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.