Written by a feeble Neurology registrar – Drawing provided by Dr Kate
Monday morning, I came in to a new list of patients. Many, with loss of function from something that happened to their brain. Some of them seemed to have had similar diseases. But the consequences for each of these individuals all differed, because one was a violinist and the other a professional golfer. Some of the diseases were on the left side of their brain, some were on the right. Some had a CT scan, others had a MRI. Some revealed their neck vessels, others didn’t. It was a mess. These made up the 8 new patients, and I still had 7 existing ones. You had to tease out all this information and remember it all. Plus, all this had to be done before the multidisciplinary meeting at midday.
Before we even had the chance to see all the patients, the meeting started. There were about 25 people, consultants, advanced trainees and other registrars. Plus all the closely knit allied health staff.
While everyone was having a cackle about how their weekend went, I was furiously trying to recite what to say when my patients’ names were called out. Then the confusion hit. There were two Chinese patients and both came from an extremely similar home situation. Which was which? Which was the one with the left ataxic hemiparesis syndrome, or was it right? Ok so I tested the left and it drifted… ok left it is. But what did she walk with… a stick or a frame?
Then her name was called out.
“So umm.. this is a errr 86.. 89 sorry years old lady from home previously independent with a frame (physio : “isn’t it a stick”) yeah I think it is, a stick who came in with a left ataxic hemiparesis syndrome. CT brain initially was unremarkable (intern: “I think it showed some old lacunar infarcts”) oh yes. Other than the initial deficit she demonstrated a left homonymous hemiparesis (rehab consultant and a few others: “homonymous hemianopia”). She is due for an MRI today and will need to see if she can return home to an eager family.”
This onslaught went for over an hour.
By the end of it I felt I really had no idea what I was doing. And the question came, is it me or is this hard? So I casually ask others questions without exposing my vulnerability. So is it usually this busy? (Colleague : yeah, it’s usually like this). But I ultimately don’t get the answer to soothe my perceived inadequacies.
Even harder to deal with is, we all come in everyday wanting to be that ideal worker that is well liked and capable. A situation like this challenged that possibility like no other. I thought, now the whole department will think I am an idiot. All my assessments will be reassessed and my plans re-evaluated.
Consequently, I dreaded these meetings. And consequently, getting out of bed on Monday was even more difficult. I simply didn’t want to look bad again.
Kakorrhaphiophobia
If you had to imagine some of the scariest and distressing situations at work, what would it be? It could be the time you were facing a deteriorating patient, crashing in ways you couldn’t comprehend. Or perhaps facing an aggressive delirious patient threatening yourself and the staff around you?
Or could it be just situations like this. I may even say, give me a deteriorating patient. That’s even easier to deal with.
That was a few weeks ago, and things became somewhat easier as time went. Part of it was from me improving clinically, but also from learning to deal with the sensation of looking bad. But fear of looking bad comes from every corner of daily practice. Certainly for me, it became a source of stress. Kakorrhaphiophobia, is the actual word for fear of failure or looking bad.
From my reflections so far, I’ve acknowledged that much of this sensation is actually irrational. Really, this perceived failure probably did not have real consequences on the patients. Ultimately the right information was produced and the patients ended up getting what they needed from the multilayered healthcare team.
And at the end of the day, everyone has a learning curve to climb. Nobody ever was born a super registrar. We all learn and become better. The fear of failure, the adrenaline overload, the butterflies in the stomach, and all the panic that comes with it is mistakenly wired into our psyche. It was useful in the hunter gatherer days, with lions and tigers. As much as some consultants look like lions. There remains no case in history where a consultant actually ate a silly registrar for dinner.
With that in mind, in situations like this, maybe the best thing to say to myself is “Well, bite me”. Because you know, they certainly won’t.
Does anyone else have similar experiences to this? How do you deal with it?
