The parenting series

Part one: It might not happen as quick as anticipated….

Photo by Dominika Roseclay on Pexels.com

This is a series I have been thinking of doing. Inspired by multitudes of my patients and addressing some issues that are related to the parenting journey in general… I am hoping that the upcoming little snippets of the journey to parenting, some very personal to me, shine a light on a topic that is rarely talked about in normal conversation. All those struggling with fertility or struggling with parenthood, just know that I see you and hope by normalising the conversation you can stop hiding your own struggles and feel open to talking to your GP.

Part 1: It might not happen as quick as anticipated…

It was a lovely weekday when Rebecca* and Sam* arrived for their appointment. They were a lovely young couple in their late twenties, and they had jumped through all the adulting milestones and were ready to be parents. Except, it was not happening which understandably was frustrating for them. They had got married, bought their house, got their large family car, and updated their health insurance for the upcoming stork delivery but it seemed the stork had the wrong address.

With the unrelenting questions of “when are you having babies?” from friends and family they had finally decided to come and see me for some assistance.

We started unpacking their presentation. They had already downloaded some apps to track her ovulation and they would have sex every day at the times when the app was saying and despite that, it was now 6 months later, and they were over the disappointment that came with the monthly period.

This was an easy one, or at least there was still room to move before we needed to refer them for specialist intervention.

First, we discussed that at their age they had 30% chance of falling pregnant with every cycle which is always interesting as most people tend to think the chances of conception are very high. Sure, if they were 16, they could have sneezed* and had an unplanned and unwanted pregnancy but usually when pregnancy is wanted, it does not always seem to follow the script as required.

Also, given their age and relative health, they were technically allowed to try for about 12 months in total before we started to investigate for medical issues that might be the cause of their difficulty in getting impregnated.

Additionally, although the ovulation apps let you know then the ovum/egg is released from the ovary, if you think of how small a sperm is and how far it must go to meet the sperm, it makes sense that if there is no sperm already at the end of the tube waiting for the egg to be released, you are already too late. Having said that, going at It like rabbits is not likely to help either as the amount of sperm in the semen is likely to reduce with time.

So as the consultation continued, I could sense their relief there were remedies we could trial before they were officially “sick”. First, they were to use the ovulation information they already knew but start the horizontal dance twice during the week and once on the weekend from about 5 days prior to ovulation until at least 5 days after the egg left the ovary. That would hopefully bring back the fun of doing the dance but also hopefully the reduced frequency will mean the concentration of sperm is maintained in the semen increasing the chances of getting knocked up. 

They left my consultation room looking more hopeful than when they arrived with some homework to consider. A few months later, Rebecca arrived with smiles beaming. She had peed on a stick and saw 2 lines…

*not real names or real patients

PS: remember that this blog entry does not constitute medical advice. If you have any questions of a medical nature, contact your nearest medical facility for help.

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Youth week celebrations

 

Friday April 5th -Sunday April 14th is time to celebrate Victorian Youth Week this year. I will be participating in one of the many Africa Day Australia activities that will be going on as we celebrate the young people around us. I cant wait to meet with everyone and be among the young minds of Victoria. Hope to see you there.

When: Saturday 13th April 12:30- 1630

Where: Library at the Dock , 107 Victoria Harbour Promenade, Docklands Vic 3008

RACISM has no excuse!!!

Today I was accused of stealing a patient’s $100 bill at work. She claimed that I had fleeced her of her money last week and “unless there is someone else in this clinic who looks like me”, then it was obviously me who could have taken her money under false pretences. Now granted, we did have a consultation last week and I organised a surgical excision which would have had an out of pocket cost compared to her usual bulk billed consults. However as all of us should know, doctors never handle money as that is what reception is for, there is no way I would have processed payment for an anticipated procedure. Trying to highlight this flaw in her thinking just led to more venomous attacks of me and going on about how unless someone “like me”, and when asked to elaborate on what she meant, she reported “black people like me”, I could be the only person who took her money.

 

Not only was this hurtful as I had looked after this patient for a year now through challenging times with her family, it was sadly not the first time I have had racist insults hurled in my face by members of our community. I have been insulted in the presence of my then 3-year-old son, and informed that the reason we are brown is because we are the s*#t of the society whilst on a train home from a city outing.

 

Today however was different and to me sadder as I realised that people who have never experienced racism are quick to make excuses for racist behaviour. The trending ones for today was “she is old, she might have dementia” as if getting old and maybe having dementia have RACISM as a side effect. Excuses for the guy on the train was “maybe he was drunk, maybe he was high” again as if drugs and alcohol should have RACISM as a listed side effect. Now, racism is not a side effect of any of the above or any other reasons people might excuse. You are racist and for whatever reasons you might become disinhibited enough to actually spill your vile ideas.

 

When someone is being subjected to such, I would advise that if you are someone who has witnessed such behaviour- call it out for what it is, listen to the distress of the person who has been vilified and say, “I am sorry you have had to endure this today”. It is the equivalent of being quiet when breaking bad news etc when the less you speak actually speaks volumes. There is no need to try and pretend people were not trying to be racist when they are or worse excusing their behaviour.

 

I admit, I am guilty of not calling out such behaviour because I actually hate to bring up the so-called race card and I am really not confrontational. Today, the whole experience was surreal, as if someone was going to come out of the woodworks and say “smile, you are on candid camera” or living through Jodi Picoults book of Small Great Things where an African American nurse was falsely accused of killing a child of a Caucasian couple. I think the realisation of what happened, the response of my boss and practice manager to the incident has actually just dawned on me and actually made me upset and very angry. I thought I would channel these feelings and educate and hopefully look forward to going to work tomorrow and a future where my chocolate flavoured son won’t have to deal with this as his norm.

 

Thanks for reading till the end, as I try and calm down and come up with a plan of what to do about this tommorow.

The day endometriosis nearly killed me…

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I woke up with the most excruciating pain and large volume, sudden onset vomiting. The time was probably a little before midnight as I staggered to my parents’ bedroom to let mum know I wasn’t feeling all too well. As mum is a sympathetic vomiter, i.e vomits when she sees anyone else’s vomit, she kindly advised me to try and small sips of water and she would try to get the floors clean. I had to sit in the lounge room, covered with a little blanket as I tried to deduce what could have made me so violently unwell. I recalled the day well. I had been to school and been home without anything eventful. Dinner was a non-event either and the following day was another school day. Every small sip of water or milk seemed to increase the pain in my tummy and before long I was vomiting again. Mum, although not a doctor, diagnosed a simple case of gastro and told me to try and sleep it off.
After a lot more vomits, the spilled contents gradually changed from food to bilious green and eventually coffee grounds colour with flecks of blood. Only on seeing the blood did mum think it wasn’t’ “gala” (gastrointestinal imbalance) and thought best we presented to the hospital. By now it had been a few hours of ongoing vomiting with me feeling completely weak and unable to walk. We quickly drove to Gaborone Private hospital, as I cried in the back seat, urging her to drive through red lights as the pain was most excruciating. On arrival, almost passing out from the pain, I was immediately sent off for surgery to manage a bleeding peptic ulcer. I remember telling the doctor in charge how much I loved him for the morphine and anti-vomiting medication he had administered.
I was 15 years old at the time and used to having severe debilitating period pains that would often make me miss a few days of school each month. I had had my period the day prior to being unwell, and not trying to miss school again, had inadvertently taken an overdose of ibuprofen to manage the pain and had caused myself to have a bleeding ulcer. My mum and I thought that severe period pains were “normal” aspect of being female and even on post-op follow up with my GP I was informed that having excruciating period pains was an accepted part of being a female.
It wasn’t until being a medical student and having ongoing issues that I was eventually diagnosed with endometriosis. On reflection, I was able to realise that I had suffered and almost died from self-medication of this condition without ever having a diagnosis. I was made to feel that, like labour pains, there is a lot of discomfort that comes with being a female when in fact this is very far from “normal”.
Let my lived experience act as a cautionary tale that not all period pain is created the same. So educate yourself about the condition, there is plenty of information on reputable medical sites and present to your doctor if you have any suspicions that you might have this condition. Like Emma the yellow wiggle let those of us who are 1in 10 illustrate that endometriosis can be managed to some extent and, although it has no cure, it doesn’t have to define who you are.
Other sites to look up

Why medicine?

 

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Some hectic days at work, especially those filled with patients with mental health illnesses, challenging social situations and complex medical needs, can lead me to question why I do this as a career. I have already discussed other jobs I occasionally fantasize about doing on one of my older blogs ( The ultimate dream job…), but sometimes it’s about recollecting the multiple steps I took to get me where I am today.

So high school finished, and I guess I could say I had done okay. At that point, all I wanted to do was computer science as I felt computers were the future. I had just completed my IGCE examinations which included a project where I computerized my grandfather’s store inventory management and as I submitted my floppy disc for assessment, I thought that my career decision was well and truly settled. Given high school ended in early December and the results were published end of January the following year, I had a restless Christmas break fielding questions from family and friends regularly about what the next step was. To kill time and avoid the interrogation, I spent a lot of my time trying to distract myself from the questions by watching a whole lot of television.

I am a self-confessed television addict and I am happy to watch anything and everything on screen. That summer, I got myself addicted to a show called Forensic detectives on Discovery channel and with every passing day convinced myself that I should become one of the forensic pathologists. I persuaded my mother to organize an interview with a forensic pathologist locally so I could decide whether that was a career to pursue and the nice gentleman just burst my bubble. He could not understand why I would be interested in the field and basically said it was not as exciting as it was made out to be on the show I had been watching. “You are just a glorified police officer” were his exact words as I left his office dismayed.

As university approached, I figured I might as well apply to study medicine and see how I would go during my “pre-medical term”. Unfortunately, the pre-med term was basically all the sciences and mathematics and didn’t provide much in terms of taste of medicine. After 12 months of the course, however, all that changed as we were placed on a 2-week job experience placement at our local hospital where I fell in love with medicine in general. A friend and I decided to extend our placement by a whole month and by the end of it we were being treated as junior doctors. We were suturing stab wounds, managing fractures and assisting in theatre which was all amazing.

I left that placement inspired to do medicine and with that in mind worked hard through medical school and fellowship training to get to where I am today as a family physician. Choosing a speciality in medicine also threatened to cause some stress but as I wanted to be a general doctor who could still do obstetrics and eventually palliative medicine etc on the side, being a family physician was a no-brainer. So, when I hear another sad story about people, their social situations or whatever it might be they attend me to help with, I find myself very privileged to help in whatever tiny way.  I hope to continue practising in this field that continues to ignite my passion regularly. I must admit that “leaving patients at work” is something I will forever grapple with but with time, and hectic days included, I can say I really do love my career.

Dedicated to my UB partner in crime Morapedi 

Doctor suicide

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I have recently completed a book by Dr Pamela Wible in which she responds to suicide letters from doctors and their family members (Link is below for the free audiobook). It’s a sobering statistic to learn that on average in the USA, about 300+ of our colleagues call it quits by their own hands ANNUALLY!!!. Unfortunately, there seems to be similar statistics globally among medical students and doctors. I have read about 8 RIP statements to doctors and medical students in the past few months and saddened to hear that the powers that be respond to such findings as “we need to pick a more resilient bunch next time” which I find completely appalling.

I have as a result tried to figure out, what about medicine drives people to this extreme option in dealing with their stress. It must be the culture of medicine that does this, because I would think that we are all very similar when we start high-school compared to when we finish college. I have come to conclude its either medical education or medicine as a vocation as I will elaborate below.

Medical education

  • In Australia, before you are even admitted to the university to start studying medicine, there are multitudes of tests which I understand are to ensure you are indeed the cream of the crop. This is in addition to having to pass your final high school examinations with a very high score or like me also having to do 18months of “pre-medical education” before even starting the medical degree. So, most of the people who are eventually admitted to med school are typically some of the smartest of their cohort with commonly type A personality.
  • As the career is basically an apprenticeship model of learning, in that typically your lecturers are also doctors, there is always a comparison between trends of the day and how things were when the lecturer themselves was going through training. “In my days we…… or do they teach you anatomy these days?” are common and sometimes very unhelpful comments from some tutors. This model of training can also leave the trainee very vulnerable to the inherent power hierarchy of their supervisor as their evaluations can make or break speciality training applications for example. There are also many different personalities to supervisors and unfortunately, some are the type that is hell-bent on destroying some peoples careers and with the stroke of a pen, are able to do just that.
  • From undergraduate degree to full consultant can take up to 15years or hard work ridiculously long hours of often unpaid work, expensive training and frequent examinations which increase the pressure and stress. This protracted learning can lead people to delay life generally i.e. dating, starting a family etc which obviously with the ever-ticking “biological clock” also adds to the pressure, especially for female trainees.
  • Usually, to complete medical school and speciality training, there is an expectation that you will be moving houses frequently to do the different rotations required. This comes with learning new staff protocols, meeting new supervisors, learning new systems etc. Also, the usual contract times with hospitals are 12 monthly which means, you are applying for a job annually with no real guarantee unless you know someone who might know someone. Applying for a mortgage with a 12-month contract is one of the many hurdles one might have to deal with as they navigate everything else.

Medicine as a vocation- this profession is one of the options parents of multiple backgrounds give their kids as career choices. “You can only be/marry a doctor, lawyer, engineer, accountant/banker etc”. So by the time you get to start training in the field, the pressure invariably also starts and can trend up with time. Its also a career where one mistake can cost someone their life, where asking for help or asking for time off is sometimes seen as a weakness or where admitting you need help can lead to a report to the regulatory agency.

Without writing a whole new book about doctor suicide, reading this book and watching the related content has certainly been eye-opening for me. Why read such a morbid book or evaluate such morbid statistics I hear you ask…  well, when you seem to be losing colleagues like flies, it’s important to take stock. It makes you take a closer look at how things are and what got us here to hopefully reduce the risk to yourself, your colleagues, your loved ones and the next generation of doctors. At the end of the day, we often forget the fact that we are all human, doing the best with what we know to somehow help humanity in some little way. And, in doing all that, sometimes it can become too much and there is nothing wrong in asking for help. I am here to listen if anyone needs to chat…

http://www.idealmedicalcare.org/blog/physician-suicide-letters-answered-free-audiobook/

*Kindly share the book and this blog post- it might save a life.

 

 

 

I am sorry…

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These are truly some of the hardest words to say. Even my 2-year-old would rather give you a cuddle and do everything to show that he is sorry whilst vehemently refusing to say the words.

I have been listening and watching as the story of the Hollywood mogul and his predatory behaviour towards women unfolded in the news and social media. Most of these women, unfortunately, were approaching him in a professional capacity and thus felt they couldn’t really come clean about his disgusting behaviour. I also heard during the drawn-out campaign of the US elections, excerpts of Trump’s recordings about how he personally dealt with and “handled” women he found in his midst. I also recall how everyone’s beloved television dad, Mr Cosby, had similar allegations brought against him in a court of law although a few more women than those who eventually took him to court had reported on similar despicable behaviour. I then asked myself- when do boys learn these sorts of behaviours and what reinforces this to keep going? What makes them think that this is an appropriate way to interact with women? Who modelled this behaviour for them during their childhood? This thought took me back to my childhood as I will elaborate below.

I grew up in a middle-class home in a small corner of Gaborone, the capital of Botswana. I attended a private school if you could call it that, from primary right through to high school. As my friends and I reached adolescence, the topic of great interest naturally steered to dating and sex – who is with who, what they did when/how etc. I recall many Monday morning assemblies, hearing whispers from other classmates about what had gone on over the weekend whilst my nerdy self-had been home. There usually, (I hate to acknowledge it was a repetitive occurrence), was a story of how some girl was invited to a “party”, had her drink spiked or drunk too much only to woke up and find that she had been sexually assaulted by a few of the boys who happened to be at the party. This was colloquially called a “gang bang” session. From memory, there were some girls who seemed to be invited to these parties and have this sort of thing repeatedly occur to them without reporting it to the teachers let alone the police. Sometimes you would hear that some of the victims had to travel to South Africa to have some surgical termination of the resultant pregnancies as termination of pregnancy is illegal in Botswana. It just seemed like a thing that occurred, that most people heard about but never really reported or prevented. It just seemed like the Harvey Weinstein scandal, except in high school of course, where a lot of people would have known about his behaviour but chose to be quiet or were quiet due to circumstances only they understand. Now, this was one school of many and if this occurrence was extrapolated to all the schools in Gaborone/Botswana, there are a lot of people who have been hurt and much more who knew about it and kept quiet.

Well, I am here now to say I am sorry…
For my participation in the silence and the ongoing victimization of the victims, I would like to say I am sorry…
For not offering you a shoulder to cry on, I would like to say I am sorry
For not asking if you were okay, I would like to say I am sorry
Most of all, for being too young to understand how I could even try to help you, I would like to say I am sorry.
I understand that we are unable to change our past and that I was merely a child myself when this was occurring but still I say I am sorry. I recently read Lupita Nyongo’s recollection of her own experiences with Harvey Weinstein and how she regrets keeping quiet about it as maybe talking about it earlier would have prevented a few more people having to endure such behaviour. I hope that my career as a family physician, a privileged position in society, allows me to try and right my childhood wrongs and to empower women who may find themselves in such situations to report such behaviour and know that I will always have their backs. I hope that little boys and young men, through the exposure of these sadistic creatures, realise that each woman who is abused could be their mother/sister/aunt or daughter and that hopefully, this different perspective teaches them how to properly and respectfully treat women. I hope with time, we can live in a world where men don’t feel the need to sexually overpower women EVER! I also hope that women continue to speak up so that, we, in turn, make these guys VERY sorry for messing with us.

I saved a life!!!

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I know that I have probably assisted in saving a few lives in my career as a family physician. However, there is nothing like having someone’s life literally in your hands and this was one of those days I still reflect on and thankful for what I do as a profession.

I was about 7 months pregnant and working the evening shift in a metropolitan medical center as a General Practitioner. I had just finished having my afternoon break and was on my way back to see my evening patients when one of the receptionists asked me for some assistance. She had been notified by a passerby that someone had fallen outside the clinic and she was pushing the wheelchair to go and see what was going on. As we strolled over to where there was now a few people standing in the middle of the road, I could hear someone saying “Sir, keep your eyes open and stay with me”. I immediately thought “F*ck, Fu*k” and quickly waddled my pregnant self to the scene where an elderly gentleman was lying lifeless in the middle of the road bleeding from his forehead.

I immediately went into doctor mode, instructed a passerby to call the ambulance, got the receptionist to call more staff to help, did a basic assessment and started doing chest compressions (CPR). I should add, it was nothing like the one illustrated on the above cartoon image, in case you were wondering. Here I was, kneeling in the middle of the road which was really wet as it had been raining that day, with a huge belly, singing “Row Row your boat” to keep count of the chest compressions and trying not to shit myself waiting for more help.

After a few minutes doing solo compressions and silently praying for the man not to die, I could finally hear sirens and knew that more help was on the way. Soon the firemen with their big muscley arms had taken over doing the compressions and I could try and recollect my thoughts and give them a handover of the situation I had found myself in. The ambulance was soon also at the scene, the road cordoned off and a mini emergency room set up in the middle of the road as they tried to stabilise the patient before transfer to hospital.

I quickly dried my pants and retreated back into the medical center to see my patients who had apparently been impatiently getting mad at the receptionists for not being seen on time despite the lights and sirens they could clearly see and hear from the waiting room. I completed my evening shift and headed home where the emotions took over as I cried, recalling and finally processing the events of the evening as I debriefed with hubby. The following day, I found out that the elderly man had survived and was admitted to intensive care. I got to meet his lovely wife the next day who couldn’t stop expressing how grateful she was for our actions as well as stroking my obviously humongous baby bump.

As I reflect today on that day years ago, I am eternally grateful for the skills I have attained in my medical training and the ability I had to make such a big difference in the man’s life. I am also appreciative of the little changes I am able to contribute to my patients’ lives daily as I continuously work on collecting brownie points to heaven.

*Some names and locations changed to protect the patient and staff

*Image from Google

I QUIT!!

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I have had time to reflect on the different curveballs medicine has given me in my career so far and one that sticks out for me is the day I quit! It was quite a surprise to me that things got that bad but more so that I had the guts as a junior doctor to call it quits and basically risk it all.
I was working in a small country town in Victoria as a surgical resident when this unfolded. Now surgery and many surgical rotations come with very long hours. It was completely normal to start work at 7am (having arrived earlier to organise everything for the morning ward rounds) and then work the whole day and occasionally be in charge of ward patients until 8-9pm to hand over to the doctor doing nightshift. Occasionally, when there was a really sick patient or you were in theater assisting in surgery, you might actually still be in the hospital until about midnight knowing you have to get home, shower, eat, sleep and try and get ready for the next day when you do it all over again. Everyone was in the same boat and you did what you could to keep sane during this time.
My co- junior doctor and I  had been doing the surgical rotation for a while when unfortunately our surgical registrar (the doctor immediately my superior) had to leave the hospital for personal reasons. It wasn’t long until we got a replacement registrar which was great although we had started to enjoy the added responsibility. Joy turned to horror when we realised that our new registrar was not really a team player as our old registrar had been. He would turn up late demanding that we do all our work and his, would only take phone call consults and not ever want to see a patient and he would spend all his days either in theatre or chilling in the staff room.  This went on for a few weeks and we all sucked it up, looking forward to the time we would change rotations.
I then drew the short straw and had to work a weekend cover shift with him which I figured could not get any worse than his mid week antics.
I started bright and early, ready for the 14hr shift and before long things were going pear-shaped. I had sick patients to attend on the ward and he was in theatre and not interested in seeing anyone I was calling for help about. I then made an executive decision and called the consultant (team leader)  to liase with him about the patients I was very concerned about. Word must have then filtered back to him in theatre that I had got help from the super boss and before long he was in my face, yelling and cursing me out for daring to ask for help when he clearly was not going to help.
As I stood there in shock and failing dismally to control my emotions, I thought “Fxk this Sx*t, I cannot be subjected to all this abuse for caring enough about my patients to ask for help” and decided to quit!! I packed my bags, told the surgical nurse unit manager that I was going home and that they should find someone to complete my shift. I called human resources manager and told them I had just quit. I walked home and spent the rest of the day in tears. I had never been humiliated, yelled at and cursed out for being chocolate skinned like that in my medical career and even though I believed I had done the right thing by walking away, I was not sure what to do next. It was the middle of a new term and getting a whole new job would be a nightmare.
The HR manager called back and between my sobs was able to understand the gravity of my decision. They spoke to all the witnesses of the yelling as well as the nurse unit manager who had been working in the ward that day. After feedback from all the nursing staff, who had apparently also written multiple complaints about the new surgical registrar, and feedback from the consultants and theatre staff, the surgical registrar was let go. I was informed of the managerial decision to let him go and asked if I could return to complete my contract.
Looking back, I am proud that I stood up against workplace abuse and even though was much junior in my training, was still able to make such a decision to protect myself. I regret that it took direct, humiliating verbal abuse to make that decision but sometimes you have to be pushed to take that leap.