Don't do this at home

PTR

So, what do you do for a job?

Patient

I'm a butcher.

PTR

Me too.  Ha ha ha ha.

Patient

...

PTR

Anyway, it's really true isn't it, that if you want a decent piece of meat you should buy it at a butcher's shop instead of a supermarket.

Patient

I'm a butcher in a supermarket.

PTR

... Sooooo, it's the end of my shift now. 

Bye!

The moment of revelation

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

Fund-raising ideas

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

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

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

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

Overestimation

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

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

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

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

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

Goose/gander

Went to an orientation session for my new position this morning and had this strange conversation concerning an Esteemed Colleague, Binky*:

Administrator

I don't think Binky is coming this morning.

PTR

He told me that he would.

Administrator

Well he doesn't need to. He won't have slept because he worked all night last night.

PTR

So did I.

Administrator

But he doesn't really need to come because he worked in this area earlier in the year.

PTR

Me too.

Administrator

It's really hard, you know, to send someone an email saying, "This session is on but you don't really have to come to it", because then people wouldn't bother to come.

 

Isn't it heartwarming to know that in these troubled times we still have people looking out for our best interests?

*Obviously his name is not Binky.  Names have been changed to protect the innocent.

Avoidant

 
Something bizarre happened to me recently which I'm still trying to wrap my head around.  Here's the gist of it:

I got a call about a patient that sounded a bit dodgy, so I went and checked him out and came to the conclusion that he might have condition X, but the decision about this and any subsequent management was in any case above my pay grade, so I called the X-ology registrar.

There was a fair bit of back and forth involved with this registrar, but here are the lessons that he imparted to me, along with some sarcastic interpretive remarks by yours truly:

• If you suspect that a patient has a serious medical condition, don't document this in the notes, because if you do, the relevant expert will have to review the patient rather than simply dismiss your concerns out of hand over the phone.
• If you do get the relevant expert to review the patient, don't document this in the notes.  Instead, you should document their findings and recommendations as your own, because clearly an intern is the guy whose opinion you should trust about this stuff.
• Similarly, do not mention to anybody else on your team that you are getting the relevant expert to review the patient, or the long-suffering expert will be forced to write his own documentation and actually sign it, and ink is expensive these days.
• When you are documenting things, write as little as you can, or even less, or else people will think you are incompetent or retarded or trying to hide something. It will also ensure that subsequent clinicians will be able to start afresh in their own assessments, free from bias or preconception.

So yeah, the guy basically was happy to go out of his way to try to get me to stick my neck on the chopping block and assume a totally inappropriate level of responsibility.  Unfortunately I had already broken all his recommendations so he was forced to actually do his job.  So I'd say that I did mine too.

Once upon a midnight dreary

Lest you think that this blog has turned into a monologue on the idiocy of people other than myself, I have a story for you about my own idiocy.  Read on, gentle reader, and remember me in your prayers...

In the middle of the night I trundled off to a distant ward to review the person in bed 3 who was, according to the taskboard, mildly hypotensive and thus warranting a breeze-by from myself.  I got there and took a quick look at her observation chart, and was surprised to see that if anything she had been mildly hypertensive.

I grabbed a nearby nurse and asked if perhaps the most recent obs hadn't been charted, but they had.  That nurse was also surprised that I was there to review the patient in bed 3 and suggested that perhaps a mistake had been made and that someone had meant me to review the patient in bed 4.

"Choh! Typical!", I said, "Choh!  Lucky it wasn't an emergency! Choh!  Can't believe anything on the task board these days!  Not like the good old days when I first started, last Monday!  Choh!", and so on and so on.  (This may surprise you if you're under the impression that I'm basically a nice guy - I'd like to think I am but at 3 a.m. I get pretty damn self-righteous.)

But then when I got the chart for bed 4, he was pretty much the same.  No hypotension there.  So I grabbed the nurse again and pointed this out to her and started out again on my "Choh!" routine whilst unfolding my taskboard printout to show her the errant job that had all these errors in it.  Wrong patient, wrong vitals...

... and I got that awful sinking feeling that you get when you realize that you're the dickhead.  I was on the wrong ward.

Alfalfanumeric

 
You may or may not be familiar with warfarin, a drug that patients sometimes refer to as "rat poison" because it is used to poison rats.  Like most drugs, it was discovered when someone's cows died after eating mouldy clover, using a scientific process that is opaque to me, but undoubtedly involved much glassware.  The dose is often tweaked up or down each day depending on the results of that day's blood tests because otherwise the after hours cover intern would have nothing to do on the weekend.  Getting it wrong might mean that your patient bleeds to death internally or perhaps has a massive stroke.  No pressure.

So when I was called to the ward one day to clarify the daily dose of warfarin, I thought, yeah - fair enough - nobody wants to stuff this up, and doctors' handwriting is actually even worse than it is reputed to be.  But when I get there, the nurse points at the drug chart and asks, and I am not making this up, "Is that a '6' or a 'b'?"

I mean - like, totally, huh?  How could you prescribe someone 'b' milligrams of warfarin?

Not even I am nerdy enough to prescribe in hexadecimal.  Although if I was, I'd make sure that I did paediatric prescriptions in octal and neonates in binary...

Trained monkey

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!

A scathing indictment of the petrochemical industry

When you find yourself in times of trouble just remember that in all likelihood you're smarter than a petrol pump.  I know I am.  Not necessarily smarter than a person who pumps petrol, that's still up for debate.  But I'm definitely smarter than the machine which pumps the petrol (known in the US of A as "gas" because it is liquid) into my car.

When I was filling up early one brisk winter's morn, I realized that the pump was just trickling the fuel into my car.  It took a minute or so just to get a dollar's worth, which these days is really only 20 mL or so (again for Americans amongst us, 20 mL is roughly five and a half drachms).  So I hung up the pump and went inside to speak to The Lady. 

"Pump one isn't going", I said. 
"Just hang it up and start again.  It's a bit cold today so it takes a while to start", she replied.

So I went out and tried again.  No luck.  So I hung it up and tried again.  No luck.  And again.  No luck.  By now it was almost lunchtime so I abandoned that pump and tried the one next to it.  Too easy this time.  The fuel gushed forth in a joyous stream.  I felt like I'd just had my prostate reamed out.  I went inside with a grin on my face but The Lady scowled at me.

"You were hanging it up too fast", she says, "It got confused".

Confused??  It should be pretty obvious that when I use the petrol pump, I want petrol.  There's not really any other option for it.  It can't give me milk or wine or blood.  It can either give me petrol or not give me petrol, and seeing as it was not giving me petrol until I arrived and attempted to instruct it otherwise, I'd have thought there was limited scope for confusion.

Maybe I'm just over-thinking this.