Breastfeeding - it’s the normal way to feed your baby and has a long list of benefits for mother and baby. Yet sadly so many new mums struggle to establish breastfeeding and part of this is that many women don’t know what to expect or how to deal with the obstacles that arise in the early days and weeks of feeding a newborn. It also doesn’t help that maternity wards are so short-staffed and midwives simply don’t have the time that they’d love to spend helping women learn to feed their babies in the first days after birth. I’ve so far been breastfeeding my gorgeous boy for five months, and though the early weeks were challenging, feeding him is now easy and enjoyable for us both. Getting through the first 6 weeks is crucial to successfully breastfeeding your baby through infancy, so here are my tips on getting set for breastfeeding success.
Decide that you want to breastfeed
It might sound obvious, but making a conscious decision that you will breastfeed your baby will enable you to prepare and learn more in the months before your baby is born. Talking to your partner and family about why you are planning on breastfeeding and discussing how they can help this to happen is really important too, so you can have them on your team to advocate for you if feeding is difficult.
Find resources that you can refer to later
Websites like the Australian Breastfeeding Association (ABA), KellyMom, and the Possums Gestalt Breastfeeding Course are full of useful and practical information, both to read during pregnancy and to refer to once bub arrives. ‘The Discontented Little Baby Book’ by Dr Pamela Douglas is an excellent read that covers feeding, sleep and fuss-cry problems in the first four months of life and discusses a gentle yet evidence-based approach to these issues. Once bub is born, the ABA Phone Helpline and in-person meet-up groups can provide invaluable information and support.
Talk to friends who have successfully breastfed
Spend some time with any mum friends who are currently breastfeeding or have previously breastfed their babies, and ask them any questions that you’ve been pondering about how it all works and how their experiences have been. The more you are exposed to breastfeeding, the easier it will be to make it happen for you and your baby.
Invest in some breastfeeding-friendly bras and clothes
Breastfeeding itself does not cost a cent, but investing in some good quality comfortable nursing bras can make a world of difference. My favourites are from Bras N Things and best of all the maternity sports bras from Cadenshae (I live in these along with my #mumlife activewear on the daily!). Some clothes are more feeding-friendly than others, especially when feeding in public. In the first couple of weeks, nursing singlets (from Kmart/Target/Bonds) are comfy and have super easy boob access. As you begin to recover from the birth and get out and about, most tops are easy enough to either lift up/pull down/unbutton. Cotton On do lots of activewear tanks with larger arm holes that can be pulled across easily. Dresses are a bit trickier but there are lots around at the moment with zips/buttons/press-studs providing easy access that aren’t necessarily breastfeeding/maternity styles - my favourites are from St Frock, Orange Sherbet and Forever New.
Put together a ‘breastfeeding station’
When the nesting phase hits, put some of that energy towards setting up a breastfeeding station - because you’ll spend plenty of hours a day snuggled up feeding your little one, in the first few weeks especially. You don’t need a fancy rocking chair or recliner, just your couch will do the trick. Basing yourself in the living area of your home rather than being stuck in the nursery is always a good idea too. Add plenty to your list on Netflix, have a couple of cushions handy, and put together a basket with a water bottle, healthy snacks, lip balm, a burp cloth and nipple cream. Once you get through the first weeks, are spending more time out of the house and your baby is faster at feeding, you’ll barely have time to check Facebook at each feed let alone switch the TV on, so be ready to embrace the initial seemingly endless feeds and the binge-watching that goes with it!
Expect that the first few weeks will be hard
Feeding a brand new baby takes up a good chunk of the day and a huge amount of your energy. It is exhausting and difficult and can make you wonder how on earth anyone could breastfeed for a year or more. However - keep in mind that breastfeeding in the first 6-8 weeks is all about you and your baby learning to feed, and about building up your milk supply. Breastfeeding works on supply and demand. The more milk your baby drinks, the more milk you will make. Your baby will feed frequently to help your body make more milk to sustain him as he gets bigger. Newborns need to be fed at least 8-12 times a day, so feeding every 2 hours or even more frequently is completely normal. A baby wanting to be fed often does not mean you don’t have enough milk or that your milk isn’t good enough - your baby knows what it is doing, as does your body. Young babies often “cluster feed” during the evenings where it feels like they are constantly wanting to be fed - this is normal and is one way that your baby helps build your milk supply. If you are able to persist through those tough weeks, the payoff is that feeding becomes easy. Your baby becomes an expert at latching on and becomes faster at draining the breast, and you become confident in feeding not just on your comfy couch but out and about too. Bottle-feeding might seem easier initially but in the longer term breastfeeding is much more convenient - no need to sterilise bottles, mix up formula, or carry around a bottle warmer; you literally have food for your baby on tap and also a very effective tool to soothe and calm a stressed out bub.
Advocate for yourself in hospital and afterwards
Make sure the midwives who are caring for you in hospital after the birth are aware that you want to breastfeed, and ask for their help checking that bub is latched correctly at every feed until you feel comfortable to go it alone. Ask if there is a lactation consultant available on the maternity ward, and seek their help. If you are not feeling confident with breastfeeding by the time you are going home from hospital, ask for referral to a lactation consultant or GP with an interest in breastfeeding. If at any point you are having difficulty, you can call the ABA Breastfeeding Helpline on 1800 MUM 2 MUM - free help is available 24 hours a day, 7 days a week from trained volunteer breastfeeding counsellors.
The reality is that breastfeeding can be physically and emotionally demanding but is worth weathering any initial difficulties as once you and your baby get the hang of it, breastfeeding can be enjoyable and relaxing for both mum and bub. Breastfeeding is an amazing gift to give your baby, and will set them up for the absolute best start in life. There will be times you will have to miss out on going to events that are not baby-friendly and you might feel like you never get a break from your cuddly koala baby, but this phase does not last forever. The time you breastfeed your babies is such a short period in your own life, but has the potential to give your baby benefits that last the whole of theirs. Breastfeeding also provides health benefits for mothers including decreasing your risk of breast cancer, with the risk going down the longer you breastfeed. Balance these positives with any FOMO you feel, especially in the first months of motherhood. Remember that breastfeeding is not just about food, it provides your baby with comfort, pain relief, perfectly balanced nutrition, quenches thirst and is a source of calm and relaxation. Taking time to learn about and prepare for breastfeeding before your baby arrives will give you both the best chance of reaping the rewards and enjoying breastfeeding success. Good luck!
Creating and growing your own little mini-me puts both your mind and body under all sorts of stress and strain. Before sperm meets egg, taking the time to get your own health in tiptop shape will give you the best chance of growing a beautiful healthy baby, and of staying well throughout pregnancy and as a new mum.
Attend your GP
The first stop on your road to pregnancy should be a chat to your GP, who can give you personalised advice, arrange necessary tests and also give you info about local maternity services. If you don’t already have a regular GP, then now is the time to find one you like. Finding a GP who you’d feel comfortable eventually taking your kids to is also a bonus. Most general practices list the special interests of their GPs on their websites, so keep an eye out for any who list women’s health, antenatal care or paediatrics as their areas of expertise.
If you are planning pregnancy, the safest choice is not to consume any alcohol. Alcohol intake can negatively affect fertility in both males and females, so now is the time to cut down and stop drinking altogether. It is difficult to know whether having one or two drinks occasionally whilst trying to conceive will have any impact on an embryo (such drinking in the early weeks before you know you are pregnant), but it is better to avoid the what-ifs by not drinking at all. Once pregnancy is confirmed, avoiding all alcohol is even more important.
Coffee addicts be warned - during pregnancy it is recommended to limit caffeine to no more than 300mg/day. This is around 2-3 shots espresso coffee, so you can hit that allowance in a single large coffee. Having more than this is associated with impaired foetal growth, and with miscarriage - although a direct causation has not been proven. So if you are consuming significantly more than 300mg per day then the time to start cutting down is prior to falling pregnant, because the only thing worse than first trimester morning sickness and fatigue is suffering through caffeine withdrawals at the same time.
It goes without saying that illicit drugs should be avoided anywhere near pregnancy, but it is just as important to discuss with your GP any regular medications you are taking to ensure these are safe to take prior to and during pregnancy. Some medications used for epilepsy and other conditions can cause damage to a developing foetus and cannot be used while pregnant. It may take some time to switch over to other treatments so don’t wait until you are ready to start trying to check on this.
Exposure to infectious disease
Zika virus affects many tropical and subtropical countries, and is spread by mosquitos and sexual contact. Zika can cause birth defects if a mother-to-be is infected. If you are planning to become pregnant, the Department of Health recommends either delaying travel to areas affected by zika virus, or delaying pregnancy if travel goes ahead. If you have traveled to an area with zika in the last 6 months, chat to your GP to find out if you need to delay pregnancy - different countries have different risk levels so it depends where you’ve been.
One of the most important things you can do now to prepare your body for building a baby is to start taking a folic acid supplement of at least 400mcg/day. Folic acid reduces the risk of a baby having a neural tube defect such as spina bifida, and most people cannot consume enough in their diet alone, so supplementation is needed. However - to prevent neural tube defects, you need to be taking folic acid for at least 12 weeks before falling pregnant and continue to take it until at least the end of the first trimester. If you have a family history of spina bifida, or if you have epilepsy or diabetes, you will need a higher dose of folic acid - ask your GP. Most pregnancy multivitamins contain the recommended amount of folic acid, but check the label as there are lots of different brands (and huge variations in price). It’s also worth noting that many ingredients in those pregnancy multivitamins have not been shown to have any benefit in either getting pregnant or growing a healthy baby. Folic acid is one of the very few supplements shown to improve any outcome and can be bought on its own for a fraction of the price of the multivitamin tablets marketed towards women trying to conceive.
Get lots of sleep
May as well stock up on sleep now while you are able to! From as early as 8 weeks pregnant, hormones and a growing uterus cause mums-to-be to wake up several times a night to pee, along with the first trimester fatigue that hits you like a truck. As the pregnancy goes on there is a baby using your bladder as a trampoline all night, and all the back pain/squished lungs/kicks in the ribs and other fun to interrupt your sleep - and that’s all before your bundle of joy even arrives earthside to keep you up all night. So stop what you are doing and go have a nap. Really, you will thank me later.
Hospital clinic vs private obstetrician vs group midwifery
Fairly early in pregnancy you’ll need to decide on the mode of your antenatal (i.e. during pregnancy) and birth care, so it’s worth researching your options before falling pregnant. In Australia there are two broad options for maternity care - public and private. In the private system, you pay out of pocket for an obstetrician of your choice, and are charged for costs incurred during a stay in a private hospital for the birth (though these are mostly covered if you have top level private health insurance). In addition to the cost of health insurance, out of pocket costs are likely to be several thousand dollars, however you’ll get your choice of doctor, a private room, likely better food and a longer hospital stay after birth. In the public hospital system, the cost of antenatal care and of being in hospital for the birth is all completely covered by Medicare with no out of pocket cost to you. In most areas, you will have a choice of GP shared care (where your antenatal care is partly done by your GP and partly by public hospital obstetric doctors) and midwife-led care. If your pregnancy is complicated by medical conditions, twins or other issues you will see obstetrics doctors at the hospital antenatal clinic, however you may see a different doctor at each appointment and are not able to choose your obstetrician. Talk to friends who have delivered in both systems, call your local hospital and ask your GP, as services vary in different areas. I personally had a fabulous experience through my local public hospital and GP shared care - the only thing I paid out of pocket for were ultrasounds (total of $300-400 over the pregnancy), and even this cost could have been avoided by choosing a bulk-billing radiology practice.
Iodine and iron
Iron and iodine are both important nutrients for conception and pregnancy, and requirements often increase more than women can consume in their diet. It is recommended that women take an iodine supplement during pregnancy unless they have a thyroid condition, in this case discuss with your GP. Many women have low iron to start with so it’s worth increasing your dietary intake (red meat, leafy greens, iron-fortified grain products) and taking a supplement if you can’t get enough from your diet. Your iron levels can be easily checked by a blood test if needed.
Journal your cycle
Before you start trying to conceive you’ll need to know which days of your cycle you are fertile - in a nutshell you can become pregnant from around five days before and one day after ovulating, and in a 28 day cycle most women ovulate somewhere around 2 weeks after the first day of their period. There are lots of apps that allow you to track your cycles and then predict your fertile days. The more data you add, the more accurate your predictions will be. You can also buy ovulation test kits which measure hormones in your urine, similar to a pregnancy test, that can help you figure out your fertile days. Knowing all of this before you start trying can make it a bit less stressful.
Know your genetic risks
About 1 in 100 babies will be born with a genetic disorder, ranging from minor to life-limiting. If any genetic conditions (such as cystic fibrosis) run in yours or your partner’s family, ask your GP whether you need genetic testing before trying to fall pregnant. Screening is not yet covered by Medicare for the general population, but this is a hot topic at the moment so may change in the near future. Potential parents can be tested to see if they carry genes for several hundred conditions, at a cost of several hundred dollars. If you are found to be a carrier for a condition, your partner can then be tested to determine if there is any risk of passing the condition to a baby.
Leave - what are you entitled to?
Find out from your work’s HR department how much maternity leave you are entitled to, as well as your options for potentially returning to work part time or in a different role down the track. Also check if you are eligible for paid parental leave from Centrelink. Paternity leave entitlements vary wildly amongst employers and are worth checking out in advance as well.
Dads-to-be also need to prep for baby making - poor diet, sedentary lifestyle, smoking, alcohol and being overweight can all negatively impact a man’s fertility.
No more sushi
You’ve probably heard at least one pregnant woman recite a list of foods she will be devouring as soon as her baby is born - sushi, brie, a McFlurry, prosciutto… These foods all have a risk of being contaminated by bacteria called listeria. If a pregnant woman is infected, listeria can cause miscarriage, stillbirth or a bloodstream infection in a newborn baby. While you don’t need to avoid all the at-risk foods prior to pregnancy, you’ll need to know what is a no-go once those two little lines appear. There is a great brochure here by the NSW Food Authority with more info.
Are you exposed to chemicals, infectious diseases or radiation at work? Or does your job involve strenuous physical labour? Now is the time to find out if any of those exposures need to be avoided in pregnancy and how your employer would be able to accommodate any need for a change in duties.
Make sure you are up to date with cervical cancer screening, which now is done as a test for the HPV virus instead of the traditional Pap smear. Testing prior to pregnancy means that any abnormalities can be further investigated or treated without being complicated by also being pregnant. Read more on the recent changes to cervical screening here.
This one is a biggie… if you smoke and have ever needed a reason to quit, growing a baby is a great one. Your GP and the Quitline website and phone line are all good places to get help to quit for good.
Review control of chronic health issues
Pregnancy can mess with all sorts of health conditions like type 1 diabetes, asthma, and autoimmune diseases. The pregnancy hormones make some of these easier to manage and others more difficult. See your GP or specialist to ensure any specific health issues are under tight control before adding pregnancy into the mix.
Social support and mental health
The transition to motherhood is a wild ride - exhilarating one moment, exhausting the next. Hormonal changes, sleep deprivation, changes in your relationship and spending every moment caring for a new baby will test even the happiest and most adaptable woman. Anxiety and depression are very common during pregnancy and in the year following childbirth, as are feelings of isolation and loneliness. Think about who will form your support system and who you can call on for help. Practical info from Beyond Blue here.
See your dentist and get those pearly whites checked and cleaned. Gum disease has been linked to lower birth weight of babies and early births. Get flossing!
Understand the likely timeframe
A healthy couple in their early-mid 20s only has a 25-30% chance of pregnancy in any one month and this chance declines with age, but knowing which days you are actually able to conceive will give you the best start (see above!). It is likely to take a few months if not longer, although plenty of people get pregnant when not trying so don’t rely on luck for contraception! If you are under 35 years old and have been trying for 12 months, or are over 35 and have been trying for 6 months without falling pregnant then see your GP about looking into any reasons that pregnancy may not have occurred yet.
Check that your vaccinations are up to date, especially for measles/mumps/rubella as rubella infection can be very harmful to unborn babies. This vaccine can’t be given to a pregnant woman so needs to be done before falling pregnant if a dose was missed in childhood.
Being a healthy weight maximises fertility and minimises the risk of some pregnancy complications such as gestational diabetes and high blood pressure. If you are overweight, losing 5-10% of weight can significantly improve your chances of falling pregnant. Taking steps (literally - get your 10000/day!) to get to a healthy weight will set you up for a healthy pregnancy.
Doesn’t quite start with X but it’s Xtra necessary to be active in the lead up to trying to fall pregnant. Doing moderate intensity exercise like swimming, power walking or aerobics classes improves fertility. Getting into the habit of exercising regularly now will make it easier to continue right up to delivery and beyond. Being active during pregnancy may reduce the risk of gestational diabetes and may make your labour, birth and post-postpartum recovery smoother.
You are what you eat
Growing a baby from two cells up to 3-4kg of squishy cute human requires a huge amount of energy and nutrients, and your ever-expanding bundle of joy will sap all of your stores before going without. Eat a varied and balanced diet high in iron and calcium with lots of fruit and veggies and lean protein. There is no need to cut out any food groups, just minimise the usual nasties (sugar, saturated fat, salt) and enjoy eating all your favourite foods before any morning sickness kicks in! Seeing a dietitian can be helpful especially for vegetarians or vegans, or people with food intolerances to help plan out a diet which includes enough of the essential nutrients for baby-building.
Sleep gets two mentions because it is so important. Now go and have a nap on my behalf!
Resources used to guide this post:
Department of Health Pregnancy Care Guidelines https://beta.health.gov.au/resources/publications/pregnancy-care-guidelines
Dorney & Black - Preconception Care; AJGP July 2018 https://www1.racgp.org.au/ajgp/2018/july/preconception-care
Pregnancy Birth Baby - Listeria https://www.pregnancybirthbaby.org.au/listeria-food-poisoning
QLD Health Pre-Conception - Health Lifestyle for Mothers https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-staff/maternity/nutrition/lifestyle/pre-conception
RANZCOG Planning For Pregnancy https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Planning-for-pregnancy-pamphlet.pdf?ext=.pdf
RANZCOG Pre-Pregnancy Counselling https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Pre-pregnancy-Counselling-(C-Obs-3a)-review-July-2017.pdf?ext=.pdf
SA Health Preconeption Advice Clinical Guideline https://www.sahealth.sa.gov.au/wps/wcm/connect/1f11de804eed8cb5afbeaf6a7ac0d6e4/Preconception+Advice_Sept2015.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-1f11de804eed8cb5afbeaf6a7ac0d6e4-moBLd0A
WHO Zika Virus Classification Table https://apps.who.int/iris/bitstream/handle/10665/260419/zika-classification-15Feb18-eng.pdf;jsessionid=0D67718AA2CA0A85F84F36B851AB9E9F?sequence=1
You will (eventually) not be terrified every time your pager goes off
I can vividly remember the first time my pager went off on day 1 of internship. I was sitting in our haematology multidisciplinary meeting and the intrusive beeping just about made me jump out of my skin. I called back, timidly introducing myself as “Kate, the new intern… someone paged me?” When the nurse on the other end of the phone asked me to review a patient who had chest pain, my immediate thought was ‘oh I better let one of the doctors know…’ - it took another minute to realise I was one of the doctors. I walked down the corridor towards the ward, internally panicking that I was about to walk into the room to see a patient half-dying in front of me. Thankfully I soon found out that not only was the patient alive and well, but they also had a history of reflux and had currently had similar symptoms, which were beginning to ease after taking their usual medications. Crisis averted. After an uncoordinated and stressful examination on my part (terrified I would miss something crucial despite a perfectly well-looking patient in front of me), I returned to the meeting and my heart rate gradually returned to normal.
Whilst in reality 90% of times I was paged over the year were for non-urgent problems or paperwork issues, it took at least 6 months to stop my heart from racing when my pager beeped, and to stop having dreams about work that mainly revolved around being paged repeatedly or my pager going off but not being able to find it. Had I realised at the start of the year that in a real emergency situation I’d never be alone for long, and that most pages would be a nurse asking me to rechart a medication or pharmacy needing me to sign something, I’d have saved myself so much stress and pager-related anxiety.
You know more than you realise
The initial weeks and months of internship provide many opportunities for the new intern to feel useless, be talked down to by rude colleagues, fumble through poorly-planned consults and not have answers to any questions patients or nurses ask you. For every thing you realise you don’t know, there are another three things that you do know and you don’t even realise.
The first few rapid response calls (MET / PACE / whichever system your hospital uses) that you are called to, you’ll feel stupid, helpless and need to ask multiple questions of your seniors to convince yourself that your fluid bolus or your stat analgesia order won’t kill the patient. Fast forward a few months, and you’ll start initiating management of deteriorating patients before senior help arrives, and running your initial plan past them rather than waiting for them to turn up and decide on the plan themselves.
Every single patient you see is adding to your subconscious ongoing learning and it isn’t until you sit back and remember how much of a bumbling idiot you felt like in the first weeks of doctor-hood that you can really see how much you are learning without even trying. Four to six years of medical school is only the tip of the iceberg in terms of a career’s worth of ongoing learning, but don’t discount how much you have learnt already. As long as you know your scope and when to ask for help, you will be a safe and competent intern.
…but it’s a steep learning curve
Having said all of the above, be warned that despite having senior help often close at hand, you will have to put in effort and reflect on your own practice to truly progress in your knowledge and clinical skills. It would be easy to coast through the year without so much as peeking at Up To Date, but to capitalise on the rich clinical exposure and breadth of patients you will look after, a little reading around some of what you are seeing on ward rounds or in clinic will do wonders to consolidate your knowledge.
After being thrown in the deep end with a highly sub-specialised first rotation, it took me a while to feel like I had the time and energy to do anything work-related outside of the hospital. But when I did take the time to jot down patient cases that were interesting or unusual, or just common things I didn’t feel confident in managing, and then spent 5 minutes having a quick read on eTG/Up to Date etc, it made it so much easier to learn having that patient in my head. If you treat every patient as a learning opportunity and do a little bit of study here and there, it will really help to solidify your skills for the next time a similar case comes along.
The year will be overwhelming at times, as well as frustrating and exhausting, and you’ll feel physically and mentally drained if you don’t step back and take care of yourself. Recognise when you are getting exhausted and speak to someone (GP, friends, supervisor etc) if you need help. It’s a massive change from being a medical student - remember that no one is expecting you to be an expert.
There’s no way to sugar-coat it - after-hours shifts can be awful
My first after-hours ward call shift was terrifying - a 14.5 hour shift on a public holiday and absolutely non-stop the entire day. I finally paused to eat something at 5pm (after getting to work at 7:30 in the morning) and was running between wards until I finally handed over to night shift. The day was a constant stream of rapid response calls, patients needing new cannulas, clinical reviews for fever/rash/headache/hypertension and endless medication charts to be redone. I needed the rest of the weekend just to recover from the onslaught.
There are no two ways about it, these shifts are long and tiring. Ward call / after-hours shifts involve skeleton staffing and lots of patients per doctor. You just have to get stuck in, prioritise what needs to be seen early and keep a list of things that can be done later. Get into the habit of finding out as much info about each patient you are asked to review when you are called, and get the management started over the phone before you get to the bedside:
- what are the patient’s obs, and what is the trend?
- what is their relevant history?
- when were their medications given?
- do they need an ECG?
- do they have a cannula?
- can I give a phone order for a medication or arrange anything else in the interim?
Think about what you need to know that will help you manage the patient when you get to see them, especially if there are other more urgent reviews and this patient might be waiting a while to be seen by you.
On the plus side, you will learn lots, get more confident at managing common problems (chest pain, shortness of breath, fever etc), and overtime penalty rates are always well-deserved and welcomed come pay day.
Being an intern is actually an enjoyable and privileged job
There’s been a lot in the media this year about doctor wellbeing, bullying amongst the medical profession and work-related distress. These are real and troubling problems. Luckily on the whole, I have found internship to be highly enjoyable and rewarding, and has cemented that I have made the right career decision in pursing medicine. We are in the privileged position of looking after patients who are vulnerable and suffering through the worst times in their lives. Though being amongst it everyday normalises the whole situation, we have the potential to make such a huge difference in the lives of others. Finally being able to do procedures independently, make clinical decisions and formulate management plans for common problems, be part of discussions about patient care and contribute to the medical team are all incredibly satisfying.
Over the course of my intern year, I have seen patients die despite intensive medical care, those who were on the brink of death recover and walk out of hospital and others walk in with a simple problem end up with a life-changing diagnosis. I have seen the routine illnesses and injuries benefit from our world-class public health system and bounce back to their normal lives. It is easy to get caught up in the mountains of paperwork, discharge summaries and medication charts that interns are lumped with, but when you finally get to work in the field you’ve spent years studying towards, it doesn’t matter. I have worked alongside some fantastic doctors who I now count as fantastic friends.
The year has flown by and I’m only a few weeks away from launching into residency and training as a GP registrar. There have been some extremely challenging days and weeks this year, but finally being able to step up to the plate and begin my medical career has made it all worthwhile.
One of the first things I was ever taught as a student nurse was that people will forget what you said, they will forget what you did, but they will never forget how you made them feel. It is a sentiment that I have carried with me in the decade spent caring for patients since then.
It was a busy Wednesday evening when I looked after an elderly man (let’s call him Jim) who had been brought to the emergency department by his wife (we’ll call her Anne). Jim had mild dementia and his wife had noticed that he was losing weight, had lost his appetite and was becoming more lethargic. “He’s normally so healthy” Anne told me, “he hates coming to hospital, but I was worried he might have pneumonia”. After taking a thorough history, examining Jim, checking some blood tests, getting a chest x-ray and reviewing notes from his GP, the cause of his symptoms became clear. Anne had brought with her some paperwork from a recent colonoscopy, along with a series of scans and blood tests done by the GP. Jim had bowel cancer which had spread throughout his body, however he and his family didn’t seem to know.
How do I, as someone who only met Jim an hour ago, deliver the heart-breaking news that he has cancer which has spread throughout his body and is slowly killing him? How do I break it to this man’s wife of 70 years that her husband will only continue to deteriorate further into a shell of the man she married? How do I tell Jim’s two children, who have now also arrived, that their Dad is dying?
No matter how many lectures or role plays you sit through on breaking bad news, giving patients a heartbreaking test result or diagnosis just isn’t a skill that can be taught, it has to be shaped and crafted through first-hand experience.
I pulled the blue curtains around Jim’s bed and sat down with his family, who all smiled at me eagerly as though I would be able to give them the answer they had brought Jim here for, and crack on with fixing him.
“Did your doctor ever give you the results of your recent colonoscopy?”
I began tentatively, however I couldn’t delay the news much longer.
“The growth that they removed at the time was cancer, and the other tests that your GP sent you for afterwards showed that the cancer has spread to your lungs and liver.”
“I’m so sorry Jim, but I think you are feeling unwell because the cancer is continuing to spread.”
Usually a diagnosis of this magnitude is delivered by a specialist at the time of its discovery, and I wondered whether there had been a decision made, either by a family member or Jim himself, to not find out the test results. But when he came to ED with clear symptoms of his cancer, it was in the patient’s best interest to know that there was a cause for the way he was feeling. Due to his age and other health issues he did not want to pursue any active treatment. I spent quite a long time talking to Jim and his family, explaining what palliative care was, and the services that community palliative care nurses could provide to enable him to stay at home and comfortable.
For those moments, the blue curtains that separated the patient’s bed from the rest of the department felt like they had separated us into our own timezone, where I didn’t notice the beeping of IV pumps or cardiac monitors, the PA system announcing the arrival of another patient with chest pain or the constant hum of activity in the background.
I finished getting Jim organised to be discharged home, with plans for him to be seen by the community palliative nurses. I encouraged his family to keep taking Jim out to his favourite coffee shop, let him eat as many Iced Vovo's as he liked and spend as much time together as they were able. The most important thing was not the number of days or months Jim had left, but the time he was able to spend with his wife and family and doing the things he loved.
As a doctor, it can be very hard to take a step back from the history-examination-investigation-diagnosis-treatment mentality to refocus on simply allowing a person to have a dignified end of life with management of symptoms and allowing death to happen without furiously holding it at bay. Having previously worked in an area of nursing where I was heavily involved in end-of-life care for patients, I felt slightly more at ease sending Jim home without a definitive treatment for his condition and instead allowing him to be kept comfortable.
Jim was ready to head home after a visit to hospital which I’m sure will be replayed in the minds of his wife and children for a long time to come. I walked over to him with his discharge paperwork and wished him and his family all the best. Anne took my hand in both of hers, with tears in her eyes and thanked me so genuinely for being patient, understanding and helpful; as if I’d been able to fix her husband after all. Jim and his children were also so kind and thankful, echoing Anne’s thanks and reminding me that it’s not what anyone says or does that we remember, it’s how they make us feel.
I won’t remember the exact words used by Jim or his family, but I will always recall that they made me feel like I had done my job well and been the type of doctor I will always aspire to be - kind, caring and my patient’s number one advocate.
I had an hour left of my ten hour shift when a patient had a sudden and unexpected cardiac arrest in the emergency department. I took over CPR on the third cycle (doctors and nurses rotate giving CPR every 2 minutes to minimise fatigue and maintain strong compressions). By the time my hands were on the man’s chest, there was already a tube down his throat allowing another doctor to provide artificial breaths, multiple lines into his veins delivering adrenaline to try and encourage his heart to restart, and he had been shocked with a defibrillator twice. It was a very odd sensation to finally be delivering cardiac compressions to a real human after so many simulations on dummies. In other resuscitations I’ve been involved in, it was my job to get another drip in, or to get the latest blood test results or send more blood off. My own pulse was skyrocketing as I climbed on top of the hospital bed and started pressing down on the unconscious man’s chest. Several of the man’s ribs were already broken, and his sternum was freely depressible deep into his chest. Try pressing inwards on your own chest - it doesn’t feel like one of those CPR dummies… but I can tell you that once the ribs are broken by the initial compressions, the dummy is a fairly realistic simulation.
I did several cycles of CPR throughout the resuscitation effort on this man. While my hands worked to try and squeeze his heart to deliver vital blood to his brain, a flicker on the defibrillation monitor and a hand over his carotid artery showed that he had regained a pulse. For a split second it seemed things were looking up and my own pulse again was racing. Unfortunately a swift ultrasound of the heart and another glance at the monitor painted a more dire picture. After close to an hour of CPR, defibrillation, drug therapies and ventilating by a team of doctors and nurses, further efforts were deemed futile. The entire team stepped back in silence as the head doctor solemnly announced “time of death, 10.48pm. May he rest in peace”.
I have witnessed the final moments in the lives of many patients. Whilst working as a nurse, I held the hand of an elderly lady as she gasped for her last breath. I have examined recently deceased patients to certify their life extinct. I have made the awful call to family members to give them the heart-breaking news that their loved one won’t live to see another sunrise. But this death was different.
This was first patient whose chest my hands had worked on to try and bring back life. This was the first patient who I witnessed complete the transition from life to death whilst working as a doctor.
It says a lot about us as doctors and nurses that after a brief pause to debrief and regroup, we all dove right back in to the rest of the department, where every other patient is unaware of what we have just witnessed. We all become a bit desensitised to just how profound it is to witness another person’s final breath, and this is necessary to some degree or we just wouldn't be able to function. It is easy to forget that we really are in a privileged position to be on the frontline to be involved in other people’s lives beginning, ending and all the most difficult moments in between.
Great news for women who hate Pap smears…
I have been at the business end of enough pap smears to know that no woman turns up for their second-yearly cervical cancer screening appointment for fun. From the embarrassment of baring your bottom half to the discomfort of the examination itself, as much as we may all dread the experience, it is generally over in a couple of minutes and is infinitely less horrible than having cervical cancer. Since the introduction of national cervical screening in 1991, the number of cases of cervical cancer diagnosed, and the number of women who have died of cervical cancer, has HALVED. That is a huge amount of pain, suffering and heartache that has been prevented by a couple of minutes of minor discomfort per test.
It has been a long time coming, but as of December 1st this year, the current second-yearly cervical screening test will be replaced by five-yearly HPV testing. But what will that involve exactly, and how will the changeover work? And why do you still need screening if you’ve had the ‘cervical cancer vaccine’?
Currently, the process of screening for cervical cancer involves insertion of a speculum (the plastic duck-bill shaped tool) to allow visualisation of the cervix and collection of cells with a small plastic brush or wooden spatula. The cells are then either put onto a slide or into a liquid medium, and sent to a lab. The samples are then stained and viewed under a microscope where pre-cancerous changes can be detected. This allows women to be treated when changes in the cervix have not yet progressed to become cancer, but are at risk of doing so, therefore preventing cancer before it actually occurs.
Once December rolls around, the process at the GP will be basically the same for women presenting for screening. It will still involve a speculum insertion and use of a small plastic brush to collect cells from the cervix, but the tests done in the lab will be completely different. Instead of looking for pre-cancerous changes, the new tests will be detecting the human papilloma virus (HPV), which is the cause of 99.7% of all cases of cervical cancer, and is the virus at which the cervical cancer vaccine (which is actually an HPV vaccine) is directed. This test is more accurate than the current testing which means you will only need to have screening once every five years!
HPV is a very common virus, spread by genital skin to skin contact, and most people will contract it at some time in their lives and be none the wiser. It is usually harmless and most of the time your body clears the infection without causing you any symptoms at all. BUT, when it isn’t cleared, there is a risk that the infection will cause pre-cancerous changes to cells in the cervix and then progress into cervical cancer. So detecting this process at the stage of initial HPV infection means that changes in the cervix can be found earlier, and potentially treated earlier, with the aim that less woman actually end up developing cervical cancer at all.
“But I’ve had the HPV vaccine! Surely that will do the trick?!” I hear you say… well there are actually 100 different types of HPV, and the vaccine only protects against type 16 and 18 which are high risk types that cause 70% of all cervical cancers. One of the HPV vaccines that is available in Australia also protects against two other HPV types which cause genital warts. Bonus! Moral of the story is, whether or not you’ve been vaccinated, you will still need ongoing screening to detect the pesky HPV infections not covered by the vaccine and ensure any abnormalities can be picked up early.
Another change beginning in December is that the age of first testing will be pushed back from 18 to 25 years old, or once a woman becomes sexually active, whichever is later. The evidence shows that screening hasn’t changed the number of cases of cervical cancer in women under 25, or the number of deaths from cervical cancers in this age group, despite halving the overall number of cervical cancer deaths in the 26 years since national screening started. In young women under 25, there is also a higher risk of ‘over-treating’, where abnormalities are treated even though they might not actually be problematic. Treatment of cervical abnormalities can include removal of tissue and laser to the cervix, which later increases the risk of pregnancy complications like cervical incompetence and premature delivery. The widespread vaccination of both girls and boys has reduced spread of virus within the community, so young women and all the immunised generations that follow will be at lower risk to begin with. So it’s a balancing of risks and benefits, and in this case the evidence points towards 25 years of age as the time where HPV testing should begin.
In the changeover period, women will be invited to attend screening two years from their last test, and then every 5 years after that. As the new test is more accurate than previously, it is safe to have a longer interval between screening. If you are due for a pap smear before December 1st, continue as normal and have the current test when it is due, then your next one in another two years time will be the new HPV test.
When all these changes were announced, there was mass panic amongst some women who were concerned that the new testing was merely an exercise in cost savings and would put women at risk with longer time between testing. However, since more information has become available and the concerns regarding risks and efficacy of the new tests have been addressed, the vast majority of women, as well as doctors and the public health sector are welcoming the changes. Not only will it bring more accurate testing but it means the number of speculums a woman will have to encounter in her lifetime has more than halved.
Despite all of the above, if you have any abnormal bleeding, pain, discharge or other worrying symptoms, do not wait for your next test to come up, see your GP straight away.
Do you have questions or concerns about the changes? Leave a comment below, I’d love to hear your thoughts!
Before I launch into a semi-rant/semi-informative blog post about healthy eating, let me get a couple of things straight. Firstly, I am not a dietitian and am in no way about to provide the definitive works on nutrition and diet. Secondly, as I am writing this I just bit the ears off a delicious Cadbury chocolate bunny and may well continue devouring it as I write the following paragraphs so I’m not about to shame you for doing the same every now and then.
It is no secret that Australians on average weigh too much, exercise too little and suffer the consequences when it comes to lifestyle-related chronic diseases. At the moment there is a huge movement bordering on obsession with ‘clean’ eating, religiously following quasi-experts who champion fad diets and tracking all our food intake and activity. And yet as a nation we still keep getting more type 2 diabetes, more heart disease, more fatty livers and more lifestyle-related cancers. There is so much conflicting information out there about whether we should eat high protein, low carb, low fat, gluten-free, low-GI, low-GL, Mediterranean, DASH, paleo or sugar-free etc etc that it all becomes too much to think about and so most of us continue on without changing anything we eat at all, or worse decide to calm down from the diet madness with a nice slab of chocolate cake.
Of course, what you eat is going to be based on your health goals, whether that be weight loss or gain, training for an event or avoiding foods that don’t agree with you. But when it comes to eating well for life, and to preventing lifestyle-related diseases that will creep up on us if we aren’t careful, what should we actually be eating?
For every research study that is published showing that low carb is better than low fat, or that sugar is the root of all evil, another is published showing that in a nutshell, all diets have the same outcome: if you can’t stick to it long term then don’t bother. Numerous large studies have recently examined long term outcomes of various diets and all groups pretty much lose the same amount of weight and have similar health effects down the track. Maybe instead of focusing on specific nutrients or specific diets, we need to take a step back and just eat REAL FOOD? Ground-breaking, I know.
So with that in mind, and without even entering the ‘which is worse: fat or sugar’ debate, here are my official ‘Dr Kate’s Guidelines for Healthy & Happy Eating’…
Fill 90% of your trolley with raw/unprocessed/real whole foods
I’m not talking about eating raw cacao beans with a hint of quinoa, I mean make the majority of the food you buy each week be as close to the natural form as possible. 90% of the ingredients you need to create delicious and healthy meals can be found in the wondrous fruit & veg, deli/butcher and fridge sections of the supermarket. It might sound extreme but if you stock your kitchen with healthy ingredients, then the meals you create will in turn be nutritious and delicious. Of the 10% that comes from the grocery aisles, aim to buy foods with as few ingredients as possible… and if you don’t know what any of the ingredients are, then maybe you shouldn’t be eating whatever that chemically-sounding thing is. On that note, the more you can learn about reading nutrition panels on foods, the better choices you will be able to make.
Everything in moderation, with a few exceptions
When it comes to food-related mottos, ‘everything in moderation’ is my number 1, closely followed by ‘treat yourself’. However, in the interests of eating for health and eating well for life, things like lollies, ice cream and biscuits need to be eaten in the way they were initially designed - as treats. Not as something to be bought regularly with the weekly groceries or chucked in school lunch boxes. When kids are eating packets of chips, chocolate bars and pies on the reg, it’s little wonder that what we consider as ‘treat’ foods have gone from a chocolate bar to a donut stuffed with 3 chocolate bars coated in more chocolate and covered in sprinkles.
Your body is constantly renewing the cells that make up all of its tissues and organs, and the only fuel it has is whatever you consume. Think about it… if you want to build a lean, healthy and happy body, you need to fill up on top quality fuel because you actually are made up of what you eat. So it goes without saying that consuming any amount of cigarette smoke (I’m looking at you Mr ‘I only smoke when I’m drinking’ and Ms ‘but if I stop smoking I’ll eat more’), excessive alcohol or just rubbish food will hinder any health goals you set for yourself.
Divide and conquer
Aim to divide your plate into 50% salad/veggies/fruit, 30% lean protein and 20% wholegrain carbohydrates… or whichever similar ratio works for your eating goals, with the emphasis on making the majority of your meal fresh produce. You can adapt any of your favourite recipes to fit, like adding more veggies to homemade pizzas or pasta, or supplementing a juicy steak with a generous serving of salad. You can gradually increase the amount of veggies you include in meals by finely grating carrot/zucchini/broccoli/any veg really into pasta sauces or hamburger patties to add ‘hidden’ veggies to meals you already like eating. Minimal effort for a maximal nutrient boost! By also buying groceries in a similar ratio, it is easier to eat a varied and enjoyable array of healthy meals.
Fuel your lifestyle
No matter how healthy your diet is, if you spend all your time sitting down and don’t do any exercise, chances are that over time you will still gain weight and develop lifestyle-related chronic health issues. Being physically active in and of itself is a protective factor against heart disease, osteoporosis, depression, some cancers and all-cause early death. Most Australian adults are sedentary at work and in their leisure time, so we have to put in more effort to be active than our grandparents, who likely walked around and exerted more energy in their everyday lives without even trying. Following current guidelines, we all need to aim for daily activity of 60 mins, and that’s vigorous exercise that increases your heart rate enough to make you breathless and break a sweat. Find an activity you love and it won’t even feel like a chore - trampolining, kayaking, hiking, yoga, boxing, jogging or good old aerobics classes - all workouts are better than none.
If the healthy ingredients aren’t in your kitchen, chances are you won’t be eating them. There is a wealth of meal prep inspiration out there for the taking (just open Pinterest for starters), and especially getting lunches organised for the week ahead of time makes it much less tempting to buy a less healthy option. Also on that note - when doing the groceries, write a shopping list and don’t go near a supermarket on an empty stomach (otherwise you will definitely leave with a chocolate mudcake, Tim Tams and none of the veggies you actually needed… not talking from experience or anything I swear…) Double wins for your wallet and your waistline! What we do every day is much more important than what we do every now and then, so getting the staples sorted in advance sets you up for a solid food foundation.
Focus on the end-game
If you have made it this far down the page you must have some interest in your health, so if you want to do something positive and health-promoting, what exactly is your goal? If you can tangibly measure whatever health outcome it is you want to achieve, then sticking to eating healthily and exercising regularly becomes a whole lot easier.
If we start viewing the food we eat as fuel for our body, rather than a reward or a currency to bargain with, we can shift the focus from short term dieting to long term eating for health and happiness. There is no point restricting yourself to only eating organic steamed kale all week if you are then compelled to binge on 5 blocks of chocolate on the weekend. By creating a balanced, delicious and nutritious way of eating that is sustainable, eating becomes an experience to be savoured and not a source of stress. The less we obsess over fads and instead embrace eating real foods, the more we will be able to establish sustainably nourishing eating patterns. On that note, time to put down the Easter chocolate and cook up some fresh and tasty lunches for the (extra short) week ahead!
So you’ve enrolled at uni, bought your stethoscope and tried to decipher a packed semester 1 timetable. The first weeks and months of med school can feel a bit being repeatedly slapped in the face or rolling down a hill covered in bindis, so here are my tips on how to survive and thrive the trials and tribulations of medical school!
‘The days are long but the years are short’ is an apt way to describe studying medicine, and before long you’ll be out in the hospital or in the clinic treating real patients who put their trust in your knowledge and judgement; so study hard, look after yourself and enjoy all the wonderful opportunities that lie before you!
I don’t know her name, and I’ll probably never know what eventually happened to her. But I do know that I’ll never forget the day our paths crossed in the most dire of circumstances.
Just a warning in advance that this blog post contains some fairly graphic depictions of a real-life emergency scenario which may be disturbing to some readers.
During a recent holiday, my husband and I took a day trip to snorkel off a small and fairly remote island. After a 30 minute drive then a 1 hour boat trip, we arrived on the tiny 0.5 square kilometre island where the only facilities were some tables and chairs and long drop toilets - not even running water.
While we took a break from snorkelling and sat down at the far end of the beach, we noticed a group of people gathering up the other end of the beach as a person was dragged from the ocean. Despite both knowing first aid and being confident around the water, we still hesitated before making the decision to go and help. Firstly (as I’m sure many other junior health professionals will relate to) there is the feeling of self-doubt - ‘yes, I’m a doctor but I’m not that experienced, I would probably just be getting in the way’, and secondly there were at least 30-40 people now standing around a person on the sand. We assumed that surely someone was performing some immediate first aid.
In the few minutes it took us to walk over to the scene, we weren’t able to get a view of the person due to the surrounding crowd, however the atmosphere was noticeably void of panic or hysteria. Subsequently, we assumed everything must have been under control. It was only when my husband stood on top of a table to try and see what was happening that he noticed that despite the amount of bystanders, no first aid was actually being administered. He yelled out to me and indicated that I would need to offer my help. While the surrounding onlookers didn’t seem to understand the severity of the victim’s condition, my stomach dropped as the seriousness of the situation became clear and I realised that I would need to manage it.
I pushed through the surrounding onlookers and my own pulse quickened when I finally was able to lay eyes on the limp, grey and clearly unconscious young woman who lay on the sand, not moving and quite obviously not being attended to by anyone who knew first aid. What had looked from a distance like a person who had been placed in the recovery position was actually a person who had been dragged from the water and left on the sand haphazardly, with her face laying in a puddle of her own regurgitated sea-water on the sand. I still feel queasy thinking about what lay before me in that moment.
As I approached the victim, a staff member from one of the snorkel boat companies also came over and I asked if they needed help. He said yes, before going back to his boat to arrange for transport to hospital, so for what felt like much longer than the 5-10 minutes it probably was, I was a lone first responder.
Prior to that moment, the only out-of-hospital first aid events I’ve had to assist in have involved minor sporting injuries, insect bites or cuts and scrapes… nothing where I had the potential to actually be the sole difference between life and death, or at the very least between life and terrible morbidity. The realisation that these potential consequences depend on your actions, on an island more than an hour from the nearest hospital or basic first aid resources is absolutely terrifying.
As soon as I reached the victim I started the familiar DRS ABCD of basic life support that to many of us with basic first-aid awareness is second nature, and perhaps we take for granted that the average lay person doesn’t immediately think of these things. In a perfect world I would have cleared away non-useful bystanders, donned a pair of gloves and called for an ambulance but unfortunately on a remote island without fresh water, soap or mobile phone signal, sometimes the best available option is far from best practice. I immediately called to the woman, squeezed her hand and yelled in her ear without a response. At the same time, I lifted the woman’s head out of the sand and had some assistance to roll her properly over onto her side as she had clearly been vomiting or regurgitating water. She began bringing up large amounts of sea water and as I continued to apply head tilt keep the airway open, she started taking regular breaths.
I’m not sure if she was breathing at all up to this point, owing to her position and the fact her mouth and nose were directly in sand and water; but I don't think I have ever felt as relieved as when those first spluttery breaths occurred. She continued breathing, at first with short rapid breaths with increased effort, but her colour changed from the terrifying blue-grey to pale but with some pink returning. I knew this woman was by no means out of the woods, this was a sign things were heading in the right direction.
The woman kept breathing but remained unresponsive and unconscious during the eternity it seemed to take to arrange the boat to transfer her to hospital. When a stretcher finally arrived on the beach and the woman was moved onto it, I felt so helpless as I tried to communicate with the boat staff who were to take her. There was no “1, 2, 3, roll” or careful consideration of possible spinal injuries. The woman was placed onto her back despite that if she stayed lying supine for any length of time it was likely she would choke on the sea water she continued to bring up. As much as I tried to signal, instruct and move her myself, it took me yelling repeatedly before another person understood and helped me to roll her over. At the time I didn’t even think about the fact those people probably didn’t speak very much English, I was just determined to try and do what I knew was best.
I felt even more helpless as the boat staff carried the young woman onto the waiting boat, almost dropping the stretcher and the woman in the process. It made me feel sick to my stomach. It seemed to take so long for them to get her back on her side and leave the beach to get her to a hospital. Just as shockingly, many tourists in the water seemed to ignore my husband and others who were trying to clear them from the water so the boat would be able to load the woman on and transport her away. It felt so frustrating not being able to do more, or to know that I had done enough. After the woman was on the getaway boat, I turned around and burst into tears. I don’t know whether it was the confronting nature of what I’d been involved in, the inaction of the dozens of other bystanders before we arrived or the frustration of it taking so long to get this woman to proper medical assistance, but the whole situation was just incredibly overwhelming and quite traumatic.
It was shocking that of the 8-10 boats who had brought tourists to the island that day, only one staff member came to assist. Especially considering we were in a country where many tourists don’t swim regularly at home, and aren’t confident in the water, I would have thought that all tour companies would have to train their staff in first aid at the very least. I would like to think that if a similar thing was to happen in Australia then there would be plenty of bystanders who would at least have some knowledge of what to do if someone is pulled from the water and sufficient resources to appropriately respond. However, on arriving home from our holiday and hearing news of a huge number of drownings in NSW over the Christmas period, maybe we all need a refresher on water safety and what to do when something goes wrong.
I held my bronze medallion and lifeguarding certification for a number of years before I completed my medical training, so somewhere in the depths of my memory I had plenty of knowledge about assisting in drownings, even if I hadn’t yet had to put it into practice. These potentially life-saving courses don't take very long to complete but could prevent one or your children, one of your friends or even a stranger from suffering terribly. Royal Lifesaving Australia runs courses in basic first aid & CPR, lifesaving techniques in the Bronze Medallion, and a swim and survive program for school-aged children and even have a course in water safety for older people. I would highly recommend checking out the Royal Lifesaving website (http://www.royallifesaving.com.au) for details of these courses. As Australians we spend much of the warmer months around the water and you never know when you will witness a person in distress.
According to Royal Lifesaving, 280 people drowned in Australian waterways last year, a 5% increase on the year before. Here are their top tips to keep yourself and your family and friends safe when enjoying our beautiful waterways:
The following advice DOES NOT replace completing a first aid or lifesaving course (which I would strongly suggest everyone considers booking in for and regularly re-doing), but if tomorrow you came across a drowning person, what should you do?
(Adapted from the Australian Resuscitation Council Guidelines: http://www.resus.org.au/policy/guidelines).
When looking back over my experience in assisting with a drowning victim, I am left with many questions, to most of which I’ll never have an answer. Was there something more I could have done to have given the woman a better chance at a full recovery? Did she make it to hospital ok, and did she in fact recover? What caused her to drown in calm and fairly shallow water? Did all those bystanders have no idea what to do, or was there a cultural reason for not jumping straight in to help?
Regular searches of the local news have not turned up any reported drowning deaths at the island where the incident occurred, but other drownings were reported in the months prior - so I have to maintain hope that this means the small actions I took on that beach might have enabled that woman to not be another statistic. We can all learn from this, especially my fellow junior health professionals, not to doubt yourself in a stressful situation; and to always offer your help in an emergency, even if it looks to be under water-tight control. Finally it is a harsh reminder that our beloved oceans (and pools, lakes, rivers!) can be dangerous places, and if we all made an effort to gain skills and knowledge to keep ourselves and each other safe, then many tragic drowning deaths could be prevented.
Royal Lifesaving Australia: http://www.royallifesaving.com.au
Australian Resus Council guidelines: http://www.resus.org.au/policy/guidelines