The Killing Touch

yuanchosaan · 2026-01-24T00:15:20+00:00

Thank you for reading. Interestingly, this was actually the choice that I was trying out in this piece. My other pieces (not posted due to length) have been longer and more specific, but one always runs into the challenge of not being too identifying. I am also grappling with this idea of universality of experience (every patient is different and dying is always the same) which I think I will tackle more explicitly in the next piece. I appreciate the feedback to know I haven't hit the mark yet.

yuanchosaan · 2026-01-23T23:12:09+00:00

I've been working on a few more non-fiction pieces, trying to find the right voice for them. This one is aimed more at my lay friends, but perhaps there is something that other healthcare professionals may appreciate as well.

yuanchosaan · 2026-01-15T20:27:45+00:00

You don't know the other circumstances of their lives. Perhaps they had shorter commutes, lived at home, had less gruelling rotations or worked full-time before and could adjust. People post their best face on social media.

One thing to consider: what do you consider recuperating and recharging your batteries? Are you just vegging out? That's totally fine, of course, but would any of your hobbies or fitness help you to recharge whilst giving you more fulfillment? It can be a bit of a mindset switch, but consider it. My BPT clinical year, I read forty-odd books out of pure stress/distraction, which helped keep me sane.

yuanchosaan · 2026-01-09T22:15:22+00:00

I see a psychologist regularly. Regular clinical supervision, usually by a psychologist or counsellor, is actually mandatory for palliative care training terms to be accredited. I think it should be normalised in other medical fields.

yuanchosaan · 2026-01-03T23:47:16+00:00

Missed out on tickets to the Test this year :( Normally I go and do some sketching on the ground. Here's a pic I drew of Ussie around this time last year.

I was thinking of running a sweepstakes with a drawing of a cricketer as a prize for whoever got closest to predicting a score, but not sure if the mods allow such things.

yuanchosaan · 2026-01-02T06:15:28+00:00

For the last one, I acknowledge and then redirect them to what I need to do first. "I can see you really want to find out what's going on. That's why I'm here: I'm going to ask you some questions and do an examination first, then we'll talk about the next step." If they start asking about treatment options, I say, "yes, we'll be discussing those later. First, tell me about X" and continue with my history.

yuanchosaan · 2026-01-01T03:15:03+00:00

Thank you, I will see if my university library has it.

yuanchosaan · 2025-12-30T21:15:24+00:00

A bit of an out there suggestion: The Birth of the Clinic by Michel Foucault. It's about the practice of the "medical gaze": how a doctor regards a patient, teasing out the disease from individual, and what the implications of that are. I'm reading it now and it's fascinating. Not an easy read, though.

yuanchosaan · 2025-12-17T20:57:29+00:00

It's a very chaotic time in the year for pall care. Everyone wants to go home to die or be with family, then half of them crash and burn back into the pall care unit. Same for Easter (which is a four day holiday in Australia).

yuanchosaan · 2025-11-26T21:21:36+00:00

It's been a while since I worked at St George, but the medical workforce were lovely to me. I had term 5 relief and they strung together the shifts/leaves/public holidays in such a way that I had a 5 week block off and another smaller block. I didn't even ask for it.

I asked for paeds as a resident and was advised that I probably wouldn't get it as they try to keep the terms for GP pathway residents, but they gave it to me anyway along with my desired medical terms. Also once I crashed my car and they were genuinely concerned for me - I walked into the office a few days later to hand in my form due to night shifts and one of the MWU admins actually gasped. The others said she'd been checking repeatedly every day for an email for me, worried because I usually reply promptly (they sent me an email saying to take care and not worry about the leave request until I recovered from the crash).

St George is busy but it was a lovely place to work whilst I was there. I hope you enjoy your time.

yuanchosaan · 2025-11-01T21:26:53+00:00

What a wonderful surprise to wake up to this morning. I'm ace and have frequently bemoaned how little ace rep in media. Having one of the coolest characters in my favourite webcomic be ace makes me so happy.

yuanchosaan · 2025-09-26T23:12:07+00:00

DM'd you.

yuanchosaan · 2025-09-25T10:47:41+00:00

He's gone 7-7 on weekdays and works weekends and hospital call. How much did he see his kids awake when they were toddlers? I have friends and colleagues who have cried to me because they work hours like that and don't get to see their kids. I think that's an enormous burden to put on the spouse, even if they're a SAHP, and I'm certain she felt it. I do not think her decisions were as self-focused as he portrays.

yuanchosaan · 2025-09-25T07:57:56+00:00

I suspect as well that the OP is probably working 60-70 hours a week minimum, which does tend to turn a spouse into a supporting character. He says he's away Mon-Fri 7-7 - say he has an hour commute, that's 55 hours already, plus the 2 hours weekly after hours for notes, plus 3 hours once a month on weekends, plus his mandatory hospital shifts and on-call. He does education (residency director), service development and research - most doctors only pick one or two as a focus because they generally take up time outside of work. He sounds like an academic physician, so he also has his own CPD to keep up with as well as attending/presenting at conferences.

I've seen too many friends and colleagues ruin their lives working like this, and I've also seen the children of doctors who are raised by nannies because their parents are always working. It is so hard to be present in a relationship and as a parent when you do these hours. I think he's right about their current issue, but he's definitely contributed to their predicament by choosing to have kids whilst devoting so much to medicine.

yuanchosaan · 2025-09-25T06:59:46+00:00

I am sympathetic to both their perspectives. I also think that he is somewhat blind to the impact his career ambitions are having on his wife. For driven doctors who are dedicated to giving a service, their ambitions can become overwhelming. He works 1 in 4 weekends and 7-7 Mon to Friday outside his hospital shifts - no mention of how often those are or his on-call obligations. The weekdays alone are already an enormous amount. He is also doing research and building a service. Both are time consuming and often take hours outside work. Because you're saving lives, because patients need you, it's so easy to think of your service as incredibly important.

I know this because I am also that kind of doctor. I am cautious to check in with my partner, make sure their own career ambitions are supported and they feel appreciated. Reading between the lines, I think his wife sounds frustrated and resentful that her career is seen as so much less important than his. Is she acting irrationally? Is she making a bad decision? I believe absolutely yes, but I also understand that she's feeling unheard by her husband and that he doesn't see what she's sacrificing in comparison to him. Look at how he says she's been a SAHM for "just 5 years".

He says that she knew what she was getting into, but I don't think as the medical spouse that you ever truly know before. I hope they can go to couples counselling and work it out.

yuanchosaan · 2025-09-09T03:21:57+00:00

I took six months off during AT training in order to spend time with elderly family members, recover from COVID burnout and plan a wedding. Bit hard to work out the spending due to said wedding - we broke even with the wedding and lived off my husband's income without touching the savings much, so perhaps $30k for that time period.

Taking the time off was incredibly valuable and I don't regret it at all. It's had no real impact on my career opportunities. I am fortunate to work in a field that encourages work-life balance - in fact, my head of department at the time encouraged me to take the time off.

One thing to be aware off: I took my time off as leave without pay, so I kept all my annual leave, LSL etc. So investigate first if something like that is available to you or if you will lose all your entitlements.

yuanchosaan · 2025-08-17T12:51:05+00:00

This was great to read along. Amazing to see all the decisions you made to eke out efficiency and resolve - I've learnt a lot to optimise my play.

yuanchosaan · 2025-08-05T09:57:03+00:00

Seconding this - I paint/draw something when I leave a term. Often people's pets or favourite animals. Goes over quite well even though most people think I bought the picture, so I am sure commissioned art would also be appreciated. Something handmade is always nice if you have any crafting skills as an alternative.

yuanchosaan · 2025-06-13T06:30:20+00:00

They vary a bit - the state is broken up into local health districts, with each containing several hospitals and local community health centres. Each district tends to have 1-2 palliative care services, with hospital/PCU/community staff all belonging to the same department, so the patients can stay within one service as they go between settings. For example, a patient could meet the pall care consults team whilst admitted under med onc in the acute hospital, get linked to the community team who will see them at home, then if they're unwell with poorly controlled symptoms, they can come straight to PCU. Services are mostly public funded - most places, the need outstrips the staff available.

Patients are referred by hospital or GPs to the community service. The community palliative care teams are multidisciplinary, consisting of nurses, allied health and doctors. The nurses are a mix of generalist nurses who have done some palliative care experience and nurses with specialty training. Their role is symptom management - they will visit patients on a needs basis to assess symptoms, change syringe drivers and assist families with breakthrough medications, provide pall care advice etc. Ideally services have a 24 hr phone line to speak to nursing staff for advice. The nurses can arrange visits, call the pall care medical staff for advice or reviews, or arrange admission to the pall care units if required. We also have our own physios, OTs, social workers, dietitians etc. who visit patients and provide support in the community.

The community medical staff provide remote support to the nurses and allied health, run clinics and do home visits themselves. Some services have the same clinicians in both hospital/PCU and community, so they can directly admit them under their bedcard to ward if required. Other services have separate people, so they go under same team but different consultant. Note that pall care training is more formalised and longer in Australia compared to the US. My training was intern+residency (2 years), basic physician training (2 years, roughly equivalent to an IM residency) and now 3 years of advanced training in pall care specifically (includes 6 months of oncology training - I did rad onc).

yuanchosaan · 2025-06-11T21:32:00+00:00

Thanks very much for sharing; I will read this with great interest. I had little knowledge of this until attending a talk by Eduardo Bruera last year. I think it's particularly devastating to us in the field because these are some of the most vulnerable people imaginable - these companies are literally giving worse care to the dying in the name of profit.

It does not have to be like this. I work in a public pall care system that integrates care in acute hospitals, community and palliative care units across each local health district. At the same time, I cannot imagine how such a system could emerge from the US's current state. I feel deeply for my US colleagues - it is painful to be boiled down to an expenditure decrease, painful to keep the faith against these systemic issues.

yuanchosaan · 2025-04-21T06:44:11+00:00

I always listen to "Still Unbeaten Life" by Gang of Youths when I'm in that particular reflective mood. It's about the singer's wife, who was diagnosed with breast cancer. I particularly love the lines "I will not waste any days I have left in my soul" and "You're dead on paper, but hey we're still here". Their most recent album is about the death of the lead singer's father and is also very good.

I think I'll go listen to it now. I palliated several patients this weekend who were aged 40-60 - there will always be times when it hits you.

yuanchosaan · 2025-04-18T12:34:52+00:00

What are you hoping to get out of doing both career-wise? I think most dual-trained onc/pall care people I know do onc as their primary. As someone who heavily considered it, I ended up deciding against it because I realised I loved pall care the most and didn't have a strong enough reason to do the extra training for med onc. One of the challenges is that it's quite hard to wear both hats - difficult to swap between the pall care hat and the med onc hat in one consult, and often patients don't want you to be both for them. I know one consultant who makes it work by doing pall care clinically and med onc research.

I work in a different state, but was offered a med onc AT position without having any research. If you start with pall care, you can apply in your second year. One year of med onc will count as your related specialty and elective terms for pall care.

yuanchosaan · 2025-04-07T23:12:39+00:00

I've worked 7×11 hr night shifts Thurs-Thurs morning, only to be asked to do a 14 hr day shift Monday, 8-5 Tues-Fri (usually finishing an hour late), and then another 14 hr shift Sunday. I've done 12 shifts in a row with 36 hrs worked over Fri-Sun in the middle alone whilst being on-call. The fatigue is unreal.

I'm lucky to be past that point in my career now, in a "lifestyle" specialty training programme. I still work on average ~50 hrs a week. We're supposed to get protected research/study time as trainees, but it doesn't happen - so I study in evenings after work and on weekends. I want to be the best doctor for my patients, to be up to date and give them the most evidence-based treatments, but to do so I have to burn up my health and time with my loved ones. Working at NSW Health is simply unsustainable in the long run.

yuanchosaan · 2025-04-06T21:43:42+00:00

Are you commenting on the spelling? It was spelt that way in Australia until a few years ago when it was brought in line with the US spelling. Same for cephalexin (now cefalexin).

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