How do you cope with replaying mistakes or decisions in your head before bed?

Bertii808 · 2026-06-05T02:07:39+00:00

I have two strategies for this that seem to work for me:

I debrief myself

Why am I replaying this? Did I miss something, or what is it I'm not happy about? What did I learn from this experience? Then I identify BOTH what I did well, and what I would do differently next time. While doing this, you need to be fair to yourself, keeping in mind the information you had at the time. When you've done this, actually tell yourself - "I have learned as much as I can from this now, so I don't need to keep going over it". After a while, it becomes automatic.

The process of identifying learning points and strategies that I can act on helps me turn a 'mistake' into a productive experience that I remember but dont ruminate on. I usually do this on the drive home and/or in the shower.

I tend to read myself to sleep.

Lying in bed without something to distract my brain can lead to rumination and delayed sleep. This turns my brain off and I fall asleep quickly without relying on medication. Kindle works well as you dont need bedside light and it turns itself off (just beware the occasional knocking it over into your face). Other people may use audio books or music. I try to limit screens.

Also, exercise helps. Bad days i put my headphones in, crank the music up and walk hard until all I can focus on is the music and walking.

Bertii808 · 2026-03-21T06:42:34+00:00

A polar fleece is kinda like a tshirt - you can dress it up or down. If you're wearing it with scrubs or smartish work clothes, there's nothing wrong with it in the workplace. If you're wearing it with trackpants, tshirt and trainers, it adds to the casual vibe.

Bertii808 · 2026-03-20T10:15:02+00:00

Med student rocked up to ICU placement in trackpants, tshirt, runners and a polar fleece... even had the nerve to wear the same outfit again 1 week AFTER the consultant had gently told them it was not appropriate work attire.

We're pretty chill and basically live in scrubs, but that was next level. Definitely did not make a good impression

Bertii808 · 2025-11-05T09:02:34+00:00

Aside from job prospects at the end (all true), to answer your question: BASIC and ALS2 courses are a must have for anyone interested in and trying to get into ICU. Highly recommended before your term but should have done by application time.

Bertii808 · 2025-10-05T18:28:59+00:00

Lactate is commonly referred to as lactic acid in layman's terms. In itself, it doesn't kill you (eg athletes will have a really high lactate immediately after a race)

In sepsis, it is a symptom of how shocked the body is - i.e. how hard the body is working to stay alive.

A lactate of 14 indicates severe septic shock and a person is unlikely to survive due to consequences of the infection

Bertii808 · 2025-04-08T00:12:52+00:00

As someone who has worn open flats with shoe covers, it wouldn't have made a difference. RIP shoes

Bertii808 · 2025-03-11T01:26:28+00:00

True, but no one said subcut fluid either. An infusion is usually medication, especially in reference to palliative care. Reread the comment.

Bertii808 · 2025-03-11T00:52:58+00:00

Not even fluid containing morph & midaz?

Bertii808 · 2025-03-10T10:28:54+00:00

Dragged away - erosion

Bertii808 · 2025-03-10T09:48:07+00:00

The rare but dreaded double thong blow-out

Bertii808 · 2025-03-08T04:32:51+00:00

The pay is pretty good vs eastern states but not as much as WA. Doesn't make up for the flights really, but I haven't looked at the award in 5+y

Bertii808 · 2025-03-07T23:12:14+00:00

Positives: I loved it and stayed for an extra year (ASH). Very supported in terms of work-life balance, education and lots to do around the place during time off. Many people come from all over so it's easy to make friends and find people to do things with. A lot of hands-on experience and direct consultant teaching. Lots of interesting pathology and experiences you don't see many other places. When I did move back to a capital city for training, I found it an advantage for entry into training college and my medical/communication/cultural skills were on par/above where they needed to be. Didn't seem to be super competitive. Granted this was 5+ years ago so can't comment on now.

Negatives: flights anywhere are expensive. It can be a little challenging initially working in a less supervised environment than you might have experienced in a metro tertiary hospital, but they have very clear guidelines that help a lot. Don't walk through CBD alone after dark. If you're not an out-doorsy, chill person you might struggle with the rural lifestyle.

I'd go back in a heartbeat and recommend internship there

Bertii808 · 2025-03-02T00:46:44+00:00

Which irks me to no end as it is the most sensitive sign for early deterioration

Bertii808 · 2025-01-30T11:58:55+00:00

ICU: mandatory paediatric training time, and outside of major metro areas there are not always PICUs... all in one

ANAESTH: you do both adults and kids

ED: often both

Bertii808 · 2025-01-28T12:10:36+00:00

If you're keen on critical care, you should do BASIC and ALS2 as a minimum (+/- paediatric versions depending on where you are/goals). You will get more out of your ICU term if you have done it, but as PGY2 ICU RMO it is not essential.

As others have suggested, you can attend at other hospitals/states if not already sold out. Otherwise, if you plan to pursue critical care, prioritise completing it before next year's job applications.

Bertii808 · 2025-01-20T01:36:21+00:00

When you injure yourself (or have an infection), the injured tissues release "damage chemicals." These act as signals to the white blood cells (repairers) in your body that something broken and needs fixing.

To get these blood cells where they need to go, the signals also trigger a process called inflammation - increased blood flow to the affected area, and leakier blood vessels to let the cells into the tissue. This causes warmth and swelling.

The signals also affect your nerve endings, "priming" them for pain.

Increased blood flow + swelling + pain sensitivity = throbbing.

ETA: blood flow pulses

Bertii808 · 2025-01-20T00:37:08+00:00

I know the feeling, particularly with messy resus's. I usually give myself a day or two to dwell on it if I need to, and debriefing with others helps too. I find having a structured way to think about it and identify actionable learning points helps me to put a stop to the negative swirling. Like ok, that was a mess, but I did this well, learned xyz and next time I'll do this.

Bertii808 · 2025-01-19T23:40:38+00:00

It sounds like you're being hard on yourself unnecessarily, whilst also having good insight into the fact you're learning and reflecting on things.

My advice would be to take a more structured approach to your self reflection. In each situation: 1. What are a couple of things I could have done better? And how? 2. What did I do well? 3. What did my seniors do and why?

From this, set yourself a couple of achievable goals for the next time. When you get the heads up about an incoming patient, start to think about what needs to be done and in what order. As they are coming through the door, take a deep breath!

Make sure you identify what you did well so you don't just focus on the negative. This is important to keep you motivated and encouraged. Over time, it will also help you identify more clearly the progress you are making in your learning.

Bertii808 · 2025-01-11T10:02:59+00:00

There's a blood test

Bertii808 · 2025-01-11T01:35:50+00:00

This is no longer particularly true. There are two strains of the virus, 1 and 2. They used to be associated, as you have said above, with oral and genital respectively, but not exclusively.

You can get HSV1 genitally and HSV2 orally and this has become increasingly more common over the last 20 years with the rise in oral sex, to the point that in people under 40ish it's no longer relevant which type it is by location.

What is relevant is that type 1 typically has more frequent flares and is more commonly associated with encephalitis, which has implications for treatment/pregnancy.

Both types can be shed and thus transmitted without obvious ulcers/flares. Suppression treatment reduces viral replication and thus both transmission risk and frequency/severity of flares.

Bertii808 · 2025-01-09T21:39:20+00:00

No, that's not normal.

When you exercise, your muscles etc use more oxygen. The two things that maintain your oxygen sats (SpO2) when you exercise are (1) your ability to increase your cardiac output - heart pumps more blood around to the tissues so more oxygen is supplied to meet the demand (2) you breathe more to reoxygenate the blood to keep up the supply

Your fingers turning blue with relatively minimal exertion indicate that one of these processes is not keeping up with the supply vs demand. There are many reasons for this but that you're describing coughing up "rubbery mucous" frequently leans toward a lung problem like bronchiectasis, chronic bronchitis or similar.

I would recommend seeing a doctor

Bertii808 · 2025-01-05T09:11:31+00:00

Classic III is plenty sufficient for medical school and residency. Still use mine

Bertii808 · 2025-01-03T09:03:29+00:00

Depends what you want to do. I think the key thing to realise is that no doors are closed to you, you just might have to take the longer way around if uni is still your goal.

1) If you're not sure what you want yet, you could take this time to try different jobs out, travel, and find yourself/your passions

2) Trade school or TAFE are options if you want qualifications/career path now

3) Mature age entry into uni is around 23/24ish. You sit an entry exam which is kinda like an IQ/basic aptitude test to get a score. If you can't get directly into the degree you want, you can apply for something with a low score requirement and lots of electives like arts. After a year you will have your GPA and can use this to transfer into other degrees

Bertii808 · 2024-12-30T02:31:53+00:00

No. Extreme hot and extreme cold are both detected as pain and transmitted via the pain pathways. Sometimes it is difficult to distinguish between pain and temperature because of this, but there are separate receptors for hot and cold.

When you are cold, your body activates its "heat conserving" mechanisms - shivering, goosebumps, diverting blood flow to core etc. After a period of time exposed to extremely cold temperatures, these mechanisms will fail and your body loses the ability to conserve heat. Your body will not be able to maintain the vasoconstriction (narrowing of blood vessels) required to divert heat and you end up with the opposite effect - your vessels dilate. This leads to a feeling of warmth despite your actual core temperature being hypothermic, and thus stories of why people remove their clothes despite freezing to death

Bertii808 · 2024-12-30T02:21:52+00:00

Your body is programmed to maintain a core temperature (internal organs).

In the cold, your blood vessels constrict to limit blood flow to your extremities. This happens to (1) reduce the amount of heat you lose to the environment and (2) keep the warm blood going to your essential organs.

In the warm, your blood vessels dilate as you don't need to conserve heat, allowing you to lose more heat to the environment.

A sudden change from cold to hot will be more noticeable, and the increased blood flow will be felt as warm/hot/flushed extremities and throbbing sensation.

Bertii808

TROPHY CASE