This week's Mr. Perfect Blog is written by David Graham.
Depending on how you count it, Dave is embarking on his 3rd or 4th career. After completing postgraduate research in mathematics he spent the next decade working for Defence, which included deployments to Afghanistan and the Middle East. He’s now a junior doctor, a research fellow, a fiction writer, and loving life as a second time Dad.
It’s been a perfect storm. People on holiday, people sitting exams, new people starting and needing time to settle in.
So we’ve been down on numbers of doctors covering the overtime roster. It was bound to be a challenge.
And rostered overtime in a large mental health hospital can be hard, really hard. I’ve been well prepared by the ever busy Nepean Hospital as an intern and resident, but the challenges and responsibilities faced by a psychiatry registrar covering admissions and looking after some very unwell people is a whole different level.
Usually I work 1-2 overtime shifts per fortnight. You need the headspace when you confront severe psychological trauma and mental illness in your day to day work. It takes its toll and you can’t be stressed out in psychiatry - the risk to the countertransference is counterproductive.
It’s been a perfect storm. Since my 2 week break over xmas, I’ve worked every weekend and had at least one overtime shift during each week. So I’ve clocked up 60-70 hour weeks for the past 6 weeks. I haven’t been to the gym for 3-4 weeks because I’m just too tired. For me, that’s a warning sign.
But I had sight of a clear weekend with plans to catch up with dear old friends, spend time with the kids, and go to a couple of birthday parties for friends’ kids.
The storm decided better. Last week I was reserve for Friday and got the call in the afternoon that I needed to work the overnight shift that night. I had an extremely unwell and very complex patient on my ward who I couldn’t just leave.
It was a busy shift with no rest, and a few harrowing tales. I ended the shift with some extra medical work that I had to do on one of the wards. Overtime on top of overtime.
My four year old developed croup that night, so she was unwell for the next few days. She climbed into bed around midnight last night, upset because of an earache, it took a bit for us to settle her, but “pink medicine” (paracetamol) - plus a pink marshmallow eventually did the trick.
Maybe it was the supermoon. I was on call last night, which is never great for my sleep - or my wife’s sleep for that matter - especially with a sick kid. When you’re on call, your whole life is on call. The “maybe” and the “what if” - the uncertainty is so vexing. I much prefer to be on site with the certainty that I know that I need to be at work. The chaos is contained and I can lend order to it.
And then my phone rang at 4am. My wife woke first, I would have slept through the fog of exhaustion. A patient was in the ED who had to be seen, but it could have waited another 4 hours; she’d already been there longer than the “4 hour rule” anyway. They insisted.
She wasn’t known to our service, so I spent about 2 hours with her, carefully excavating her history while gently reassuring her. It could have waited. At that hour, my assessment wouldn’t have got her a bed or started treatment any sooner. I understand where they’re coming from and can’t blame them.
It’s not the physical exhaustion, so much as the mental and emotional exhaustion. I take my hat off to Yumiko Kadota [https://www.abc.net.au/7.30/young-surgeons-speak-out-about-the-pressures/10809496] and looked to her for inspiration. I could never have endured what she had. What she went through was disgraceful, but frighteningly all too common.
The thought of the overnight shift this Saturday was too much. So I tapped out. And I was flooded with support from the other registrars, the consultants, the nurses, and the management.
It was a perfect storm. But at least I had support.