Prone To Reverie

Hyper-tension

2012-01-31T19:18:00.001+10:30

Aah. Today I got home at 6pm. There's a small pile of late discharge summaries on my desk (the things we send out to the GPs telling them all the terrible screw-ups we made in hospital) but I have a new registrar arriving tomorrow so I seized the opportunity to be slack and took off. My old registrar called me at about 5.45 asking me where I was and I was delighted to tell him that I was gone, all the patients were stable, and there were no new issues, goodbye and good luck.

I realized today that the suckiest thing about my job right now is not my job. I actually kind of enjoy my job. It's satisfying in that way that looking at a big pile of blood clots that someone has just pooped out can be.

No, the suckiest thing about my job is that when I get home it takes me about 4 hours to unwind. I can't stop replaying the day in my head, wondering if I did this or that right, wondering what I forgot to do, trying to remember the detail of some x-ray or sputum culture in case I get asked about it the next day, trying to make sense of what's happening to me via the medium of sick people. It makes me so tense that I lose my appetite and can't eat dinner, and I find talking to my Smaller Half and the Hatchling really hard.

I can usually stop this just before I go to bed. Then I sleep (or not) and wake up tense again because I know that I have to go in for the ward round, which always brings a new shovel full of surprises. So I can't eat breakfast much because I'm freaking out again. As for lunch - ha! The El Dorado of meals. Much discussed, never seen.

I'm pretty sure that I've already lost about 5kg, especially when you factor in the brutal gastro that I caught in the first week on the ward.

So basically what I'm saying is that I've developed some kind of panic disorder precipitated by work. From what I can gather, everyone does in this business when they first start. It's just that people don't admit it.

Bee

2012-01-30T21:58:00.000+10:30

Oh. So. Tired.

Did another 13 hour cover shift yesterday (Sunday) and was busy busy the whole time. Nothing too scary or deadly but it was exhausting. It's a bit horrifying to realize that it's Monday and I feel like it's Friday.

The highlight of the shift was getting paged to go to a distant ward. I walked in and the faces of the nurses behind the desk lit up like it was Christmas. "Here's the doctor", they said, "He can help!"

At that moment I felt so proud. The doctor is here to save the day. "What seems to be the problem?", I asked in my most nonchalant manner, as if I've been doing this for years rather than two weeks.

They looked at each other eagerly, then turned back to me and asked, "How do you spell abscess?"

Telemedicine

2012-01-29T09:31:00.000+10:30

On Thursday I was sitting in the ICU playing phone tag with my registrar and the cardiology registrar regarding one of my patients when my mobile rang:

PTR
Hello?

Caller
Hi, this is Kathy, could you please re-send that order for the iron infusion? It's gone missing in pharmacy.

PTR
What?

Caller
The iron infusion for Mr Gibson.

PTR
[Desperately flipping through my patient list looking for a Mr Gibson and freaking out because I know nothing about him...]
Mr Gibson? Where is he?

Caller
He's gone back to Caloundra.

PTR
Caloundra? I'm in Adelaide.

Caller
Is that Dr Hamface?

PTR
No, sorry, you have the wrong number.

My week so far

2012-01-28T08:35:00.000+10:30

On Monday I kept telling myself that I just have to get through this year.
On Tuesday I kept telling myself that I just have to get through this rotation.
On Wednesday I kept telling myself that I just have to get through this week.
On Thursday I accidentally went to a nude beach.
Yesterday I kept telling myself that I just have to get through the day.
This morning I am telling myself that I just want to go back to bed.

Status idioticus

2012-01-25T21:14:00.001+10:30

Thanks for your supportive comments to my previous post. Since then things have improved a billion percent plus or minus 999,999,999 or so. I'd like to think that it's because I am a winner, but that's only partially so. Sadly, I still haven't managed to have any Vitamin C(ricket) but life can't be perfect.

Monday was not good. I was there for 12 hours straight, didn't get to eat anything, didn't get to drink anything, if I hadn't been running around like a madman you'd have thought I was fasting for surgery myself. Perhaps I'd be more productive if I wheeled a drip-stand around with me, with cool refreshing sea-water flowing into my veins, and a nice fat urinary catheter to cut out those pesky bathroom stops.

Things got off to a poor start when the Hatchling woke umpteen times the previous night. I then managed to somehow miss half of the plans during the round and never quite caught up. It didn't help that my RMO (the person between me and the Registrar, who is the person between the RMO and the consultant, who is the Big Boss) is away this week and there's no reliever so I'm kind of flying blind.

I failed to arrange some urgent consultations from cardiology and anaesthetics to prep a patient for surgery on Wednesday (today) because I simply couldn't get anyone to return my pages. Either that or I wasn't in one place long enough to actually take a phone call.

Then the consultant surgeon came and asked me some questions about my patients and it turned out I had no idea about them because again I sleep-walked (slept-walk?) through the round, so he deservedly rebuked me for that.

Then I had two code blues (dramatic emergency for crashing patients) in 4 hours plus another patient started having massive rectal bleeding so I had to quickly arrange a whole bunch of stuff that I previously had no idea about. And because of that, I fell further behind and the consults never got done and as I was sitting at my desk at 8pm scribbling out blood forms for the following day my Registrar came in and revved me about needing to get my shit together.

So I went home and the Hatchling was screeching because she hadn't eaten and was sick and was driving my Smaller Half bonkers because she's been just as busy as me and by bedtime I was pretty much ready to run away and join the circus until I realized that I already lived there.

Tuesday was better though and today was better again. Here's some tips for new interns on how to make it so:

Get a student to write the notes. Concentrate on trying to figure out what the plan actually is.
Review your patients yourself. For surgical patients you need to listen to breathing, check IVT/fluid balance, check calves for DVTs, check the surgical wound is clean and ensure that they have correct anticoagulation. This will put a cap on how much of an idiot you look like when the consultant starts quizzing you.
When your registrar starts flinging around multiple, ambiguous or conflicting instructions, make him clarify himself (or indeed herself). He may in fact get annoyed that you "waste his time" by doing this, but if you don't you'll regret. This is no time to be meek.
Page people once. Give them 5 minutes to answer, then go through Switchboard to call their mobile. Why we have a paging system when I am the only person who seems to actually use it is beyond me.
DO NOT LOSE YOUR PATIENT LIST WITH YOUR JOBS WRITTEN ON IT. Seriously.
Ask for help within a few seconds of getting baffled or confused or being unable to find something or not knowing how to do something. Sure, you might look silly, but at least you'll be able to go home at a sensible hour. This is no time to be proud.
Write down everything you do in the notes. Writing it down often makes you remember what else you should be doing as well. Which may well make you yoyo back and forth between the patient and the notes, but hey, what's the alternative. This is no time to be super-organized and work hard through med school so you know what you're doing. It's too late for that shit.
Drink lots of water. Do not eat the junk food in the office.
Stand up straight. Sniff the morning breeze.
Be strong. Be energetic. Be determined. Know yourself. Be the ball. Keep left. Buy low. Sell high. Take the All-Bran Challenge. Squeal like a pig. Something's gotta work!

I just wanted to say good luck, and we're all counting on you.

Low

2012-01-23T20:51:00.001+10:30

Someone commented recently that I hadn't been posting much, and then posted a link to a blog about Antarctica. Well, Antarctica sounds pretty good right about now.

Never in my life have I felt so disorganized, so incompetent, so useless, so tired, and so over my new job which I just spent the last 4 years "preparing" for. Time to get some rest and go back and do it all over again tomorrow, hopefully slightly less ineptly than today.

Aptitude

2012-01-16T22:02:00.002+10:30

I'm great at never and always. It's sometimes that I have trouble with.

Shock redux

2012-01-12T22:38:00.001+10:30

And another thing. One of the patients mistook me for someone he was once previously hospitalized with, who was getting electroconvulsive therapy. Presumably this is another hint that I need to get my hair cut.

Shock

2012-01-11T22:16:00.001+10:30

First real day of work today. For some reason I got mistaken for an electrician (???) by the theatre nurse. Soon the anaesthetist knew, and it didn't take long before she was answering the phone saying, "Well the new intern is here, I could get him to do it. Yes, that's right, the electrician. Hahaha!"

Ha ha ha.

Dysorientation

2012-01-05T22:15:00.001+10:30

For the week before D-day - when I'll be expected to actually do real doctory-type stuff - I am being subjected to a brutal program of "orientation". It's bewildering.

The general gist of it seems to be:

A senior doctor comes in and tells us that we can do it, not to be scared, and to call them for help if we get worried about a patient.
A junior doctor comes in and tells us war stories about the past year and all the freak-out moments they've had and how you get shouted at if you call a senior doctor.
A cyborg administrator comes in and tells us that even if you are on the roster to eat the bits of capsicum out of someone's poo that you'll get paid a 15% penalty rate only after the fourth piece and it's a Sunday in Aries rising and your supervisor authorizes said payment in their own cerebrospinal fluid.
Some of the interns start backchatting the hand-hygiene apparatchiks with an argument that would seem to suggest that because self-defence is okay that recreational murder should be permissable too.
Insurance salesmen come in and give us lunches that look like they were catered by 15 year old boys.
And then it starts all over again.

I get the impression that in the far-distant Neolithic era, the orientation program involved mostly useful stuff like being told how to use your pager and where to park your car. Then the lawyers got involved because if they could show that at some stage we were warned not to kill people, that when someone unfortunately died they could point the finger and scream "We told you not to let that happen!". Then the new interns freaked out and complained that they weren't supported enough so they brought in the senior doctor to play nicey-nicey. Then the interns found that they were being shouted at because they were labouring under the mistaken belief that senior doctors want to be their friends, so they brought in the junior doctors to tell horror stories.

I don't know why she swallowed a fly. Perhaps she'll die.

Ceiling, Seville, Spain

2012-01-02T07:00:00.000+10:30

New Years Resolution

2012-01-01T01:55:00.002+10:30

First thing in the morning, I'm going to pour boiling water over the salt again whilst verifying my answer to that tricky problem that I worked out previously.

The least bad parenting win

2011-12-30T12:40:00.002+10:30

There have been a couple of parenting lapses in Chez PTR recently. I won't reveal who is accountable for what, but I'm interested in your feedback on which lapse is more irresponsible. Once you've read the descriptions, please vote in the poll to be found for a limited time only to the right of this page.

Allowing the Hatchling to grab a steak knife off the table whilst distracted by one's own dinner.
Allowing the Hatchling to eat dead bugs off the floor whilst distracted by the cricket (not the bug, the sport) on the television.

Please encourage your friends to vote. If I end up being less irresponsible I will buy myself a coffee mug saying "World's Greatest Dad".

It's just not croquet

2011-12-29T09:17:00.000+10:30

Gee I miss Peter Roebuck.

Not personally of course. For those of you scratching your heads, he was an Australian cricket analyst of English extraction who flung himself to his death out the window of his hotel room in South Africa a month or two ago after he was questioned by the police regarding an allegation of sexual assault. A sad story - and who knows what really happened? Not me, that's for sure, but he was a great cricket writer and for that I miss him. He tended to write sprawling articles reflecting on the events of the day and how they may enlighten us to the struggle inside the players' heads, and thus inside our own.

After the annual Christmas gulag I've finally allowed myself to relax enough to sit back on the couch and listen to the Oz summer of cricket on ABC's Grandstand. The Hatchling seems a bit bemused by it all but she applauds along with the crowd whenever there's a dismissal. She keeps me busy enough that I miss a fair bit of the action, so I have to check the scoresheet online once she's gone to bed.

And in the morning, I get up and look at the Sydney Morning Herald website to see what Peter Roebuck made of the day's play. But he's dead.

I would have liked his opinion on the latest shenanigans involving the Decision Review System, which has been blocked by the Indian voting bloc and would have avoided a couple of howlers by the umpires already in this Test, versus, ironically, (or is this just Alanis irony) India. There has been some interesting discussion on the radio about it but I feel like everyone so far is missing the big picture, and perhaps Mr Roebuck would have been able to sit back and ponder the big issues to my satisfaction.

I feel that everyone is obsessed on the idea of "getting it right". We have the technology to find out what really happened so we should use it to ensure that the game reflects as accurately as possible the "true" battle between the two teams without the shadow of the umpires eclipsing the brilliance of the performances. For example, they are shocked at the idea that in one country the DRS might have 150-fps cameras whilst in another only 30-fps cameras. This inequity cannot stand, they cry.

And if this was medicine, I'd agree with them. It's important to get medicine right. Or stopping an airplance falling out of the sky. That's important too. Or even designing a voting system for the Americans so the less adept of them can actually vote for the person they intend to. Those things matter. But cricket is - gasp! - a game.

I'm pretty sure that cricket players would scoff if the ballroom dancing fraternity insisted on using high-speed infrared cameras to figure out who had the "best" tango. They would point out, I am sure, that in cricket there are rules that clearly define the circumstances of whether someone is in or out, and we should strive to use all the investigations at our command to ensure the game follows its natural course. They would say that ballroom dancing is subjective and that the judge's decision are interpretive, whereas cricket is all about hard facts and numbers and is thus amenable to technological intervention. To which I would reply that to a man with a hammer every problem resembles a nail.

My opinion on the matter is that this is a game, a.k.a. a sport, and human error is what it's all about, for the umpires no less than the players. Variations in umpiring from country to country, from game to game, or from day to day have as much relevance as the weather, which is to say that they are hugely important and help to make the game as interesting as it is. High-speed cameras and remote bowler-assassinating drones are all well and good for spicing up the viewing experience for the audience. But please, please, leave them out of the game itself before it gets sterilized and vaccuum-packed, like every other part of Western culture.

Vale Peter Roebuck.

Christmas jeer

2011-12-26T23:54:00.000+10:30

My Aged Mother said to me this morning, "You know, PTR, we do pretty well at Christmas, don't we? A lot of families just get totally drunk and get into beating each other up but we're not like that."

Part of me feels proud that she's right, but the other part of me feels sad that our threshold of success is so low.

Investigative phrenology

2011-12-20T00:57:00.001+10:30

My parents had a small phrenology bust sitting on the mantlepiece in the seldom-used dining room, where the shiny table, uncomfortable chairs and musty lounge-suite also lived. I was poking at the lumps and bumps in the Hatchling's head and wondering what the significance of them might be when I started wondering if perhaps the entire scientific bulwark of phrenology might be undermined by interpersonal variation in the character of each region of the skull.

A small amount of experimentation on myself involving three D-batteries, a wire coat-hanger, and a couple of largish gramophone needles enabled me to map out the contours of my own cognition. A fascinating GAAAAAAAARRRGHH process indeed. Since I'm not much of a artiste on ye olde computer I googled up a numbered version of the phrenology head (pictured above), which you can correlate with the list below:

Pride
Envy
Corduroy
Love
Depth perception
Embezzelment
Puns
Man-o-wars
Beft
Musicality
Vengeance
The Spanish civil war
Chocolate
Slip-slop-slap
Soviet monuments
Running writing
Writing running
Willpower
Blogging
Chronic condition self-management
Batman
Fashion
Sex
Arithmetic
Taxidermy
Comparative religion
Black powder
Bacon
Architecture
Flattery
Insolence
Procrastination
Politics
Fatherhood
Erbium

What I find fascinating GRAAAAAAAGHH is the fact that every single experience, thought, emotion and memory that I ever have had or will have can be expressed as a combination of items from the list above. For example, last week when I graduated with a medical degree and stood proudly on stage as a doctor, that experience was basically 1 + 18 + 23 + 26 + 28, or more descriptively, Pride + Willpower + Sex + Comparative Religion + Bacon.

You should try it yourself. It could change your GAAAAAAHKK life.

McFly

2011-12-19T23:47:00.001+10:30

It's funny that more people aren't named after insects. Insects are pretty common. If a person can have a colour as a surname (Black, White, Green, Brown, etc) which is a pretty abstract and subjective notion, why can't they be named after insects?

The only insect surname that I can think of right now is Slater. It's a good name. But why not Millipede or Cockroach or Ladybug?

One day I'll write a novel and all of the characters will have insect surnames. I think it'll really be big.

True story

2011-12-17T10:09:00.000+10:30

Patient

I have an unquenchable thirst.

Doctor

For power? Knowledge?

Bloody Oath

2011-12-16T01:07:00.000+10:30

I'm a doctor. *boggle*

At the qualifying ceremony we all had to stand up and read out this thing called the Physician's Oath. As Physicians we had to promise to be good guys and to always do our best and where-ever there's injustice, you will find us, and so forth. Unfortunately it wasn't the pithy old Hippocratic Oath in which you vow solemnly to put African wildlife in boxes. No, this was lengthy and sounded like it was written by someone with a Diploma in Public Health and a shiny pair of pants.

As a result, my mind wandered. I started thinking - which is always dangerous. I thought to myself, Hey! Hey Self! You've got this degree: Bachelor of Medicine, Bachelor of Surgery. Is that two degrees or just one? And how come you know a little bit of medicine but almost no surgery. And how come I'm taking this Physician's Oath but not a Surgeon's Oath? Maybe nobody has written one!

Ladies and Gentlemen, in the red corner, may I present...

The Surgeon's Oath

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE SURGICAL PROFESSION:

I am honoured to make this declaration in front of such of my family and friends that I still have, my colleagues whom I have not yet backstabbed, and teachers and mentors that I have been sucking up to;

I commit myself to practising surgery with speed, speed, and ... um ... speed;

My relationship with my patients will be built upon masculine slaps upon the shoulder and brisk promises to have them back on their feet in no time;

I will value all aspects of my patients - cash, credit, and other convertible assets;

I will not permit considerations of gender, race, religion, political affiliation, sexual orientation, nationality or social standing to influence my duty of care - but I should mention that if I do you on my private list I can get it done next Thursday even though the public waiting list is chockers until September 2013;

I will work with my patients to enhance their quality of life and provide support both in times of suffering and well-being - unless it's outside my specific area of research interest in which case I'll just expect the intern to handle it.

My commitment extends to the health of the community, valuing the diversity of people within in it as valuable providers of novelty ethnic food and taxi drivers to/from the airport;

I will support my colleagues working in health care, and treat them with honesty and respect, if they are both senior to me and within earshot; otherwise - shrug...

I will contribute to a work environment that fosters learning and cooperation. I commit myself to passing on my loudmouthed opinions on topics of interest to me such as luxury watches, sportscars and Fascist politics whenever I have a sharp instrument in my hand, as have those who have gone before me;

I will acknowledge my limitations and mistakes, should they ever occur, preposterous as that may seem to all of us here today in light of my obvious talents;

I will strive for satisfaction and enjoyment in my work but reserve the right to brutalize those in my power should I be having a bad hair day;

I will maintain balance in my life, drinking both red and white;

May these affirmations guide, strengthen and inspire me in practising the art and science of surgery.

Hypothetical awards for which I coulda been a contender

2011-12-14T22:00:00.001+10:30

Most destructive relationship with clinical supervisor.
Most adorable baby.
Most patient wife.
Most prolific blogger.
Least sociable.
Most consistent seating position in First and Second year.
Lunch.
Fewest appearances in theatre during a surgery rotation.
Most arty tie.
Least kempt.

Assault and pepper

2011-12-14T09:22:00.000+10:30

Here in RrrrrrAdelaide! there is a well-known restaurant that specializes in serving big thick steaks to big thick men. The kitchen has a window that abuts the footpath so that passers-by can peer in and marvel at the juicy cuts. Cuts, I say, cuts. There is something compelling about it that causes everyone to stop and look, even people like me who don't eat much in the way of enormous slabs of meat anymore.

I invented a fun pastime last week which involves strolling up behind the people ogling the thick steaks and interjecting in their conversation. The game is simple: every time somebody makes any reference to the meat, you must say, "No, that's one of the chefs."

Here's how it unfolded:

Stranger 1

Oh my god, look at the size of those steaks.

PTR

No, that's one of the chefs.

Stranger 1

Huh?

Stranger 2

Is it all just steak?

Stranger 1

I think there are some lamb chops up the back there.

PTR

No, that's one of the chefs.

Stranger 1

Huh??

Stranger 2

Look they also have chicken.

PTR

No, that's one of the chefs.

Stranger 2

Huh???

Stranger 1

I don't even think I could finish something that big.

PTR

No, that's one of OW!

Worth it

2011-12-13T00:39:00.003+10:30

As usual, my Aged Mother asked me today whether I thought that it was a good idea to study medicine and be a doctor. Normally I brush off these questions with a glib answer in order to avoid losing my mojo. Let's face it, dwelling on whether you've made a really really bad decision to throw your career away is not fun.

But now that I am halfway there, in the sense that I have studied medicine but not yet actually worked as a doctor, the question made me sit back and wonder.

Had I known four years ago how much work still lies in front of me I don't think I would have ever started. But now I'm here I'm glad I did. The work is actually enjoyable. It's interesting. It's fulfilling. It's rewarding. It's a shame though that the medical uber-institution, by which I mean the grand total abstract "church" of medicine at whose altar we are apparently expected to sacrifice our lives, takes itself far too seriously.

Here's a great quote from Thoreau that I read yesterday:

"The youth gets together his materials to build a bridge to the moon, or, perchance, a palace or temple on the earth, and, at length, the middle-aged man concludes to build a woodshed with them."

The upper ranks of medicine are heavily populated by people who burned up their youth trying to build that bridge to the moon. I honestly don't know if they believe they succeeded or if they know they failed and hate the world because of it, but I often get the feeling that they look at older students like me, just trying to achieve modest goals, and get angry that I'm not trying to emulate them.

Back in first year, one of my tutors once said to me that being a doctor is not a calling, it's a job. At the time I thought he was just being a cynical old bastard (despite the fact that I was actually older than him). Actually, I still he think he was being a cynical old bastard. But even stopped clocks are right twice a day, and in this case I have grown to appreciate his words.

I don't deny that for some, medicine IS their calling. They will devote themselves entirely to it and will achieve incredible things. They will spend their lives making an amazing contribution to other people and I admire them greatly for it. But it's not for me. Not anymore.

I'm not prepared to make medicine my life. Maybe that will make me a bad doctor. But I think it will make me a better person.

Care factor

2011-12-12T00:09:00.001+10:30

So that's the end of medical school I guess. Looking back, by far the most useful classes I got were the tutorials on taking a medical history from somebody. I'm not sure if it's true that 80% of diagnoses can be made on the basis of history alone, but it certainly is true that if you can't take a good history you'll look like a idiot at least 300% more frequently.

In those classes we were also given a few other useful tips. The one I have made best use of is how to handle the inevitable questions that you start getting from family and friends as soon as you start medical school, asking for medical advice. The advice was to simply say, "You should talk to your doctor about that." Not only does it absolve you of responsibility for serious illnesses, it also avoids getting entangled in dull discussions of minor ailments. In fact, it can be used in a wide variety of contexts, even non-medical ones!

Here are some real-life examples:

Friend: "I have this terrible rash in my crotch, what do you think it is?"
PTR: "You should talk to your doctor about that."

Friend: "I'm incredibly thirsty all the time and I've been losing lots of weight."
PTR: "You should talk to your doctor about that."

Friend: "I have crushing central chest pain that radiates to my jaw and left arm, shortness of breath, nausea, sweating, and a feeling of impending doom. Aggggghhhh the pain!!!! The pain!!!! Hhhhhh ... can't ... breathe ..."
PTR: "You should talk to your doctor about that."

Supervisor: "You're the worst medical student I've ever supervised."
PTR: "You should talk to your doctor about that."

Mechanic: "Looks like you've blown your head gasket."
PTR: "You should talk to your doctor about that."

Try it tomorrow, you won't be disappointed!

All Australians are thieves

2011-12-12T00:03:00.001+10:30

The Hatchling was just over a year old when I first caught her shoplifting. She was in the pram, we'd done a circuit of a shop, nothing much had really caught my eye, so we'd moved on down the road to another store. En route I looked down and saw that she had a bright green toy bird in her hand that I had never seen before. She looked very pleased with herself too. She must have just reached out and grabbed it without me noticing. Very light-fingered.

I took it back to the shop and asked if they sold birds like this. They did. I explained that my daughter had stolen it. They complimented me on my honesty.

I've spent the three days since trying to get her more interested in Omega watches and black truffles. No progress so far.

Clouds, Mt Kosciuszko

2011-12-03T22:42:00.001+10:30

Out

2011-11-30T09:45:00.001+10:30

As you may have noticed on your daily peregrinations to the shrine of this blog, I ain't been updating it much recently. Reason being, we've moved. Again. You know how much I hate moving and also how often I've had to do it, so I won't bore you with the psychological background this time. But the circumstances of this move are interesting (I think).

Way back in the dawn of time, in October 2010, we shifted into House Minus One (present house being House Zero). At the time I had just had a nasty fall-out with my clinical supervisor, my exams were a few weeks away, and my beloved Smaller Half was about to give birth the Hatchling, and we had to find a house to live in. Time was short, so when I found an airy, spacious house in the hills I signed on the dotted line and didn't worry too much about the little niggly voice in the back of my head telling me to be careful, especially since the landlord seemed so houseproud and promised that the collection of little maintenance issues would be taken care of pronto.

Fast forward 6 months and nothing had changed. The landlord had gone awol somewhere in Bulgaria to star in adult films and as a result the curtains were still moldy, the paint was still peeling off the ceiling in the Hatchling's room, the fan in the bathroom still didn't work, and so on in that vein. We kept hassling the real estate agent but she was helpless to act without the landlord's say-so. When the hot water system leaked into the ceiling we could get that fixed. And when the drains blocked up time and time again we could get that fixed. But that was about it.

Then the landlord came back and started hassling the real estate agent about the fact that we needed a plumber every week. Somehow this was our fault. He'd done so much for us already, apparently. Then the smell started.

The smell was more of a stench. It started one day immediately after the plumber had come round to ream out the drains again. Strangely, it was localized to one room only and got worse when we opened the windows. We kept complaining about it and the agents kept saying that there must be a dead possum in the roof despite me telling them back that it didn't smell like a dead possum unless perhaps the possum had died of dysentery.

Eventually we cracked. There was mold growing on the walls of our bedroom and on the curtains and windows all around the house. The Hatchling's room stunk. The drains kept blocking. And and and and and and. So we bailed - we got a new house next suburb over and wrote to the agent saying that we were giving them two weeks notice to break our lease and we weren't going to pay a penny more because the house was a dump. We also got a letter from our GP saying that mold was a health risk, just to put a nice medicolegal aspect on the whole thing.

The agents were a little taken aback but it turned out that they were so jack of the landlord that they wanted to ditch him too because it was more trouble than it was worth. So they bullied the landlord into letting us not pay any more rent even though we had six months left on the lease. The landlord pushed back a bit and insisted that we let a building inspector take a look at the place. And his conclusion was that there was a leaky sewage pipe under the house. Which would account for the smell, the damp, the mold, the blocked drains. So ha ha sucked in Mr Landlord. Take your smelly house and jam in up your cribriform plate.

Functional anatomy of the tongue

2011-11-18T09:07:00.001+10:30

The muscles of the tongue can be divided into two groups, extrinsic and intrinsic.

The extrinsic muscles are named for their bony attachments. Their function is to control the position of the tongue within the oral cavity. The extrinsic muscles are:

Genioglossus, which attaches to the mental prominence of the mandible and acts to protrude the tongue,
Hyoglossus, which attaches to the hyoid bone and acts to depress and retract the tongue,
Styloglossus, which attaches to the old-school stylus and acts to scratch up some wicked beats,
Cranioglossus, which attaches to the head-bone, and acts in amateur local theatre.

The intrinsic muscles of the tongue have no bony attachments and are named for their function, which is to modify the political affiliations of the tongue. The intrinsic muscles are:

Tyrannoglossus, which acts to increase centralized control of government,
Populoglossus, which acts to decrease centralized control of government,
Socioglossus, which acts to move to the tongue to the Left,
Conservatoglossus, which acts to move the tongue to the Right, particularly in New South Wales.

The innervation of the tongue is complex. Motor control of the tongue is primarily via the 59th cranial nerve, the Diagonal Tongular Nerve (CN LIX). Sensory afferent fibres from the anterior 2/3 of the tongue, carrying gustatory sensation for salt, sour and umami, course westwards along the state boundary, evading authorities for weeks before holing up in an abandoned farmhouse and dying in a shootout at the end of a protracted siege. Sensory afferent fibres from the posterior 1/3 of the tongue, carrying gustatory sensation for sweetness, bitterness and elbo cheese, join the lingual nerve, before diverging acrimoniously and writing a tell-all memoir.

Vascular supply to the tongue is via the lingual artery, a branch of the external carotid artery, which is a branch of the carotid artery, being the twelfth exit from the Southern Expressway, but only between the hours of 2pm and 1am. Venous drainage occurs in the reverse direction between 2am and 1pm. This schedule is inverted on weekends and public holidays when the tongue is expected to be more active in the evening.

Clinical spills

2011-11-17T19:29:00.001+10:30

It's kind of hard to believe, but soon I'll be a doctor.

I've done all of my assessment.
I have eleven days left on the wards.
Two weeks after that I'll graduate.
In January I'll start working.

And yet, frighteningly, I am unable to diagnose a simple case of tonsillitis.
Despite having been in the ear-nose-throat team for just shy of a month.
And it was in my own child, the Hatchling.
I shone my torch down her gullet and said, "Nope, those tonsils look fine".
Well, apart from the exuded pus, apparently.

I'll give myself part marks for actually thinking of it and checking for it, but zero (obviously) for my actual clinical skills.

Majestically swept back

2011-11-15T12:12:00.001+10:30

Here's a time-saving tip: you don't need to keep track of whether or not you need a haircut because eventually people will start reminding you themselves.

I was late yesterday morning and intercepted my team halfway through the ward round. I apologised for being late and said that I'd been racing around trying to find them. The Big Boss said to me, in his kindly voice, "That's okay PTR, we can see from your hair that you can walk very fast indeed."

A nifty quote

2011-11-14T22:52:00.001+10:30

"It is interesting to note that patients who have been stabbed do not usually describe the pain as stabbing." - Pocket Clinical Examination, Talley & O'Connor, 3rd Edition.

Confidential

2011-11-13T23:21:00.001+10:30

A couple of weeks ago I got roped into a teaching session for the 2nd year students by my surgical team. They were running a rotating series of 5 or 6 learning stations for about 8 students per group, and since one of the registrars was away they got me to run a station instead of him.

In the other stations the big boss surgeons sat the students down and presumably taught them surgeony things like the best bottle of red between $50 and $75, and who the best trainers for racehorses are. My station, bizarrely, was a test. Tough luck if you got the test first before you'd been taught anything. Not that it really mattered because the test didn't count for anything.

It seemed to me to be a pretty pointless exercise. Also, watching people do tests is not my idea of fun, so as each new group came into my room I would explain that they could choose between doing the test by themselves or having us all sit around and talk about the answers. To their credit (I thought) the groups all chose a middle path and had a crack at it themselves before having a discussion afterwards.

The discussions were good. I would let them air their theories about what they thought was the right answer and why, and I made sure that everyone contributed at some stage, before I would tell them what I thought was the right answer (note the important caveat there - I was not given the answers) and why, and then we'd discuss it some more. I got the impression they all found it kind of useful and somewhat interesting.

I was told to collect the papers but made an executive decision that the students might as well take them home instead, seeing as I pretty much told them all the answers anyway. As a result I had this almost surreal conversation with one of the surgeons:

Indignant Surgeon
Where are all the test papers?

PTR
The students took them home.

Indignant Surgeon
How will the students know what the right answers are if we don't mark their papers?

PTR
I suppose they could always look things up.

Indignant Surgeon
But they'll pass the information on to the other students in other groups who haven't sat the test yet!

PTR
The test doesn't count for anything, right?

Indignant Surgeon
We'll have to change the test.

To recap, he was upset that students might go away and learn something, and even worse, might help other less motivated students to learn something too! Silly me - I forgot that medical education has nothing to do with educating people. It's actually all about making sure that people feel bad about how ignorant they are.

I was discussing this with my Smaller Half and she pointed out the additional absurdity that there is no way in hell that a surgeon is going to sit there and mark 50 exam papers that don't even count for anything. I suggested that it would probably have been passed down to the Fellow, who would dump it on the Registrar, who would delegate it to the RMO, who would handball it to the Intern, who would sling it to me.

So not only was I able to actually teach people something, I also thwarted a stupid plan and saved myself some dull work in the process. Win-win-win.

Tiling, Seville, Spain

2011-11-12T10:16:00.001+10:30

Sticky dates

2011-11-11T10:26:00.001+10:30

Centrelink, from whom all benefits do flow, is ever so slightly frustrating because their payment timetable does not accord with my Smaller Half's pay week. This means that I need to analyse her paysheets and divvy them up into the overlapping fortnights into which Centrelink carves up time.

A similar situation exists in the unit that I'm with at the moment at the hospital. Rather than having a weekly schedule so that I can turn up to the operating theatre and say, "If it's Wednesday you must be Mr Farkas", they have a four-weekly schedule. So there are meetings that happen on Wednesday of Week 2, or Friday of Week 4.

Although this complicates my life slightly, I can cope with it. It gets annoying though because there are other meetings/events that happen on the third Thursday of the calendar month, for example. So there are clashes with the four-weekly timetable which means that things are Never As They Seem.

Again, this is something that a somewhat intelligent and sophisticated person such as myself should be able to deal with. Unfortunately the Big Boss Surgeon is quite old and grew up in Tsarist Russia and still denounces the Gregorian calendar as a communist conspiracy. As a result, whenever he's around we all have to pretend that it's thirteen days in the future. This meant that not only did I have to come in on a Sunday, I also missed out on my birthday.

I got so fed up with this that last week I didn't bother to go in at all. When I turned up this week I was going to tell them that I'd been at home preparing for the Mayan apocalypse, but since I'd been using a reconstruction of Antikythera Mechanism to calibrate my diary I'd erroneously thought that it was going to happen on November 3 2011 rather than December 21 2012. Unfortunately I'd forgotten that it was Daylight Saving so I was an hour late and they'd already finished the ward round and gone off for coffee so I missed them entirely.

Frosty

2011-11-10T08:51:00.001+10:30

So today's lesson for beginners is this: when the surgeon walks up to the team and asks, "Is everyone good?", the wrong answer is, "I'm great thanks!"

They are not interested in you. They are asking about the patients.

Timing is everything

2011-11-04T22:48:00.000+10:30

Registrar
So what structure do I need to be careful of when operating just here, PTR?

PTR
The facial artery?

Registrar
No.
PTR
The external carotid?

Registrar
No.

PTR
The cervical branch of the facial nerve?

Registrar
No, the marginal mandibular nerve.

PTR
?!?

[Enter Consultant]

Consultant
So, PTR, what structure should the Registrar be careful to preserve in this area?

PTR
Hmmm. The marginal mandibular nerve?

Consultant
Yes, that's right. Excellent!

[Exit Consultant]

PTR
So - what's this marginal mandibular nerve then?

Bohemian rhapsody

2011-11-02T15:58:00.000+10:30

People often ask me why I decided to study medicine. I usually lie to them and tell them that I wanted to help the helpless, bring hap to the hapless, and so on, especially if it's an interview panel or they are dressed like the Three Amigos. But the truth is that I did it because I really like funny names.

Medicine is chock full of conditions, diseases, syndromes, body parts, microbes, and devices that have been named after people. The number of things is so vast that all of the Bakers, Browns and Smiths got in early, meaning that the field is wide open for people with unusual and sometimes amusing names to be enshrined for all posterity.

So it helps me while away the hours thinking about how Reiter's syndrome is different to writer's block, or why Kawasaki disease has nothing to do with motorcycles, or how Wohlfart-Kugelberg-Welander disease has the word "fart" in the middle of it. Snigger. This is PTR's First Law Of Comedy: funny names are funny.

The problem comes though when you find out that the condition that you're laughing at the name of is serious, horrible, and generally dire for all concerned. This is PTR's Second Law Of Comedy which contravenes the First Law: dead people aren't funny.

Fortunately, I have recently discovered PTR's Third Law Of Comedy, which contravenes the Second Law: dead people are funny if they happen to have been officers in the Prussian army during the 1866 campaign against Austria in Bohemia.

As evidence, may I present Exhibit A:

Verdy du Vernois
von Wartenleben
Schlotheim
von Tumpling
Finck von Finckenstein
Prince Kraft zu Hohenlohe Ingelfingen

These names are fantastic, and in fact I feel a bit disappointed that they chose the military life rather than the medical. Just imagine finding out that you've ruptured your Ligament of Ingelfingen, or that your doctor was about to slot home the Schlotheim speculum. Now that would be worth the pain.

Eye opener

2011-10-26T18:12:00.000+10:30

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.

Play it as it lies

2011-10-25T16:42:00.000+10:30

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:

They know all about "Code Brown".
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.
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.

Roof, Seville

2011-10-23T23:42:00.000+10:30

I've got your deposit right here

2011-10-22T09:30:00.000+10:30

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.

Praise me

2011-10-20T14:18:00.000+10:30

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."

Nutri-brain

2011-10-18T22:38:00.002+10:30

Registrar
So once the mRNA is produced, what happens then?

PTR
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.

Not really

2011-10-14T13:30:00.000+10:30

Checkout Person
That'll be $87.76

Smaller Half
The register only says $28.76

Checkout Person
Oh, you know what I mean.

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

2011-10-13T19:16:00.000+10:30

Nurse
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.

PTR
That's terrible.

Nurse
No, it's not.

PTR
?

Nurse
It's unacceptable.

Extreme child care

2011-10-12T13:51:00.000+10:30

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.

Bark, Flinders Ranges

2011-10-01T19:26:00.001+09:30

Clouds in my coffee

2011-09-29T22:30:00.001+09:30

In the middle of my day I found myself lost in a bureaucratic meeting. People were talking words that I knew but their meaning was obscure to me. There was discussion of leveraging client actualities, of service overlap, and of negative expression of emotion prior to an upcoming facility transfer.

So I wrote some poems in the haiku style instead.

There's a cardboard box in our doctors' office that has the coffee supplies in it. On the sides are written poems in the haiku style about or inspired by coffee. Coffee haikus - I hear you think - what a bunch of hipsters. And truly, there is no defence against such an accusation. The ones I wrote are pretty damn good though...

A warm cup to hold
To take the place of a hand.
Welcome to the tribe.

Black? White? Some sugar?
Do you embrace or mask the
Bitterness of life?

The top 10 songs in which you can substitute "fart" for "heart"

2011-09-25T21:14:00.000+09:30

My Fart Will Go On - Celine Dion
Unchain My Fart - Ray Charles
Two Strong Farts - John Farnham
What Becomes Of The Brokenfarted? - Jimmy Ruffin
Achy Breaky Fart - Billy Ray Cyrus
Good Farted Woman - Waylon Jennings & Willie Nelson
Fart Of Glass - Blondie
Fartbreak Hotel - Elvis Presley
Listen To Your Fart - Roxette
Sgt Pepper's Lonely Farts Club Band - The Beatles

Not thinking about elephants

2011-09-24T08:54:00.003+09:30

Psychiatrist
Well, what would you like to talk about in today's tutorial?

Registrar
Oh, anything at all, as long as it isn't the Oedipus Complex again.

Psychiatrist
It's interesting, isn't it, how the Oedipus Complex often brings out these types of very strong reactions from people. It just makes you think that Freud must really have been on to something. I know you don't want to talk about it but there are some fascinating things to consider such as how...

[One hour and fifteen minutes pass]

... ending in the destruction of civil society and the slow rebuilding up again which is, of course, the tragedy of man's inability to process or work through the Oedipus Complex.

Urban legends

2011-09-22T17:51:00.000+09:30

The Candyman
Legend: If you look at your reflection and say "Candyman" five times, he will appear and brutally murder you.
Status: False. This is actually the plot of a 1992 slasher film.

The Handyman
Legend: If you look at your reflection and say "Handyman" five times, he will appear and unblock your drains.
Status: False. There is no way to summon a handyman when you need one.

The Randyman
Legend: If you look at your reflection and say "Randyman" five times, a sexually aroused man will appear.
Status: True. But only if you're a highly narcissistic adult male.

Thatch, Kuala Lumpur

2011-09-21T00:01:00.000+09:30

Clinical audit audit audit

2011-09-20T23:27:00.003+09:30

Introduction
Although most medical students are accustomed to producing audits, few are used to audit auditing. Thus, this audit audit audit audits audit audits to measure their compliance with the protocol suggested by the Trans-Tasman Council of Amateur Humorists (TTCAH) and makes recommendations to improve the audit auditing process.

Method
Ethics Approval
Ethics approval was sought for the audit audit audit because of the high likelihood of two adverse events:

That those exposed would find it so unutterably funny that they might bust some kind of internal valve from laughing so hard.
That those exposed would find it so unutterably tiresome that they might lapse into a narcoleptic coma and miss their next dental appointment.

The Ethics And Human Research Committee advised that ethics approval would not be granted for such diabolically try-hard self-deprecation as contained in this sentence and thus the final audit audit audit would contain no such sentences. Otherwise they said it would be fine.

Selection of audit audits
The auditor briefly considered a range of semi-humorous methods that may have been employed to find and select audit audits before deciding that it was getting reasonably late and he wanted to get on with the main business of making stupid jokes so he would just present the selected audit audit for audit as a fait accompli with a white wine sauce and simply post a link to it. (LINK)

Analysis of audit audits
The selected audit audit was briefly reviewed to refresh my memory and some suitable categories were invented in order to produce a few graphs that were relevant to the audit audit. These, coincidentally, are also identified in the TTCAH protocol for audit audits as being both necessary and sufficient for a late night blog post stretching one simple idea out to several hundred words, to wit:

Snappy title
Thin veneer of respectability
Classical allusions that are actually totally bogus
Leaving the door open for a sequel just in case it works this time.

Results
The audit audit audit revealed that the audit audit had been undertaken with due regard for TTCAH processes. This is clearly illustrated by the following charts:

Snappy title - check!

Thin veneer of respectability - check!

Classical allusions - check!

Sequel - check!

Recommendations

That I go to bed soon.
Bacon and cheese toastie.
More charts.
Sell! Sell! Sell!
Shift down a gear once you hit 2000 rpm. This is also true of driving.
Winning the Victoria Cross twice.
Banana (serving suggestion).

Clinical audit audit

2011-09-19T23:44:00.002+09:30

Introduction
As part of the final year of the medical degree at this Fine University, students are required to complete a clinical audit. This audit examines the adherence of the auditors to the auditing protocol and makes recommendations to improve the auditing process.

Method
Ethics approval
Since this audit was conducted only upon the auditors self and was entered into voluntarily, no ethics committee approval was sought or, therefore, granted.

Selection of audits
A retrospective selection of all audits undertaken by the auditor during the 2011 was performed. The auditor's email account and hard drive were searched for all files containing the words "audit", "overdue", "panic" and "apathy". This resulted in the retrieval of several thousand files which would be impractical to search by hand, so they were further searched for the tags "piece of shit". One record was retrieved, a clinical audit recently submitted by the auditor.

Analysis of audits
The audit was examined for the following key items, drawn from the guidelines to auditing published by the International Lazy Students and Bullshit Artists Association (ILSBAA):

Excessive verbosity clearly intended to boost word count.
References farmed from unreliable online sources such as Wikipedia.
Formatting and structure plagiarized from example audits provided to students.
Meaningless recommendations.
Precision in statistical calculation used to distract from data collection flaws.

Results
For each audit audited, a high degree of adherence to the ILSBAA protocol was found, as shown in the charts 1 through 5 below:

Discussion
Notwithstanding the recent episode where the auditors audit was submitted late for no reason other than his inability to submit the audit on time, the auditor found that the audit was conducted largely in accordance with the ILSBAA protocol, or else in a sleep-deprived stupor, which is also an approved method of production of student audits. Acute observers may question why confidence intervals were not calculated and quoted above, to which the audit auditor may only quote Demosthenes in the Palladium when he was stabbed in the Ides by the Emperor Octagon: "Auditor, audit thyself". Whilst the relevance, and indeed the veracity of this quote are lost in the dawn of time, it cannot be denied that they most usefully added some sorely needed bulk to this paragraph and furthermore avoided it being a one-joke section, albeit at the expense of some rather heavy-handed surrealism.

Conclusion
It is recommended:

That further audits by this auditor be audited to determine adherence to the ILSBAA protocol.
That this audit audit be audited.
That the audit audit audit be audited in order to complete the third repetition really needed to hammer the point home.
That you send money now.
That you read Dune by Frank Herbert. It's full on shit, man.

Botanic gardens, Madrid

2011-09-14T00:01:00.000+09:30

Lost

2011-09-13T15:27:00.000+09:30

There's a scene in one of my favourite films, Star Wars, where Indiana Jones is describing how clueless his colleague is by saying, "You know Marcus. He once got lost in his own museum". Well - today I got lost in my own Emergency Department.

In my defence, it was only my second day. Plus, there are extensive renovations happening so there are temporary walls being flung up that seem to move on a daily basis, opening up mysterious corridors haunted by bull-headed freaks (sorry - by surgeons) or sealing up unwary strangers inside wall cavities to be entombed forever.

Also, when I was given a tour yesterday I got the impression there was (currently) only an A side and a E side (don't ask me what happened to sides B,C and D. Perhaps a mad geometer proved them to have zero length, or perhaps they got together with Type 3 renal tubular acidosis and ran away to join the circus). But it turns out that the A side has two halves which look really similar, like the Olson twins, so I went to the wrong one and walked around it several times looking like someone on one of Escher's endless staircases.

Plus, I was tired.

It's not the first time I've gotten lost (or as I prefer to think of it, afflicted by momentary topographical ambiguity) but it was the most embarrassing. Not only did I run into two of my Esteemed Colleagues who had to free me from where I had become wedged behind a vending machine, I had in tow an unfortunate and quite distressed woman whom I was attempting to take to her husband who was a patient. So at first I got just a bit sheepish when I couldn't find his bed number. Then I got to side A part 2 and located his bed, flung back the curtain with a dramatic flourish, only to find it occupied by a complete stranger. Awkward!

I recruited the help of some bemused nurses who checked the compooters and showed me that while we'd been careening around in circles in the wrong area, my guy had been transferred to the E side, which is where we'd come from. It didn't take me too long to find our way back but I could only do it leaving the ED and starting again as if I was arriving in the morning.

Tomorrow I'm taking in a bag of breadcrumbs.

First depressions last

2011-09-13T00:04:00.000+09:30

Like you, I've been feeling under the hammer a bit recently, what with the Hatchling to look after, a rogue assignment rampaging through my spare time, and some pesky Hittites to suppress. Busy busy busy.

Or so I thought.

Today I met someone who is about to complete their big scary ED exams, they are also training for some intense athletic event, they have two kids, they dress with elegance and poise, and they are a really nice person too. They probably also play woodwind in a symphony orchestra.

People like that should be banned.

New adventures in cheese

2011-09-06T11:44:00.001+09:30

Like you, I bought a big block of Nimbin cheese today. No, "Nimbin cheese" is not some kind of euphemism for psychoactive substances. (For those of you not from Australia, Nimbin has the widespread reputation, rightly or wrongly, as a hive of hippies with heaps of hemp.) Nimbin cheese is in fact a cheese produced in Nimbin.

I was so surprised to see it right there in the stupormarket that I bought it without really thinking about it. I don't even know what type of cheese it is. Presumably it's a tasty cheddar or something similar. Gets up to look in fridge ... oh my god - it's something called "Elbo style cheese". Eurgh. I know that Elbo cheese must be a real and delicious thing, but the name is very unappealing, sounding like the consequences of a long-neglected personal hygiene regimen.

Anyway, I think that the reason I bought it was because of its colour. Sitting there on the shelf amidst the other (non-elbo-style) cheeses it really stood out. Yellow, dark yellow, yellow, pale yellow, green, yellow ... wait - green???

Yes, Nimbin cheese is green. I was so enraptured that I threw it into my basket without a moment's further thought. I thought about it all the way home though. This cheese, from the home of the hippie, is a triumph of marketing. Distinctive name, distinctive colour, colour has multiple connotations directly linked to the distinctive name (green = eco & green = dope). The only comparable idea I can come up with right now would be to sell a Tony Abbott blue. But the idea of somehow extracting milk from Tony Abbott to make it is an even worse concept than Elbo cheese.

Which is why I was so bitterly disappointed when I got home and unpacked the shopping and found a plain old boring block of pale yellow cheese in my bag. Had I grabbed the wrong cheese off the shelf in my excitement? Was the green colour just a product of my fevered imagination when I read that it was Nimbin cheese? Was I stoned out my mind?

No, no, and no. It turns out that Nimbin cheese is not green at all. It's just ordinary looking cheese inside a wrapper which is green on the front and clear on the back. Man... I've obviously read Green Eggs and Ham one time too many.

Rusty steel sculpture, Madrid

2011-09-05T00:01:00.001+09:30

Blogging

2011-09-04T23:05:00.000+09:30

Like you, I've been pondering this strange thing called "blogging" a bit recently. I very nearly called it quits with this blog recently but decided to just leave it and stew for a while instead. Ultimately I seem to have decided to keep things going, so I suppose that's good for those of you who come here to read this stuff because you enjoy it rather than because you hate me and you're slowly assembler a dossier to clonk me over the head with one day when I'm running for Prime Minister.

Anyway, one I'd stopped writing here frequently I suddenly became unable to figure out how to start again. I kept thinking of ideas but was unable to develop them in my head into fully-fledged posts ready to leave the nest and soar the information superdooperhighway without me. It took me about three weeks to realize that that has always been the case. I don't develop these posts in my head at all.

What actually happens is that I have an idea or two, or maybe not even that - sometimes just a feeling that I need to discover or explore - and I sit down and let things go. That's why it's fun. Planning things is not fun. Doing things is fun.

When I succumb to the urge to plan I usually find myself trying to perfectionize things, which results in a clean crisp dull icy ache in my brain and a clean crisp dull icy ache on the page. Sure, structure is good, and structure is something that is probably a good idea to plan, especially if you're trying to make some kind of point. Fortunately for me I seldom am in such an unfortunate position. I have the liberty of just blabbing all this stuff down onto the page.

And why? Why do I do it? Mostly just so I don't think so much about it any more. Once I notice that there's a post welling up inside me I tend to start to overthink it, which, as mentioned above, kills it. So the more frequently I blab this stuff, the sooner I can launch my unconscious out through my fingertips and onto the screen.

Stand by stomach, here come banana!

Profundity

2011-08-30T10:03:00.000+09:30

Why are they called recorders when they can only play?

Exterior wall of Mezquita-Catedral, Cordoba

2011-08-29T00:01:00.001+09:30

Horse artillery

2011-08-28T10:14:00.000+09:30

Like you, I've always been unsure how to use horse artillery effectively. I've been doing some research on the matter, and it seems that the way to handle them is to gallop right up to the enemy infantry and use your cannon to shoot large iron balls at high velocity into their ranks, rending limb from limb, soaking the ground with blood, and tearing the veil from Death's face so he stares them right in the the eye.

Art meets science meets Aspergers

2011-08-26T23:16:00.000+09:30

Like you, I'd never really paid much attention to textures until I tried to get my computer to recognise and classify them using a Wold-like decomposition. This was for my honours project in engineering - as previously noted in these pages, I managed to get an electrical engineering degree even though I only did two classes on electricity, one of which I failed the first time around because it was too easy.

As a result of my hate-hate relationship with electricity, I fell into signal processing, basically because the mathematics of it all kind of clicked for me. What I was trying to do was nothing particularly original - I was just trying to duplicate some results I found in a paper with a view to extending the method later on. Of course the extending bit never eventuated because I sat on my backside for 7 months then crammed all the work into the last couple, but anyway.

The general idea was that I would feed these texture swatches into my computer which would do some two-dimensional signal analysis on it, treating it as a sum of a deterministic signal found by Fourier analysis and a random signal being a random number generator being fed into a filter. This is a Wold-like decomposition. The computer would assemble a library of texture signatures and then if you gave it a new swatch it would spit out a list of which textures resembled it the most closely.

The hope was that the textures that the computer thought were most similar would also be the ones that a person would think are most similar, thus ushering in a new era of happiness and plenty throughout the globe. This too did not eventuate.

The textures I was working with were a semi-standard set of photographic plates known as the Brodatz Textures. Here's a link to them: <linky>

So that's all a prelude to the main point, which is this: textures are interesting. Once you start really looking at textures and trying to think about what makes them unique, you notice that lots of things - in fact, pretty much everything - are covered with interesting textures. Grab some random object and examine it right now. Really peer at it closely, turn it to and fro in the light. Take the time to notice what you've always taken for granted. The object may be ugly but it's not because of its texture. What is an ugly texture? Do this regularly, day after day, and pretty soon the world is a richer and more beautiful place to be in, which will compensate for all those friends you've lost by behaving like such a freak.

If you're now more enthusiastic about textures, here's some things to ponder:

Is the texture you're looking at more cellular or is it more amorphous?
Is the texture you're looking at designed or is it emergent or natural?
Is the texture you're looking at due to colour variation on a surface or is it due to lighting effects on a surface of varied elevation or both or neither?
Does this texture have a direction?
Does this texture have a size or scale?
If a person had this texture on their forehead would they resemble an alien from Star Trek or a severe dermatological condition?

It's not an exhaustive list by any means but it should be enough to get you started. Go forth and enjoy textures today!

This week I have been mostly thinking about

2011-08-25T08:35:00.000+09:30

Sabbatical

2011-07-31T21:25:00.000+09:30

Just so you know, I'm hanging up ye olde keyboarde for a while. I need a break from this place. Lots of ideas coming and going all the time but to be honest my interest in bothering to capture them for the Library Of Congress and the CIA is pretty minimal right now.

So I'll be going back to basics for a while. See you when I see you.

Shadowlands

2011-07-30T23:28:00.000+09:30

This is something that I almost didn't write but I need to write it to keep going here, so forgive me my sentimentality.

I won't lie - having the Secret Cat die last week was awful. She was 19 years old, and although we didn't start to look after her until she was about 10, it still feels like a lifetime.

In the end, we had her put down by the vet. She had been deaf and blind for about a year. Surprisingly, she adapted well to moving into a new house, and she learned to find her way around. Gradually though, she got sicker and sicker, slowly getting thinner and thinner and wasting away. Part of it was arthritis. She clearly was uncomfortable moving. But part of it was the slowly evolving diabetes that we didn't know about.

Lots of people said we should have her put down, but we always thought that she was still enjoying life. She'd find the sunny spots somehow. She'd find her way to the kitchen when she could smell us cooking and ask us for some meat.

In the last fortnight though, things went downhill fast. She got painfully thin. She seemed to have trouble walking straight and seemed to get lost. And she sometimes got very weak and couldn't straighten her legs out. We would find her crouched on the floor in the morning, stranded in the dark for who knows how long, waiting for us to rescue her.

A cat that can't or won't move is a cat that is suffering. And we couldn't watch it, and there was nothing we could do to help her. So we took her to the vet one last time.

It was such a hard decision to make. I knew what my decision was though, when I found myself hoping that she had died overnight so that it would be over for her, and for us. At least this way we could be there with her as she died. I think she deserved that.

I'm glad that we had her put down when we did. Any earlier and it wouldn't have been right for us - we would have felt that we did it for convenience. Any later and it wouldn't have been right for her - she would have suffered too much.

But it doesn't make it easier when the time comes. It had never occurred to me that you sometimes need to plan these things. There was no last minute call to the vet, begging for help in an emergency. There was just an appointment made, a schedule to keep.

We walked out with an empty cage. And she danced by the light of the moon, the moon, the moon - she danced by the light of the moon.

Heartache

2011-07-22T23:30:00.001+09:30

The Owl and the Pussy-cat went to sea

In a beautiful pea green boat,
They took some honey, and plenty of money,

Wrapped up in a five pound note.
The Owl looked up to the stars above,

And sang to a small guitar,
'O lovely Pussy! O Pussy my love,

What a beautiful Pussy you are,

You are,

You are!
What a beautiful Pussy you are!'

Pussy said to the Owl, 'You elegant fowl!

How charmingly sweet you sing!
O let us be married! too long we have tarried:

But what shall we do for a ring?'
They sailed away, for a year and a day,

To the land where the Bong-tree grows
And there in a wood a Piggy-wig stood

With a ring at the end of his nose,

His nose,

His nose,
With a ring at the end of his nose.

'Dear pig, are you willing to sell for one shilling

Your ring?' Said the Piggy, 'I will.'
So they took it away, and were married next day

By the Turkey who lives on the hill.
They dined on mince, and slices of quince,

Which they ate with a runcible spoon;
And hand in hand, on the edge of the sand,

They danced by the light of the moon,

The moon,

The moon,
They danced by the light of the moon.

- Edward Lear

In memory of Belle, 4 March 1992 - 22 July 2011

Kapow!

2011-07-20T23:30:00.000+09:30

After my glorious salmon joke yesterday, I was zinged back by the consultant today. He was examining a little 5 month old girl and she kept craning her head back to peer at me where I had suddenly appeared above her head.

Consultant
She is trying very hard to look at you.

PTR
It's because I'm so handsome.

Consultant
I am very worried about her eyesight.

Courage

2011-07-19T13:01:00.002+09:30

Sometimes an opportunity to make a stupid joke arises and you just have to seize it. This morning I was standing in the room with a patient, her mother, the consultant, two registrars, an intern, and four other medical students. We were discussing animal vectors of infectious enteritis.

Consultant

So, PTR, what type of animal is a frequent carrier of salmonella?

PTR

Salmon?

He laughed. In a strained, God-help-me kind of way. I was so proud of myself for not wussing out. (For the record, the correct answer is "reptiles". So not only are Galapagos tortoises immune to ouabain, they are also dangerous to kiss.)

Apocrypha

2011-07-19T12:39:00.000+09:30

I usually have a small notepad secreted somewhere about my person where I jot down phone numbers, book references, interesting quotes, and other things that I am otherwise liable to quickly forget. Scattered throughout the book will be little seeds of ideas for things to post about here. About half the time I follow up on it. About half the rest of the time I'll decide the idea is a dud. Very occasionally I'll decide that an idea is good but would be more effort to complete than I'm prepared to give. And the rest of the time I find the note at some later date and think to myself, "What the hell is that supposed to mean? I must have been smoking crack."

Sometimes I can look at a note and clearly remember the circumstances under which I wrote it - just not what the note actually signifies. Sometimes a note makes me think of something quite definite - but I'm pretty sure it's not what I meant myself to think of when I wrote it. Sometimes a note is truly mysterious - it's in my hand but I have no memory of it at all.

Here's a collection of extinct blog prompts from the last couple of years. It resembles the ravings of a madman, so I've chosen to arrange it visually to resemble poetry - the poetry of driftwood and lost balloons and old photos.

Muntries
Sealink!

favourite bowl

Thar she blows!

character "in" a book - from? of?

Greatest American Hero

Wolf Creek Cafe
Calendars and other people's dogs
egogram

Kit fox

itch! actual ants!

glasses with bizarre sideboards

Shadow puppet - doctor?

Sad second-hand stores

HOTKEYS = NERDS

CREATION - FRANKENSTEIN

David Bowie over 20 years

Body dysmorphic effect vs re-reading own writing

aqueous humour - watery joke?

visualizing blood vessels!

eating vs studying - good-bad or bad-good

gold injections!

stress reduction kit

only girls and Italians cook

presentation - ongoing fear

who wants a ride up?

SHOP ANGRY

tuning fork

BKA v DKA

chopping veggies - not dice!/cubed! chinese style

on screws

book cover/binder

concentrate on not reading things

awards for med school

a blob for you

psychic expo

smelling like chicken

towel - bee - cold - A-delta - alfalfa

lostradio - insulting people, standing in dog shit

Colonel Light's laser powers!
evil genius of Pat Rafter accumulating sinisterness
What's next?

New poll

2011-07-18T19:01:00.000+09:30

It's been quite a while since my last poll. If I remember rightly, the Mob called for my child to be female and lo, I complied. Since then I've been a bit distractabubble and haven't been able to think up something to poll you about. So that's what I'll poll you about. It's up now to the right ->

Vote now or else you won't!

Maslow's hierarchy of blogging

2011-07-16T23:06:00.002+09:30

Naming. When finally committing to starting a new blog, a blogger needs to find a unique name for his blog which at once indicates his depth of thought as well as his insouciant whimsicality toward the whole thing. He also needs an online handle which will fulfill the same needs for him.
Posts. Now that she has a blog name and a handle, the blogger actually needs to post something. She feels fulfilled by coming up with an idea and writing something observant or clever which is long enough to be worth reading but not so long as to not be worth reading.
Comments. Once fulfilled by his ability to generate posts on a semi-regular basis the blogger is driven by his insatiable need for comments. He will seek them out by asking questions in his posts, leaving comments on other blogs to lure readers to his blog, and casually mentioning the fact that he has a blog that people leave comments on to acquaintances. He will check his blog dozens of times each day to see if there are any new comments.
Subscribers. Comments are eventually taken for granted as merely the blogger's due return for her efforts. What she really wants now are subscribers, a.k.a. followers. She wants a little band of imaginary friends who owe her fealty and might perhaps, in the event of some kind of internet war, be drafted into her private army to fight for her. She imagines that they check her blog dozens of times each day to see if there are any new posts.
Notoriety. The blogger has now gathered his disciples but what he wants is fame. He'd like, for example, for his blog to be mentioned in another blog, or in a newspaper, or for him to overhear people at the next table in a trendy cafe discussing some uproarious post that he recently wrote. Ideally, he'd like for one of his friends who doesn't realize that it is in fact he who writes the blog to recommend it to him.
A book deal. If only someone would just email her and offer to print out all these years of crap and sell them in time for the Christmas gift rush, she'd never have to work again!

Gender mender

2011-07-15T23:04:00.000+09:30

So why is it that men seem to behave so strangely around boy babies? Show a guy a little girl baby and he'll go all cutesy-pie and goo-goo trying to get her attention and he'll praise her gorgeous smile and beautiful eyes and all but start to file adoption papers.

But show a guy a little baby boy and he'll go all blokey-matey and call him "chief" or "muscles" and not be nearly as snuggly and friendly and generally nice.

Is it some kind of bizarre fear of being thought to be homosexual? Or are they genuinely unable to relate to other males except via the medium of sport? Or is it actually a reflection of men only valuing females for their appearance and thus not being threatened by them whereas boys will in future grow up to slit their throats in the night and steal off with their daughters?

Man, I can't wait for my psychiatry block!

Charms to soothe a savage breast

2011-07-10T20:15:00.001+09:30

Music which puts the Hatchling to sleep:

Mozart's string quartets
Johnny Cash
I Monster
30's swing
Paul Kelly
The National

Music which does not:

Rage Against The Machine
Queen
George Michael
Gillian Welch
Ladyhawke

Draw your own conclusions.

A cunning plan

2011-07-08T13:53:00.000+09:30

My problem is that I am a bad liar.

When I go home in the afternoon, my Smaller Half will conversationally enquire about what I had for lunch. And if I had a moment of weakness and had hot chips for lunch I am unable to adequately account for my time and money. I know perfectly well that not only are chips bad for me but I also feel queasy afterward and regret them.

"Err", I say, "My lunch. Indeed, my lunch was delicious! I had something good, I can't recall now the details but it was very satisfying."

"You had chips didn't you?" asks my Smaller Half.

"Yes", I say, "I am so ashamed."

The stupid thing is that even though I know I need an alibi, I am unable to come up with one because I don't want to actually lie. It would be easy to just tell her that I had a chicken sandwich or some such innocuous thing. But I think that if a man is going to fib about his lunch he isn't much of a man.

So this is my plan from now on: "I had some potato salad".

Brilliant, eh? If pressed for details I can concede that it was a deep-fried potato salad, of the French variety. But otherwise, the truth remains safe with me, you, and the internet.

Top 10 Australian Albums

2011-06-29T19:48:00.001+09:30

A little while ago my Wise Brother asked me what my top 10 Australian albums were, prompted by Triple J's recent poll. I had to dwell on it for a while and then set myself some ground rules. Here are the rules:

No pseudo-Oz Kiwi bands.
Only one album per artist.
No "Greatest Hits" or "B-sides" type collations. Which is a shame because some of my favourite CDs are in this mob but it's not really an album is it? Feel free to assail this decision in the comments section.
I must actually own the album to nominate it. If I don't like it enough to own it, well...

So here's my list, in alphamobetical order, with as brief a review as I could summon:

Cat Empire - Two Shoes. Joyous chaos.
The Cruel Sea - The Honeymoon is Over. Dark swaggering.
Mia Dyson - Parking Lots. On the shady side of the street.
The Herd - Summerland. Opinion columns to a beat.
Lazy Susan - Long Lost. Anecdotal.
Professor Ratbaggy - Professor Ratbaggy. Unscientific experiment.
Powderfinger - Internationalist. First half: rock epics. Second half: zap gun duel
Josh Pyke - Memories and Dust. Extroverted introversion.
The Simpletons- Matter. Sign of things not to come.
Something For Kate - Echolalia. Black humoured life.

Some things jump out at me about this list. It's surprisingly narrow, dominated by music that got played on Triple J in the late 90's, early 00's, mostly because this was when I had a job (hence could buy music) and also listened to the J's in my car to and from work. Since then I've been either incomeless or radioless or both, so I've strayed far from the rock of mainland Oz.

Nevertheless this list would be one I would happily take on a long driving holiday. They're all musically rich and lyrically interesting, at least to me. They're all albums that very quickly got put onto high rotation on ye olde NAD 510, and hence are intrinsically entwined in my memories of those times.

I'd be interested if a few of my Gentle Readers would post their own top ten lists as comments for perusal.

Socrates drank hemlock - we can only wait and hope

2011-06-28T12:25:00.003+09:30

One of my pet peeves, if not monstrous hates, is the type of doctor who chooses to "educate" students using the lazy man's version of the Socratic method. The Socratic method, if you're not familiar with it, consists of not directly answering questions but instead challenging the student with questions that engage them in thoughtful discussion. This works well if you are Socrates - not so well if you're a pompous git who can't be bothered interrupting your own scribbling in the notes to even look at the student, let alone allow your cerebrum to process more than a few key words in the original question.

My boss last year was a big fan of this. When I asked him why we weren't getting the tutorials we were supposed to, he got all Zen and said, "My job is to open the door but only you can walk through." Deep. Anyway, this is all prompted because I had the following exchange with one of the doctors this week:

PTR
Why is the girl in bed 12 on roxithromycin?

Doctor
Well, why do we put patients on roxithromycin?

PTR
Mmmm. A telling point.

I wonder if they do this sort of thing every time anybody asks them a question...

Policeman
Do you know how fast you were going ?

Doctor
Do you know how fast I was going?

Bookshelf

2011-06-27T11:50:00.000+09:30

Whilst idly perusing my google analytics stats I noticed that I'd gotten a few hits on my "Bookshelf" page. Which is sad because I've been too lazy to update it for at least six months.

From time to time I get briefly excited about a new concept, such as writing book reviews in haiku form or as limericks. But then apathy takes over again and nothing happens. I did briefly consider starting up another blog just for such reviews, but reasoned that the likelihood of actually keeping it going once the novelty wears off is very slim. As you may have noticed, new concepts are very exciting to me for about a fortnight.

For those who wonder, here's a short list to update you on some the books I've read since about Christmas. You may notice that there are quite a few 5/5 ratings here - I was lucky and hit a real purple patch around March...

Currently reading:
Titus Groan - Mervyn Peake. The Tolstoy of baroque fantasy.

Recently read:
Never Let Me Go - Kazuo Ishiguro. Haunting and sinister chick-lit. 5/5
Dictionary of the Napoleonic Wars - David Chandler. Can you really "read" a dictionary? 4/5
Rifles - Six Years With Wellington's Legendary Sharpshooters - Mark Urban. Like a Napoleonic Peter FitzSimons. 3/5
Welcome To The Monkey House - Kurt Vonnegut. Assertively off-kilter. 3/5
Blind - Matthew Farrer. Confusingly creative non-genre genre sci-fi. 3/5
Open - Andre Agassi. Inside the tennis racket. 5/5
How To Make Gravy - Paul Kelly. This is what blogs should be. 5/5
Into Thin Air - John Krakauer. Tragic personality clashes at altitude. 5/5
Invisible Cities - Italo Calvino. Hallucinatory travelogue. 5/5
Brighton Rock - Graham Greene. Queen's song is better. 2/5
The Book Of Sand + Shakespeare's Memory - Jorge Luis Borges. Betrayed by elevated expectations. 3/5
The Gospel According To Jesus Christ - José Saramago. A cynical epiphany. 3/5
The Happiest Refugee - Anh Do. A dull comedian from a fascinating family. 2/5
Eisenhorn Trilogy - Dan Abnett. Batman in the 40K-verse. 4/5
Titanicus - Dan Abnett. Kill! Crush! Destroy! 3/5

Paeds case review

2011-06-24T20:56:00.002+09:30

A 37 year old male presented to the Paediatric Ward this morning at 0830 hrs complaining of tiredness and abdominal pains.

The tiredness has been present since early December 2010 when his first child was born. The tiredness has been relatively constant but generally is better on weekends and is relieved by additional sleep. He complains of a lack of motivation and concentration, precipitated especially by his enrollment in a medical degree.

The abdominal pains began shortly before his arrival on the ward. Further questioning elicited that he had not had any food or drink yet today due to rising late and rushing out of the house. He states that in similar circumstances in the past he has suffered from identical abdominal pains which persisted until he ate.

On examination he was thin although healthy, mildly dehydrated, showed no neurological abnormalities, and had a clear chest. He was prescribed a caffeine solution and referred to the volunteers BBQ breakfast in the courtyard, where he was treated with oral toast, bacon, sausage, egg, hash brown, onion and sauce. Shortly after treatment he was observed to be sleeping soundly in the doctors' office.

Please review in the afternoon - should be suitable for early discharge to home care.

They hate me because I am pretty

2011-06-24T12:56:00.000+09:30

They hate me because I am pretty. That's the only possible conclusion.

After the ward round this morning the consultant drew me aside for a private conversation where he pinged me for not using my initiative. This soon after I volunteered to write a letter to the school of one of the patients addressing a problem and the hospital's stance on it, discussed it with the mother, wrote the letter, got the registrar to sign it, gave it to the mother and also put a copy in the notes. All in ten minutes tops. I thought I was a bit of a hero actually, so I was mildly taken aback to be rapped on the knuckles for not trying.

And what was the actual problem? It seems that earlier in the round I had had the temerity to walk with the consultant to the next patient's room, rather than run off and grab the notes. Parenthetically, the reason that I didn't scurry off and get the notes was because someone else was already doing so, so it seemed superfluous for me to make a token effort. Little did I know that my presence alongside the consultant for those ten or fifteen seconds that it took for the notes to arrive would be so distasteful to him.

I got thrown into a bit of a funk by it, but after lunching with some of my Esteemed Colleagues, I'm back on track. Let's face it, it's not my fault I was born so pretty. I can't be held responsible for the fact that merely glancing upon my godlike visage unprepared can stun the viewer into a drooling stupor.

Heavy

2011-06-21T22:34:00.001+09:30

I was doing my special curtain dance this evening for the Hatchling. It's the one where I pull the strings that draw the curtains surreptitiously and meanwhile make like David Copperfield, as if I'm magically enchanting the curtains to close without touching them. The Hatchling loves it. She also loves the curtains when they are totally stationary, so maybe it's them rather than me, but I'm keeping it fresh until she's old enough to tell me just in case.

Anyway, after putting on this great performance, my Smaller Half made some remark to the Hatchling, that she should be scared because half of her genetic material is mine. I pointed out to my Smaller Half that since I weigh almost twice as much as her it's probably more like me:her in a 2:1 ratio.

It's kind of strange the way people usually talk about being half Scottish or a quarter Aboriginal or one-eighth Indian, but you seldom hear people say that they are one-third this or two-fifths that. Yet a set of scales and some simple arithmetic is all that it would require to calculate much more accurate genetic histories for the purposes of determining risk. Tip for all you first-year med students out there: in your upcoming genetics exams you'll get top marks if you include these types of weight-based calculations in your answers.

Knife edge

2011-06-20T13:21:00.000+09:30

Fresh start today. I'll be doing six weeks with the little people, by which I mean paediatrics. I've been really looking forward to it, from both a personal and an professional point of view. I got to see very few kids last year so this will be a good learning experience. Plus, I like kids.

A few times I've heard people say to me, "I couldn't do paediatrics, I hate seeing kids in pain". Which kind of confused me. I always felt like replying, "But you like seeing adults in pain do you?" I didn't actually say that since obviously that would be a pretty jerkish response. But I guess I couldn't really connect to what they were saying.

But last week I was reading a book on death and dying and I opened it up to a chapter on the death of children. The sentence that fell under my eye was: "Parents who have a child that dies will often experience grief, guilt and anger so severe that they feel that they are losing their minds".

As I read that sentence I involuntarily contemplated how I would feel in that situation. And it was like a panic attack. For about twenty seconds, my chest was tight, I couldn't breath, my whole body seemed to tense up and freeze. And that was just from reading one sentence in a book. I can't imagine the horror of having to cope with it in reality, day after day, forever.

So now I'm feeling quite apprehensive about the next six weeks of paediatrics. Hopefully I'm not going to be a walking mess of raw nerves. On the round this morning I didn't see any kids who were really life-threateningly sick. Which was nice. But it meant that I spent the morning wanting to grab them all and play with them and then feeling increasingly homesick and missing my little Hatchling.

This is going to be tiring...

And on and on

2011-06-18T20:16:00.000+09:30

One of my Esteemed Colleagues was lamenting to me that the Moronic Nursing Student has now appeared in this blog more often than him. I say to him, "Good sir, thank your lucky stars. For the Moronic Nursing Student is my arch-nemesis, and were your deeds to match his in infamy your brain would be in a most parlous state, unfit for the practice of medicine."

Meanwhile...

Moronic Nursing Student
People are so stupid. The number of people who say to me that they don't like to take medication because they don't like chemicals is incredible. Don't they realize that everything is made out of chemicals?

PTR
I suppose not.

Moronic Nursing Student
And people who want to take herbal remedies because they're natural and organic but won't take medical drugs. Don't they realize that the definition of organic is that it contains carbon? So all drugs are actually organic?

PTR
What about lithium or gold?

Moronic Nursing Student
(puzzled) They're natural.

PTR
But they don't contain carbon.

Moronic Nursing Student
No, but they're natural. God people can be so stupid.

Gold

2011-06-17T14:31:00.000+09:30

O rapture, O sweet sweet manna from heaven, O light of my senses, O dream of summer days! I just witnessed a thing of marvel and wonder. The nurse who has been very rude to me for the last six weeks just slammed the Moronic Nursing Student. I experience the whole thing in slow-mo, it seemed to last for hours.

Nursing Student
I just wanted to say thanks very much to you guys, I really learned heaps from being here compared to when I started.

Nurse
Ha! Compared to when you started I'm not surprised!

Trained monkey

2011-06-17T12:28:00.000+09:30

So today is the last day of having to put up with my friend the Moronic Nursing Student. I turned up this morning and had to grit my teeth so hard that they crumbled like chalk. Here's a rough transcription of the first 30 seconds, prompted by me throwing a piece of paper at a bin and having it land right on the rim:

Moron
You've obviously never played basketball. I used to play basketball with my mates, half of them were in the state team, they were just psycho. How'd your plumbing problems go yesterday? I reckon a trained monkey could be a plumber. It's not hard. I don't know why they get paid so much. It's like electricians. I reckon a trained monkey could be an electrician. I don't know why they get paid so much. So tell me, why do you reckon that person was there in the hall?

PTR
The special sitting on the chair? Presumably the patient is bonkers or violent or a wanderer.

Moron
See, the thing is, with age-related cognitive decline, people forget they can't walk, so they're a falls risk. Some people fall over really easily, they get up and boom, they fall down. We had one guy who fell down more than six thousand times in one month, he was full on. So you've got to have someone sitting there watching them to make sure they don't try to walk.

PTR
My goodness, I never suspected.

Moron
It's pretty boring having to watch them, I reckon a trained monkey could do it.

He has also lectured me extensively on painkillers, napalm, styrofoam, back pain, how to put in cannulas, his last bout of diarhoea, his mobile phone plan, the legality of restraining patients, what the effective dose of anti-epileptic medication is, and so on and so on and so on. And so on.

I got some small measure of retribution just now when he slipped up and admitted to never having heard of conversion disorder. So I expressed great astonishment that such information was not in the nursing curriculum and wondered why he had never come across this in his background reading, then brutally patronized him him for a few minutes whilst desperately trying to remember the few scanty shreds of knowledge that I could dredge up from second year.

Revenge is a dish best served hot!

Lower back pain explained

2011-06-12T19:01:00.001+09:30

In the last five weeks I've seen a lot of patients with chronic lower back pain. Depending on the cause, they can also present with other symptoms which can be quite mystifying unless you have a detailed knowledge of the lumbosacral plexus - the network of nerves which leave the spine in the lower back and control the motor and sensory function of the lower body.

The problem is, the lumbosacral plexus is rather complicated. That is, it has always been considered complicated until just this week when I realized that it can be easily understood in terms of the battle of Waterloo. A little bit of work and voila! This aide memoire inventee a moi pour la purpose de la education medique, as they say in France.

To use it, simply note that the French commanders are in blue, the Allied commanders are in red (British), grey (Prussian), and black (Brunswick), and the local villages and farm buildings are in brown. (The Dutch are not included in this diagram since they correspond better to the visceral innervation.)

For example, if a patient came in complaining of lower back pain and sudden onset ineffectual cavalry charges in the genital area, the diagram clearly shows that this is the fault of Marshal Ney, and that the underlying lesion lies somewhere in the vicinity of the sleepy hamlets of Rossomme and Papelotte. Or if the patient instead complained of lower back pain and surprise arrival on their flanks of a brigade of horse artillery, the diagram indicates that this is related to the activity of General Bulow of Prussia.

Every patient is different, of course, so please use these suggestions with caution and don't leap to conclusions. But it's definitely worth asking, when your next patient comes in with long-standing back pain unresponsive to conventional treatment, whether or not a whiff of black powder or a snifter of grape-shot might help!

Insidious mind-control

2011-06-09T13:52:00.000+09:30

As you know, life is unfulfilling unless I have something to rail against. At the moment, things are going fantastically because I am on a righteous crusade against non-canonical nursery rhymes. It may seem harmless when people tweak these little rhymes and songs a bit but stop for a moment and think about what these shadowy powers-that-be hope to achieve with their historical revision? I put it to you that the culture wars are being fought (and lost!) right under our noses. Soon our children will be placing calls to the Stasi in the dead of night to report on our activities. Think I'm exaggerating? Read on.

It all started when we were given some type of poster-thing by a community midwife to encourage us to sing and read to the Hatchling. All well and good. But these are the lyrics to Twinkle Twinkle Little Star that were printed on the poster: (the emphasis is mine)

Twinkle twinkle little star

How I wonder what you are

Up above the world so high

Like a diamond in the sky

Twinkle twinkle little star

I'm so glad that you came by

How about that last line eh? Stupid or what? Stars don't "come by" to visit like they are your friends. And it completely stuffs up the rhyming scheme of the song. I can't say for certain why some faceless bureaucrat in the Department of Nursery Rhymes saw fit to change it. But I'm pretty sure it's part of some leftist conspiracy to indoctrinate our children into thinking that it's nice to have people just dropping in out of the blue, so as to weaken our resolve in the Great War On Immigrants and erode the sanctity of property ownership.

It's amazing how many leftist conspiracies you can find in children's literature once you become sufficiently deranged and paranoid. For example, one of the Hatchling's favourite books is one called Where is the Green Sheep? This simple book shows us all sorts of other sheep in our lengthy search for the Green Sheep. Entertaining stuff, to be sure, but the author and illustrator don't miss a single opportunity to brainwash us into their pinko views. Here's a short list of some of the sheep in the book and their barely subliminal messages:

The red sheep and the blue sheep - clearly intended to make us think that it's okay to look funny or to be born ethnic.
The train sheep and the car sheep - the train sheep reclines in unnatural comfort amidst a seething menagerie of unhygienic foreign animals while the car sheep struggles to repair his broken vehicle. How much multiculturalism, environmentalism, communism and other isms can be crammed into just one page?
The thin sheep and the wide sheep - because sheep can't be called fat anymore because it might hurt their feelings. Still, they can't stop me from the enjoying the juicy strip of wide down the edge of my lamb chops!
The wind sheep and the wave sheep - more environmentalism, more lazy layabouts. I see there's no brown coal sheep, no uranium sheep, not even a natural gas sheep. Sheep don't need real jobs, being happy to fly kites and go surfing. Hence no need for a construction worker sheep or a chartered accountant sheep or a soldier sheep or any other form of gainful employment sheep. I'm surprised the illustrator didn't just draw the surfing sheep with a disability support pension sticking out of his back pocket while it laughs all the way to the bank!

I'll bet you're not laughing now. The next time you are reading a book to your child or singing a song to your baby, give some thought to what they might really be hearing. Remember, if you don't vote Right, don't vote at all.

In a nutshell

2011-06-08T13:33:00.000+09:30

Doctor
So, what did you think of that patient?

PTR
Well his relationship with his wife seemed very strange. She's very passive and seems to out-source her aggression to him. And she's very dependent on him but he just shuts her down when she vocalises her guilt. He seems like someone with a lot of frustration in his life but the only way he is able to express that frustration is through anger.

Doctor
There's a simpler way of putting it - he's an arsehole.

My five favourite soups

2011-06-06T20:53:00.003+09:30

My five favourite soups are:

Pho
Potato and leek
Pea and ham
French onion
Minestrone

Thank you for your help

2011-06-05T20:43:00.000+09:30

Before I start... bugger. Now that I've started, I want to make it clear that I do not have a seething contempt for nurses. Oh sure, some nurses. Like the bizarre passive-aggressive nurse I currently work* with. He somehow manages to undercut me at me every opportunity. Like the time I called in sick and he answered the phone. When I told him I wouldn't be in, he said "Oh. Well, I don't suppose it really matters anyway." He's either a comic genius or a brutal misanthrope. Or both. Or neither. Yep, that about covers it.

Anyway, I was telling you that I don't hate nurses. I have no stories to tell you about likeable nurses to prove this because stories in which everyone acts in a reasonable and pleasant way aren't very memorable or interesting. But just keep in mind that most nurses are great because I'm about to unload on one chump who happens to be a nursing student.

The problem is this - he seems to be very competitive with me and is always trying to show me up. For example, on his first day I had a syringe driver that I was about to hook up to a patient. The guy stops me and points to a series of tiny bubbles in the tubing and insisted that I flush them out of the line. When I said I hadn't noticed them, he said "That's what nurses are for! Lucky I was here." For the record, to give someone an air embolus you need to get about 200 mL into their veins, The bubbles in the tube would have been a fraction of a drop. Still, nice catch there, Inspector. He spent the next 10 minutes flicking the syringe to try to remove some errant molecules of nitrogen clinging to the side of it.

This week he managed to creep up behind me while I was discussing a patient's medication with her, and chip in with unhelpful comments just at the worst moment:

PTR
So you've gotten good pain relief from fentanyl. This means we'll be able to think about a range of medications to find one that's right for you.

Annoying Nursing Student
It's a class of drugs called opioids. Things like morphine.

Worried Patient
Morphine? I don't want to take morphine! Isn't that for people who are dying?

PTR
A lot of people are worried about that. But there are lots of people who use morphine or similar medications for pain control. The reason that these drugs have this reputation for being for dying people is that they are effective. So they do get used in extreme situations. But they are also useful for people like you who only need much smaller doses.

Annoying Nursing Student
Watch out though, because if you take too much you'll stop breathing and die.

PTR
Sigh...

*"work" being defined in this case as performing pointless tasks for no remuneration.

The truth shall set you free

2011-06-03T14:34:00.000+09:30

Baffled Consultant

I've never known students to be placed in that unit before. Did you choose it?

PTR

Well, it was my 5th preference so, in a sense, yes.

Monologue

2011-05-25T22:59:00.000+09:30

A rabbit.

Trust and safety

2011-05-24T11:20:00.000+09:30

Today I simply present a longish quote from the book "Evidence-Based Medicine: How to Practice and Teach EBM". Those long-time readers familiar with my tribulations in 2010 will understand why it resonates with me.

First, an extract from a table:

"Table 7.3 The top 10 mistakes we've made or seen in in teaching EBM.
Teaching EBM fails when:
...
9. When it humiliates learners for not already knowing the "right" fact or answer.
10. When it bullies learners to decide or act based on fear of others' authority or power, rather than on authoritative evidence and rational argument."

Then, the discussion:

"The ninth and tenth entries are included here because they are still commonplace among medical education programs, and at some of these institutions they remain a source of twisted pride. Such treatment of learners by their teachers is not simply wrong in human terms, it is demonstrably counterproductive. First, the resulting shame and humiliation learners feel will strongly discourage the very learning that the teacher's ridicule was meant to stimulate. Second, in adapting to the rapid loss of trust and safety in the learning climate, learners will start employing strategies to hide their true learning needs and protect themselves from their teachers, undermining future learning and teaching efforts. Understandably, learners with prior experiences of these behaviours may be very reluctant to even start the practice of EBM by asking a question, since it exposes them to the potential threat of repeated abuse.*

"*Contrast this with the actions of colleague David Pencheon, who asks new medical students questions of increasing difficulty until they respond with "I don't know". Upon hearing these words, he rewards them with a box of Smarties and tell them that these are the three most important words in medicine."

Confidence booster

2011-05-23T13:25:00.000+09:30

PTR

Hello, is it okay if I put a drip in your arm?

Patient

Oh my god! Oh Jesus!

PTR

Do you have a needle phobia?

Patient

No, I just saw what you did to that other woman.

Welcome to Port Adelaide

2011-05-21T18:24:00.000+09:30

WELCOME to historic Port Adelaide!

THRILL to the wide open vistas of the deserted streets. MARVEL at the endless blocks of boarded up shopfronts! RELAX in a neighborhood cafe where moustachioed women ignore your every whim! PONDER the local economy which seems to be dominated by the police station and magistrates court! FEAR for your life as belligerent bikies roar past! TRUDGE down the waterfront and wonder if things will open some other day!

Port Adelaide is happening. No really, it is! It's happening to you, right now! Can you feel it?

Crazy horse

2011-05-20T17:03:00.001+09:30

Being a parent sometimes seems to be a kind of benign psychosis. You get so caught up in it that you lose track of reality.

The Hatchling really laughs and smiles when I bounce her up and down on my knee. While I do this I sing an amazingly tuneful song that I made up about riding horses. It goes:

Doo da doo doo doo-da-doo,
Doo da doo,
Doo doo doo-da-da-doo!
Riding on a horsey,
Riding on a horsey,
Doo doo doo-da-da-doo!

I've been doing this several times per day for the last two weeks and it only just occurred to me tonight, for the first time, that she has no idea what a horse is. She doesn't understand a word I'm saying. She just likes being bounced around.

It isn't her pretending that she's riding a horse, it's me.

I can speak English

2011-05-20T17:03:00.000+09:30

Elderly Man
We've just been admiring your beautiful baby.

PTR
Thank you!

Elderly Man
If you don't mind me asking, where is your partner from?

Smaller Half
Queensland.

Leopard hunting

2011-05-16T08:43:00.000+09:30

It is a truth universally acknowledged that it is more embarrassing to be caught staring at someone peeing in the park than to be stared at while peeing in the park. Okay, perhaps it's not universally acknowledged, but it's the core tenet of my moral philosophy - one which finally came in handy yesterday when I caught someone peeing in the park.

We were taking a stroll in the crisp afternoon air down by the parks near the racetrack, when I glanced to my side and noticed someone behaving furtively. She was middle aged, well-dressed, and would not have looked out of place sharing a bruschetta in a trendy cafe with her friends. Except she was standing beside a clump of trees, looking back and forth anxiously.

Curious, I stared. Suddenly she whipped her daks down and squatted at the base of the tree. It was apparent to me that she was peeing in the park. Normally I would have laughed and looked away, but now she'd committed to the act she was carrying it off with great zeal and elan. In fact I wasn't even sure that she was peeing at all. She wasn't hunched awkwardly forward - she was restfully squatting with a split-stance and gazing calmly into the middle distance in the manner of someone who is hunting a leopard and has just finished contemplating its spoor. Perhaps I had misjudged the situation. Perhaps she was in fact hunting a leopard in the Adelaide parklands. With her pants down.

At this point I realized that if she were to look around and see me staring in astonishment I would be mortified. The tables would be turned and I would feel like a creepy pervert. The thing is, if you need to pee in the park, so be it - you just have to. Whereas I was a voluntary participant in this sordid drama and I felt it reflected very poorly on me indeed. So I alerted my companions to the situation so that we would be in the majority. Excellent!

The woman then stood up, whipped her daks up again, and briskly strode off casually adjusting her fly as she went, in that way that people do when they are trying to look as if they aren't really fiddling with their groin when they actually are. About 40 yards away a family picnic continued in blissful ignorance, which she then rejoined.

I wonder what she told them she was doing?

Aristotle said

2011-05-11T19:18:00.002+09:30

"All men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease."

Maybe we still are in Kansas, Toto!

2011-05-01T00:15:00.001+09:30

As usual, we went out tonight to celebrate Willie Nelson's birthday. We had a great time, going back to our favourite Japanese restaurant. We ate extravagantly, and lapped up the admiration of our fellow diners for the Hatchling.

Afterwards, we headed south and checked out a new dessert-only cafe. Its doors don't open until 8pm and we fortunately arrived on the dot and secured a table to beat the rush. Sticky black coconut rice, rose panna cotta and a stein of teh tarik. Mmmm.

We got up to pay at the counter and I overheard one of the girls behind me admiring the Hatchling:

Girl

(to friend)

Look, look, how gorgeous!

PTR

(turning to show off the Hatchling a bit more)

Thank you.

Girl

(to friend)

Look at the little half-caste baby!

Gotta love Adelaide...