. She looked drowsy and unwell. I immediately asked that she be taken to the examination room while I spoke with her companions who were her relatives- husband and friends. I saw the results they came with and from the history they gave, the diagnosis was sinister. I afterwards informed my seniors while I tried to write out the necessary materials to get and tests to do.
While her relatives were trying to get the necessary materials, I began trying to attend to the now new patient with my reserved medical supplies. The previous patient I had been attending to, I quickly completed our interaction, her complaint was a mild one and necessary prescription and assurance given.
The patient I was now attending to was hysteric, she was not merely drowsy, her orientation was poor. Her arms had been poked many times from the centre she had been referred from and I was struggling citing a good intravenous line. Her respiratory rate was high and oxygen was to be administered when she began violent and refused every form of handling. This was a risk for me as the sharp end of the cannular I was attempting to insert was exposed. I could not continue the procedure and had to stop. Though hysteric she insisted on refusing our intervention. Her family members were informed and we took a step back for we could not force our management on her.
Time passed and after much persuasion and finally intervention by my seniors, her intravenous line was cited and she was placed on oxygen.
Sadly, she was having sepsis and it had gotten to the sinister stage. Her temperature was beyond the grading on the thermometer and the decision to take here to the ICU was made as her respiratory rate as well had remained high and her assessment was poor. On the way to the I.C.U, she passed.
I did not sleep all of that night and this experience took a toll on me.
The painful cries of her husband and friend pierced deep
PTSD
I did not take notice but on this day, I realized that being a doctor was a risk factor for PTSD. I had witnessed a lot of deaths by this time and it was in that moment I felt the numbness of everything.
There was a patient I had spent my night on as well, she was been managed for DIC (Disseminated intravascular coagulation). Still passed after all the combined efforts to keep her alive.
I remembered all the patients I managed that passed especially those I had developed cordial interaction with or had gotten fond of. The dark emotions came sweeping, the realization that I had just seen a person alive and also seen them dead within a short space of time was palpable to me.
It is a reason I believe some health personnel dissociate from patients because the pain eats deep with time and leaves you numb because you still have to face other patients.
The job still has to be done.
I will continue my journey in the next part.
If you are enjoying this, give it a like and kindly share.
If you also want to leave a comment, the comment section is open for you.
By the way, YOUTUBE and PODCAST pages have been busy as well. You may check them out too.
We are gradually coming to the end of my experience in housejob.
If you have been following, I hope you have had a great ride so far.
With that being said, let’s ride in again….
NEWCOMER
It was my last posting and I still needed some guidance in this unit.
Now, this was a unit I had interest in and was considering specializing in.
I came with a happy heart and had one major goal.
A MAJOR GOAL
My major goal was to do episorrhapies. I really wanted to do it. I dreamt of it and looked forward to it.
I looked out for opportunities and eagerly wanted to find myself doing it.
The other one was to assist a cesarean section….
YOU NEED TUTORIALS
This was not the unit where you’d just know what to do, you needed tutorials.
My first two calls were called pilot calls and what I was meant to do was to observe and learn what I was to do when I was alone.
This was a good to ask questions and guided properly in what was expected with time and especially as I was in my last posting, a lot was already expected of me.
I was eager to participate so observing was not a problem for me as I wanted to work well as much as possible.
On one of those days
ANTICIPATE
I had heard so many stories and one of the major ones was how busy the unit was and how draining the calls could be. I had gone through the toughest units in my previous rotations and I braced myself for a possible repeat of what I had gone through before.
However, was this going to be my reality?
I will share that in the next part of this experience.
As always, if you are enjoying it, kindly share with others and leave a gracious like.
Let ride in…..
LITIGATION?
There were sour experiences in the past where court cases came up and these experiences made my seniors extra careful with the process of managing patients. They went extra miles to make sure everything was in place. There was always a crosscheck of every written word and supervision was followed strictly.
“Rose, make sure you write the name of the patient on the front and back of the sheet” my senior mentioned as I wrote her findings down on the sheet of paper (I was in a center that was yet to be computerized).
CLINICS
We had two clinics in a week and they were long.
It took a while to get used to them but after a while I did. The clinic was a unique part of my time in this unit. I had to do many things at the same time. I was designated with collection of data from patients, I also had to see new patients, old patients and still review with a senior.
After the clinics, we had ward rounds and those bit into chunks of the remaining day.
HISTORIC WARD ROUNDS
The ward rounds were excruciating.
We often spent long hours on a single patient and that meant standing for long hours and this was irrespective of the number of patients available. It was one of the moments I dreaded because there was no time frame for the among of time we were going to stand. However, it was not everyone that made us stand that long and we had a favourite who will looked forward to having lead the rounds especially as there was going to enough teaching and a lighter atmosphere.
I specially looked forward to having this very senior person come around
There is no way my story about this unit would be complete without mentioning about the ward rounds.
Interestingly, most of the patients we co-managed felt more loved as they knew we would come everyday and still spend a reasonable time explaining and taking them along with us in the management of their conditions.
CALLS
Now, I had about three calls I was to respond to and they were the unit call, departmental calls which could either be a ward call or medical team on call, then the general casualty call (which could either be once or twice in a month).
All these were preferably best not to be but on the same day, however, it also meant that the days of the week were scarcely free.
There were unit weekend calls that often interrupted the weekend plans. This call was not meant to be a tasking but for my unit, it remained a demanding call.
I already told you about meticulous.
There was a patient that came in during one of these calls that became a core painful memory for me. I’ll share my experience without sharing details about the condition or anything patient sensitive.
If you have been following this journey, thank you.
If you are reading for the first time, kindly scroll back to catch up.
Let’s ride in…
THE BURDEN OF PAIN
I had been dodging this unit. It was a dreaded one and my colleagues I had seen in the unit looked like zombies.
I was curious about the unit because of the unique procedure done in it but I was not ready to volunteer or be coerced into it.
But I had an unique encounter in the first week in Pediatrics
The unit was the hemato-oncology unit. A unit that handled sickle cell disease patients and cancer patients.
The demands on this unit were firstly emotionally draining from interacting with tense parents to handling the chronically ill children.
I got into this unit because the consultant of the unit insisted that my presence be there. We had met during my first week in pediatrics and my face was registered. At the close off my time in the department I was made to stay in the unit.
I joined reluctantly but it turned out to be unit I felt a sense of ease workwise. Not because the work was less but because of the people I got to work with.
I enjoyed the people I worked with and this was what helped to lighten the burden. However, I was faced with the burden of seeing children suffer immensely with help I could offer.
Their samples had to be taken regularly for the routine monitoring they were under. Chemotherapy drugs had to be constituted for them and the days not missed. They often had blood transfusion and transfusion of other blood products and that needed to be done with care.
Siting their lines was another herculean task. It needed patience especially as their veins were already affected by the chemotherapy medications and also because of the frequent samples, their veins got clogged easily.
It needed finding veins in odd places
The pain these litle ones had to go through was well reflected by theior agitated and tense parents, some of which waited for the slight provocation to unless all their frustrations on any of us.
I had an incidence where a parent harassed me twice verbally and when had insisted on standing my ground, the parent tried to implicate me to my seniors. Gratefully, the people that were told were people willing to hear my side and believed me instead. The warning I got was to be careful and avoid as much as possible any close interactions as there had been cases in the past where parents had been malicious enough to take photos and videos and post it online with half baked stories to tarnish the doctor’s image. After that incidence, I became extra cautious.
It was true I tried to sympathize with the patients and relatives. I also knew that I could not fully understand the trauma they were going through but I could relate a little because I had lost a dear person to cancer. However, I had to protect myself by making sure that my boundaries were not crossed.
THE BURDEN OF HOPE
The other tormenting aspect was the hope these parents had. Death was eminent but hope was stronger than the diagnosis and we did not tamper with this hope.
We fed it
The hope was what gave the parents the courage to go through every session, stay with their children and provide what was needed.
This burden to be was draining because the chances we had for most of them were slim yet we continued hoping that what we were doing was going to be effective and helpful to helping arrive at a safe zone.
Interestingly as we continued, most of them improved and this was welcomed with so much joy.
But….
RELAPSE
This was our enemy.
It frustrated all our efforts and brought us back to the starting point.
And this painful for everybody.
At this point, most times managing the patient was more difficult than the first time and hope seemed as a ghost rider.
A ghost rider that could not be seen
For these patients, the atmosphere was always charged and tenderness was given carefully.
SOME FRESH AIR
I and my colleagues released stress by finding time to joke as much as possible, play with ourselves and be warm with each other. We avoided conflicts as possible and made sure we had each other’s back with handling the patients.
Our clinics were demanding and added to being in this emotional roller coaster unit that was demanding, we still had our calls to do.
We used any break available to allow ourselves breathe before continuing work.
I was able to survive this unit because of my colleagues and also because of the seniors I worked with who understood the difficult of the unit and did not add extra pressure and tried to make the atmosphere as light as possible.
ATTACHED
I tried not to get attached but it was difficult with the kind of patient I was dealing with and also because I spent some time with them. They were always on my mind and included in my daily prayers. I tried to be as warm as possible. I wanted every interaction they had with me to as warm as I could offer. even in times when I got frustrated as some of them, I tried my nest to keep my cool as much as possible.
Before I left the unit, some of the patients had deteriorated and some passed.
After I left more of them passed and the pain that came with hearing the news was processed gradually.
I felt quite pained. I had became mentally attached but had to accept the reality of their passing.
My time in the unit had come to an end and I had to prepare for the next rotation.
I had hopes that my next posting was going to be calm. I already had many plans for it but was my desire going to be met?
You will find that answer in the right part.
I took so many selfies as a way to cope with the stress and burden of being worn out. Saying cheese at the camera everyone morning was my warm up. I adapted the term “Sunshine baby” because I needed to keep myself in a cheerful mood as much as I could try.
Another thing I did was to make my hair intentionally lighthearted.
The neonatal ward was meant for neonates, the most fragile in all of the wards.
They needed to be handled with extra care and monitored as closely as possible.
And for me this reality meant less sleep.
I got attached to the babies I managed and would check up even when there was nothing I was supposed to be doing.
In managing these babies, we had the ones in intensive care; that is in the incubator and those who were put in a cot and for most of them, a regular blood sugar check was needed. Those in the incubator were the premature babies that needed to still complete their needed developmental period before they could be released out of it.
I had some unique experiences and I will share a bit of them.
When transfusing these babies, we needed to do it in what we call a Aliquot method and this needed intentionality. So on one of the nights, I needed to transfuse a neonate but the baby was too active and kept disrupting the procedure. A new line had to be set and yet the neonate’s arm in active movement kept tampering with the line and it frustrated me.
It was as early as 3am and I was still battling to complete the procedure. The child could not understand my frustration and we both were frustrated with the procedure. My eyes were with sleep and my body fatigued from leaning over and holding the child little arm. Gratefully, I was done and cleaned up to rest my head for only few hours.
Being on the neonatal ward call also meant we had to cover for special deliveries which included caesarian sections or neonatal emergencies that presented during call hours and that to added bulk to the load work as one’s presence could be demanded for in many places at the same time.
There were days that in the process of multitasking, some our routine work suffered. However, in the process I got to appreciate the resilience of some neonates with some of the least expected making remarkable improvements and recovering faster than expected.
Then there were the loses, some very painful as they showed often showed signs of being able to pull through.
The mothers of these little ones were heroes in my eyes. Most of them handled this very challenging period with grace and patience and sometimes when they became edgy, I could easily give them a break and offer comfort the way I could.
THE BURDEN OF PAIN
I will continue this part actively in the next part as this will be the most emotional section of this chapter.
In the last part, I ended it with a hanging sentence.
I will continue it here.
Now, even though the emergency unit was the first point of contact for all the patients before dispersing them to appropriate units, it remained a place where some patients remained for a while under care even though they were no longer in an emergency state.
The emergency was a bubbling space and attention was needed frequently.
Gratefully, I worked with people I enjoyed and eased work sometimes.
But there is an aspect I am yet to talk about and it is part of the reasons the previous part was ended on a hanging sentence.
HERCULEAN CALLS
The calls in pediatrics were not a joke. They were the main reason that this unit was exerting.
Now, it was one thing to be in the emergency unit and another to continue a call there. It felt like a continuous journey with small spaces to breathe.
Being on a call in the children emergency unit also involved being in charge of the wards and hands were few.
Two house officers manning about 4 wards plus incoming emergency cases
Children being children could be demanding and their lines difficult to site. One had to be mindful and careful when attending to them and hence despite the bulk of patients to see, one could not rush processes with children.
It was hard to have a proper blink at night.
And this will not stop the fact that one had to be ready the next morning to continue work as usual excepted to be fresh and properly composed.
On some of the nights, the calls from the ward were excessive and sometimes uncalled for, however despite that one still needed to be available.
Sometimes, attention was needed in several places and the tension caused one to be on the edge.
Yet one had to maintain composure because everyone would be on edge at that point and as the doctor you had to be the least person on edge.
VAMPIRE?
On my calls, I did so many blood transfusions that I felt like a vampire.
There was a call that I did about three blood transfusions almost simultaneously and at the same time my attention was being called to attend to incoming patients. My colleague was attending to a critical in one of the wards and I had to attend to the different demands placed on me.
Transfusing blood products meant giving premedication and then monitoring to avoid reaction and also keeping vital signs in check.
With children, extra attention was needed and in times where I was attending to many children I still needed to pay attention to the ones I was transfusing making sure the transfusion went smoothly.
There was an incidence I had of transfusion reaction where the child began coughing when the transfusion started. I was transfusing platelets and was almost done with the first bag to commence the next one when the child began to to cough. I immediately stopped the transfusion. Commenced intravenous fluids, steroids and observed. a senior colleague was standing by to monitor then afterwards the coughing subsided and was relieved. we waited for about 20 minutes before commencing the second transfusion to which the patient did not react to.
This experience scared me because I had never experienced a reaction in all of the transfusions I had administered but once again it stressed the importance of paying close attention and observing patients during the first 10 minutes of commencing transfusion as that was a crucial time in notice transfusion reactions.
But this was not the unit I did more calls…
Talking about calls, the neonatal ward was a different ball game but that would be a story for another part…..
On one of those days….
I missed last week and I hope to cover up with a post this week.
If you are enjoying this series, kindly let me know and until next part, continue to stay safe and God bless.
My break was over and I was to resume my new posting.
I was ready (according to myself) to have another unique experience and I was open to what it came with.
With this department, there were different units and we were to spend weeks in each of them with two units have more prominence (per compulsory).
G.I?
I was posted to the Gastroenterology unit and it was said to be the calmest unit with few to sometimes almost no patients.
There was a clause I was not aware of
I did not realize that I had to work with a sister unit that was more demanding than mine and I did not know that I would have to work with difficult persons.
And this was supposed to be a soft beginning for me
The unit that I ended up participating in more was the Infectious unit and it demanded more from me than my primary unit.
Now, I found myself in a department that handled children of all sizes and ages and this meant that they needed to be handled with extra care. Not only were we managing the children but the parents as well. The more concern were the parents more than the children.
Children are easily forgiving, parents are not
Being in infectious unit meant doing more. It meant being involved in more responsibilities and meant staying longer in the hospital.
It also meant filling research papers
On my first day, I was given a topic to present in about 3 days from my starting the unit.
But that was not the main cause of stress.
The main cause of stress in this unit was the people I was working with. The combination of people I worked with nerve wrecked me. I though I had gained experience from Surgery due to the different kinds of people I had worked with but it did not prepare me for the rattling I was going to go through.
Now, I came to this unit with the desire to get the work done but I did not know that it was going to come with issues I had to handle.
I was working with unique individuals, and my immediate colleague at some point felt I was excessively proactive and that caused a friction between us to the point I felt threatened. We had to involve senior parties to bridge in the gap and mediate. That experience helped me to be aware of workplace jealousy.
I eagerly looked forward to rotating to another unit and change my environment.
EMERGENCY?
God answered my prayers and after 2 weeks I moved to the emergency unit. There I met colleagues I enjoyed and though the unit was demanding, it was bearable.
I will share one of the unique experiences I had in the unit. Two children were brought in with burns. The older one was scarcely burnt on the forehead while the second had burns on both arms and legs.
The culprit?
The older one had dropped a lighted match into the small generator that still had fuel in it and the younger one in curiosity bent over the flames that caused the burn.
Interestingly, the older one was hurt less and received a good amount of scolding. When asked why the act was done, a good response could not be gotten.
The experience was an eye-opener that children should not be left unmonitored and especially when they are hyperactive, there should be a limited contact to harmful appliances.
Being in this unit required that you were always available even when there were no patients to attend to. There were days that the station was so filled, that it was hard to sit down with the need to pay consistent attention on the patients being admitted.
There were days we had to spend overtime because of the influx of patients. From acute diarrhea to severe malaria to febrile convulsions to asthmatic attacks to neoplastic conditions. The emergency unit was the first point of contact for the patients before dispersing them to other units.
However…..
My first day feeling pumped but would that feeling last?
I have dragged this part for more than a week. I will stop here and continue in the next part.
If you are enjoying this series, kindly let me know and until next part, continue to stay safe and God bless.
So I had one week to rest before starting a new posting.
I wanted to stay at the place but on a request to travel instead, I decided to and that was a good decision I made.
For context I am not a fan of travelling
Travelling and being with people that were like family was therapeutic. It served as an opportunity to meet up with a close friend.
During this break I had the opportunity not to think about work and just rest, relax and have a warm time.
But…
Before long, it was over and I had to return to the new posting.
Now, the purpose of the break was to prepare for the next posting and I was only able to use three days out of it. The remaining days were used to travel and then prepare my ward coat. The day I returned, rain fell and beat me to it.
I will confess that for this part I thought I had something profound to share but realized that whatever it was I have forgotten but I will share something on Medium.
Deeperlook 