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Diary of an FY2 – Gotta Catch ’em All!

February 11, 2016

As you probably know, I’m doing my time as an SHO in General Surgery these days. It’s alright – the people are good but the on-calls are rough – but it’s not for me. So last week, I took the opportunity to do a Taster Week in something I want to do.

I dream of being a Microbiologist.

When the drugs don’t work, I want to be the doctor at the end of the telephone line with an idea of what antibiotics to try next. I want to hack my way through agar and biofilm to uncover the microscopic culprit behind a patient’s pneumonia/abscess/septicaemia. I want to wander around the microbiome, knowing the quirks of each bacterial species, with a scrapbook of Gram stains like a goddam Pokedex!

Basically, it’s bugs, drugs and rock ‘n’ roll!

This glorious vision of the future did not arrive fully assembled. Instead, it’s something that has been slowly growing, slowly forcing up shoots into my consciousness. At the start of FY1, I was toying between Psychiatry and Paediatrics – but with jobs in neither. Instead, I rotated through Urology, Respiratory Medicine and Haematology. Three very different specialties…

Urology – Drains. I became proficient in inserting catheters to the point that passing the tip beyond a swollen hyperplastic prostate now gives me a Zen-like rush of fulfillment. Kidney stones were a fun lesson in pain management. And of course there were UTIs. Some were entirely inconsequential while some resulted in horrific sepsis. That was where I first met Pseudomonas aeruginosa.

Respiratory Medicine – In the winter. Very busy. Asthma, COPD, Bronchiectasis…with gratuitous sputum everywhere. Steroids, nebulisers, carbocisteine, chest physio and BIPAP. A myriad of tricks for easier breathing. And Pseudomonas returned, again and again, in some of our recidivist patients. Weeks of IV antibiotics or fumigating the patinet with colomycin nebulisers.

Then Haematology – This was where I realised I needed to do smart medicine. Medicine in amongst the cells, with CD marker and cytogenetics. Medicine down the microscope. I considered Haematology as a career. Then, after we blasted our patients’ bone marrow with chemotherapy, out came Pseudomonas again, with all its cronies against an immune system of precisely zero.

At the end of the year, I knew I wanted to do something near a lab. Smart medicine. I liked the idea of providing advice (That probably says something about my ego) and working things out (the puzzle-solving cliche is irritatingly accurate). Symptoms + Bug = Give This Drug.

But I would be lying if I said this itch started last year. Even in medical school, I enjoyed putting the bacteria in their pigeonholes (Gram stain, coccus, bacillus) and I got a real kick out of how antibiotics work. And why they don’t work. Why this drug will treat this bug and this bug – but not that bug.

It was only recently that I realised why this geekish, stamp-collecting approach appealed to me so much. It was bedding down on existing schemas in my mind, flowing freely along well-trodden neural networks. The idea that everything has a type, can be categorised, and can be treated on the basis of those categories.

Pokemon.

Yes. That cultural phenomenon that went global in 1996 and ignited my 7-year-old mind. I obsessed over my copy of Pokemon Blue, striving to catch ’em all (to train them was my cause!). As the schoolyard trends and popular culture moved on, I did not. I devoured Pokemon Silver then Pokemon Sapphire and so on, as more Pokemon were added and more complexities layered on. To this day, I remain in Pokemon’s thrall. All those hours, all those Pokemon battles, countless pokeballs – They’ve worn a track in my mind and now Pseuodmonas has covered it in a biofilm.

Part-Microbiologist, Part-Pokemon Master. It’s all bugs, drugs and rock ‘n’ roll!

 

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