101 Reflective Lessons from a Year with Sydney HEMS. Part Seven: Life Lessons

This post, detailing my reflections on life lessons, is the seventh and final post in a series recording my reflections on the twelve months I spent working for Sydney HEMS in prehospital and retrieval medicine. The first post covers medical education – you can find it here. The second covers human factors – you can find it here. The third covers clinical lessons from retrieval medicine – you can find it here. The fourth covers more clinical lessons – you can find it here. The fifth post covers leadership lessons – you can find it here. Part six covers self care – you can find it here.

Moving to a different country to work in a different healthcare system is challenging and will involve being out of your comfort zone in a number of ways, frequently. That’s definitely not a bad thing for your growth as a clinician (and a human being!) but it can be very hard to prepare for, particularly when you don’t know where some of the challenges might be coming from. There are obvious things – like knowing how to “make things happen” in an Emergency Department (where to find local treatment protocols, where equipment is kept, who to ask for help, which specialty to refer patients with pyelonephritis to…!) – and less obvious things, like knowing how to own, register and maintain a car in a different country.

The lessons below are a mixture of clinical and non-clinical lessons I’ve learned during my year working at Sydney HEMS, some related to work – others less so. I hope you find some wisdom here too 🙂

Wear sunscreen

Australia is notorious for its skin cancer rates with approximately 2/3 of Australians diagnosed with some form of skin cancer by the time they are 70. The Australian cancer council tells us that melanoma is the third most common cancer diagnosis (excluding non-melanoma skin cancers).

As such, Australians have become pretty obsessive about sun care. Sunscreen is often sticky and gross but it is not optional. Sunburn is socially frowned upon down under. Please, please wear sunscreen, particularly in Australia – as a pale-skinned Celt, my house is full of the stuff and I carry sunscreen in every handbag as well as in the car.

Don’t send angry emails

This is age-old, sound advice. Write them if you must, but don’t send them – sit with them, sleep on it, consider deleting them altogether or removing the most emotive lines. If you feel you really have to write something about how annoyed/upset/irritated you are, focus on articulating how you feel and what you want (you can use giraffe rules for this). You might find this gets you greater traction but remember that emails have greater permanence than a face-to-face or phone conversation. It might be better to try a face-to-face approach instead.

Some people just love bureaucracy

That’s just the way it is. If you want some really specific advice, having your maiden name on your driving licence and all your other ID in your married name is NOT helpful (even if you think it might be).

We have all met the “computer says no” type people – maybe they are like that all the time, maybe they are having a bad day, maybe they’ve just taken an instant dislike to you and decided to make your life miserable today. This is where we must invoke one of the central tenets of the Philosophies of St Emlyn:

E + R = O

This equation means “event plus reaction equals outcome” and is one of the most quoted philosophies among the St Emlyn’s team.

We cannot control all events but we have total control over our own reactions and as such we get to shape the outcome. For the current body of St Emlyn’s philosophical practices, see here.

People do stupid things

People do ridiculously stupid things. They’ll probably do them again if you can get them well enough to have the chance. And actually, that’s kinda the point of much of Emergency Medicine. Ours is not to reason why they thought that balancing a chair on a table on a carpet was a good idea – ours is to pick up the pieces and facilitate non-judgemental reflection while we do our best to help people recover. We can’t let our judgements of our patients colour the care we deliver (although I’ll admit to being surprised at the breadth of power tools one can rent…)

The sea is dangerous

It’s lovely to swim in, particularly when the weather is hot. But never, ever forget that it is dangerous and powerful, and if you can’t swim, please – just don’t get in the water.

If you can’t swim, take some lessons – they might save your life – and be wary of the power of any body of open water.

Don’t turn your back on the sea – it’s easy to see why Sydney HEMS visits this particular spot on the coast a couple of times every year to rescue tourists with broken ankles…

You can face your fears!

I was really not a fan of flying before I took this job. I could tolerate commercial flights and even enjoy them provided I didn’t think too hard about how the plane was staying up in the air. But I didn’t love turbulence at all.

Fast forward twelve months and I discovered that when in the Emergency Medicine zone, I get to decide what inputs have an influence over the way I feel (see the E + R = O philosophy above). Looking after a sick patient or travelling to a job with work-stuff to think about was a great distraction from flying related fear and even worked for some spider-related stuff (although I’m still working on that particular phobia).

Don’t let your fears limit you. You can get over, around and through them.

Travel insurance is a sensible idea

Particularly if you intend to engage in activities which might result in your hospitalisation – but anyone can get sick or injured. Your health matters – take responsibility for it.

230ft is a long way down. Or up

In the picture at the top of this post, I am being winched into a helicopter (with a patient in a stretcher) in the Blue Mountains. The winch cable was out more than 230ft (70m) when the paramedic was winched out of the helicopter onto the ground before I was. It takes quite a long time to winch someone up over that distance and about halfway up the patient lifted his head to have a look around – I found myself yelling over the rotor noise “everything’s ok, don’t worry” before looking down to see the ground a long way below and the helicopter and long way above. It’s a looooooong way down – and up.

You can see some video footage from this mission here (in a new window).

You are not the best judge of how tired you are

So be careful. Be honest about your recent sleep and workload, be vigilant for cues that suggest you might not be your best and most capable self. You’re important – don’t take risks. Take care of yourself and your colleagues.

Some days you’ll be awesome. Other days you’ll fall on your bum

Humility is incredibly important. There’s something to learn from both kinds of day. Keeping a record of these reflections has been really powerful for me’ I hope and believe it will make me a better doctor (and a better person),

Don’t laugh at your colleague who just fell on their arse – you’ll likely be next

See the point above. Sorry, Cam Marks – I shouldn’t have laughed at you!

Don’t be tempted to use more words than you need to

Over the last year I’ve noticed that there are times when it’s good to be succinct; I’ve spent more time thinking and less time talking.

Of course, sharing your mental model is really helpful, but that doesn’t mean you need to share every single thought in your head (actually, please don’t do that – I will tune you out completely). Some people speak more when stressed, others find the opposite. Which one are you? Do you have the balance right?

You never know when you might need cash

Plan this in advance – carry some. I was pretty lucky to avoid getting stranded on any missions but I did go on some very long jobs. When we started with the service, wise bosses suggested carrying an ATM card with you. I prefer to have a few notes (around £10-20 equivalent) and about £5 equivalent in coins, as well as my phone: my online banking app allows me to get cardless cash out.

Your family (whatever that means to you) is worthy of your time and investment

I’m using the term family here to mean whatever you choose it to mean – the important people in your life. They make you who you are – spend time with them to retain your sense of identity. As the RAGE podcast guys identify, we find ourselves constantly balancing the work and non-work aspects of our lives. I’ve had a brilliant year because for the first time in ages I’m living in the same city as my husband – we have had a lot of fun exploring Sydney in our time off and it’s been great for my overall mental health.

We’ve also spent more time in communication with our families – somehow being further away means we make more effort to chat on Skype and we’ve spent quality time with our parents when they’ve come to visit for longer spells than they ever would in the UK.

My learning point here is that these people won’t always be there – we should make time for them and make them a priority. It’s an investment with a high return rate and you don’t have to move to the other side of the planet to make it.

Put down your phone!

I’ve spent more time off twitter this year for a number of reasons. I have struggled in the past to get the signal:noise ratio right despite good filters. I’m still trying to find a way to engage effectively with the FOAM community to get the things I need from it (knowledge, community, inspiration) without losing a huge chunk of my life. It’s a journey.

Never forget

Never, ever forget how fortunate you are, or how amazing it is that you are where you are – how far you’ve come! I feel incredibly privileged to be able to move to the other side of the world, to work in an incredible job alongside inspiring, motivated, skilled, wonderful people and to learn from them. Count your blessings too – reflect on who you used to be and how far you’ve come. Celebrate your successes and continue to strive to deliver even better care – that’s why we’re all here 🙂

Final Thoughts

Thanks for sticking with me through this process. It’s been powerful and useful for me so if you got something out of it too, that’s a great bonus. Huge thanks to everyone at Sydney HEMS for teaching and training me, for working alongside and supporting me, and for generally contributing to an incredible year of learning and self-development. You’re all marvellous!

The Sydney HEMS experience is well worth it. Australia has many other things to offer too: it seems only fitting to leave the last words of this series to an actual Aussie with some life lessons of his own.

vb

Nat

@_NMay

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