Greeting from the land of Eng

Spending 30 hours on a plane is not much fun.  But at least we didn't have some kind of medical crisis en route, unlike the poor old biddy somewhere up in premium economy who did.  The announcement came over the PA system: "If there is a passenger on board who speaks Polish, please alert a flight attendant as we require your assistance.  Also, could any medical practitioners please contact an attendant."

My Smaller Half and I both immediately thought, oh please let there be a doctor on board, because I really don't want to be involved.  I'd be pretty confident if the patient just needed a prescription renewed, but something told me it might have been more complicated than that.  Even worse, I don't know much Polish.  I used to buy Polish pickled cucumbers - Polski Ogorki it said on the label - but even then I don't know if that's the brand or the Polish word for pickles.  And it seems unlikely that the person requiring medical attention on the plane was having an acute pickle attack.

Fortunately, the person sitting in front of me turned out to be a Polish-speaking doctor, thus killing two birds with one stone.  I've never seen such relieved-looking flight attendants.  The patient seemed to do okay because the doctors didn't look too stressed afterwards, plus they got upgraded to business class for their troubles.

Maybe this doctoring caper is worthwhile after all!

Vignettes

Medical education relies fairly heavily on the vignette - a short summary of the relevant information from which the budding doctor is supposed to be able to draw their conclusions.  Here's an example from the book I have open in front of me right now:

"A 40-year-old woman presents complaining of difficulty with swallowing.  Examination shows she has nasal speech, weakness of facial and neck muscles, receding hairline and a weak and slow hand grip."  

On reading this vignette, I conclude that I should probably study harder.

(Interestingly, the word "vignette" means "little vine", and comes from the curly vines used to border illustrations in books.  It eventually came to refer to the pictures themselves and the idea of the vignette as a small portrait was carried over into the literary meaning.)

Anyway, we had a doctor giving us a tutorial recently who was presenting a series of short cases like this, but she was referring to them as "vinaigrettes".  Naturally enough, me and my Esteemed Colleagues were trying not to smirk every time she did this, since we all get words wrong from time to time.  But maybe she was doing it on purpose.  It's the kind of thing I would do to amuse myself - deliberately mispronunciating words to make people wonder.  Even worse, perhaps she was deliberately insulting us, implying that rather than giving vignettes to students she was giving vinaigrette to vegetables. 

(I'm sorely tempted to go off on a rampage of vegetable puns but I'll restrain myself.  Maybe some will turnip in the comments section though.)

Mind tricks

Sometimes you just happen to know a piece of seemingly arbitrary information, even though you might know not much else in the same field which is useful at all.  When that happens to me, as it did today, there's usually a strange reason that I remembered the fact.

There is a certain sci-fi movie which was popular back in the 70's called Star Wars.  In it there is a scene on the Death Star where Senator Leia Organa is being interrogated by Grand Moff Tarkin to reveal the location of the hidden rebel base.  He threatens to use the Death Star to destroy her home planet of Alderaan unless she complies.  She (falsely) reveals that the base is on the planet Dantooine, at which point Tarkin proceeds to order the destruction of Alderaan anyway in order to make an effective demonstration of the power of the Death Star.

Why is this relevant?  Because today I was able to pipe up in a tute and remind the presenting doctor, who was having a mind blank, that anaesthetic induced malignant hyperthermia should be treated with dantrolene.  Can you see where I'm going with this?  Dantooine = dantrolene.  Destruction of a planet using giant lasers = malignant hyperthermia.  I can still remember standing in the operating theatre when I first heard about dantrolene and that's exactly what I thought of.

Oh yes, my friends, that's how you scale the dizzy heights of success.

Count down

T-3 days and counting.  I can't wait to get out.

I've reached the point where, when I'm at the clinic, I'm watching the clock.  At 9.30 I'm thinking that it's only an hour until 10.30 at which point it'll be halfway to lunchtime, at which point the day will be half over, and when it's over I can go home.  And when I go home I get to talk to my Smaller Half, light the fire, roast chestnuts, make potato soup, go the gym, read a good book, and do all those things that I'd prefer to do pretty much anytime rather than think about medicine.  Sadly, I've reached the point where I'm feeling demoralized and disinterested.

The strange thing is that I'm still enjoying my sessions with specialists.  Even though sometimes they are quite rude to me, the thing that's different about the specialists is that they seem to have some appreciation that it's unrealistic to expect to know how to do their job so they bother to explain things to me and are generous with their time.  The GPs that I spend most of my days with, however, seem to be constantly astonished at my ignorance.  The other day I asked one of them a question and his answer was, "How long have you been here?" - his point being, presumably, that I must be a dumb lazy piece of shit or else I wouldn't have to ask that question.

The three weeks of holiday that I have coming up will be a godsend.  With a bit of luck, by the time they are over I'll be so panicked about the exams in November that I won't have time to feel all precious and fragile about jerks being rude to me.  Fingers crossed!

Nokia's ark

Have you ever noticed that the predictive text dictionary on your phone is missing words?  I think it's fair enough that they might leave out swear words or racial slurs.  Such things might, somehow, at some point in the far future (or else in America) cause some kind of PR disaster.

But my phone doesn't have the word "penguin" in it.  It hasn't inconvenienced me too badly so far - in fact I only discovered the shortcoming today after owning my phone for 3 years.  But why has this word been left out?  Perhaps it is actually a racial slur or swear word that I am not aware of.  "What the penguin do you think you're doing?"

A quick bit of experimenting reveals that "hippopotamus" is another word that is missing.  It also doesn't know "giraffe", and takes a guess that perhaps I mean "iircede".  Good guess Mr Phone-guy, but no.  On the other hand, "rhinoceros" is in there, as is "leopard", "tiger", "lion", "hyena", but not "cheetah", "zebu", "oryx", or "alpaca".  "Koala" and "kangaroo" are in but "echidna" and "wallaby" are out.

I really can't imagine what the defining criteria might be for whether an animal name is in or out.  Surely they didn't just get a room full of Nokia engineers to quickly jot down the names of all the animals they could think of.  Surely.

A bit of humour

I'm incredibly superstitious.  For example, this morning as I left the house I saw, lying on the ground, a broken drill bit.  That never augurs well.

Quoted for truth

Some entertaining statements made today:

"If you're going to be the sort of doctor who only treats people who don't harm themselves, you won't have much work to do." - Esteemed Doctor

"Unless you really need to you shouldn't be sticking your finger up someone's bum and that applies in a lot of situations." - Esteemed Doctor

"I don't know what 'flatulence' really means." - Esteemed Doctor
"Come to my place tonight and you'll find out." - Esteemed Colleague

Romance

People often ask me why I decided to study medicine.  Was it to save lives?  To get rich?  Nay, I say.  It was because one day, I want to be on the cover of one these little pink books!

We found a big pile of these in a bric-a-brac shop down the coast.  These aren't just romance books, these are medical romance books!  Woo-woo!  I decided that I needed to snap a couple of pictures because I noticed certain themes developing.  In the picture above you can see that all of the doctors are Spanish.  "The Spanish Consultant's Baby", "The Spanish Doctor", and "Spanish Doctor, Pregnant Midwife".  Spicy sauce indeed.  You can tell just how hot these books are by the fact that the box they are kept in says, "STORE BELOW -18 DEGREES".  Check the picture if you don't believe me.

Here's another lot with a slightly different theme:

"Greek Doctor, One Magical Christmas", "The Greek Doctor's New-Year Baby", "The Greek Doctor's Proposal".  Apart from the slightly sleazy subtext in the sequencing of the titles, I find this kind of thing really encouraging.  First the Spanish, then the Greeks.  If they keep moving east, eventually they'll hit Australia.  And that's where I come in.

By then I should be a doctor and eminently qualified to appear on the cover of a romance novel.  And I've already come up with some good titles.  How about this: "Aussie Doctor - A Beaut Root In A Ute"?  Or "The Aussie Doctor and the Outback Coxsackie Outbreak"?

Man I am going to be famous.

Tender

The word tender weirds me out a bit.  It has a bunch of different meanings, none of which seem to have much to do with each other, yet there's a certain subcurrent of association running beneath the surface that is barely detectable.  It makes me uneasy.

When I first started studying medicine I was surprised at how often we were taught to check if patients had tenderness in the area we were examining.  To me, tenderness is something that a delicious steak has.  Even onions are often recommended to be cooked until tender.  Conflating patients with food is odd, yet it comes up surprisingly often, especially in pathology.  Fortunately I have yet to see doctors advised to check to see if an inserted skewer come out clean.

So what is the tenderness that patients feel anyway?  Is it the same tenderness that a mother feels towards her baby?  No, it's a feeling a pain.  But not pain, really.  It's a feeling of having to be ginger (whoops, there's the food again) with a part of your body.  It's not necessarily even discomfort.  It's more of a feeling of being well-used, an excessive awareness of your own self.

But the tender feelings we have towards (say) a little baby seal are almost the reverse of this.  It's the feeling of wanting to protect and nurture, as if the little baby seal itself was feeling a bit tender.  Join the club, I say.

Then there are the tenders that you put in to win a contract - it's as if you're doing it slightly reluctantly because it might hurt.  Oooh, preparing this bid has made me a bit tender.  And the little boats that race around carrying people to and from ocean liners.  Those are tenders but they aren't very tender.  Nor do ocean liners line the ocean for that matter.  The whole area of nautical jargon is opaque to me actually.  I think I'd understand life better if I knew more about lee winds and sheepshanks.  But that's a topic for another time.

Woo!  Just went to look at the most excellent online etymological dictionary and found a whole bunch of stuff about the word "tender", including that the word "bowels" derives from a word meaning "sausages".  Go educate yourselves and report back with any questions or handy hits about cheese selection.

Another idea

If someone is cutting up baby bocconcini (for example, to put in a pasta or a salad), it's fun to stand behind them making tiny little screaming noises.

PTR asks the hard questions about sandwiches

You know when you get little triangular sandwiches on a big platter for lunch - the ones that are made with several brightly coloured yet strangely bland fillings in each one - and they are propped up on their little crusts so the points stick up in the air like upside-down bunting - have you ever noticed that they look more like drawings of sandwiches than they look like the actual sandwiches that they are?

I have.

At some point I must learn some medicine

[WARNING - THIS POST CONTAINS VIOLENCE, PROFANITY AND ... ADULT THEMES]

A doctor I was consulting with said to me, "You have to be an idiot savant to do medicine.  You can't be too bright."  I think he was trying to make me feel better about myself because I forgot to wear a belt today so my pants kept falling down.  However, he obviously also didn't think much of my memory because he then said, "Don't write that down."  Okay.

Later on, in a splendid demonstration of his own lack of savant powers, he forgot his Medicare prescriber number, which he has probably written down about a million times by now.  When he found it he said it didn't even look familiar.  So we got into a weird conversation about jamais vu, which I only know about because I read Catch-22 when I was younger but have become intimately familiar with in the last two and a half years.  It's a close cousin of déjà vu, which is French for "A big black bear" and also presque vu, which is not.  Anyway, me knowing about the vus seemed to impress him.  I think I'll stick with using literature rather than medicine to impress people, it seems like less work.

He swore a lot.  He said to me, "There's a lot of bad shit around in medicine.  Your colleagues will be so fucking lazy or inept or greedy that they'll diagnose disease that doesn't even fucking exist just so they can treat them and get paid."  His contempt wasn't reserved for doctors though.  He was talking about a patient who'd been to see a chiropractor and had been told that her brain pan was malaligned and needed manipulation, "and all that fucking bullshit crap."

I admire someone who can string three cusses together with a straight face.  It's really inspirational.  I think mastering that will help me a lot in my viva exam at the end of this fucking bullshit arse of a year.

A book for idiots

In a store I recently saw the book "Ideas For Writing In Blank Greeting Cards".  At first I was excited!  What a great idea for a book!  I opened up to the contents page, wondering what kind of awkward and esoteric situations might be listed?  Perhaps there would be a page of suggestions for what to write in a card that you are sending to a friend because their priest was sent to jail.  Or perhaps some ideas for what to say to your ex who finally broke up with that putz she was with for years so you might be a real chance again now.  Or what to write in a condolences card for a unpleasant workmate who is heartbroken over her Shetland pony that has just developed diabetes.

Sadly, I was disappointed.  The contents page listed events such as birthdays, anniversaries, funerals, admission to college, graduation from college, and so forth.  Honestly, if you can't come up with something to write for events like this you need a punch in the head.  Yeah yeah, I know that some cards are hard to write - condolence cards for example.  But everybody knows this.  No-one is expecting Beowulf.  You just need to turn up.

But even though the events themselves were pretty run of the mill, I was expecting some entertaining suggestions or at least something mildly original.  But this is the kind of stuff the whole book is filled with: "Congratulations!  May you know many more years of wedded bliss."  Gosh!  I could never have thought of that!

There's nothing intrinsically wrong here, but why do you need to buy a book to get these suggestions?  Why not just buy a blank card, then saunter over to the Wedding Anniversary section of the shop and browse what's written in those cards for ideas?  What I find bizarre, almost scary, is the way the ideas are written using hints such as "I/we" and "(No.) years together" just to make sure that the idiot using it knows that they may have to actually insert some relevant detail, rather than trusting them to both figure it out themselves.

Furthermore, how can it possibly have taken three people to write this book???  The world really may be more full of morons than I currently suspect it to be.

On the other hand, here's a sign on the side of a bed & breakfast that I saw around the same time.  "Vue de Merde".  It restored my faith in humanity just enough to get me through the day.

Operating theatre

Being assigned to shadow a surgeon when they operate is very exciting, in much the same manner as falling off your bike is exciting.  There's a brief moment when you think you're flying, then you smash face-first into the ground and get gravel in your hands.

In my experience, surgeons will ask a few anatomy questions in order to demonstrate how stupid you are and then you get to talk to the anaesthetist for the rest of the time.  This morning though, the surgeon was a chatty guy who proceeded to talk to me the whole time.  Sure he was mostly asking me question in order to make me look stupid but as it turns out I had pretty good answers to some of them.

He asked  me:

• Where is the dorsalis pedis pulse?
• Where is the posterior tibial pulse? ("posterior to the tibia" is not the answer he wanted)
• Why do we operate on varicose veins?
• What is a varicose vein?
• What is an ulcer?
• What is inflammation?
• What is a cat? (Yes, he asked me to define a cat.  He was making a point about how difficult it is to define common things that you know well.)
• What is a car?
• What's the capital of Slovakia?
• What's the capital of the Czech Republic?
• What's the capital of Rumania, Bulgaria, Scotland, Holland, Belgium, Denmark, Norway, Sweden, Finland, Brazil, Paraguay, Uruguay, New Zealand, Canada?

I did pretty well with my capitals - he called me a "Man Of The World".  That gave me enough confidence to dispute his claim that New York City is not in the state of New York, which led to him not wanting to play the capitals game any more.  I also did pretty well with my medical definitions, which he fiendishly countered by telling me that my answers were very clever but he thought they were probably clever by accident rather than by design, which strikes me as being unfair.  I didn't do very well with my definition of a cat but that actually made him happy since it suited his rhetorical purpose.

I didn't know that the main reason to operate on varicose veins was as prophylaxis for venous ulcers (which is why we got into the whole ulcer discussion).  I told him that the main reason was cosmetic, which led to him spending the rest of the morning asking if I thought the elderly fellow on the operating table was going to win any beauty pageants, so I said that the elderly fellow should take kindly the counsel of the years, gracefully surrendering the things of youth.

Exit stage left.

Tomorrow is another day

Today was futile.  Today I:

• drove 95 km and got there late,
• contributed nothing to a report back on a PBL that I hadn't looked at yet,
• started a new PBL that might have been interesting if I had bothered to turn on my brain,
• was unable to hook up to a video conference about asthma, so it got junked,
• ate a giant bowl of chips for lunch simply because they were called "Beer Battered Bad Boys" on the menu which I thought was funny enough to be worth sacrificing my arteries to,
• was unable to hook up to another video conference about the end of year exams, so it got junked, then
• drove 95 km home again.

Fortunately I was able to come home and resolve my own personal credit crisis by agreeing to give them all of my money.  They're nice like that.

Casus belli

Today was the final straw.  This means war.  Not since the heady days of the great War On Innumeracy have I been this incensed.  I am outraged.  I am appalled.  The only way this can be stopped is by direct confrontation.  I am put a name to my pain, and the name is me.  I am declaring war on myself.

I have finally noticed a pattern to the ongoing tribulations that I suffer.  In almost every instance, when I really sit down and trace back through the pattern of cause and effect (or is that effect and cause???), I find that the person that I hold most responsible for these incidents is not the Third Man, but the First Person: I.

For example, today my GP supervisor sin-binned me, getting me to do nothing but take blood pressures all day, stunning me into a stupefied state of slobbering sleepiness.  But why did he do it?  Because first thing this morning I completely screwed up presenting a patient to him, making such a hash of it that he clearly thought I was an idiot.  I'd asked the patient all the right questions, I'd even done a decent physical on him, and I know perfectly well how to present a patient.  But I had Monday-brain, which is closely related to monkey-brain, which is itself closely related to donkey-brain, and hence I was unable to think straight and stuffed it up reeeeeal good.  Black eyes: 1.  Feathers in my cap: nil.

Another example: the duty nurse came to get me because she'd been having some trouble getting a blood sample out of someone and in a bout of supreme optimism, thought it would be better to try me next rather than the doctor.  Nevertheless, I sized up the situation, identified a likely vein, then ... ah, but then!  Then, I chickened out.  I decided that the vein looked a bit small.  A bit of a funny angle.  I felt sorry for the patient.  Her skin was a bit fragile and she was a bit lumpy so it could get ugly.  So I chickened out.  I went to get the doctor.  He dug around brutally with the needle, as doctors do, and ended up getting blood from "my" vein.  Black eyes: 2.  Feathers in my cap: nil.

And that's not to mention the pile of unopened mail strewn across my desk.  I've lost my old passion for opening the mail ever since people stopped giving me money and started asking for it instead.  Problem is, if you don't give it to them when they ask the first time, they want more the next time they ask.  Especially the cops.  Does that make me open my mail?  No, it does not, because I am an idiot.  Black eyes: 3.  Feathers in my cap: nil. 

In addition, this morning I did a load of washing, hung it out to catch some rays, then took off to the clinic.  Came home, went to get the washing - gazooks!  Someone has stolen all off our clothes off the line!  Or perhaps ... yes, perhaps I was an idiot.  Yes indeed, a quick check in the washing machine reveals that the clothes are still mashed up soaking wet inside.  I forgot to hang them out even though I planned doing it so carefully that I actually tricked myself into thinking that I had done so.  Black eyes: 4.  Feathers: nil.

And on it goes.

Let me tell you, I'm sick and tired of being treated like this.  I won't take it any more.  I may be able to get away with treating other people like dirt, but I certainly won't put up with it myself.  From now on, I'm getting no second chances.  Every time I try to do this to myself, BLAM!  Alpha strike!  Shock and awe, baby.  I won't know what's hit me.  I think initially I'll get pretty angry at myself for finally standing up to me, but in time I hope that I'll recognize that I have rights too, and that I can't get away with treating myself like this.  It's no good for either of me.

Agony Aunt 3

Dear PTR,

I'm in agony!  My head hurts, my back aches, my toes and fingers feel like they are burning up!  What can I do?
(signed)
Idealistic in Adelaide

Dear Idealistic in Adelaide,

Take two aspirin and call me in the morning.

Sincerely,
PTR

Be alarmed, not alert

We got back from celebrating Willie Nelson's birthday around midnight.  There was an alarm going off somewhere down the road.  I went to investigate.

Ever since an aboriginal woman had a stroke at a bus-stop in Brisbane a few years ago and had to lie there paralyzed for hours and hours because everyone assumed she was "just" drunk, I've been applying the "How Would You Feel If You Needed Help And Nobody Helped You" test to situations like this, where you might prefer to walk away but you know that if you're wrong you're going to look like an arsehole.  So I did.

After promising my Smaller Half that I wouldn't attempt to do anything heroic, I wandered off into the night.  It didn't take long to establish that the alarm was going off in the house just up the road.  It was all blacked out and I didn't want to go creeping around the yard and peering in windows, because one of my close relatives once ran into his yard in the middle of the night brandishing a katana because he thought there were prowlers in the yard, and there's got to be more than one lunatic like him around so why take the chance?

So I came home and called the local constabulary.  The conversation went like this:

Policeman
[Yawns] Yes?

PTR
Good evening, my good man.  Or perhaps I should say, good morning!  It is past the witching hour after all.

Policeman
[Sighs]  How can I help you?

PTR
In my capacity as a concerned citizen, I'd like to place a report of an untended alarm sounding in the borough.

Policeman
Has the house been broken into?

PTR
I don't know, I didn't want to get chopped in the neck with a katana.

Policeman
We don't attend security alarms.  We leave that to the security companies.

PTR
What if it's a smoke alarm?

Policeman
Well, keep your nostrils open and call us if anything happens.  Thanks for your call.

Okay, so I took a bit of poetic license with my lines, but I swear that's what he said back to me.  He didn't even ask me for my name or an address.  What if there's an inquest?  What if I do end up doing something heroic, like saving a dog or a parrot, and I sign a movie deal with novelization rights to follow, but I need to establish that I did actually call for help and I wasn't just holding out for a movie deal the whole time?   I want this on the record!