Wednesday, October 26, 2011

Eye opener

My new team starts at 7.30 a.m. which is slightly challenging for me, but no more so than, say, waxing my eyebrows.  It simply takes an effort of will to haul myself out of bed.

But from time to time my willpower fails me and I end up running just a smidgen late.  I was late this morning.  I stylishly swerved my car into the carpark and trotted towards the hospital entrance.  Glancing at my phone, I realized that I'd missed a call.

Oh no!  Perhaps it was my new registrar and she'd called me up to urge me to redouble my efforts to arrive on time.  Or perhaps to tell me that the notes I took yesterday were so good that I'd better take the day off as a reward.  Better check my voicemail.

My voicemail had a call from an mystery number - a man's gruff voice:
"When ya git outta the shower washin' that beautiful body of yours, wanna give me a ring?  Thanks darlin'."

Hmm.  I guess it wasn't my registrar after all.

Tuesday, October 25, 2011

Play it as it lies

The most useful thing I learned in my recent six week stint with the psychiatrists is that psychiatrists are doctors too.  Here's the evidence:
  1. They know all about "Code Brown".
  2. They get really annoyed at inappropriate referrals, such as the person with confusion due to an infection that the ED docs think is bonkers and should get detained and given anti-psychotic medication rather than something more appropriate such as, say, antibiotics.
  3. Their handwriting is illegible.
With regard to point 3, although it's illegible, it does have the benefit of being voluminous.  They write so much that often you are able to get the general vibe of their notes even though the actual words are gibberish.

In contrast, the surgical team I've just joined, while they also have unintelligible writing, don't seem to be able to use sentences in their notes.  To be fair, this is probably because they are scribbling madly, desperately trying to catch up with the surgeon, who conducts the round so fast that windows are shattered by the sonic boom.

It's pretty intimidating getting thrown into the midst of this as a student because it means that anything in the notes is thruply confusing.  Not only is the handwriting terrible, the actual text is just bizarre abbreviations of things that you wouldn't understand even if it was actually written out in full.  On the round this doesn't matter so much because as a student my main tasks seem to be to hold the tongue depressors in case anybody wants to do some Playschool craft projects and to not get trampled underfoot by the aforementioned rampaging surgeon.

Clinics though - clinics are a different story.  Today I was given the job of taking notes, which is fine (in fact, the surgeon told me I was a "born note taker", which may actually be an insult, but anyway) except it means that I'm holding the notes and hence also have the job of flipping around in the previous notes and trying to answer questions about the previous appointments.

The surgeon would turn to me and ask something like, "What was the original plan when Mr Smith first presented last year?".  I'd find the page and see that it would seem to say something like, "P) OPO f/u A/S2 w C+R".  Now if you're roolly smart like me you can mentally adjust for the scrawlings and say, "Outpatient followup up in 1 month with a chest x-ray".  Which is fine. 

But the next line says, "2. FFfFt + ananas - ref/ chok", and what do you do with that?

I can't figure out what it means, nor even what it might mean.  The nihilistic part of me wants to throw caution to the wind by saying, "Klaatu barada nikto", just to see what happens.  However, that is not how you establish credibility on day 2 of a new clinical placement.  It's more suitable for a morning tea in week 5 when everyone already knows you're a bit of a nut.  So I simply say, "It looks like the plan was for fffffft, ananas and ref chok."

The surgeon pauses and stares at me long enough for my heart to skip two beats.  "Hmm, fair enough.  It wouldn't be my approach but I'm pretty conservative", he says, and carries on.

Saturday, October 22, 2011

I've got your deposit right here

My Smaller Half and I want to buy a house.  But we've hit a snag - we have no money.

Apparently a few years ago there was a big stink-up because some chumps in the USA borrowed more money than they could ever afford to pay back, plunging the world into a screaming spiral of horror and causing a number of billionaire sociopaths on Wall St to temporarily lose their jobs.  As a result, Australia's pinko government rammed laws through parliament infringing my democratic right to borrow more money than I could ever afford to pay back, thus grossly offending my inflated sense of entitlement.  This country is stuffed!

After ringing 4 banks and 3 other non-banks (by which I mean non-bank financial institutions rather than other non-banks such as ice-cream vans or Belgian pederasts) I resigned myself to having to live in penury for another 3 months until those juicy payslips giving me substantially less than I used to earn in my old job start rolling in.  But then I got put onto a mortgage broker in town who turns out to have all sorts of tricky tricks up his sleeve, so maybe we're still in with a chance.  Actually it's not so much that he has tricky tricks, it's more that he seems to motivated by wanting to succeed, whereas the loan processors at the banks and non-banks seem to be motivated mostly by malice and spite.

We had a two hour meeting with him on Friday where he sussed us out and did some brainstorming of possible ways around the road blocks.  It was really interesting to watch a professional from another field work.  It reminded me of nothing so much as a good doctor taking a really thorough medical history.

For example, it's important to know what medications people are on (for both doctors and banks, but I'm talking about doctors now).  So you ask them, and they tell you.  And then you typically ask them about a whole bunch of medications that most people don't think of as medications, like the contraceptive pill, asthma inhalers, anti-inflammatories and other analgesics, insulin, and so on.  It's easy to start thinking that people are pretty dumb for not telling you this the first time.

But lo, yesterday the shoe was upon the other foot.  He asked me if I had any debt.  No, I said, quite proud of myself.  Any credit cards?  Oh, yes, sure.  Any HECS debt?  Oh, yes, that too.  Oops.

And, just like a doctor, sometimes he used words and jargon that I didn't understand.  It's incredible how many times I've seen doctors walk up to a patient, dump a mouthful of polysyllabic Graeco-Latin blah-blah on them, then consider the job done.  It's excruciating to witness, and now I know how difficult it is to get it to stop when it's done to you.

It's really hard to ask questions about what something means when you can't remember what the thing was even called.  I'm sure he was horrified when I got my Third Party Mandated Lending Policy Exception mixed up with my Conditional Approval Pending Party People Mandate.  Or something.  It'd be like confusing your cardiorenal syndrome with your velocardiofacial syndrome.

I reacted by just calling the different things "The First Thing" and "The Second Thing" and so on.  I must try that on Monday morning when I turn up to my first surgical ward round of the year.  I'm sure it'll be looked upon kindly.

Thursday, October 20, 2011

Praise me

I was feeling generous and expansive, so I was talking up my Esteemed Colleague who is going to be replacing me after tomorrow in this unit.  The registrar obviously found me unconvincing in my universally positive comments, so he asked me if there was anything bad about him. 

"Why yes," I said, "He compulsively makes inappropriate jokes."

"Oh," said the registrar, "He sounds just like you."

Tuesday, October 18, 2011


So once the mRNA is produced, what happens then?

I have the word "ribosome" in my head.  But maybe that's just something in my breakfast cereal.

As it turns out, ribosome was the word I was after.  The other word that I was afraid I was confusing it with was "riboflavin", a.k.a. vitamin B2, which is essential to life because it makes your pee yellow.  All those nutri-grain ads on the idiot box when I was a kid nearly derailed my medical career.

My vulnerability to the all-pervasive cereal advertising industry in lieu of any kind of actual medical training is regrettable.  But still, I can walk the walk and talk the chalk or something like that when I have to.  Check out this picture from a talk I gave earlier this year on tuberous sclerosis:

It's complex but I think it captures the essence of what I was trying to say, which is that I had no freakin' idea of what is really going on but it's probably too complex to matter in an informal talk.

Friday, October 14, 2011

Not really

Checkout Person
That'll be $87.76

Smaller Half
The register only says $28.76

Checkout Person
Oh, you know what I mean.

Thursday, October 13, 2011

I wasn't aware until now that I was an apologist for sexual predators

There is a well-known case here in this city of a psychiatrist who had sexual relations with no fewer than five of his patients.

That's terrible.

No, it's not.


It's unacceptable.

Wednesday, October 12, 2011

Extreme child care

Most mornings, I drop the Hatching at child care then come in here to the hospital.  Yesterday morning, it was the child care workers who dropped the Hatchling - literally. 

I got a phone call around 10am, it was the child care boss.  My first thought was that she was ringing me up to rouse on me for not paying our bills.  This is a splendid example of a conditioned stimulus.  The first thing she said to me though was, "The Hatchling is fine.  There's been a bit of an incident."  Good first line - I guess lots of parents would assume that disaster had struck as soon as the child care centre calls them at work, so it's sensible to defuse things immediately.

But "an incident"?  That's too vague.  I suppose she said it was "a bit of an incident" so I wasn't thinking of sieges and hostage-taking so much as perhaps she's had her finger bitten or something.

Anyway, it turns out that two other kids mugged one of the child care workers while she holding the Hatchling, with the result that the Hatchling plummeted earthwards.  Fortunately she landed on the child care worker so there wasn't much of an impact.  Nevertheless I scurried up the hill to go give the Hatchling a cuddle.

As soon as I walked in the door the poor woman who'd dropped her burst into tears and started begging for forgiveness.  "YOU BITCH, I'LL SEE YOU IN COURT, YOU'LL NEVER WORK IN THIS TOWN AGAIN!", I screamed, spittle flying from my lips.  No wait, that was the feedback I gave my supervisor a few rotations back.  What I actually said yesterday was, "It's okay, she's not hurt, accidents happen, you must have got a real scare but it's all okay now."  That made her cry even more. 

Once the staff realized that I wasn't going to burn the place down in righteous fury they all got kind of manic with relief.  They launched into a detailed account of how it happened, where it happened, who was standing where, what similar incidents had occurred in the past, re-enacting how people had rolled around on the floor in desperation trying to catch the babies that were raining from the ceiling, and generally creating a ruckus.  It was quite a scene so I beat a hasty retreat, shouting reassuring words to them as I went.

I reckon they probably have a policy that if anything bad happens to any of the kids, they call the dad first.  Dad turns up, nobody is missing any limbs, so he jiggles the kid a bit and takes off again.  Saves time for everyone.