I'm back!

Sorry for the lengthy absence, by the way.  I know that for many of you a day without me is like a day without sunshine (except warmer).  My only excuse is that I was off gallivanting around in foreign lands eating like a glutton and impulsively buying an awful lot of cheap shirts and books and so I didn't have time to document the process.

The cheap shirts were sorely needed.  A whole heap of my shirts had frayed collars and unravelling seams.  They were in this condition because I haven't bought any shirts since the last time I was in Malaysia 3 years ago.  Whenever I am there I track down the reject shops where the big US manufacturers dump all their unwanted stock from the previous season.  Because I am normal sized by comparison to the average yank, but a great hulking godzilla compared to the average Malaysian, it's very easy to find shirts that fit.  And as for looks, my signature style is to look blandly unfashionable, so it's a perfect match!  And at about $10 per shirt, you can't go wrong!

As for the books, my Smaller Half and I came back with about half our luggage consisting of books.  We bought some medical textbooks in Malaysia and some novels to read as well.  But we were very controlled until we hit Melbourne in transit on the way home and found a book clearance sale where everything was $10 and you got 30% off for total sales over $100.  So we kind of cut loose and bought a whole heap of stuff.  To be fair, my Aged Mother had instructed me to buy myself a couple of interesting books for Christmas for myself so she could discuss them with me.  That was what started the avalanche.

So we've made a new rule that we aren't allowed to get any more books until we've read the ones we have.  Ha ha ha.  Anyway, here's a list of the books we bought, since I think it gives a pretty well-rounded picture of our reading taste:

• Stieg Larson, The girl with the dragon tattoo.  Murder mystery.
• Matthew Frederick, 101 things I learned in architecture school.  Architecture for morons.
• Somerset Maugham, Ashenden.  Semi-autobiographical tales of the author's time as a spy in the Great War.
• Peter Doherty, The beginner's guide to winning the Nobel Prize.  Scientific autobiography.
• Aleksandr Solzhenityn, One day in the life of Ivan Denisovich.  
• JG Ballard, The drought.  Disaster epic sci-fi.
• Virginia Woolf, Mrs Dalloway.  Bought to sate my Virginia Woolf obsession.
• Bob Woodward and Carl Bernstein, The final days. (Of Richard M Nixon)
• Peter Singer, Pushing time away. A philosopher's biography of his Jewish grandparents life in Vienna.
• Beginner French.  Mais oui!
• Larry McMurtry, Books.  How can you resist a title like that?
• Orhan Pamuk, My name is red.  Praised by a friend years ago, hence acquired.
• Kate Grenville, The secret river.  Ditto.
• Ernest Hemingway, A farewell to arms.  Dangerous reactionary lunatic writes good stuff.
  
• Ernest Hemingway, For whom the bell tolls. Ditto.
• AA Milne, The house at Pooh corner.  Go Pooh!
• Steven Erikson, Gardens of the moon.  Forced upon me by an eager relative, not really my thing...
• Malcolm Gladwell, Blink.  The longest magazine article in the world.  The perfect airplane book.
  

Coffee slurry

So there I was, chilling out in the heat with an iced coffee as I waited for my plane.  I slurped it up through the straw.  Mmmm, delicious.  Odd consistency though - it was very difficult to slurp up the straw and there were some chewy bits in it.  Wait, that must be some kind of coffee or chocolate syrup that has been thickened by the cold of the drink.

But it was a little bit gritty.  Hmm.  I caught some with my tongue and poked it onto my finger to take a look.  Hmm.  Funny colour.  Kind of brown, kind of gray.  Taupe - that's what this colour is called.  A good colour for interior decorating.  Not such a good colour for food.

It didn't look like what I expected it to, so I re-tasted the blob with my tongue.  Nothing in particular.  I smeared it around on my finger with my thumb and tasted it again.  Bland, earthy.  What the heck?

I looked again at the straw.  Metal straw.  I lifted the straw out of the drink.  Uh-oh.  It wasn't a straw, it was a spoon with a hollow handle, open at the top and almost but not quite closed at the bottom.

The truth dawns on me.  Ice cream has been accumulating over time inside the spoon handle and I've managed to slurp up the decomposing sludge and eat it.  Bummer.

The rest of the drink was fine though.  Very refreshing.

Valis

It's strange that when I hear an odd tapping noise I will turn to look at it, but when I see a strange flashing light I do not turn my head to check if it is making a sound.  But that's not what I'm going to talk about.

This is.  I'm currently reading Valis by Philip K. Dick.  I'm only up to page 50 but it's already a weird experience.  Any PKD book is a weird experience at some level, but this one more than any other so far.  What's weird about it is that he keeps diverting the narrative off onto seemingly random/arbitrary topics - but those topics are often things that have some kind of personal resonance to me.

I've started marking the pages where this happens so I can go back and check, since it occurred to me that maybe it's an artifact of me being really tired when I'm reading it.  Here's a partial list of statistically unlikely topics to arise so far:

• The concept of degrees of psychosis or delusion, where you get delusions about delusions.  You may remember that I queried my psychiatry teacher about this some time back and just got a funny look in return.
• Inguinal hernias, which I have previously ranted about.
• T-34 tanks, as used by Russia in the second World War.  I don't recall mentioning them in this blog but I certainly have played an awful lot of WWII war-games.
• The issue of Kevin's dead cat and the central question of its nonexistence before its own birth and how that is qualitatively different from its nonexistence after its own death, which is something that I have pondered at length in my offline life.
• Deus Absonditus, or the hidden God.  I have a book at home which uses game theory to analyse and explain why God doesn't just tell us all to our faces that he's right here, and related topics.
• Paroxysmal atrial tachycardia, which I seem to have discussed repeatedly with my Smaller Half recently because of a minor technical disagreement between us as to whether it really is a subset of the supraventricular tachycardias.  Yeah, we're dazzingly charismatic.

As mentioned, I'm only up to page 50.  What delights lie in store for me in the next 221?

It's a strange sensation - as if I'm reading a book that was written by someone who knows all about me and deliberately wrote a book that I would find appealing.  That kind of thinking, that the radio is broadcasting specially to you, or that there are hidden messages intended for your consumption in everyday occurrences, is known as a delusion of reference, and is a marker of psychosis.  Valis is all about the main character's drift into madness, unfortunately either initiated or accelerated by thinking too much about madness.  So I'm thinking that pretty soon now they're going to come for me.

Hopefully they won't take my book away.

Grayslant

The first album I ever bought was Paul Simon's Graceland, on cassette.  I liked the single Call Me Al and my Wise Elder Brother suggested that I should spend my money on buying it instead of some more Technical Lego, Dungeons and Dragons modules, or other such nerdy stuff.  Sure, Paul Simon is pretty nerdy for a musician, but you've got to start somewhere.  I gave him $12 and he bought it for me at K-Mart the next time he was in town.

I had a number of misconceptions about the album though.  Such as its name.  It wasn't until I actually had it in my hand that I realized it was called Graceland, not Grayslant.  Also, it wasn't until then that I realized that the little guy in the video clip for Call Me Al was Paul Simon.  I had assumed that Chevy Chase was Paul Simon, and to this day I think he may actually be him.

It was years before I realized that the National guitar that is mentioned in the first line of the first song is actually a brand of guitar.  I thought that the National Guitar was some of guitar monument, akin to the Big Pineapple.  I think I found this out while watching a documentary about Dire Straits and they mentioned the National guitar on the cover of Brothers In Arms.  It was a revelation to me.

It was also a long time before I found out that Graceland was an actual real Elvis-related place.  I thought he was just being metaphorical, as in a Graceful Land.  I think I realized this when I heard Mark Cohn's Walking In Memphis.  Spent a while wondering why everyone was so obsessed with Memphis.  That was around the same time I found out that Priscilla Presley also had an Elvis connection.  Huh - who knew?

The funny thing was that at the time I was great friends with a kid who grew up in Zimbabwe.  I played the tape one day while we played some Dungeons and Dragons, and he remarked that the music was heaps like the songs he'd heard in Africa.  I basically thought he was full of it.  Of course, turns out he wasn't.  How about that...

Anyway, that's all from this particular Human Trampoline.  Hope you're enjoying your holidays if you're on 'em and your work if you ain't.

Wisdom

I think it's true what the ancients said, that you can travel the whole Earth over but it's only when you finally return home to your electric toothbrush that your teeth feel really clean.

Party people

When you get to the party, the very first people you see are the people near the door who are the very people that you are anxious to avoid talking to, so you walk right by.  Immediately afterward you are accosted by the people are keen to talk to you even though you have never had anything much to say back to them.  Shaking them off, you then become enmeshed in a conversation with the people who you'd like to talk to but who you can't hear because the music is too loud so you are reduced to nodding, smiling and laughing at what seem to be appropriate moments.

In order to get out of that mess, you strike out across the room but are waylaid by the people who are very drunk and sling their arms around your shoulders and mouth breathe through their winey teeth at you and tell you how very drunk they are.  Simultaneously you are trapped by the people who stand too close to you and never break eye contact.

Fortunately you are able to direct your attention towards the people who you'd like to talk to some more but can't find again after returning from the bar.  Instead you briefly talk to the people who you'd like to talk to some more but don't seem very interested in returning the favour.  That awkward situation is interrupted by the commotion caused by the people who only turn up to parties to undress, but in the confusion you are carried away and thrust against the people who are spouses or partners of boring and unpleasant people and who turn out to be even more boring and unpleasant than them.

You manage a brief interlude with the people who you feel like you could be good friends with, if only your relationship could progress beyond the point of making the same stupid in-jokes to each other every time you meet.  Standing with them are the people who tell the same limited repertoire of stories to you over and over again.  Finally you are able to take a breather with the people that you get along with so well that you don't actually have to talk at all. 

Later, you find yourself stuck with the people that you would like to talk to some other time but but at the moment are too preoccupied with getting stupefyingly drunk.  So instead you talk to the people that you feel obligated to talk to because of some tangential social connection rather than genuine interest, so you're counting every minute until you can find a decent pretext for escape.  This is provided for you by the people who sidle backwards into you and force you up against a piece of uncomfortable furniture.  So you make your excuses and talk to the people who you don't want to talk to at all but do because otherwise there would be nobody to talk to and you don't want to stand there alone.

And finally you have a quick chat with the people that you always assumed were idiots so you've never bothered to talk to them before but have only now discovered how interesting they are and that they're leaving town forever tomorrow.

What a night.

Go slow

Ayyy!  Since I finished on Wednesday I've been simultaneously rushed off my feet and going as slow as I can.  Life is good with no deadlines but I've been flat out getting away from it all.  So sorry for the lack of posting interesting things.  That may continue for the next little while.

Blogging as a stress relief valve from the pressure of studying works really well for me.  But once the pressure comes off, there's no steam to jingle that little bell any more and I find myself with not much to say.

But I will say this: I'm re-reading a book I last read at least ten years ago and it's really interesting how I have changed since then.  Some of the things in it which I thought were profound and insightful back then now seem plain obvious or even wrong, while other things that I skimmed over and ignored then now seem fascinating.  It will be interesting to see what I think of all this stuff I type out here on my blog in ten years time when I am totally different person.  No doubt I will be ashamed of some it and find other parts fantastic.  I hope I have the courage to leave all of it as it is rather than try to go back and excise out the parts that I find uncomfortable or embarrassing.

Move along!

Bravo X-ray November

It's hard to read x-rays.  The darn things just shoot straight through your eyeballs!  Ha ha - stick with me, it gets better.  Since we might have to interpret some x-ray films in the next couple of days, here are some tips from me on how to Get It Right!

The very first thing to do is to figure out which side of the film is the left and which is the right.  My preferred technique is to guess while watching the consultant's eyebrows.  If the eyebrows twitch, quickly correct yourself and laugh at your slip of the tongue.  A quick excuse such as, "Ah but of course, we're in the southern hemisphere here!" will cover up your ignorance.  Other excuses that I find useful are, "Wait, you have no goatee - that means I'm back on Earth 1", "It's all been so different since Obama", and "I have a neurological condition that means I'm unaware of whether I'm saying left or left.  So if I mean left, I'll say left, but if I mean left, I'll say left instead.  How about I just point?"

Next, you should determine if the film is AP or PA.  AP stands for armour piercing.  This is a film that has been shot with pointier x-rays than normal so they can punch straight through armour.  AP is useful if your patient is wearing a flak jacket or is riding inside a Sherman tank.  The heart always appears enlarged on an AP film because the armour piercing x-rays are making it explode.  PA stands for personal assistant.  A film that is shot PA is one that was done with some extra help there, so it will probably have been done better than other x-rays.  The heart is the right size on a PA x-ray.

After that, comment on the exposure.  X-rays can see right through people's clothes, so you can almost always say that the exposure looks great!

The voice that you use is important.  Most radiologists speak slowly and ominously in sonorant voices so you should mimic them.  The more you sound like Gandalf, the better.  Try this phrase with chest x-rays: "I see a shadow in the East."  If you're looking at an abdo x-ray, you could try this one: "You shall not pass!"

A great tip is that any horizontal line on the film indicates a fluid level.  This can be helpful if you are hanging pictures, putting up shelves or building a fence and need to make sure it is straight.  Just ask the patient to hold the relevant item in place, take a quick snap with your x-ray machine, and adjust as needed.  Note: this doesn't work if you are putting up shelves made of radiolucent material such as glass, cholesterol, or air.

Another important thing to know is that it's calcium that makes bones show up so well on x-rays.  So if there's something unusually bright in a funny place on the film, it's probable that the patient ate something will lots of calcium in it.  For example: hyena faeces, milk, cheese, calcium tablets, limestone, cement, teeth, and/or eggshells.  You should be able to tell by the shape.  Limestone, for instance, will resemble the profile of a 19th century aristocrat, whereas cheese will be in large triangular wedges with holes in it.


Finally, it's very important to have a system.  For example, after a run of four or more tuberculosis cases, the odds of getting five in a row are miniscule, so at that point I would always switch and bet big on sarcoidosis.  It's easier to do this if you're back-betting someone else since your funds won't run out while you're waiting for the good run.  On the other hand, it will be very easy for the house radiologist to notice what you're doing, and most hospitals will throw you out quick smart.  Still, you might have been able to get some free drinks while you wait.

I hope these tips on interpreting x-rays will be helpful to you.  Until next time, try to cut down on the hyena faeces.

OSCE tips

Before exams I sometimes post up some tips on how to pass (eg: here).  Seeing as we have OSCEs on this week, I thought I'd better change tack and offer some advice oriented to them.

Don't be afraid to ask for advice from the examiner!
Sure, we're told that they won't help us, but if you get really stuck, just turn to the person assessing you and say, "Sorry, I really don't know what I'm doing here".  If they start to tell you that they aren't allowed to help, just say, "No no, I meant I don't know what I'm doing here in medicine.  I always thought that being a doctor meant being able to help people, but lately I've found that it all seems too abstract.  Do you think I should volunteer overseas for a while just to get my head straight?" and then burst into tears.  Take great gasping breaths and say something like, "Think of the children!".  They'll be so impressed with your deep compassion for all living beings that you'll get an immediate pass.

If you don't know what to ask in a history-taking station, treat the patient as a drug-seeker!
It's bound to happen at some point - you just run out of ideas, or your mind goes blank and you can't think of what else to ask.  You can save the day by glaring at the patient suspiciously and asking them how long it's been since their last fix, how many other doctors they've visited today, and did they really think you were going to believe this cockamamie story?  The examiner will know that you've been doing it tough in the bad parts of town and you know how things are in the real world, and no amount of fancy-pants book-learning can make up for that!  Immediate pass.

In any station where you are asked to do something even remotely clinical, refuse to do it until you've reviewed the local protocol!
Injection technique?  "I'd like to see the protocol that you have in place."
IV cannulation?  "Where's the protocol?"
Rectal examination?  "Protocol please."
Chronic care self-management plan?  "I'm afraid it would be unsafe for me to continue until I've reviewed the protocol."
Rest station? "Protocol."
Immediate pass.

If you're required to use a fundoscope to read the tiny leetle words out of the ping pong balls, bluff.
Try this: "klaatu barada nikto".  They may or may not be the words in the ball, but when you've just stopped a giant alien robot from destroying the Earth, who's going to quibble?  Immediate pass.

When you get to a rest station, make good use of it!
Hyperventilate.  This will ensure you are fully oxygenated for the next station.
Review.  Think about all this things you should have done two stations back.  Go back and fling open the door and let the examiner know the extra things that you missed out.  It all counts!
Relax.  Do some knee bends, sing a song, have a quick micro-nap.  A hip flask may be handy, as well as one of those neck pillows for sleeping on planes and buses.

Carry a small Yoda figurine at all times.
Immediate pass.

Schoolies and toolies

I noticed during the week that a lot of our neighbours were packing up and going away for the weekend.  Now I know why.  It's schoolies time!  The town where I live is the state's premier destination for kids who've just finished high school and want to get away for the week/weekend and write themselves off with booze, drugs and loud music.  It's shit.  Most of the time, my town is the state's premier destination for old people driving Subarus at 80 kph on the highway who feel like a spot of lawn bowls and like to drink really awful coffee.  So as you can imagine, things get shaken up a bit this time of year.

Last night really gave me the pip.  There was loud music, in fact there were loud musics from several different sources, pounding away at 11.  People were roaming the streets shouting and swearing at each other.  Someone threw something onto our roof while we were trying to get to sleep.  This went on until well after 11pm.  This country is stuffed!

I never carried on like that when I was on schoolies.  We used to rise with the sun, do some gentle exercises, picnic in the park, do a spot of horse-riding, then play bridge until 6pm when we would dine in the conservatory and have some poetry readings until the lanterns were turned down by the attendants at 9.

Normally all the to-do wouldn't have bothered me that much, but my Smaller Half has her big face-to-face exam this morning - the dreaded OSCE (Objective Standardized Clinical Examination) - which as my Wise Elder Brother has pointed out is better than a SRTE (Subjective Randomized Theoretical Examination), but only just.  Anyway, she's stressed enough about it as it is, and really didn't need to be kept awake.  I am also stressed about it since it has become apparent to me that although my exam next week should be a bit of a doddle, next year is going to break me unless I change my work habits.

So I lay there trying to get to sleep but also mentally running through an inventory of the house and identifying all of the things that I would like to hit those goddamn schoolies in the throat with.  5-iron, check.  Desk lamp, check.  Umbrella, check.  Philodendron, check.  The list goes on.

The other odd thing about it being schoolies week is that all the toolies turn up too.  That's not really a direct concern to me, but I suddenly became self-conscious about letting people know that I'm not a toolie.  Not that I really look like one, but it's better to be safe than sorry.  For example, I went down to the main street to get my hair cut.  The barber was very laconic so it was a struggle for me to achieve my conversational objectives of letting him know that I live in town and I'm not a toolie, and also that I'm a student so he should give me a discount.  It went a bit like this:

Barber

Hot outside?

PTR

You bet.  Not as hot as last week though.  Here in town I mean.  Because I live here, so I was here last week too.  Now that was hot.

Barber

Yep.

PTR

It's nice and cool in this barbershop.  Much cooler than it would be if I was in my car driving up to university, which I attend on a daily basis in my capacity as a student, which consequently leaves me with only limited discretionary spending power.

Barber

Yep.

PTR

Boy it's crowded in town.  All these out-of-towners coming into town from outside of town.  Not like me.

Barber 

Sigh.  Yep.

I think he got the point in the end.  He only charged me $14, which is the cheapest haircut I've had since 1992.  All the same, sometimes it would be nice to be mistaken for a toolie.  There was a random drug and alcohol screening van on the road into town last night.  When I drove up to it, they looked at me and waved me through.  How insulting - I obviously don't look dangerous enough.  Maybe it was my bumper sticker saying, "I don't know the difference between a direct and indirect inguinal hernia and I'm proud".

Amigos para siempre

Wow - it was only just now as I was doing the dishes that I realized that I just had my last day of med school "school".  I'm happy about that, don't get me wrong.  But it hit me that never again will I sit in a lecture theatre with my trusty gang of side-kicks.  Oh wait, maybe I'm the side-kick.  Never mind, it doesn't matter.

Bye bye guys, I'll miss youse.  Thanks for putting up with my stupid jokes.  Thanks for letting me sit with you at lunch time.  Thanks for not calling me out for my lack of work in our first PBL group.  Thanks for letting me have the good red seat in the new LT2.  Thanks for sticking that goddamn needle in my arm so far that it was bruised for two weeks - ha ha - oh, the memories.  But mostly, thanks for helping this old man across the street. 

I was pretty shit-scared for my first couple of months of medical school.  I knew some of the folks in the year ahead of me thanks to my Smaller Half, so I could always take refuge in their company if I needed to, but I didn't know anyone at all in my own year.  Everyone seemed to already know each other so I figured I was stuffed.  Med school is incredibly cliquey, which is a great shame. But it was such a relief to eventually find a little circle of friends I could call my own, rather than have to keep circling around the periphery of the crowd.

Next year we'll all be fanging off to different parts of the country and we might not see each other much at all from now on.  But every time I see a completely hairless man, I'll think of you.

Control

Sometimes I like to walk down the confection'ry aisle at the supermarket and look at all the stuff I'd like to eat.  I take it off the shelf, imagine eating it, then put it back and walk on.

Sometimes I drive into service stations, open the fuel tank, take the pump off the bowser, stand there for a minute imagining myself filling up my car with cool rich petrol, then put the pump back again and drive away.

Sometimes I hang around doctors' waiting rooms, wondering what it would be like to go in for an appointment.  I sit there, holding a 1994 National Geographic, imagining myself reading it.  Then I leave.

In winter when it's cold, I like to stack up wood in the fireplace, carefully getting all the kindling in just the right place.  I put the matches right there next to it.  I leave it overnight, then take it all apart again in case, in a moment of weakness, I light it.

Sometimes I get on the interwebs and go to google.com and just sit there for a while, thinking about all the fantastic sites that I could find if I just typed in the right search terms.  Then I turn off my computer.

Sometimes I wake up in the morning and lie there in bed for hours, thinking about all the wonderful things I might learn if I was to go to uni that day.  Then I read a book, have a snooze, and get up to make myself dinner.

The Gravy Boat

When my great-aunt Eunice passed away, the only thing I inherited was an old china gravy boat.  At first I was disappointed.  I had no use for such a thing.  Other people in the family got watercolour landscapes from her time in Zanzibar, or richly knitted ponchos made from the hair of her three favourite rabbits, or her infamous collection of recipe clippings from Eastern European community newspapers.  I got the gravy boat.  Until I was given it, I didn't even know she had owned such a thing.  I'd certainly not ever seen her use it.

We'd attended the reading of her will mostly out of curiosity.  Everybody had known that she had a master list of all her possessions, with names written next to them indicating to whom each item would pass after her demise.  Some things had been allocated, withdrawn and reassigned multiple times over the years as certain people fell in and out of favour for various crimes and misdemeanours, mostly to do with "interfering" or "advice".  Conversely, an unguarded remark or query about a strange object in her house would be met with her assurance that she would pencil your name in next to it on the list.  So we ended up with an informal competition to see who had gotten stuck with the most inconvenient inheritance.

The solicitor read out my name, breathed deeply, and solemnly intoned, "In return for his unflagging support and friendship across the intergenerational chasm, I leave my favourite gravy boat".  My sister laughed out loud, but I was disappointed.  I took the gravy boat home and it sat in my garage for a few months, forgotten.  Then winter came.

Something about the cold air made me remember the gravy boat.  It seemed a shame to let it sit there, gathering dust.  I decided to use it, just once, to honour her memory, no matter how foolish I might feel.  So I tied it to the roof of my car, hung a little red handkerchief from the back to flutter gaily in the wind, and set off down the street.  It had been years since I'd been down to the gravy lake, in fact I hadn't been since I was a child.  At first I thought I might have to stop and ask directions, but I just kept turning down the familiar looking roads and soon enough I could smell the gravy and all I had to do was follow my nose.

From the shore the gravy looked smooth enough, but I knew from experience how treacherous it could be.  The ground dropped away sharply once you'd waded out beyond your knees, and it was unnerving not being able to see your own feet.  I got the gravy boat down from my car and slid it out into the gravy, pushing through the rushes that clustered around the shore.  With one final shove, a quick dash, a hop, a wobble, a curse, a lurch, and a relieved sigh, I was aboard, dry feet and all.  Taking my little paddle, I pushed hard at the gravy and steadily worked my gravy boat out from the shore until I was a hundred meters or more from dry land.

I stowed my paddle and rested.  The breeze blew lightly, sending ripples across the gravy and bringing the hot salty smell to my nostrils.  So this was the nautical life!  My cares and worries seemed faded now, like the china gravy boat itself.  I sat for an hour or so, doing a little bit of paddling, and dabbling my feet in the gravy from time to time, before heading back to land and hauling the gravy boat out and back up onto my roof-rack.  As I drove back up the road away from the carpark I caught one final glance of the gravy lake in my mirrors, and I thought of Eunice.  Had she ever been able to come here to sail?  Was it a lost dream or a passing whim?  And what long-gone comment of mine had made her think that I, among all her family, needed the gravy boat? 

Another whine

You know what I'm looking forward to next year?  Not having to wander the halls of the hospital like a lost sheep, desperately trying to find a patient to do stupid history/examination practise on.

I really dislike it.  Once I find someone who is cooperative I am as happy as Larry.  But I hate having to charge into someone's room and ask them to let me do them no good whatsoever by repeating stuff that has already been done to them a thousand times by more experienced people who were doing it for a good reason rather than to fulfill a course requirement.

The people I feel sorriest for are the patients that the other medical staff steer me towards.  They steer me towards the people who are newly admitted, younger than most of the older folks on the wards, and have "interesting" health problems.  "Interesting" meaning "serious".  So these are young, otherwise healthy people, who've suddenly had to be admitted for some unexpected and life-threatening problem.  They're still getting used to the idea themselves - the last thing they need is someone like me rubbing their noses in it.  I think it sucks.

Next year will be different.  Next year I'll be actually contributing something to their care, so I'll be more of a symbiote than a parasite.  I can hardly wait.

Knucklehead driving

In my role as a frequent utiliser of transport infrastructure, I've just completed a detailed study of knucklehead driving on Australia's roads.  I have identified important independent risk factors for knucklehead driving.  Knucklehead driving includes behaviours such as:

• tailgating,
• passing on the left in a turning lane at an intersection,
• changing lanes without signalling,
• weaving through traffic,
  
• egregious acceleration,
• gratuitous overtaking so as to never be behind another vehicle no matter how fast it is travelling,
  
• speeding, especially in built-up areas.

Knucklehead driving is distinct from hat-driving.  Hat-driving includes behaviours such as:

• struggling to park on a busy street,
• going slowly in the passing lane,
• not realizing the traffic lights have changed,
  
• dithering when turning into traffic or merging.
  

To assess a driver's risk of displaying knucklehead behaviors, carefully examine the vehicle in question and use this score chart:

Spoiler?  +1
Very large spoiler? +2
Very small penis? +3
Ute +1 (excludes utes actually carrying goods or equipment, including all tray-tops)
Ute with dog in back? +1 more
Station wagon? -4
"Sports" station wagon? +2 instead
Motor scooter? -10
Bullbar? +1
Bullbar on car in metropolitan area? +1 more
Bright yellow? +2
Bright green? +2
Bright purple? +1
Bright red? +1
Chameleon paint? +3
Bumper stickers with anti-immigration sentiments? +2
Bumper stickers with Southern Cross? +1
Bumper sticker with "Magic Happens"? +1
Shiny wheels? +1
Low profile tyres? +1
Lowered suspension? +2
Multiple exhausts? +1 per pipe after the first
Holden? +2
HSV Holden? +2 more
Ford Falcon? +1
Subaru WRX? +2
Subaru Liberty, Forrester or Outback? -5
Driver male? +2
Driver on P-plates? +2
Driver wearing singlet? +1
Driver shirtless? +3
Driver's seat reclined at greater than 60 degrees? +1
Driver barely able to see above steering wheel despite being of apparently normal stature? +2
Driver has only one hand on the wheel? +1
Tinted windows? +1
Windows down? +1
Driver has arm out window? +1
Driver has head out window? +2
Passenger has feet on dash? +1
Driver has feet on dash? +5
Custom plates? +2
Custom plates that match the colour of the vehicle? +2 more
Custom plates with clumsily executed sexual innuendo that it takes more than 10 seconds to decipher? +3 more

Add up all the scores then look up the total in the chart below to find the risk of knuckleheaded driving and your appropriate response.

• Less than 3: Sensible driver, though may be at increased risk of hat-driving.  No follow-up necessary.
  
• 4-8: Isolated infuriating incidents may occur.  Some tut-tutting and/or head-shaking may be required.
• 9-12: Infuriating incidents likely.  Swearing will relieve tension.
  
• 13-16: Enraging incidents commonplace.  Consider either pre-emptive hat-driving or retaliatory knucklehead driving.
• 17 or greater: Knucklehead.  Nothing you do will help.  Next time catch the bus.
  

Your time re-starts now...

My earliest memory is ... sausages.
At school I ... sausages.
My first relationship was ... sausages.
I don't like talking about ... sausages.
My most treasured possession is ... sausages.
My mother and father always told me ... sausages.
In the movie of my life, I'd be played by ... sausages.
I wish I had ... sausages.
I wish I hadn't ... sausages.
My most humiliating moment was ... sausages.
I was happiest when ... sausages.
My guiltiest pleasure is ... sausages.
My last meal would be ... sausages.
I'm very bad at ... sausages.
When I was a child I wanted to ... sausages.
If I could change one moment of my life it would be ... sausages.
It's not fashionable but I love ... sausages.
If I could live anywhere, I'd choose ... sausages.
My worst trait is ... sausages.
My best trait is ... sausages.
My greatest fear is ... sausages.
If only I could ... sausages.
The hardest thing I've ever done was ... sausages.
I relax by ... sausages.
What I don't find amusing is ... sausages.
I'm always being asked ... sausages.

Wow - that was heaps easier than last time.  And funnier too.

Hernia schmernia

Allow me to make some generalizations.  Holden drivers are knuckleheads.  People who vote conservative are heartless and greedy.  And sturgeons are jerks.

Generalizations being what they are, many exceptions exist.  But if you keep these guidelines in the back of your head I reckon you'll be right more often than wrong.  Naturally, should you encounter a conservative voting sturgeon who drives a Holden, steer clear.  Haha - of course, this is patently ridiculous - what sturgeon would ever drive a Holden?

Anyway, you've probably figured out that I've got a bee in my bonnet about sturgeons today.  I'm sure that by next week I'll be fine, back to my normal idolization of them as suprahumans, veritable giants among us.  Which is a good thing because I'll be stuck on a sturgical ward next week so I'd better learn to kiss some serious butt.  But today I am riled up because I am sick of being patronized.

Of course, I am used to being patronized.  It happens all the time, especially when you're a newbie in a field with a staggeringly immense sense of self-importance and hierarchy like sturgery.  And to be honest I don't really much mind being patronized as long as I am actually learning something useful at the same time.  Which brings me neatly around to direct and indirect inguinal hernias.

But first, let me digress by noting that if I had a dollar for every time some smart-arse sturgeon smirked at me and said, "Oh, but you guys don't learn anatomy these days, do you?", I'd be off to the shops right now to buy some more pies and when I had, I'd throw them onto the road to be run over by trucks then I'd go back into the shop and buy some more just because I could.  I was so happy this afternoon because shortly after our instructing sturgeon unleashed this particular piece of tripe at us, he was forced to retract it after one of my Esteemed Colleague correctly named the pampiniform venous plexus.  So there!

The thing that really gets me about sturgeons harping on about this anatomy thing is that:

1. It wasn't us who changed the course, so shut up.
2. It was changed because it was a big fat waste of time, so shut up.
3. It's because of people like you badmouthing us in front of patients that I have to put up with patients asking me if I even know where their spleen is, so shut up.
4. You've got your pants pulled up so high I can see your socks, so shut up.

Anyway, back to direct and indirect inguinal hernias...  Every time (and yes, it has happened multiple times) this topic has come up in our anatomy classes (when?  in our ANATOMY CLASSES) our instructors have emphasized that it's very confusing and of no practical consequence but that we should learn it because sturgeons like to ask students questions about it so that they can prance around clutching at their chests and bemoaning the state of modern education which then gives then a further license to tell stories about how many patients they accidentally killed when they were interns working 72-hour sleepless shifts but it was all for the best because look how brilliant they are now and it was a public hospital anyway.

Where was I?  Oh yes.  I had always had the sneaking suspicion that our instructors were just bitter academics and that there must actually be some clinical significance to the direct/indirect inguinal hernia issue that they weren't aware of.  So I did my best to understand hernias, and lo and behold, I became vexed and confused.

But today when we were getting grilled about hernias by the sturgeon, after he gleefully ridiculed us for our lack of anatomical knowledge and showed us how to determine at examination if a hernia was direct or indirect, he told us that it didn't really make any difference because the treatment for both direct and indirect hernias was EXACTLY THE SAME and in fact the only real way to tell if it was direct or indirect was once you'd cut the patient open in sturgery, so the examination result was not only irrelevant, it was inaccurate.  And he sternly emphasized that we should be careful to learn the anatomy and the definitions so that we could answer the questions that other sturgeons might ask us, like he just had.  And he was deadly serious.

Perhaps I am just bitter and stubborn myself, but I fail to see why I should devote my time or energy to learning something that is of zero clinical significance solely because people higher up the food chain are likely to grill me about it on the basis that it is notoriously hard to learn.  I might as well memorize the first hundred digits of pi, or learn to recite some poetry in Greek.  What a sad indictment on the profession that this kind of crap still goes on.

Join with me, fellow medical students, and refuse to learn the difference between direct and indirect inguinal hernias.  Maybe we can get bumper stickers printed.

Minor update

As predicted yesterday, the stunami stuck today.  It's still only mild though - I did just over one and a half hours just now before running out of steam.  Considering I blew off going to the wards to find a patient to write up, and then skipped a lecture that probably would have been quite interesting, on the grounds that I refuse to spend more time in the car than in class, I'm not sure if I'm ahead for the day or not.  Still, I'm counting it as a moral victory of sorts.

Also, the final vote has been tallied in the Eponymous Virus Dystourismia poll.  The winner is Subiaco virus.  This surprised me.  Considering that the vast majority of readers are in Adelaide I was expecting Toorak haemorrhagic fever to score heaps, given how bitterly Adelaidians complain about Melbourne all the time.  Maybe it's some kind of football thing, which would explain why I don't understand the result.  Manuka tick fever came second, which I found gratifying as an ex-Canberran in a perverse "Oh my god, people have heard of Manuka" kind of way.

Any suggestions for a new poll?

Stunami Warning

The Bureau of Meteorology has just issued a Stunami Warning for South Australia!  Please see the map for the areas expected to be worst affected.

Stunamis are a rare phenomenon, occurring only a couple of times each year.  Pressure released by massive shifts in the subconscious initially cause a low ebb in the levels of study.  However the trough is rapidly followed by a sudden onrushing wall of study that sweeps all before it.  The tidal wave of study has the power to destroy houses, trees, relationships, and egos. 

Do not attempt to resist the stunami.  Do not attempt to flee the stunami.  The only way to survive is to be carried along by it until it deposits you at a distant point in the future.  Be warned that unless you quickly secure yourself to flotation devices such as books or computers you may be overwhelmed and crushed.  You must also obtain adequate supplies of food and water as supply to the area affected by the stunami will be sporadic at best.

Do not try to assist others who may be struggling in the stunami.  Your first duty is to yourself.  The weak will perish.  If you can, seize their books.  Avoid panicked crowds.

I'll see you on the other side.

Liver function tests, brain function tests

We had a gastroenterology session this afternoon.  Those of you who are stalking me will know about my avoidance of all things gastroenterological, on the grounds that it's all basically the same anyway.  Or so it seems when you don't really know what you're talking about.

There was a station on interpreting liver function tests (LFTs).  We went into the room, the GastroGuy thrust some pieces of paper at us which had some abbreviations and numbers on them, and asked what questions we would ask a patient with these LFT results.  Now I find LFTs hazy at best so it was good to be part of a group.  Some of the other people came up with some good ideas and were doing splendidly until I opened my mouth due to my intense dislike of awkward silences.  This is how it went:

Esteemed Colleague #1

I'd ask if he'd taken a lot of paracetamol.

GastroGuy

I like how you're thinking.  Paracetamol overdose is important to consider, although these typically aren't the numbers you'd see in that situation.  What else?

Esteemed Colleague #2

Does he work on a farm with chemicals or fertilizers?

GastroGuy

Well, occupational chemical exposure is good to check, but there's no reason to limit it to farms.  What other sorts of jobs might be dangerous?

[Awkward silence.  Tension builds.]

PTR

Maybe he works in a paracetamol factory?

GastroGuy

Go and stand in the corner.

Psoriasis

I was just reading about psoriasis on wikipedia and was startled to learn that the following treatments have fallen out of favour:

• cat faeces
• onions
• sea salt and urine
• goose oil and semen
• wasp droppings in sycamore milk
• soup made from vipers
• arsenic

I guess my doctor must be pretty old-fashioned.

How to choose an alpaca

People often accost me as I go about my daily business, demanding that I help them select an alpaca.  While I'm happy to assist my close friends and family in this way, the sheer volume of requests that I have been receiving is grossly inconvenient.  Hence I present you with this handy guide to choosing the alpaca that is right for you.

First, don't just think about alpacas.  While alpacas are fun-loving delightful companions, so too are all of the llamoid species.  And let's not leave out the mixed breeds!  To help you decide, ask yourself these questions:

How much do you weigh?  If you have a "fuller figure", perhaps you'd be happier with a vicuna or a guanaco.  Or perhaps not!  Sometimes the "fuller figured" gentleman about town is best served by an alpaca after all.  Only you can tell for sure, but not until you've gotten out there and met some of these other friendly camelids.

Next, how experienced are you?  If you're a new alpaca owner, there's no sense spending $10,000 on a prime alpaca which is just going to get all dinged up in the first few months while you're figuring out how to use it right.  Just get an el-cheapo from ebay for $100 that you won't be afraid of hurting, and you'll learn faster and can sell it to the next sucker learner once you're ready to upgrade.  Be warned - postage can be expensive so it's best to buy local!

How long are your arms?  Measure from armpit to the tip of your middle finger on both sides and use the shorter arm as your guide.  DO NOT buy an alpaca with a chest girth larger than your shortest arm length.  It will be extremely fatiguing to carry.

What's your personality type?  Don't choose an aggressive alpaca that likes to spit unless you're prepared to defend it with your fists or a length of cycle chain.  Likewise, don't choose an alpaca which is flippant or sarcastic unless you don't take yourself too seriously.

Are you planning to travel a lot with your alpaca or just keep it at home?  If you're going to take your alpaca onto public transport, to work, or on holidays, you'll want one with a slow metabolism so you don't have to lug around bags of heavy food.  It will also be sluggish and easier to catch when it inevitably tries to flee. 

Finally, consider your own personal appearance.  You should choose an alpaca that complements your best features.  For example, if you have straight even white teeth, choose an alpaca with stinking yellow buckteeth.  If you have stinking yellow buckteeth, grow a long moustache that covers your mouth.  If you have pale skin, choose an alpaca that is a rich green or deep red.  If you have two legs, choose an alpaca with four or more.  It's common sense really, but take a friend along who you can trust to be honest with you.  It can really help to get your friend to photograph you with a few different alpacas so you can see for yourself what an idiot you look like.

Good luck choosing your alpaca.  A good alpaca will be your constant companion for many years - a shoulder to cry on, a friend to laugh with, and a source of courage and inspiration.  I find it hard to imagine how my life would have turned out without my many alpaca friends.  It really is true what the Bolivians say: "A house with no alpaca is like a beard with no letterbox."

GLIYE

The part I don't like about sending flowers to someone is having to dictate what will be on the card.  I would much prefer to actually write it myself.  But instead I have to tell the person and they write it down.  It's particularly annoying when you realize that all you can think of to say has clearly been said a thousand times before - so many times, in fact, that they have a standard abbreviation for it.

For example, imagine that I'm sending flowers to my friend to encourage her in some big exams.  I might say to the florist, "Could it say: Dear Betty, Good luck in your exams, I'm sure you'll make us all proud."  And what the florist writes down is, "Dear Betty, GLIYE, ISYMUAP."

I realize that flower cards are usually not a great outlet for creative innovation in messages, but please - let's not emphasis the sheer banality of the card too much.

Hay mucho hay

You may not know that I am the world's leading hay photographer.  Few people even realize the existence of such a field.  (Haha - a small agricultural joke there!)  It's a small but fiercely competitive arena, where the men are real men and the hay bales are rectangular prisms made from dry grass.  Well, that's what hay was like when I was a youngster.  These days it's all rounded, curvy and sensual.  Alluring and inviting while also distant and unobtainable, these cylindrical bales are a perfect foil for the camera.  Here are some images from my latest shoot:

See the hay frolicking in the wild!  Defiant, fresh, free - the spirit of the hay can never be downtrodden!

Hay isn't the social type, but it never gets lonely.  Friends are never too far away but until then it's time for some relaxation and quiet contemplation.  Hmmm.

 Hay can prosper and flourish in such a wide variety of environments, from paddocks to fields to farms.  Amazing! Its go-anywhere, do-anything attitude is why it seems to be everywhere you look!.

Here we can see that the hay is wearing little white jackets - so clever, so cute, so now!

Keep an eye out for hay in your neighbourhood.  Something tells me that you'll be getting to know hay a lot better real soon now...

Medicine is basically pretty gross

Most of the time I consider myself really lucky that my Smaller Half is also studying medicine.  But tonight, when we had a lengthy conversation about ulcers while eating our dinner, was not one of those times.  We also got in a quick chat about various dermatological lesions.

Still, it was better than this afternoon at uni.  I had a three-hour-long block of lectures, most of which was pretty dull.  All I had to break the monotony was a clear view of the screen of an Esteemed Colleague's laptop in the row in front of me.  She spent the whole time downloading pictures of various diseases and conditions of the anus.

I've had enough education for today.

Get rich quick

Who wants to go and live by the scenic river Ebola in Congo-Kinshasa?  How about Marburg in Germany?  Or Hendra in Queensland?  Omsk perhaps?

Of course you don't - all of these places are the unfortunate victims of something that I call Eponymous Virus Dystourismia (EVD).  Whenever a horrible fatal virus outbreak occurs somewhere, the virus tends to get named after that place and it really puts people off going there.  It doesn't always happen this way.  Spain, for example, is famous for much more than just Spanish Influenza.  Ebola, on the other hand...

It occurred to me yesterday, while reading about Hendra virus, that it would be a great idea to buy an investment property in Hendra.  I reckon prices must be plummeting around now.  The cure for EVD is the same as the cure for the underlying disease itself.  Eventually some clever person will develop a vaccine for Hendra virus and it won't get much more media coverage after that.  Prices will rebound once people start seeing Hendra for the delightful, family-centric, garden utopia that it is.  If you take my advice and get in now, you'll make a killing!

But there's a hitch in my plan.  The government has denied ongoing funding to a research centre that is investigating Hendra virus and it will close next year.  Get out there and hassle your local MP - ask them why Australia's only defence against this potentially disastrous disease has been axed.  If they reinstate the funding, you'll be saving lives AND saving my retirement nest-egg!  It's a win-win!

I've always wondered

How can the Tabasco sauce people make any money?  I've been using the same bottle now since 1948.

Dispel all doubt

I'm a little bit older than most medical students.  So when I'm standing around on the wards trying to figure out what the heck is going on, every now and then a nurse mistakes me for an actual doctor.  It's perfectly understandable - the only way she (and yes, most nurses are still women) could tell would be to closely examine my ID tag, so she just goes by the age, the stethoscope, and the ... I don't know what else.  Maybe my watch looks expensive or something. (It's not.)

Anyway, typically we have a little exchange like this:

Nurse

Doctor, may I quickly check something in the notes you're reading?

PTR

Oh, of course, I'm just a medical student.

But perhaps the nurse thinks I'm making some kind of self-deprecating joke, because when she hands the notes back to me she says,

Nurse

Thank you very much Doctor.

I really really hate this.  It is incredibly awkward because then I have to say, "No really, I am a medical student", and perhaps even specifically say, "I'm not a doctor".  But that's okay, I myself am crap at names and frequently call people by the wrong name so I can cope with having to correct people.

What I hate more is the sneaking feeling that if the nurses think I am a doctor, they may well start doing some hare-brained thing right in front of me and expect me to intercede if they shouldn't do it.  Seems ridiculous, I know - when did a nurse ever pay attention to a doctor?  But I just can't get the idea of out my head that something bad might happen to a patient just because someone else thinks I know a lot more than I do.

The way I deal with this situation is twofold. First, as noted, I make sure that anyone who is explicitly confused as to my status is promptly corrected.  Second, I make sure that anyone who may be implicitly confused as to my status is immediately set straight, which I achieve by asking every person I meet a stupid question.  It's working out pretty well so far.  Everyone on my ward thinks I'm an idiot.

In case you too are plagued by these fears, here are some examples of good questions to ask:

• How does this bed work?
• Can you help me? I'm tangled in this curtain!
• Where in the patient does that tube go?
• Where's the handwash?
• Are you a nurse?
• Is it always this busy?
  

Some careers I considered when I was younger

Lego set designer (age 8)
Rat brain scientist (10)
Stuntman (11)
Pilot (12)
Policeman (15)
Paramedic (16)
Industrial designer (17)
Physiotherapist (17)
Physicist (19)
Actuary (21)

Desk

My desk still isn't looking any better either...

Tangeria

By the way, I was pleased to see that Tangeria handily topped the recent poll for imaginary things.  It got 8 votes, while the next best was the number seblen with 3 votes.  Seblen is deservedly the silver medal winner, but Tangeria undoubtedly carried the day due to the fact that I've written about it before.

For those of you who came late, get more information about Tangeria here:
http://pronetoreverie.blogspot.com/2008/10/fictional-country-name.html
and here:
http://pronetoreverie.blogspot.com/2008/10/tangerine.html

I still get about 5 people each month landing on this blog after searching for "fictional country names".  It's clearly a field with great unmet demand.

You're disorganized - I'm creative

Fascinatingly enough, I am taking a break from tidying my desk.  This is not as trivial as it sounds.  Currently, apart from the laptop that I am typing this on, every other surface of my desk is covered by an average of 15 cm of crap.  Not literal crap, fortunately, but metaphorical crap.  Metaphorical crap such as: 5 golf balls, a Matchbox 1969 Karmann Gia convertible, rules for World In Flames, rules for Space Hulk, 10 or so CDs ranging from Something For Kate to Willie Nelson, Yoda, two different rulers marked with ECG info, a bunch of pens that don't work but are being kept just in case they change their minds, my passport, my old passport, a stack of fuel receipts for the whole year that I keep meaning to do something scientific with, a plastic golf ball, some disposable tweezers, the notes from the six different blocks I've studied this year (all mixed in together), about 30 pieces of unopened mail (at least 10 of which are probably demands for money from outraged utility or credit companies), old shopping lists, phone rechargers, coffee cups, things I've ripped out of the newspaper for some long-forgotten reason and God knows what else.

I was tidying my desk because I was doing my tax and realized that amidst all the crap there were probably important financial documents that I needed to find.  Sadly, I haven't found them yet.

I'm really starting to wish I hadn't had three cups of coffee in an effort to snap myself out of that post-lunch slump.  I think I've been thrust well out of the slump, past energy, past euphoria, past agitation, and into the panic attack.  Clearly three cups of coffee alone shouldn't do this to me.  It's the coffee plus the tax plus the desk plus the looming realization that I really need to pull my finger out and do some preparation for my exams at some stage.

And world peace.  I'm very worried about the lack of world peace.  Why can't we all just get along?

I don't understand why my desk isn't getting any tidier - I've been typing this now for 10 minutes and nothing has changed.  If the Desk Fairy doesn't show his face soon, someone's going to get machine-gunned.  BRAAAAAKKKK!

Your time starts now...

I like to imagine that I'm a minor celebrity.  Not a big celebrity like Hugh Grant.  Everyone knows big celebrities are all unbearably egotistical despite not really deserving any of what they have.  In fact the written Chinese word for "celebrity" is a combination of their words for "thief" and "fortune"*.  I'm only annoyingly egotistical, ergo I think minor celebrity status suits me fine.  Minor celebrities don't typically get asked for autographs on the street like Boonie, but there will be a certain subculture who will recognise the minor celebrity and say to their friends, "Hey, isn't that ...?"  I'm pretty sure I might actually be a minor celebrity because today when I sat down at a table in the cafeteria with some of my Esteemed Colleagues, they knew my name and everything!

Anyway, one of the things that minor celebrities do is answer fixed format interview questions, like the one that appears every week in the weekend magazine of the Sydney Morning Herald.  I always enjoy reading it so I've decided that since I too am a minor celebrity I should have a go at answering the questions.  Some of the questions are a bit gammy in my opinion, but the ethics of shameless plagiarisation forbid me from leaving them out.  It's all about the principle you see.  Anyway, let's get this show on the road...

PTR
Med school celebrity and blogging superstar

My earliest memory is ... hitting the snooze button on my alarm.
At school I ... was probably an insufferable twerp.  I must have been able to run real fast because I only remember getting into three fights.
My first relationship was ... misguided, but I have some happy memories nevertheless.
I don't like talking about ... people's exam marks - thank the Whirley-bird we don't get them in this course.
My most treasured possession is ... Yoda - he gets me through all my exams.
My mother and father always told me ... to stop crying by the time they counted to three or they'd really give me something to cry about.
In the movie of my life, I'd be played by ... the offspring of the crazed mating of Ryan Gosling and Ed Norton.  The mating itself would not be part of the film.
I wish I had ... learned to play the guitar in Bolivia from a toothless old man called Jesus in return for a bag of oranges.
I wish I hadn't ... started playing Bejewelled Blitz on Facebook.
My most humiliating moment was ... losing my underpants down my trouser leg and onto the floor whilst on work experience.
I was happiest when ... I was at my own wedding.
My guiltiest pleasure is ... cheese.  Especially cheese that I stole from the hand of a hungry elderly widow.  So guilty.  So delicious.
My last meal would be ... difficult to stomach if I knew that it was really my last meal.  So it'd have to be blended up into a smoothie or I think I'd spew.
I'm very bad at ... not making smart-arse remarks in conversation.  It's almost like a form of Tourette's.
When I was a child I wanted to ... spend all my time drawing space-ship battles.  Not much has changed.
If I could change one moment of my life it would be ... accepting that invitation to the year 10 formal then backing out the next day.  I should have just refused up front.  It was so dishonourable of me.
It's not fashionable but I love ... Dolly Parton's bluegrass.
If I could live anywhere, I'd choose ... New York.  But it would have to be a two-storey apartment with south-facing windows, lofted ceilings and a gas oven.  Otherwise no deal.
My worst trait is ... egotism.
My best trait is ... awesomeness!
My greatest fear is ... dementia.  No wait, dementia with a laser strapped to its head.
If only I could ... swim better than a jellyfish.
The hardest thing I've ever done was ... quit my PhD after 2 years.
I relax by ... releasing acetylcholine from preganglionic synaptic terminals, stimulating post-ganglionic parasympathetic fibres that terminate on effector organs.  Ahhh...
What I don't find amusing is ... almost anything that football players do.
I'm always being asked ... for directions on the street.

* I made that up.

Making time

People sometimes say to me, "How do you find time to write a blog?"

It's an interesting question but the answer is fairly lengthy so I decided to write this entry explaining how I work this miracle, so that in future I can just refer them to this URL.

First, I'd like to point out that I have never ever found time.  I found $40 once in Brisbane but then my friends made me buy everyone pizza for dinner.  I find paperclips frequently.  But I've never found any time that has been carelessly misplaced by its owner.  So if you're thinking of relying on finding more time to help you get through your busy schedule - don't!

When I tell people this, they look at me funny and explain that they really meant "making time", not "finding time".  Then they look at me funny again and explain that they're not really talking about making new time, they're metaphorically talking about making better use of the time they already have.  Now, I'm all in favour of making wiser use of time, though personally it's something I struggle with.  But it's a myth that you can't make new time.  I make time all the ... well, all the time.  Here's how.

There are two main techniques for creating time.  The hammer method, and the screwdriver method.

The hammer method for creating time relies on recreating the conditions that existed at the start of the universe.  As that smart guy explained in "A Brief History of Time", before the Big Bang there was no space-time.  It was only when an infinitely dense singularity manifested itself that space-time formed, unfurled, and POW! - plenty of time created right there.  Billions of years of it in fact. 

Now most of us don't need billions of years.  Even I don't procrastinate that badly.  Let's just say we need an extra week.  It's estimated that the universe is about 13 billion years old, the observable part of it contains about 10^80 atoms (that's a 1 with 80 zeroes after it), and the Jack Russell Terrier was bred from the Fox Terrier.  Some simple arithmetic tells me that I just need (whirr, click, bing!) about 100 grams of carbon to create an extra week of it.  Something like a lump of coal should do.

What you do is simply compress the lump of coal until it is infinitely dense.  An easy way to do this would be by hitting it with a hammer, whence comes the name of the method.  Be careful though - it will make a big bang!  (ha ha ha)  But seriously, you'll have to hit it very hard, so put some newspaper under the coal or you'll damage your table.  Once you've created this new universe, simply enter it and enjoy the extra week that you have created at your leisure.

The screwdriver method is more elegant, but trickier to execute.  The theory behind it is this: imagine a plane that can be described using two coordinates, x and y.  An arrow in the direction of x can be converted into an arrow in the direction of y by turning it 90 degrees anticlockwise.  The axis of rotation is in the 3rd dimension, z.

Similarly, the space-time continuum is a four-dimensional space defined by 3 space coordinates x,y,z and time, t.  To make time, you simply take a piece of space of the appropriate length and rotate it about an axis in the 5th dimension to convert the space into time.  The speed of light, c, is 10^8 metres per second.  Therefore space converts into time at a rate of 10,000 km for every second.  So to create a week of extra time you simply need a piece of space 60x60x24x7x10,000, or roughly 6 billion km long.  Give it a twist, and the week is yours!  Note: don't do this with a piece of space that someone is using, or they'll get very angry at you.  Also, you should do this outside unless your house is very large.

So that's how I make time to write this blog.  I hope this has been helpful to you and that you will now have all the time you need to do whatever you want.  But be warned, use this power for good, not evil...

Have a go

I have a great affection for people who persist in doing things badly.  I don't mean people who deliberately do things badly, like how some people ridicule other people's fan-fic by writing deliberately absurb piss-takes on it - that's just mean.  I mean people who aren't very good at things but keep doing it because they love it and they don't particularly care what some other judgemental people might think.  It's a great virtue in my book.

I like to see people paint drab watercolours and get it all wrong.
I like to see fat people at the gym trying out new classes.
I like to see unco people play sport.
I like to see old people dance.
I like to see middle aged people stab away at the piano keys.

When I was younger I also liked those things, but I liked them because it made me feel (falsely) superior to them, because (I convinced myself that) I could do better (if only I tried).  As a result, I didn't do anything except the stuff that I could do well.  Which meant that I missed out on a lot of opportunities to try new things.

Now that I am old and wise, I like these things because they remind me that I'm not so good as I think I am, so I might as well just enjoy life for what it is.  It's a whole lot better, let me tell you.

The reason I've been thinking about this stuff is because I was pretty hopeless at medicine today and I needed to reassure myself that it was okay.  It was my second day on the wards and I rocked up at some ungodly hour (does God get up at a particular time?  Does he like daylight savings too? Who's in charge when he's asleep?) and the RMO started firing questions at me that I was forced to parry and stall so feebly that it was humiliating.

RMO

So what causes seizures?

PTR

Well ... lots of things cause seizures.  ... Like ... drugs!

RMO

What drugs?

PTR

Um... the ones that mess up your neurotransmitters and ... that's all.

RMO

Hmm, okay.  What else?

PTR

Metabolic things.

RMO

Like?

PTR

... I don't know.

RMO

What makes a cell fire?

PTR

Electrolytes!  If your electrolytes are wrong then the membrane potential will be wrong.

RMO

Which electrolytes?

PTR

... Gatorade?

RMO

Go and stand in the corner.

Twilight fan-fic

Bella dashed ahead of Edward so he could barely see her through the woods in the moonlight.  He could easily have caught her in an instant with his sooper-dooper vampire speed but with his hunter's instincts he knew that the pursuit was more enjoyable than the chase.  For a moment his mind wandered, thinking back on the first day he met her.  She seemed so clumsy and foolish then, but now she was all he could think about.

All of a sudden Edward realized that he couldn't see Bella anymore!  "Oh no!", he thought, "What if she has been ambushed by that other bad vampire James, or that werewolf Jacob, or that ninja-pirate-monkey Rex?"  But then he breathed a sigh of relief as he entered a little clearing and saw Bella sitting there on the soft mossy ground waiting for him.  Her chest heaved as she gasped for breath, not because she was puffed, but because Edward was so breathtakingly beautiful in his gracefulness that she had a short attack of dyspnoea.

"Oh Edward!", she said, "I know that you do not want to drink my blood because you think it is wrong."  Edward nodded, knowing that he had lived for more than a hundred years on black pudding.  "But now, when we are to be married so soon, perhaps you should have a taste of my vital essence so it will bind us together in love and so on and so forth."

"Okay", said Edward.  Bella bared the flesh of her neck and arched her back.

"Please relax your neck and turn slightly to the left", said Edward.  The pulsation of her internal jugular vein was clearly visible as it ran deep to the sternocleidomastoid muscle and beneath her clavicle.  Edward paused to savour the moment - then he bit down.  His teeth sliced through her so delicately, light as a lover's touch, and she felt an exquisite pain that sent ice through her muscles and fire down her spine.  She felt like she was both melting and burning up.

Edward had to wrench himself away from her neck and her blood before taking too much and putting them both in peril.  He rolled his tongue around his mouth, feeling the blood richly coat his teeth and gums.  "Strange...", he thought.

Bella looked deep into his eyes and saw him hesitate.  "What is it?", she cried, "Is something wrong?"

"Well, yes", said Edward, "The taste of your blood, I can tell..."

"What?  What?", begged Bella.

"Your blood tastes rich and thick.  Delicious.  But ... too thick.  I can tell by the taste that you have an inherited coagulopathy."

"Huh?", said Bella, taken aback that their passionate encounter seemed to be getting a little wierd even for them.

"It's called Factor V Leiden disorder.  Basically, factor V that forms part of the clotting cascade in your blood is unable to be cleaved and degraded by protein C due to a single nucleotide polymorphism that results in a change of one amino acid in factor V." explained Edward, romantically.

"ZOMG, I'm a monster!" wailed Bella.

"Not at all", Edward sternly reassured her.  "About 5% of white North Americans have this mutation.  Most of the time it has no effect on you at all, though it does predispose you to developing deep vein thrombosis.  If you were to go on the pill or go through menopause or take up smoking or have a prolonged period of immobility (for example during a long-distance plane trip or following surgery), it's much more likely that you'd get a DVT and possibly have a pulmonary embolism, which could be life-threatening."

"Wow - how did you learn so much about blood?" marvelled Bella.

"I'm a vampire", said Edward, and chuckled his vampiric chuckle.

"I love you so much", gushed Bella.

"Me too", agreed Edward, and they held hands and looked at the stars and talked about how beautiful they were.

Red-eye

Again, not much to report.  I've begun the final 4-week block before the last exams of 2nd year.  I'll be spending them on on two two-week attachments to wards at the hospital while we also get various clinical skills tutes flung at us.

Today we learned some stuff about eyes.  Namely, how to shine lights into them, how to test people who can't read good, and a little mini-lecture about "the red eye" and some info about various ophthalmological (a difficult word to say, let alone type) potentially life-threatening problems.  The red eye stuff was interesting.  When I hear the phrase, "red eye", some part of my brain leaps to The Lord Of The Rings and imagines Sauron's eye of flame in his tower at Barad-Dur.  My guess is that Sauron had a subconjunctival haemorrhage.  Maybe Elendil poked him in the eye.

Anyway, that's enough prancing elf-speak.

I went up to the ward that will be my home for the next two weeks and met the interns who will shepherd me around.  They were really nice and friendly.  They even gave me a chocolate!  The only downside is I have to be there at 8 am for ward rounds, which means I'll be either getting up really early or driving really fast.  Actually, the other downside is that apparently I am supposed to have some kind of basic competence in history taking and examinations.  However, I have a cunning plan.  I will head off the requirement for competence by appearing to be a dolt.  I reckon it'll work like a charm.

Insects, the League of Nations, goats, socks and coins

Not much to report from me, sorry.  Friday was kind of fun, in that it became apparent that nothing much I was exposed to was going to be assessable.  Oh sure, it's possible that jamming steel prongs up people's noses is an expected competency, but I don't think it'll make or break me to be honest.  But I'm getting ahead of myself...

First up we had a lecture from some kind of arthropod.  No wait - he didn't look like he had an exoskeleton, he must have been an orthopod.  The lecture was pretty light.  The only things I really took in were that the humerus is "not a happy bone and is full of black ingratitude" (I don't know what that means but it made me laugh) and a useful three-point grading scale applicable to most medical or surgical situations.

1. "Oh yeah."
2. "Oh no."
3. "Oh shit!"

The afternoon was some clinical stuff from the ENT guys.  Now I'm not that keen on entomology but as it turns out none of this was about insects either!  The first station was run by President Woodrow Wilson.  I think it was supposed to be about the neck but he spent almost all the time talking on his phone to his wife so we really only got the various triangles of the neck (again) and a reminder of how to examine the lymph nodes.

The second station was looking at the larynx or, as I like to call it, the larnyx, because that way it sounds like some kind of exotic goat.  This was quite interesting.  The larnyx is a bit like a little sock puppet in your neck.  You can use it to make all sorts of noises like, "aaaah", "aaaaaaaah", "aaaaaaaaah", and "hyachhh", just like an exotic goat.  The "hyachhh" noise is the sound of a giant blob of white mucus leaping out of the larnyx and out of the video screen like those old movies of trains coming towards the screen that made people panic and run out of cinemas.  I didn't run out of the consulting room, but I did decide at that point that ENT was not for me.

The third station was not really a station.  They must have miscalculated how many people there were, or maybe someone didn't turn up.  We just sat in the waiting area and one of the entomologists banged on about ear syringing and nosebleeds.  It was probably useful info but I couldn't pay attention because he was sitting too close to me for my liking and kept making eye contact with me and I started to hyperventilate.

The fourth station was also not that detailed.  We looked into each others ears with otoscopes (Latin for "ear-looker").  It's obligatory to make jokes like, "Congratulations, you have a brain!" so we did that and the consultant said we'd fit in just fine.  The best part of this station was the giant tendon hammer that we noticed on a trolley.  The head of it was the size of a saucer.  I don't know why an entomologist would need such a big tendon hammer unless he was testing the reflexes of a pony, and why would he do that?  It's not an insect, right?  Or is it????

The fifth station was where we got to bang tuning forks on our elbows until we were able to play Mozart's Verdankt sei es dem Glanz (German for "Thank you for them glands"), which is a traditional song to be sung while examing the lymph nodes of the neck.  You can also use it to diagnose conductive or sensorineural hearing loss.  The procedure is to play the song on the tuning forks, and if the patient remains in the room, they probably have conductive or sensorineural hearing loss.

The sixth and final station was the aforementioned jamming of steel prongs up each other's noses.  There's no real skill to this - when I was a kid I jammed my Older Brother's whole coin collection up my nose. In fact, it is so easy that they force you to hold the prongs in your left hand in this bizarre way that really hurts your fingers.  Thus, they can spend years training you to do it and also charge people lots of money.  Plus I think if you pull any money out of someone else's nose it's yours to keep.

So that was my Friday at uni learning to be a doctor.  I'm pretty sure that 5 days a week of this for four years straight is going to make me an awesome doctor.  Or a raving madman.  Either way, I'll be able to wear some pretty colourful socks, and isn't that why we're all here?

Sell me more crap

A while ago I posted something about the strange Facebook ad with the neo-Nazi guy trying to get me excited about my abs.  Ever since then I've been paying more attention to the ads that turn up on Facebook, especially since someone told me that they are generated by big databases that analyze my browsing habits.  If so, I'm a bit concerned, because I've been getting some pretty wacky ads.

The other day I got a "Rate This Hottie" ad, featuring bizarre photoshopped pictures of pneumatic blondes.  Simultaneously, I was urged to join a gay mens social networking site.

Today, the ads seem a little more relevant.  I've got some kind of snoring remedy (snoring: check!) as well as some kind of unspecified method of male hair removal (hairy: check!) and fluffy toys made to look like infectious agents (med geek: check!).  Oh, and an ad for me to advertise on Facebook.  Maybe I should make up some up some stupid product like a special piggy-bank-smashing hammer or something and direct the links to my blog.

I reckon if I ever won the lottery I would institite a policy of buying everything that was advertised to me on the internet.  Some of it is truly bizarre, but it would be a lot of fun opening those boxes when they arrived! 

Two humorous stories about death

When we stroll down to the local hotel that makes good coffee we like to sit out the front overlooking the sea.  It's very sea-nic - haha, just a small joke there to get us all warmed up. 

The hotel actually overlooks the greens of the town bowling club which are right next to the sea.  The thing that struck me recently is that the companies that have chosen to put up advertisements on the low brick walls enclosing the greens seem to have a very definite target market in mind - old people.  And fair enough too, since the vast majority of the people I see bowling there would be of retirement age or older.  But the strange thing is that the ads almost seem to have been placed in chronological order along the wall so that they tell a little retirement story.

First comes the ad for the real estate agent.  (Buy a holiday home!)  Next comes the ad for the removal company.  (Move down here for good!)  Finally there is the ad for the funeral home.  (Drop dead on the bowling green!)  It all seems a bit blunt for my liking.

Speaking of funeral homes, it was drawn to my attention recently that in a lot of small towns the ambulance service is run by volunteers, and apparently in one town nearby the ambulance volunteer is the guy who runs the funeral home.  While I think there are obvious efficiencies to be gained by this arrangement, I do find the clear conflict of interest a bit unnerving.  What if he got tempted to convert some of his volunteer ambulance clients into paying funeral clients?  All it would take is a bit of dawdling on the way to hospital.

I'm not pointing the finger, you understand.  I'm just saying it's kind of strange.  I'd rather have an ambulance driver who had some kind of vested interest in me staying alive, like a barber or something.

Life is hard, like a diamond

The universe conspired to make me late to uni today.  Here's what it did:

• One o'clock (pm) start.  The freeway closes at 12.30 pm.  It was always going to be tight.
  
• In the car I was listening to the triple CD All Time Greatest Hits Of The 30's (which isn't really "All Time" now is it?) with hits such as "On The Good Ship Lollipop" with Shirley Temple, "Swing Low Sweet Chariot" with Paul Robeson, "Night and Day" with Fred Astaire, and I could go on for 57 more tracks because songs were short back then, but the point of it is that I realized after a while that I was driving at 80 instead of 100 because those classic toe-tappers made me think I was old.
• Hitting every single traffic light in Morphett Vale, which is a lovely place to whizz past on the freeway but not so fun to negotiate at lunch time when all the bogans are trying to get their utes to McDonalds.
  
• Those other (non-medical) uni students are back and had taken all the spots in our car-park so I had to trudge an extra 200 metres or so.
• And I know you're going to tell me that I should have just left home earlier, and so to you I present the final fact of my case that the universe conspired against me: my watch stopped.
  

Okay, my whinge is over.  Back to work, people.  This ice-cream isn't going to lick itself!

P-plater

As a means of promoting my blog (Prone To Reverie - you're reading it right now) I have been wearing a little orange badge with a "P" on it.  Next year, I will switch it for a badge with an "R" on it.  And so on. Some time around 2022 I'm expecting a big spike in my page hits when people figure it out.

Sitting in class today, I was stitching up a pig's trotter for what seems like the millionth time this year when the instructor came over and said to me, "In what sense are you a P-plater?" (explanatory note: drivers on their provisional license, ie: the one after your learner's permit but not a full open license, have to display a large red "P" on their car.  Hence: "P-plater")

I had no idea what she was talking about, of course, since I am notoriously obtuse, so I said, "whaaa?", and she gestured at my badge and I was going to be funny by saying, "I'm a big fan of P-ness" but then realized that it really wasn't appropriate so I just went, "aaaahmm.." and she got bored and wandered off, leaving me wishing I had thought of a less rude joke but also wondering what she meant when she asked me that in the first place.  Here's some of the possibilities I thought of:

• She was insulting me for being an old fossil by implying that I am so old that there's no way I could be on my P-plates.
• She was complimenting me on being so fair and youthful like a budding flower by implying that I must still be on my learner's.
  
• She was complimenting my suturing skills by implying that it was so great that I must be on my full license by now.
• She was insulting my suturing skills by implying that it was so crap that I must still be on my learner's permit.

See the general problem?  Because P-plates have something worse and something better, I wasn't sure what she was really getting at.  This is the great danger of bantering with someone using the median case.  You should always pick an extreme point of view so that people understand what the hell you're talking about.

Unless I missed the point entirely.  Which is always on the cards, frankly, since I daydream a fair bit.