Monday, November 30, 2009

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.

Friday, November 27, 2009

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!

Tuesday, November 24, 2009

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.

Sunday, November 22, 2009

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.

Saturday, November 21, 2009

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:

Hot outside?

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.


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.


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

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".

Friday, November 20, 2009

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.

Thursday, November 19, 2009


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 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.

Wednesday, November 18, 2009

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? 

Tuesday, November 17, 2009

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.

Monday, November 16, 2009

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.

Sunday, November 15, 2009

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.

Friday, November 13, 2009

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.

Wednesday, November 11, 2009

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?

Tuesday, November 10, 2009

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.

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?

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.]

Maybe he works in a paracetamol factory?

Go and stand in the corner.

Monday, November 9, 2009


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.

Sunday, November 8, 2009

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."

Saturday, November 7, 2009


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.

Thursday, November 5, 2009

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...

Wednesday, November 4, 2009

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.

Tuesday, November 3, 2009

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.

Monday, November 2, 2009

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:

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

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,

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?

Sunday, November 1, 2009

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)