The moment of revelation

Which reminds me, there was a period of a few months in the late eighties when I actually believed there were two bands, one called "In Excess" and another called "Inxes" (rhymes with "lynxes"). For some reason I never twigged to the fact that I only ever heard about In Excess and I only ever read about Inxes. Until one day I was on a plane listening to the pop music channel (8 separate channels!) through those old rubber-tube stethoscope-style earphones (aaah, no wonder I became a doctor) while perusing the playlist in the back of the in-flight magazine, and I realised that I was listening to INXS. 

Game over, man, game over!

PTR

What spell do you think I would cast on you if I was a fairy?

Hatchling

I don't know, what?

PTR

I would cast a spell to make you BEAUTIFUL.

And a spell to make you CLEVER.

And a spell to make you FUNNY.

And a spell to make you PLAY A MUSICAL INSTRUMENT.

And a spell to make you KIND.

And a spell to make you LEARN ANOTHER LANGUAGE.

And a spell to make you STRONG.

But if I could only cast one spell on you, I would cast a spell to make you HAPPY.

Hatchling

Thank you Dadda.

PTR

What spell would you cast on me if you were a fairy?

Hatchling

I would cast a spell - ALIEN!

PTR

What? Really?  Why would you do that?

Hatchling

Because all of the aliens are friendly.

PTR

Thank you sweetheart, that's very kind. 

The story about the happy Bony-Head

One day Bony-Head had a birthday.  Do you know how old he was?  He was one!  So invited all his Bony friends to the party.

He invited Bony-Fingers, and Bony-Elbows, and Bony-Chin, and Bony-Feet and Bony-Bottom.  They all came to his party and they brought Bony-presents for him, wrapped in pretty Bony-paper.  They played Bony-games, and sang Bony-songs, and ate Bony-cake.  They even got to take turns riding on the Bony-Pony.

It was the best birthday party ever.

Oh my god, it's full of wax

So the med student had been off to assess this 1 year old, who was fine, and I'd gone in afterwards to check him out.  All was ok, but the kid certainly did have waxy ears (the patient, not the student).  No biggie.  The main task is to dissuade the parents from trying to prise/scrape/plunge/burn the wax out in future.

And as usual, I got the med student to do the write-up which I then counter-signed.  But, as always, I like to read what I'm actually signing, and when I got to one particular sentence I did a double-take:
"Unable to visualize tympanic membrane due to excess ceruleum"

From the context, waxy ears, but what the hell is ceruleum?  I'm 99% certain he meant to write "cerumen".  So I show it to my colleague Dr Rmo, and we have a good old chuckle about it.  Then it occurs to us that ceruleum might be a real thing rather than a typo, so we google it.  And it turns out that:

"Ceruleum is an energy source in Final Fantasy XIV. Ceruleum is a refined form of Aether, obtained by draining elemental Crystals of their energy, usually in processing factories. It is a powerful yet highly unstable source of energy, mainly used by Garlean Empire to power Magitek engines."

At which point we basically pissed our pants laughing. 

But honestly, it's not the first time this kind of thing has happened.  I remember when I was an intern on nights, trying over and over to get a nasogastric tube down into an elderly lady with a bowel obstruction.  Eventually I sent her for a lateral neck x-ray and, sure enough, she had a retro-pharyngeal deposit of dilithium which was almost blocking her oesophagus.

Then there was the guy whose prostate was jam-packed full of unobtanium, preventing me from forcing a urinary catheter through.  I would tell you about the young woman and her vibranium but that might be sailing too close to the wind.  Suffice it to say that a day without an orifice filled with imaginary power sources is like a day without sunshine.

The story about the dinosaur, the Bony-Head, and the school-children

Once, the teacher at the school decided to take all the school-children out to dig up fossils.  They went out into the country and the teacher gave each of the school-children a little spade to dig with.  They started to dig, and soon they found a bone!  They kept on digging and they found another bone, and another bone, and lots more bones.

They took all of the bones, and they put them together into a Mr Bony-Head.  But the bones were actually dinosaur bones, not Bony-Head bones, so the Bony-Head they made was very very angry.  He stomped all around, stomp stomp STOMP, and was chasing the school-children, trying to eat them up.

So they took the Bony-Head apart again, and used the bones properly to make a dinosaur.  And the dinosaur was so happy that he had been put together properly that he was really really nice and friendly and made friends with all the school-children.  So they took him to the museum to live, and he really liked it there because of the other dinosaurs there.  And the school-children would come to visit him on weekends to play.

Guest post by The Hatchling

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Med students = softcocks

My latest shift in the ED was made more awesomer than usual by the presence of some med students.  Med students can be a mixed bunch.  I'm not very keen on the ones who are both diligent and knowledgeable, because they often ask me questions that I don't know the answers to, which requires me to respond by crushing them like helpless ants.  The ones who are neither diligent nor knowledgeable are also useless, because, well, they are useless.  You can't effectively delegate anything to them because they'll either stuff it up or wander off because they saw something shiny.

I suppose that in theory there could be med students who are not diligent, but are knowledgeable.  For a moment I was going to pretend that I was one, but that would be stretching the truth too far even for the interwebs.  Which leaves the diligent but not knowledgeable students.  Eeeeexcellent!

These are the guys you can send off to do stuff and they'll actually do a good job.  Usually better than I will do, actually, at least in the sense that it will be more thorough.  And as a special bonus, I often know how to answer their questions.  And if I don't, they can't detect my bullshit.  Or at least they aren't confident enough to call me on it, which is effectively the same as far as I'm concerned.

So it's great if you get the right students, because you get them to do all your work for you while you sit back on the couch eating bon-bons and sucking down all the Imperial Dust instant coffee you like.  It's prudent to go and actually check the facts for yourself at some stage, but you still save a bunch of time.  Presumably the students get something out of it as well.  I have vague memories of being a student and having nothing but respect and admiration for the junior doctors who exploited my labour so ruthlessly - yes, that's it, respect and admiration.  Made me the man I am today.  And I'm sure the respect and admiration flowed in both directions, as it most surely does still.

Having said that, a couple of the student were total softcocks.  One of them did a really good job of history taking and examination and writing up his notes, but I was shocked, SHOCKED, to discover later on that he had forgotten to list the patient's medications.  Instead there was a forlorn empty paragraph beginning (and ending) with "Meds:" - it took me at least a minute to enter the patient's four medications there.  Sheesh.  Next time I see him I'll crush him like an ant.  But not before I guilt trip him into buying me a coffee and giving me a footrub.

Another student was an even bigger softcock.  She found out from the nursing note that the patient has tested positive for parainfluenza by her GP, and then didn't want to see that patient in case she got sick because she had exams coming up.  In how long?  Six weeks.  Six.  Weeks.  If you don't recall, I actually gave birth to triplets DURING my med school exams while recovering from breaking the land speed record wearing sandpaper undies.  Honestly, if you're going to get frightened of parainfluenza, maybe you need to rethink being a doctor.  Or at least buy me a coffee and give me a footrub to make up for being such a softcock.

My day was lightened though, by the aforementioned patient. She said to me, "Parrot influenza? I don't have anything to do with birds!"

Gold.

It's from Belarus?

Elderly patients often ask to see my ID badge so they can get my name.  At first this made me a bit twitchy - were they preparing affadavits against me even as I was treating them?  But then a couple of patients sent thank you cards to me at the hospital afterwards, which was really nice.  Thanks for not fucking up.  So now I'm always happy to let them peruse my ID badge.  After all, maybe they'll send me chocolates, or offer to adopt me!

So the other day, an old chappie asked me how to pronounce my name, and as I leaned forward, he reached up his trembling hand to my badge.  But not my ID badge, which hangs at my waist - he reached for my swipe access card, which hangs around my neck.  It's just a white card with my position description on it: RMO, for Resident Medical Officer.  

And it suddenly occurred to me that my patient thought that my surname was Rmo.  How cool would that be, if you were Dr Rmo?  At least, it would be until you progressed higher up the food chain.  Unless you were like Major Major Major Major and thus destined to never be a colonel because the army didn't want to lose the only Major Major it had.

Darts

I was chatting recently with a colleague who has kids older than the Hatchling.  He said to me, "Does she like it when you play music on the radio?  Does she tap her feet or wiggle around?"  When I said that she did (don't all kids?), he said, "You know what you should get her into? Darts."

This left me reasonably flabbergasted.  In the hiatus left by my speechlessness, he filled me in with more detail: "The great thing about darts is that it really gives them something to carry with them as they get older.  It's great for their confidence, their posture, and they really love it.  Seeing them get so excited as they go off to their darts lessons, it's a real hoot."

I began to make two main points, in a Kevin Rudd kind of way, the first being that giving a three year old child access to darts seemed like a good way of not ever having to look after a four year old, and the second point being that I certainly would get the Hatchling involved in darts just as soon as she weighed 120 kilos and had a beard.  There were also other subsidiary points involved, in a Kevin Rudd kind of way, but then I realized that in fact I wasn't speaking at all but simply lost in my rich inner world, and my colleague was still talking to me.

He was saying, "My daughter started darts when she was three - she's still doing it now and she's twenty four.  It used to be ballet of course, and now it's more this hip-hop stuff, but she still loves it", and I realized that he wasn't saying "darts", he was saying "dance".

The reason I had mis-heard him is that I pronounce "dance" to rhyme with "pants", whereas most people in this neck of the woods pronounce "dance" more like "dahhhnce", like "dahhhling, would you like to dahhhnce?  No tea and scones for me, mater, I'm orf to play on my grahhhnd piahhhno."

Anyway, having figured that out, I'm glad I hadn't launched into my two-fold refutation of the wisdom of getting pre-schoolers playing darts.  He would have thought I was a complete nut.

Fund-raising ideas

Movember - we've all seen the slow-mo train wreck happening year after year right?  It's all about guys growing a mo during November and getting sponsored to raise money for men's health issues.  It's not something I've done myself, despite knowing I would dominate, for two reasons:

1. It really annoys me that people will happily donate to charity only when someone else is being made to suffer or look absurd.  The ice-bucket challenge - yeah it raised a lot of money but why can't people just donate to worthy causes without all these shenanigans?
2. My Smaller Half says my Mo is too scratchy.  Sad face.

Nevertheless, it seems to be an effective way to raise money for worthy causes.  Since I won't actually participate in these fund-raisin exercises, I decided that the best way for me to contribute would be to suggest some other monthly fund-raising activities for worthy causes that sometimes struggle to get the support they desperately need.  

1. Jamuary - Broadcast noise on your neighbor's wi-fi frequencies for a month, and raise money for music education in schools.
2. Sledruary - Get sponsored to use a toboggan as your sole means of personal transport.  Funds raised to support measures preventing global warming.
3. Fartch - Raise money by catching all your farts in a jar for a month.  Monies used to support research into Irritable Bowel Syndrome.
4. Tape-ril - Help raise money for diabetes research by swallowing tapeworm eggs and getting sponsors to pay you for every pound you shed in the next month.
5. Nay - All you have to do is say "Nay" and "Yea" instead of "No" and "Yes" for a month to help set up holiday farms for retired racehorses.
6. Dune - To raise money for water purification kits for African villages, get sponsored to wear blue contact lenses all month.  Bonus sponsorship for drinking your own urine.
7. Jewly - Vow to not visit cheezburger.com for a month to raise money for charities fighting antisemitism.
8. Orcgust - Get your sponsors together and play D&D every night for a month to help fund the fight against autism.
9. Sectember - Get sponsors to contribute for each follower you indoctrinate into your personal cult.  Have a blast and gather donations for Scientology de-programming all month.
10. Cocktober - Wear only a chicken suit all month to raise money for eliminating non-free-range chicken farms.
11. Movember - See the intro...
12. Freecember - Get your friends/family/colleagues to pledge to support you to eschew money and only engage in barter for a month.  All donations go to the IMF.

Wake me up before you go-go

Oh woe is me! Here I am at work at the godforsaken hour of 4 a.m., finally taking a well-earned break, but tragedy of tragedies, I can get no respite!

Unfortunately one of the orderlies happens to share my first name (actually we both use it at the same time so it's not really sharing) so he has a propensity to chat at me. And he is taking his break at the same time as I am taking mine. Sad face. 

His opening gambit was to observe that in the days before mobile phones people used to talk to each other. I assume this was intended to guilt-trip me into putting down my phone and talking to him. But I am made of sterner stuff than that. I simply agreed and kept on reviewing the fascinating bullshit on Facebook. 

Then he tried to engage me football which of course failed because I have no interest at all in football. So he tried asking my opinion of the upcoming war in/on Iraq mk III, which I am parlously ill-informed about, and said so, so that went nowhere. The whereabouts of his plastic cutlery - nope. The verdict on Oscar Pistorius - nope. The inability of the South Australian government to build good roads - nope. The fact that one of the nurses just walked in on him in the dunny. Nope. His insightful observation that I look tired. Grrr. 

It's not that I'm above talking to him because he's 'only' an orderly. It's just that I'm tired and need to rest and talking is not restful to me. And yeah I guess he isn't exactly scintillating. 

I am a rock. I am an iiiiiiiiiiiisland. 

Overestimation

One of the interesting things about being a doctor is the exposure you get to a representative cross-section of the community, probably more so than many other professional jobs.  For example, if I was a corporate tax lawyer I'd mostly be interacting with people from the top end of town, and if I was a social worker, I'd mostly be interacting with people from Struggle Street.  But as a doctor, particularly as a doctor in the emergency department, I've come to realize that people from all walks of life have heart attacks, fall over and break their hips, and get fruit lodged in their rectum over a long weekend.  Not usually all three at once, but sometimes, usually in reverse of the order listed.

This fact should have immunized me against the potential for, or at least possibility of extreme stupidity.  But it still astonished me when I run into someone incredibly obtuse in my day to day life.

Recently I was in a cafe with my Smaller Half.  We ordered some coffee and, because we wanted something to eat but didn't want to spend too much, we also ordered some fruit toast.  The girl behind the counter looked at us in disgust and contempt, as if we'd asked for a mug of warm vomit, and asked us what we meant.  Admittedly, my Smaller Half is not of Anglo descent, so she doesn't really have the right to just waltz into a shop and order stuff using our language, so a brief period of confusion is understandable.

My Smaller Half repeated her request for fruit toast, politely at first, then in sentences increasingly bereft of such ornaments as courtesy, subordinate clauses, or verbs.  Finally she was reduced to tapping her finger on the glass case where the (as yet untoasted) fruit toast was displayed, saying "Fruit toast?" in the same tone of voice that explorers used in 1950's action serials when talking to the natives - "You likey? You likey shiny beads?" and the poor shop girl was using her tongs to prod the muffins, the custard tarts, the dead blowflies, anything and everything EXCEPT the fruit toast in a desperate attempt to decipher what we were asking for.

Finally something registered in the shop girl's tiny brain and she gestured at the fruit toast - "That? That's raisin toast."

Great Old One of the Cthulhu Mythos, or Pharmaceutical?

1. Lythalia
2. Rokon
3. Cynothoglys
4. Lapatenib
5. Inpesca
6. Romiplostim
7. Cyproterone
8. The Worm That Gnaws In The Night
9. Zindarak
10. Irinotecan
11. Zonisamide

Answers
Great Old One: 1, 2, 3, 5, 9
Pharmaceutical: 4, 6, 7, 10, 11
Both: 8

The story about the time I got baked into a pie

One day, your Mama was making a really big pie for us all to eat for dinner.  She used a bathtub to bake the crust until it was lovely and flaky and crisp.  Also, on the stove was a great big pot of boiling yummy pie filling.  Mmmmm.

I was leaning over the bathtub, smelling the delicious hot crust, when Mama turned and took the big pot of filling off the stove.  As she turned around again to begin to pour it into the bathtub, she bumped it into my back and knocked me into the pie crust without even noticing!  She poured the pie filling into the tub and covered me up with it, then put the pastry onto the top of pie, and popped it into the oven to cook, with me stuck inside.

An hour later, when the pie was piping hot and ready to eat, Mama came looking for me.  She asked you if you knew where I was, but you didn't.  "Dadda, Dadda, where are you?" you called.  Finally, you and Mama were getting so hungry that you couldn't wait any longer, so you decided to eat.  The great big pie went up onto the kitchen table and Mama cut it open with the big sharp knife.

She was very surprised when out I popped, all covered with flaky pastry and pie filling.  Wasn't that a funny thing to serve for dinner?

The story about the time your pram rolled away

Once, when you were a tiny baby, we took you to the markets to go shopping and your pram rolled away!  What happened was that I was pushing your pram with you inside, then your mama asked me to choose some mandarins.  So I let go of your pram, took a shopping bag, and started to choose the juiciest, yummiest mandarins.  But I didn't notice that your pram had started to roll away.

It rolled past the fruit shop. It rolled past the vegetable shop.  It rolled past the mushroom shop.  "Hey that pram is rolling away!" called the stall-holders.

It rolled past the chocolate shop. It rolled past the coffee shop.  It rolled past the deli.  "Won't somebody think of the children?" wailed the balloon-twister.

It rolled past the fish shop. It rolled past the chicken shop. It rolled past the bakery. "Oh the humanity!" cried the shoppers.

And it rolled all the way over the lift, and rolled right through the open doors.  And then, you reached out your tiny baby hand and pushed the button for the 3rd floor, where our car was parked.  Up, up, up, went the lift, and when it reached the third floor, your pram rolled right out the door and into the car park.

It rolled past the red car. It rolled past the yellow car. It rolled past the white car. But it didn't stop.

It rolled past the blue car.  It rolled past the black car. It rolled right up to the grey car and, bump, it stopped.

And your mama and I brought our shopping back to the car. Mama was cranky with me even though I had chosen very good mandarins because I was supposed to be looking after you and I had lost you and I didn't know where you had gone.  But then, when we got back to our grey car, there you were, in your pram beside our car, waiting happily for us to get back.

And we were so happy that we gave you lots of cuddles and kisses and nobody was sad or cranky anymore, and we all ate mandarins together.

Paddling

Consultant

And what other regular narrow-complex tachycardias do you know of?

PTR

Atrial flutter - but this is too fast so it isn't flutter.

Consultant

Unless?

PTR

Unless... it is flutter.

The Hatchling can read - kind of...

[Scene: sitting in the hospital cafe, the Hatchling points at a sign on the wall] 

Hatchling
Dada, look! "C", "O", "F", "F", "E", "E"! 

PTR
Good reading, sweetheart!  And what word do all those letters spell? 

Hatchling
Emergency? 

PTR
Close enough.

Painbook

As has been observed before, Facebook is a stinking heap of shite, which is why I seem to be irresistibly drawn to it, like a dung beetle when the moon is full.  A quick perusal of my news feed shows me that 95% or more of the posts are:

• Videos of people's ugly kids.
• Self-evident platitudes from Paul Coelho typeset in bold over a picture of a sunset.
• Quizzes urging me to find out which inanimate object or abstract category I am most similar to.
• People bitching about football.
• People bitching about television.
• Clearly fabricated heart-warming stories about returned veterans who rescued rabbits from snow-drifts then had their legs ripped off by crocodiles moments later only to have their houses renovated by rehabilitated Malaysian slum-kids.
• Desperate pleas to adopt yet another enormous and demented-looking canine.
• Gloating about holidays.
• Exaggerated news stories about scientific breakthroughs, implying that treatments for cancer and rocket-cars are just around the corner, again.
• Desperate pleas to vaccinate your ugly kids.

I'm not saying that I'm blameless here - I've blotted my escutcheon from time to time with at least one of the sins above.  But I've just spent 20 of the richest minutes of my life scanning for comments that I've left on other people's items, and I must say, the quality of my work is impeccable.  Here is a selection of some of the comments that I left over the past weekend:

• "Those are lyrics from a Starship B-side"
• "Your appearance is illegal in Queensland."
• "What if you force-fed the glitter to the celebrities, then took their livers to make sparkly foie-gras?"
• "That depends on where that finger has been I guess."
• "Racial profiling is so 2001."
• "I'll bust my ass in your cap."
• "This sack does not contain legal tender."
• "Which one are you again?"
• "I think it's a Bavarian flipperwaldt. Or possibly Hanoverian."
• "Look ma, no hands!"
• "An extra eyeball!!!!!!"

In many cases they garnered two or even three "likes", thus simultaneously sating and stoking my narcissism.  But not only did they briefly embellish my own self-regard, they also provided a breath of fresh air to the conversation they were lobbed into, in much the same way as a drunken smart-arse at a pub, reeling from person to person and belching into strangers' faces can change the atmosphere in an instant.  My final observation though, is that they are stand-alone works of beauty and truth.  My challenge to you is this: the next time you feel the need to leave a comment on any type of social media, why not use of these modern classics instead?  And not just social media - you could send one on a post-card to your Mum, you could spray-paint it on a billboard of Tony Abbott, you could blurt it out during an early morning surgical ward round.

Every comment dies. But not every comment truly lives!  

The Smiling Assassin

One of bosses at work is known as the Smiling Assassin. Not the most original nickname, I'll grant you. But it's very apt. He will stare you down, and take you apart piece by piece, while grinning affably from ear to ear, as if he's your best friend in the world. 

Contrast this with one of the other bosses, the Inquisitive Assassin. He just keeps asking you question after question. What do you mean by this? What did the patient say about that? What other things might you consider? What's the evidence for that management plan of yours? Where exactly did you get your degree from anyway?

Then there's the Frowning Assassin. She will also show no mercy, but instead has a big scowl on her face the whole time. She's either perpetually disgusted at what you have to say, or very hard of hearing. 

Still, she's easier to deal with than the Surprised Assassin. Every time I speak to him about a patient, he reacts by jumping up, mouth wide open, eyebrows lifted, hands waving in the air like a jack-in-the-box. It's very unnerving, especially when he maintains that expression and pose while telling you why every thing you have said and done for the last three years was wrong. 

Once you've faced him down, you then might have to deal with the Weeping Assassin. He just sits there sobbing, presumably reflecting with a broken heart on the dreadful fate of the poor patients that we are trying to manage as we struggle along in our ineptitude. 

The last of the bunch is the Thoughtful Assassin. He sits there, rubbing his chin in contemplation, giving nothing away, just taking it all in. Then, when you've said everything you have to say, he kills you. Actually kills you dead. His favourite method is to wait until you turn away, then he stabs you in the back of your calf muscle with a poisoned umbrella. For the more senior registrars, he will use a more complex plan, as they are naturally wary from seeing so many colleagues fall along the way. For example, recently he obtained advance information on an incoming patient transfer from a regional hospital, and planted an explosive device in the handset of the telephone in the doctors' office, keyed to go off when the pager number of the relevant surgical registrar on duty is dialled. Kaboom. Whereas with the interns, he usually doesn't even let them finish their first sentence. He just has an accomplice in a nearby building pick them off with a sniper rifle. 

The Thoughtful Assassin is on duty tomorrow. I think I might call in sick. 

The day that you realize you're married to a psychiatrist

[Scene: On the couch, watching an advertisement for the forthcoming movie, Dawn Of The Planet Of The Apes] 

Smaller Half
Why do they keep making the same kind of film over and over? 

PTR
Aheywha? 

Smaller Half
They keep making these films about Man versus the Other, and the Other must be destroyed, but of course in the end it's Man who is the Other. 

PTR
Well thanks for ruining it for me.

Commentary commentary

And that's kick-off!

If you've joined us late, welcome to the exciting commentary between David Basheer and Craig Foster, who are commentating the World Cup match between Australia and Spain. This is expected to be challenging for both commentators, but possibly more so for "Foz", who, despite his big-match experience has been known to lose his composure and forget the big-match plan.  The challenge for Basheer, of course, will be to rein in his co-commentator and exert some control over the pacing of the commentary itself.

And yes, Fozzie is already starting to let his emotions get the better of him.  It's an exciting match, to be sure, but he needs to remember what his producers told him before the match: he's not part of the crowd now, he's part of a professional team delivering commentary to an Australia-wide audience, and to do that he just needs to relax a little and sit back - talk us through the action, try to provide some inside knowledge and perspective rather than simply rushing headlong into the play.

Basheer is having a good match though.  Each time there's a turnover from Fozzie, Basheer slows it down, uses his brain, constructs some good sentences by linking up words together to form coherent concepts.  It's a pleasure to watch him commentate, regardless of the result.  Oh! And that's an aggressive challenge from Fozzie during a key play, and Basheer is down! No, he's okay, back up again quickly and trying to get back into the action.  Fozzie needs to watch himself, if he gets too excited he could find himself on the bench for the second half.  The last thing the commentating team needs is to be down a man.

And that was a key moment, almost a blunder - Fozzie briefly referred to a player as Xavi when he was in fact Xavi Alonso, but immediately recovered and continued play.  An easy enough mistake to make, but it will get pounced on at this level and exploited.  I must say, the improvement in the Australian commentary team in the technical skills of name identification and pronunciation is remarkable.  We're simply commentating so much more fluently than even four years ago.  Some of the really tricky foreign phonemes have been rolling off the tongues of the team all tournament long.  Xavi is a case in point - that X, that V, neither of which are handled in the same way as they would be in Australia.  It's clear that both commentators have really done their research.

Oh dear, that's a let down - both commentators momentarily lost control of the situation when Australia conceded a sloppy goal.  Fozzie simply lying groaning on the floor, and Basheer sitting mute at the microphone.  This will be added to stoppage time at the end of the match.  The crowd back home will be disappointed in that - nothing but dead air coming over the audio.  They'll have to lift their game for the second half.

How interesting it is to reflect on the difference between the Australian style of commentating and the English.  Martin Tyler, the English great, seemingly ageless, able to stay calm and offer clear, dry, abstract commentary at all times.  Perhaps too calm for some, especially in the Australian leagues where the audience seems to require more overt barracking from their commentators, perhaps reflecting an underlying lack of faith in the team or lack of enthusiasm for the game.

But the team, Fozzie in particular, seems to have steadied their nerves now. Listen as he describes a poor sequence of Spanish play in objective teams, and then adds that it's disappointing to see that, whereas in the first half it would have been framed as an Australian triumph. He's acting much more in concert now with Basheer and it's clear from the way they hand the commentary back and forth, smoothly switching directions, effortlessly weaving anecdotes and analysis in between play-by-play descriptions  Surely if they keep up this level of performance they'll break through soon!

And here, Australia on the attack again, listen to Foz, he's really flying now. Back to Basheer, who rapidly disposes back to Foz - Foz to Basheer again, watch them go.  Basheer with a little metaphor there, very tricky, no, he's mixed his metaphors, but Foz has scooped it up and recovers well with some alliteration, but that's an opportunity lost.

The underlying structure and organisation of the team is emerging now as the game develops late in the second half.  Foz is taking over more when the ball is in Australia's half, with Basheer doing duty in Spain's half.  It's a good system which give some balance to the listener, and I think the producer has allocated their roles well.  When the ball is near the Spanish goal, Foz does become hysterical and incoherent, so Basheer is better placed to take over here, notwithstanding the screams and grunts that can be heard over the top of him.  And when Spain gets a good attack rolling you can hear the strain and desperation in Foz's voice but he retains control with occasional backup from Basheer.  How much influence, I wonder, has Les Murray had on this system, with his vast experience of managing Foz's enthusiastic ramblings on television?

And here we are, only two minutes of stoppage time added.  Both commentators, I'm sure, will be relieved to reach the end of this game.  You can hear them tiring, the energy is simply not there.  I can't help wondering if perhaps they didn't push just too hard in that first half when they were so hopeful.  I think it left them lacking legs in the second half when they really needed to keep the listeners involved after Spain's second goal.  Their talk became just a little lacklustre, lacking imagination and not as crisp as it really had to be to perform for a full 90 minutes at this level.  Nevertheless they put in a spirited performance which is so much a part of the Australian way of commentating.  I do wonder, though, if this might be the last time we see them commentate at a World Cup.  Sad to think that this could be the end of an era.

There's the whistle!  That's full time!  They push back their chairs, turn off the microphone, and take a deep breath. Another splendid performance from SBS's commentating team.  They're swapping shirts now, another one for the pool room.  Thanks for joining me, I'll see you next time with more commentary commentary.  If you have any commentary commentary commentary, leave a comment below.

Placebo effect

The placebo effect is oft misunderstood.  Strictly speaking, the placebo effect is the subjective or objective improvement in a patient's health after being administered a deliberately inert treatment which they believed would genuinely benefit them.  The label tends to get stuck on any number of unrelated though equally baffling phenomena.  Here's a few examples of similar effect which are in fact not placebo effects:

The nocebo effect. This is the subjective or objective deterioration in a patient's health after being administered a deliberately inert treatment which they believed would genuinely harm them.

The albedo effect.  This is the subjective or objective improvement of a patient's surface reflectivity after being adminisered a deliberately inert treament which they believed would genuinely make them more shiny.

The gazebo effect. This is the subjective or objective transformation of the patient into an outdoor, open-walled roofed area, usually octagonal, after being administered a deliberately inert treatment which they believed was a psychedelic drug.

The Placido effect.  This is the subjective or objective improvement in a patient's singing voice, particularly in the tenor range, after being administered a deliberately inert treatment which they believed was a gift from the Aoedean muse.

The libido effect.  This is the subjective or objective improvement in a patient's sexual drive or endurance after being administered a deliberately inert treatment which they believed was an aphrodisiac.

The bushido effect.  This is the subjective or objective improvement in the patient's ability to temper his violent martial instincts with forebearance, serenity and insight, after being administered a deliberately inert treatment which they believed was prescribed by the long-dead Japanese author and diplomat Nitobe Inazo. To be honest, it doesn't really come up that often but I thought I'd include it for completeness.

So the next time you go to your doctor complaining of having changed into a pavilion, belvedere, rotunda or pergola while you were tripping, and he mistakenly suggests that perhaps it was due to the placebo effect, you'll know precisely what to say!

No Known Drug Allergies

One day, when I have a bit more spare time, I'm going invent a medication which could be plausibly abbreviated NKDA, such as norketodopamine. (Does that name even make sense? Don't ask me, I'm a idiot blogger not a biochemist. But if you can have owlbears, I can have this.)

Then I will discover that it is not only therapeutically vital for the treatment of depression, acne, obesity, ischaemic heart disease, or some other such common condition, but also lethal if treatment is abruptly ceased.

And all over the world, pharmacists will have conniptions because patients will be bringing in prescriptions for norketodopamine re-supply, but the script will also have written, in the little box for Allergies/Adverse Reactions:

(Wait for it)

(You can see it coming, can't you?)

NKDA

That will be briefly amusing for me as I lounge on my Throne Of Spleens, contemplating my empire and watching the dancing girls.

A modest proposal for the solution of my employment woes

[Editor's note: this was written more than a year ago, and was recently unearthed from the dusty archives of my "Drafts" folder.  History does not relate the ultimate destiny of the young poet who scribed it to his beloved, so many moons ago blah blah blah but I forgot to hit the "Publish" button. Enjoy.]

Man, the last hour of work is always a real struggle.  Yesterday I powered through the first 11 hours of my shift with (relative) ease.  I was an admitting machine.  Ask ask ask. Talk talk talk.  Examine examine examine. Write write write write write write write write write write WRIIIIITE!!!  It's a doctor's life.  But the last hour, from 11 to midnight, was a killer. 

In all honesty, it was not a killer.  Nobody died.  I've had many many worse hours of work.  But it just sapped my energy and enthusiasm.  Lately I've really been struggling with my response to people who've had lifelong illness or disability.  I think my parental paranoia gets hyperstimulated by it and I start to dwell on the difficulties that these people and their families must have faced.

Then I get all shirty about how objectively wonderful my life is and why I'm not subjectively more over the moon about it all. But that's not important right now. What I'm talking about is how if I'd had that same patient earlier in the day I'd probably not have been so bothered about him.  But by the time I was tired and looking forward to going home, I was all fragile, like a beautiful butterfly or a little crispy cookie.

I think to address this, all my shifts should be one hour shorter.  Of course, it's possible that the same situation would recur, and I would once again become all dysphoric and whiny in the 11th hour of work rather than the 12th.  In which case I submit to you that the best thing would be to shorten my shifts again by another hour.

Eventually I hope to be working 1 hour days.

Dice man

Necessity is the mother of invention.  And boredom is the father.

Having to do solo ward rounds on the weekend is pretty easy.  Most patients don't need radical changes of plan over the weekend, and in any case the services often just aren't there anyway.  So most of the time you can make sure that nothing disastrous has happened and write, "Continue current management" as the plan.  All well and good.

But last year I was having to lead lots of ward rounds with me, the intern, and a med student.  My registrar had been off sick a fair bit and two mornings a week she was in theatre so I was "in charge" those days too. There's only so many days in a row that you can stall and do nothing before even the med student starts to look at you funny and (presumably) wonder if they couldn't do a better job themselves.  (I know this because I was a med student two years ago and frankly, the residents then were two-bit dumbo nothings. Not like now.)

So I needed some means of coming up clinical management plans despite not actually knowing anything.  (Necessity).  And one afternoon I found myself with 10 spare minutes while waiting for a phone call.  (Boredom).  Invention!

Presenting PTR's Patented Platonic Prismatic Planning Pthing:

I took one of the blue rubber cubes that come with ABG syringes.  On each of the six sides I wrote a clinical plan.  When you find yourself needing a quick change of direction in management, simply roll the dice and do as it says.  Here's a quick guide and accompanying commentary:

1. ICU.  You should call ICU and ask them to review the patient.  All patients benefit from an ICU review.  Even if they are completely clinically stable, ICU loves to be called so they get the chance to review patients before they get really sick.  It gives them something to aim for.
2. Discharge.  Everyone hates to be in hospital.  Everyone has to go home sooner or later.  We need the bed for the people who will be sick tomorrow.  Are you getting the hint?
3. Psych.  "You don't have to be crazy to be a patient here, but it helps!"  People who are sick in hospital often feel sad or withdrawn.  It's a reasonable reaction to a significant stressor.  But who is to say where the dividing line is between hidden relief at missing a day of work and crippling depression with suicidal ideation? Who is to say where the line is between an intermittently irreverent blog and complete psychotic breakdown?  A psychiatry registrar would love to get involved.
4. Nursing home placement.  Everyone hates to be in hospital.  Everyone has to get old sooner or later.  We need the bed for the people who will be sick tomorrow.  Are you getting the hint?
5. CTPA.  A honking great CT scan of the chest with plenty of radiation and some intravenous contrast to boot.  All to rule out some speculative nonsense diagnosis which was never going to be true anyway.  CTPAs are a great way to buy yourself extra time.  The radiology registrars need the practise, and for added fun you can remove the patient's IV line before the test so the radiologists can keep up their clinical skills by reinserting it themselves.
6. Palliative care.  Everyone hates to be in hospital. Everyone has to die sooner or later.  We need the bed for the people who will be sick tomorrow.  Are you getting the hint? 

Try it out yourself and let me know how it works out.  I'm thinking of developing a similar one for use in the Emergency Department so I'd love to get your ideas.

PE self-test

A pulmonary embolism (PE) is a dangerous, potentially lethal medical condition that is notoriously variable in its clinical presentation, hence is difficult to diagnose without performing invasive medical imaging. PEs occur most commonly when a blood clot travels down the pulmonary artery to the lungs, blocking circulation and thus preventing the lung from being able to absorb oxygen from the air properly. Not the sort of stuff you expect to see in a late night TV advertisement.

Yet a few nights ago I found myself watching an ad wherein an attractive young couple switched off the light in their bedroom, only to turn it back on again a few (subjective) minutes later, evidently much to the young lady's disgust. She then proceeded to harangue the young gentleman about his PE, urging him to seek assistance, whereupon the contact details of a suitable company were placed upon the screen. This all made no sense to me at all until I later discovered that PE is also an abbreviation for premature ejaculation.

It occurred to me that this type of mix-up must happen all the time, with potentially dire consequences. A patient turns up to hospital suffering PE and somewhere along the way there is bound to be some confusion unless everyone is clear exactly what is going on. So I have compiled this short quiz to help you test your knowledge of PE. Simply read each statement and decide which type of PE the statement applies to. Good luck!

1. Pregnancy can cause PE. 

2. A brief period of mobility in bed can cause PE. 

3. Patients with PE can appear breathless, tachycardic, and sweaty. 

4. PE can manifest within seconds, with little warning. 

5. A prolonged period of immobility in bed can cause PE. 

6. In PE the primary problem is often venous.
7. PE can cause pregnancy.

8. In PE the primary problem is seldom Venus. 

9. PE can cause sudden collapse and unconciousness.
10. PE is often preceded by the appearance of a hot, red, swollen extremity.

I will post the answers in a comment below in a week.

On being farty

Today I am farty.  Yesterday I was not.  But at the stroke of midnight, something changed: I am now farty and will be farty (at the very least) for the rest of my life.  Some of you who read this may be surprised to hear that I'm farty.  Perhaps you know me personally and I just didn't have that air about me.  Or perhaps you're surprised that I'd be talking about it like this; for some reason, being farty seems to something to be ashamed of in modern society.

In our grandparents' era, being farty meant that you were of a particular level of maturity.  People gave you respect.  You had responsibilities.  You had solidity in your life. Sure, you might be slowing down, people might have thought of you as a bit of a pompous gas-bag but that doesn't mean you weren't still full of beans.  But these days, and I am a case in point, being farty just means that you're older but perhaps not wiser.  People's lives are much more fluid these days; I had a whole other career and trajectory before I even started to study medicine.

There's a pressure that comes with being farty.  I'm hoping that I can ease some of that pressure by trying to keep things more fluid, while also striving for solidity in the future.  I guess what I'm really trying to say is that I don't think it's helpful to label yourself as farty, or not-farty - surely everyone is farty in some way, at some time, even if they'd like to pretend otherwise. Farty is a just state of mind. Before I was farty I fell into the trap of thinking of it as the end of something rather than the beginning.  Being farty is nothing more than a sign of more surprises in store.

Am I really farty? The answers, as Bob Dylan said, are blowin' in the wind.

Up the wolves

There's bound to be a ghost 

At the back of your closet,

No matter where you live.

There'll always be a few things, 

Maybe several things,

That you're gonna find really difficult to forgive.

There's gonna come a day 

When you'll feel better.

You'll rise up free and easy on that day.

And float from branch to branch,

Lighter than the air.

Just when that day is coming, 

Who can say,

Who can say.

Our mother has been absent,

Ever since we founded Rome

But there's gonna be a party 

When the wolf comes home.

We're gonna commandeer 

The local airwaves.

To tell the neighbors what's been going on.

And they will shake their heads,

And wag their bony fingers

In all the wrong directions,

And by daybreak we'll be gone.

I'm gonna get myself in fighting trim.

Scope out every angle 

Of unfair advantage.

I'm gonna bribe the officials,

I'm gonna kill all the judges,

It's gonna take you people years

To recover from all of the damage

Our mother has been absent,

Ever since we founded Rome.

But there's gonna be a party 

When the wolf comes home.

- John Darnielle

Potato Varieties for Fun and Profit

The Désirée is a red-skinned main crop potato originally bred in the Netherlands in 1962. It has yellow flesh with a distinctive flavour and is a favourite with allotment-holders because of its resistance to drought, and is fairly resistant to disease. It is a versatile, fairly waxy variety which is firm and holds its shape and useful for all methods of cooking; from roasting to mashing and salads.

The Russet Burbank potato is a large potato with dark brown skin and few eyes. Its flesh is white, dry, and mealy, and it is good for baking, mashing, and french fries. It is a common and popular potato. Russet potato came to headlines in 2014 when U.S. Secretary of State John Kerry presented a pair of russet potatoes to Russian Foreign Minister Sergei Lavrov. Kerry stated that the gift was in reference to a previous conversation and was not motivated by any hidden meaning or metaphor.

The Robertson Emperor is a grandiose, elaborate potato.  It has a floury, mealy flesh which is not well suited to boiling or steaming.  However, when triple roasted in duck fat and rubbed on the inside of a silver tureen, it is capable of raising even the most tarnished tableware to a brilliant shine.

The Blackroot Honeycrown is a traditional Iberian throwing potato.  Its rough and pitted skin affords an excellent grip to the thrower but sacrifices the control thus gained for raw speed of delivery due to the aerodynamic drag.  Legend has it that the champion Honeycrown tosser Anante Tescolenes will one day return to earth on a golden blimp to revive the lost art of "Acuraverio", or flinging the potato with such violence that it spontaneously self-exfoliates and arrives at the target entirely devoid of skin.

The Cheerful Florence was bred in 1930's New Jersey in an attempt to lighten the lives of the poor slum-folk of Newark.  When immersed in water to cook, the steam escaping from its eyes forms bubbles which, to a sufficiently imaginative or desperate listener, seem to tap out of the rhythm of some of Cole Porter's lesser known Broadway show tunes.  It was not a popular success and is believed to be extinct.

Doctor Starlight's Opal Fritter is a disappointing potato.  Blandly flavoured, mushy fleshed, smelling faintly of used cat litter, and drab grey in colour, it is nevertheless a common entrant in the North American Tuber Fancy shows since 1992 due to the commercial clout of Monsanto which continues to heavily subsidize the Opal Fritter, whose patent rights they acquired in mysterious circumstances during an Egyptian river cruise with representatives of the Vatican.  Approximately 1 in every 2 million Opal Fritters will contain a skin lesion resembling Gene Wilder.  These rare specimens are highly prized among members of Gene Wilder's family.

The Dragonclaw Dragontalon Dragonlady Katana Griffonclaw Axekiller is a good mashing potato but is surprisingly vulnerable to frosty weather.  It grows well in drier, well-drained soils and will flourish with regular top ups of potash and a little TLC to keep it free from pests.

Another business proposal

My new ambition is to make plastic owls a thing of the past.  Our grandchildren will one day be rummaging through the attic and will find an artificial owl and they'll say, "Why on earth would you buy something like this?", and we'll say, "We bought it to stop pigeons shitting on our cars", and our grandchildren will say, "But why didn't you just use PTR's All-Natural Method For The Repulsion Of Pigeons(tm)?"

And you - YOU, Dear Reader - will be able to say that you got in on the ground floor.

Here's how it goes.  At the moment, if the pigeons keep shitting on your car, you buy a plastic owl and stick it on the roof of your garage.  "Holy shit!", the pigeons think. "I don't want to get eaten by an owl. I'm off!"  And they leave.  But eventually even a pigeon will realize that the owls never move.  They clue in to the owl being fake, and come back in even greater numbers.  It'll be like that Alfred Hitchcock film, "The Pigeons That Kept Shitting On My Car".

So my initial plan was to instead attach a plastic pigeon to the roof of your garage.  The owls would see it, and come to attack it.  The real pigeons would then see the owls attacking the fake pigeon and think, "Holy shit! I don't want to get eaten by an owl. I'm off!"  And they would leave.

The problem with this plan is that:

1. owls are smarter than pigeons, and
2. it's a lot easier to realize that something is plastic when you're trying to eat it than when you're trying to hide from it.

So my revised plan, now known as PTR's All-Natural Method For The Repulson Of Pigeons(tm), is to sprinkle bird seed on the roof of your garage.  Real bird seed, not plastic, in case you're wondering.  The (real) pigeons come to eat the (real) bird seed, the (real) owls come to eat the (real) pigeons, and the (real) pigeons think, "Holy shit! I don't want to get eaten by an owl. I'm off!"  And they leave.

Who's interested?  I need seed capital.

Candystore

Doctor

So you have you ever taken risperidone? 

Patient

No.

Doctor

Quetiapine?

Patient

No.

Doctor

Olanzapine?

Patient

No.

I tried marzipan once.  I got it from a friend. 

Questioned

I took my merchandise up to the shop counter.  The sales assistant took it from me, peered at it, peered back at me, looked me up and down, and said, "Are you sure you really want King-size?"

I'll never buy socks from them again.

Dis-Organisation part 2

In the previous episode our hero found himself without a job, with the end of the year fast approaching...

Whereupon he got an unsolicited email revealing that he had inherited millions of dollars from a previously unheard-of distant relative in Nigeria - no wait - different story. 

Whereupon he got an unsolicited email from the administrator of a training program for junior doctors asking him if he would like to take part. (Ok I'm not going to write this whole damn thing in the 3rd person - get ready for an illeism purge - yoink!)

So I got an email from the people running this training program asking if I'd like a job. As with my experience at the end of 2012, I have no idea how they got hold of my details or why they chose me, but when someone offers to give you money to buy candy, you say YES!

I was told that they would be having interviews in a couple of weeks, but a couple of weeks later I hadn't heard anything, so I shot an email off to the person who had contacted me, asking wassappnin? And I got back an autoreply saying she didn't do that job anymore.  Uh oh.  I contacted the person who had taken over from her, and he had never heard of me.  Furthermore, they were interviewing candidates in a few days.

Somehow I cajoled him into adding me to the interview list, rocked up to the interview, told a bunch of outrageous lies and half-truths, wept shamelessly while pleading for mercy, and got the job!

I had a friend a while back who was doing some recruitment for the public service for a largish group of people to get involved in a special project. She had had to take over the job from someone else halfway through, who had already sorted the applicants into PROBABLEs and OVER-MY-DEAD-BODYs.  So she took the PROBABLEs and proceeded to offer them jobs and train them and send them off to do their work, all the while thinking to herself, "Boy these people are idiots.  I'd hate to see the ones who were rejected."  At some point she began to get the same feeling of dawning realisation that you may be experiencing even now, and pulled the rejected candidates' paperwork from archives, only to find that they were highly qualified, motivated and intelligent people who would have been great for the job, and she realized that she had gotten the two piles of applications mixed up and had given jobs to the OVER-MY-DEAD-BODYs.

So it goes to show - never give up. No matter how shambolic the recruitment process, no matter how unqualified you are, you can always shoulder your way onto the payroll if you have persistence.

Unless you actually are qualified and good at the job with plenty of relevant experience.  Then you're fucked.

Et two sandwiches?

At another cafe near my house, the general air is that it's a hang-out for the retired and impaired.  There is nothing cool or stylish about it, but it's clean, new, and well-maintained with an atmosphere best described as "home-made v clinical".  But that's not why I go there.

I go there because I can get a toasted cheese and tomato sandwich and a coffee for $6.90.  I've been there 2 or 3 times per week in the last few months, just to sit down and read the paper and forget my woes.  The guy who runs it is a bit bumbling but nice, and eventually learned what my "regular" order was just in time for me to stop going there because I got a new job.

When it was time to leave I would sit there reading, covertly watching him out of the corner of my eye, until he was busy with another customer.  Then I would briskly get up and with a wave and shout of "See you later!", I would bolt for the door while avoiding eye contact.  Strange behaviour, I know, but if I didn't do this I would be trapped in a deadly escalation of farewells.

This is what would happen - every time I would say goodbye he would come back at me with another goodbye.  He would ALWAYS have the last word.  Which is fine - I can deal with that - but then he'd throw in another zinger to which I would have to respond.  He had an enormous arsenal of valedictory phrases to assault me with.  Example:

PTR

Thanks very much, bye!

Guy

You're welcome!

Have a great day!

PTR

Thanks, you too.

Guy

I will.

Thanks for coming.

PTR

Ha ha, no worries.

Guy

Yep, no worries.

Take it easy!

PTR

You too.

Guy

Too easy!

See you next time!

PTR

If we do meet again, we'll smile indeed;

If not, 'tis true this parting was well made

Guy

Why, then, lead on. O, that a man might know

The end of this day's business ere it come!

But it sufficeth that the day will end,

And then the end is known. Come, ho! away!

Exeunt.

I just have this nagging feeling that it's not going to end well...

Did you say "long black"?

There's a little coffee shop by a park near my house. They have a little chalkboard out by the road, with messages upon it to entice in the weary motorists.  It will usually say something like,

"Try Rhys's famous soup!"

or

"Fresh muffins!"

or

"Free wi-fi"

or

"Cool inside".

Recently I drove by and it said, (and I am not making this up, not even a little bit)

"Friday - my favourite F-word".

I really really wanted to go in and order a cup of my favourite C-word.  But I didn't because it's a nice little cafe that I like to take the Hatchling to and I didn't want to spoil it by acting all creepy.

Earworm

I heard a great song the other day.  It went something like this:

A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!

A-dance-a-dance-a-dance-a!
A-dance-a-dance-a-dance-a!
A-dance-a-dance-a-dance-a!
A-dance-a-dance-a-dance-a!
A-dance-a-dance-a-dance-a!

A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!
A-jump-a-jump-a-jump-a!

A-boingee-boingee-boingee!
A-boingee-boingee-boingee!
A-boingee-boingee-boingee!
A-boingee-boingee-boingee!
A-boingee-boingee-boingee!

[Repeat ad nauseum with verbs or onomatopoeia of your choice]

Really great lyric writing like that can just connect you to a higher plane.  Especially when you hear it coming from the back seat of your car for about 45 minutes non-stop as you drive along a long, straight, wilderness road while your Smaller Half snoozes in the passenger seat.

What a trip!

I've gone viral

At the moment, I'm working in a position where I am supposed to move around to different places depending on who is away - a lot like a relief teacher.  If one of my Esteemed Colleagues goes on leave for a week, I take over their job for that time.  Sometimes the job lasts a few days, sometimes for months.

Being an organized, control-freaky kind of guy, I thought it would be nice to know how long I would be working in my current position before having to move somewhere else.  This has important ramifications for my planning of various activities such as stealing stationery, staking out a claim to a good desk, whether or not it's worth maintaining my personal hygiene, and so on.

So I emailed my boss and asked how long I would be there for.  I was told to ask her boss.  So I did, and I cc-ed admin so they would get the answer. And her boss told me I should have asked my boss, and cc-ed admin, my boss, and the director of training.

The director of training then responded to all of the above, and added in my boss's boss's boss, and that person's boss for good measure.  This then got forwarded to another big big boss, who then responded to everyone and also included twenty-three other people in the distribution list, including 12 big big bosses.

Then my boss emailed just me, repeating the information.  Then she emailed me, her boss, admin, head of training, the big big boss and the big big boss letting them know that she planned to answer my question and in fact proceeded to do so in the same email (presumably for the sake of efficiency).

Just in case that's not clear, I've prepared a diagram.  Time flows downward, each email is indicated by a red line.  For the sake of brevity, I have grouped all 23 people emailed by the other big big boss into one column, since they themselves didn't send any further emails themselves.

If you've ever wondered why waiting times at hospitals are so long, or wondered why the health budget consumes approximately 600% of available revenues, here's at least one answer. It takes more than fifty emails for me to find out whether I should shave today.

Dis-Organisation part 1

So, once again, I found myself without a job. This happened after internship, as I have previously documented.

Once again I applied for a year of general training. And once again I crashed and burned - worse, this time, because I wasn't even deemed worthy of interviewing by ANY of the hospitals I applied to. This perplexed me. I don't wish to cast aspersions on my colleagues, but there's some fucking numbnuts out there that seem to have no difficulty at all getting jobs despite presenting a clear and present danger to the lives of their patients and the mental health of their cow-orkers.

So I rang up the hospital to find out what was going on. They told me that I wasn't ranked high enough for interview; I asked why. They said that my aggregate score was not high enough; I asked which scores. They said that my referee reports were very good, my CV was very good, but my cover letter was only average. Well excuse me.

Apparently the cover letter, or to be more accurate, the assessment of the cover letter by an embittered HR manager, is just as important a predictor of success as a doctor as the opinions of said doctor's actual supervisors and their previous record of achievement.

Fuck.
That.
Shit.

Admittedly, I have nobody but myself to blame. Labouring under the delusion that recruitment would be a rational process, my cover letter basically said something like:

"Dear Hospital, give me a job. I don't want anything special, just don't screw up my paychecks too egregiously. Sincerely, PTR. p.s. I am not a numbnut".

And presumably they get a lot of cover letters like that because this was assessed as average.

I'm unsure precisely how one would write an above average (or even exceptional) cover letter. I suppose a below average one would contain errors of fact, spelling, grammar, and so forth. I could get the Hatchling to dictate mine:

"Dear Hossabil, I am a goktor. Do you want moneys? I want moneys. I give you a cuddle. ROOOAAAAR!! No, you not roar. I roar. Sincerely, PTR"

Hmm, that's actually pretty good. Perhaps that would actually be assessed as Exceptional. I don't wish to cast aspersions on the cognitive capacity of the typical embittered HR manager, but they don't seem like the fluffiest pavs on the table. But to be honest, given the aggressively proactive manner in which some of my colleagues promote their own career interests, I suspect the Exceptional cover letters read like this:

"Dear Hospital, any o' you sumbitches don't gimme a job, I'm not only gonna kill him, I'll kill his wife, all his friends, and burn his damn house down! Sincerely, PTR"*

If I was an embittered HR manager wishing to perpetuate the employment of antisocial personality types in the public hospital system, I would cry from happiness when I got a letter like that. Seriously, try it yourself next time.

So - that's the story of how I came to not have a job. Next - the story of how I came to have one again (or so it seems).

*With apologies for plagiarisation to the writers of Unforgiven.

Premature retirement

Walk in the sun, or

Shall I wallow in silence?

The day off - again.