You're only a day away

The days of the week are, of course, illusions.  We usually aren't aware of this though because they are so ubiquitously subscribed to.  Somehow, somewhen, someone bullied everyone else into agreeing that this day, so indistinguishable from every other day, was in fact special and different, and should have a name.  And, weirdly enough, it would come back again in another seven days, just the same.  Think about it, it's a freak show.

No, I am not stoned.

It's just that working shifts for the first time in my life has torn the veil from my eyes, swept back the hoary eyebrows of familiarity, and shown me the truth.  It's made of people!!!!  Or something like that.

In my last position I was working a lot of Saturdays.  And on the Saturdays I wasn't working, I was working Sunday.  So Sunday kind of ceased to exist for me.  My week would start conventionally enough on a Monday, then go Tuesday, Wednesday, Thursday, Friday, then one extra day of work.  The Day That Dares Not Speak Its Name.

Being a programmer in the past, I was tempted to call it Friday++.  But that doesn't convey the full blackness of having to work that sixth day.  So instead I call it Double Scorpion.  Then the day after, that everyone else is calling Sunday, is my virtual Saturday.  If I had to work then too it would be Triple Scorpion.  This is when things get crazy, because the Monday after would be actually be Quadruple Scorpion for me, escalating all the way to Octuple Scorpion by your Friday and then Nonuple Scorpion when it should simply be my Double Scorpion on your Saturday.  That's only happened to me once, and it wasn't really that bad because the first Double Scorpion was only two hours work in the morning.  But that's the situation when you work a lot of overtime.

Shift work is different.  I'm now on my fifth consecutive day of work today, so it's virtual Friday.  (Not actually at work right now because my day starts at 11pm, but it's rostered for today.)  And this is my longest stretch of consecutive days for the next 2 months.  So this will be my only virtual Friday, and there will be not a single Double Scorpion for me.  Whoo!

Because my working week is broken up into little 3 or 4 day chunks, it means I'm frequently resetting the clock back to virtual Saturday, totally out of sync with the rest of the world.  When I started this placement it was (actual) Wednesday, but I had two days off, so for me it was virtual Saturday/Sunday.  Then I had three days of work, so it was virtual Monday/Tuesday/Wednesday.

Then I had four days off.  The first two days were virtual Saturday/Sunday.  But then the next two - what were they?  What happened is that at 11:59pm on virtual Sunday, the previous day was retconned to virtual Good Friday, and things proceeded from there to virtual Holy Saturday, virtual Easter, and virtual Easter Monday.  It was incredible! 

The practical effect of this is that for the next little while almost all my days are virtual Saturday/Sunday/Monday/Tuesday, with a few virtual Good Fridays and virtual Wednesdays thrown in.  A couple of virtual Thursdays, no more virtual Fridays.  It's amazing!  The only disadvantage is that my Smaller Half is also doing shift work but on a totally different schedule to me.  So right now I'm virtual Friday, she's virtual Tuesday, which coincidentally is also actual Tuesday.  But on Wednsday we're both on virtual Saturday which will be nice, although I'll be asleep for most of it, having worked all night, so it'll be more like virtual Friday night for me.

Still, it was worse beforehand.  The one time I had a Triple Scorpion, she was on her 5th day off because she was only working 2.5 days per week.  I don't even know what the 5th day off is.  It's unprecedented in my experience.  I guess if you went to a Twelve Days Of Christmas naming scheme you could call it Gold Rings.  I like the sound of that. 

Of course, this all goes out the window in August when I start a 7-on, 7-off roster.  So it'll be virtual Monday on Wednesday through to Triple Scorpion on Tuesday, then virtual Good Friday right through to Swans-a-swimming, then back to virtual Monday again.

I think it could catch on and be the next big thing.

Seine, Paris, France

Adding value

PTR

Hello, what's happening?

Man with moustache

Hi, this woman is having plasmapheresis and she's reported some peri-oral tingling.  Her ionised calcium before we started was 1.3 so I started with the standard citrate flow, but since she's gotten these symptoms I've turned it down 40% because I'm worried that she might be getting a citrate induced hypocalcaemia.

PTR

Mmmmmmmm.

[to patient]

How are you feeling now?

Patient

A bit better I suppose.

PTR

[to man with moustache]

So what do you think?

Man with moustache

Well we're nearly finished and her symptoms have resolved somewhat.  I think we might as well continue on as we are.  She's due for another run tomorrow, so what I might do is leave a note for the home team asking them to give some calcium prior and start off the citrate at a lower flow rate as well.

PTR

Ok then, that sounds good.  Anything else I can help you with?

Man with moustache

No, that's all thanks.

PTR

It was nothing.

 

A culinary proposal

Do any of you own a cafe or restaurant? Here's a tip: instead of having a cheese platter on the menu, have a “cheese splatter". It sounds much more hedonistic and indulgent.

First night last night

Last night I did my first night shift down in the Emergency Department.  It was also my first shift of any kind in the ED.  So I was a bit tense beforehand about a new environment as well as a bit tense about the whole "stay up all night and deal with stuff when there's only a skeleton crew on in the hospital" thing.

But you know what?  It was actually fine.

It's still a bit intimidating knowing that not only could literally anything walk (or be pushed) through your door, but also that the triage screen details sometimes bear only a tangential relationship to what's actually going on.  Like the guy last night who was noted to have haematemesis and malaena (ie: bleeding from both ends) who actually had neither.  Thankfully.  But the saving grace is that the staff who work there are all incredibly supportive and helpful.

Astonishingly, you are expected to function in accordance with your experience and training.  So if you're an intern like me, they keep an eye on you and give you lots of help.  And if you're new to the ED like me, they also are happy to explain the processes that you're unfamiliar with, without all the harrumphing and sighing and implied dissatisfaction that I have become accustomed to in some of my other rotations.

As you have probably guessed by now, this was a great revelation to me.  If only other parts of the hospital were as good, I would probably have been good deal less stressed for the past couple of years, and I would probably be a better doctor as well since people would actually have bothered to give me a headstart on what I needed to know and do, rather than lay guilt trips on me and stomp off into the distance.

On the other hand, the staying up all night thing is a bit pants.  I had a master plan to get myself into sync.  I stayed up late the night before, intending to sleep in and get as much rest as I could.  Instead, my Smaller Half got sick and had to sleep in instead, I had to get up early with the Hatchling, so I went into my stretch of night shifts even more tired than if I'd done nothing at all.

I got home at about 0900 today, was in bed by 10, crashed out and slept until 3.30pm.  So five and a half hours sleep.  I'm feeling a bit ragged but I've already got that seedy "too much coffee" feeling in my eyes so I guess I'll just be staggering through the night and hoping to catch up on sleep tomorrow.

By the way, the phrase "I'll sleep when I'm dead" really annoys me. No you won't, you'll be dead.  And you will have been really tired and shitty when you were alive because you weren't sleeping.  Just get some sleep while you can, moron.

Out.

Coffee tips

In a comment to my previous post, the boldly titled "Anonymous" questioned why I was calling a babycino a bubbacino.  Fair call.  To clarify, here are some similarly named coffee styles with explanatory notes.

Babycino: an espresso cup filled with frothed milk.

Bubbacino: an espresso cup filled with frothed milk served in a jail cell with a large, lonely, tattooed man.

Bobacino: an espresso cup filled with frothed milk served by a Mandalorian bounty hunter.

Babarcino: an espresso cup filled with frothed elephant milk.

Babayagacino: an espresso cup filled with frothed milk from a cannibalistic Russian witch.

Barbarinocino: an espresso cup filled with frothed milk served by a young John Travolta.

Bulbarcino: an espresso cup filled with frothed milk by a barista with a cranial nerve palsy.

Baabaacino: an espresso cup filled with frothed milk from a black sheep.

Not all of these are commonly available, at least not in Adelaide, but keep an eye out.  They're worth trying if you get the chance.

My bubba's too beveragalicious

PTR
Could I please have a cafe latte, a chai latte, a weak latte, and two bubbacinos?

Numbnut waiter
What's a bubbacino?

PTR
It's a little cup filled with milk froth.

Numbnut waiter
Oh, like a babycino?

And to save you the time making snide comments, I concede the following points:

1. Yes, bubbacinos are an absurdly yuppyish thing to order.  But at this place they were free, and I'd rather order a free bubbacino than have my $3.50 coffee sabotaged by a lunging Hatchling.
2. Yes, a weak latte is a girly thing to order.  Fortunately my Smaller Half is quite girly.
3. Yes, a chai latte is also an absurdly yuppyish thing to order.  But it was for a friend we were meeting hence I take no responsibility for her choice of beverages.

Now those issues are cleared up, let's focus on what a numbnut the waiter is.

Gargan Death Carrot

Yesterday I was alerted to the existence of the Gargan Death Carrot.

I know you think I made that up but I didn't.  Admittedly, even Google only seems to be aware of it tangentially, and Wikipedia not at all, but I can assure you it is real.

If you want to verify the truth of what I am saying, travel to the misty shores of far off Adelaide.  Go to the Botanic Gardens, just to the east of the Royal Adelaide Hospital, where the bamboo sways to unfelt breezes.  And find therein the eternal Museum of Economic Botany.  Enter by the door on the south side, amidst the deepest shadows.  Turn away from the temporary exhibit of Banks' Florilegium and the grim posturings of Robert Hughes displayeth on video beside.  Turn ye to your left and inspect the display of the members of the carrot family in the glass cabinet before you.

And quake as you behold the Gargan Death Carrot.  Marvel at the shrivelled pieces of unrecognisable vegetable matter in front of you.  Wonder at the simple description that from it can be extracted a resin that is mixed into plaster.  And leave, because that's it.  Yes, having included an exhibit called the Gargan Death Carrot, the curators then failed to provide any information on it beyond some simple home decorators tips.

What is the Gargan Death Carrot?

Is the carrot deadly?  Is it poisonous?  Is it very sharp and pointy and can be hurled like a spear?  Is it hard and useful as a bludgeon?  Or perhaps it incites in its devourers a murderous rage?  Perhaps, like the mandrake, it shrieks as it is uprooted, slaying all those in earshot.

Or is it a symbol of death?  Did the Society Of Assassins in distant Garg have as its symbol the native carrot, for reasons unknown?  Or were condemned criminals permitted one final meal of Gargan carrot, which is so delicious that consumption is otherwise only permitted to the Prince Regent in his Black Tower?  Or were slices of carrot used to weight down the eyelids of the dead, granting them eternal rest?  Are the shades of the dead welcomed to the gardens of paradise by the carrot?  Or perhaps the dead are terrified of the carrot, so bunches hang in every peasant hovel to guard against witches and hobgoblins.

I looked long and hard through the rest of the exhibits, searching for similar items of eldritch lore.  I sought out, but did not find, the Guinean Haemorrhagic Yam.  I heard rumours of the Batavian Agony Pea, but could not confirm its whereabouts.  And the Apoplectic Prussian Leek was conspicuous only by its absence.

The wheels of knowledge turn slowly.

What we do in between patients

PTR

What does this abbreviation FFMN stand for?

Registrar

"Fasting from midnight".

PTR

I wouldn't abbreviate midnight as MN.  I'd just write FFM.

Consultant

But that would be "Fat free mass".

PTR

What's that?

Consultant

It's the old-fashioned way of saying "Lean body mass", your weight if you weren't obese.

Registrar

Oh, by "mass" I thought you meant a church service, one just for skinny people.

Consultant

So a fat free mass would be where you give the anorexic the wafer and she just vomits it back up again.

Bored on a wire

Internship is all about balance.  People will give you all sorts of garbage advice about work/life balance.  It's garbage because it's impossible.  Work wins.  Life loses.  The end.

No, the balance I am talking about is the balance of how you spend your time at work.  At various times you are working for the patients, and at other times you are working for the consultant (the big boss).  Very occasionally you are working for yourself, such as when you go and get a cup of coffee or sneak off to open your bowels.  Refer to my previous comments about work vs life.  Pooping is life and is to be savoured as it arises.

So anyway, I was talking about patients vs consultants.  This is something I struggle with.  I tend to get caught up in spending lots of time talking to patients and their families.  Nobody else but the intern bothers to take the time to explain what the test results are, what they mean, what the prognosis is, what else might happen, whether or not this is all someone's fault or not, and in as much plain English as can be mustered.

I tend to spend a fair bit of time on this because:

1. Ostensibly it's what the hospital is there for.
2. I feel sorry for these people that Life has dealt a bad hand too and I want to help them out.
3. When I do it, they always say really nice things to me later on when they leave hospital about what a great doctor I am.

So it's a mix of idealism and rampaging ego that motivates me.

Unfortunately, spending my time working for patients means that every now and then my consultant misses out.  Such as the other day when I was busy explaining to my patient's family what was going to happen now that we'd discovered that a lot of bad shit was going down with him.  It meant that I was 5 minutes late to a drug rep talk about some new drug that does the same thing as some existing drug except it costs more.  It had been arranged by my consultant and clearly his dignity was bruised that I hadn't prioritised it above all else.  I could tell this because he said to me, "If you can't be bothered turning up to education sessions you can get the fuck off my ward."

You know, the more I think about it, the more I think I've got the balance just about right.

Awaken the giant within

Every now and then someone remarks to me that they wonder how I can cope with doing my internship at the same time as my Smaller Half whilst also trying to look after the Hatchling. The answer is of course that I don't. Cope, that is. I spend most of my waking hours desperately trying to catch up to where I'm supposed to be and never quite making it. And my sleeping hours I spend having bizarre dreams about imaginary medical conditions suffered by fictional patients that I have to try actively to forget upon waking lest I blurt out something insane sounding on the ward round the next morning.

"Mr Upendis hasn't had his brain biopsy yet so we still don't know where the chocolate is coming from!"

Be that as it may, it is made easier than it might be one you realise that caring for patients is almost exactly like looking after a one year old.

Patients: did they sleep well?
Hatchling: did she sleep well?

Patients: do they have a temperature?
Hatchling: does she have a temperature?

Patients: have they had their bowels open?
Hatchling: has she just made a special delivery?

Patients: how's their fluid balance?
Hatchling: has she had enough to eat and drink?

Patients: have you checked the gentamicin levels?
Hatchling: would you like me to read you Hairy Maclairy From Donaldson's Dairy?

Patients: can you get the neurosurgery registrar to review them ASAP?
Hatchling: you look so cute in those little purple trakkie-daks!

The similarities go on and on and it makes everything so much easier. So for those of you embarking on medical careers, my advice is to have children right now. Especially if you might be competing with me for jobs in the future. Yeah, that's it.

And if you already have small children, why then, enrolling in a medical degree and working 7 day weeks for some sociopathic overseer will be just the ticket to sharpen up your parenting and really bring you closer to your family.

And while you're at it, write some damn blog posts on your phone using the stupid touchscreen. Ow! My arm!

Watershed

This is a milestone. History in the making! One small step and all that. This is the first (and at this rate possibly the last) post I have written and posted using my mobile phone. So much technology! I am also typing it using my bionic arm. And it is packed full of subtle military nanomemes that will compell you to melt down your jewellery and send it to me. Electrickery!

Breaking bad

Doctor 1

[Bursts into room, sweeps aside the curtain around patient's bed]

So mate, turns out you've got cancer.  Any questions?  No?  Sure you'll think of some later.  We'll see you tomorrow, okay?

[Sweeps out again] 

Doctor 2

And that's a really good example of how not to break bad news to someone.

Honestly

The truth is, it's been a dark time.  My last post before my prolonged exile from blogging was back in January.  On that day I got news that my cousin, just a few weeks younger than me, had died.  It was unthinkable to resume writing here as a professional smart-arse, so I thought I'd take a break before posting a moving tribute to her.

And the break grew.  Because I didn't know what to say.

How is it, I wondered, that I can write an eloquent and moving tribute to my crusty and decrepit old cat, and even write a eulogy for a pair of underpants, but can't come up with something for a person - a person who had had their whole life, and the lives of her family and friends, stolen away?

So I waited.

I kept waiting for inspiration to strike.  I'm a doctor, I thought.  I'm close to sickness and death every day.  I must have some keen insight to offer.  Some deep philosophy to soothe the pain for those still living.  I even tried writing something a few times and came up with nothing but cliches.

Eventually I realized that I had nothing new to say.  How could I possibly even begin to enlighten, let alone comprehend?  How could I be so vain?

My cousin's brother, who, in a coincidence worthy of the Celestine Prophecy, is also my cousin, sent me a message after she died saying that she had really enjoyed reading this blog and that it had made her happy to laugh at it.  I was thinking about that message when finally I decided that if all I could come up with to honour her life was cliches, then I'd do so with the worst cliche of all - "This is what she would have wanted".

So, K, the resumption of this blog is dedicated to you and to everyone who shed a tear for you, myself included.  I like to think you would smile to read it.

PTR

They seek him here, they seek him there

So it seems I have some explaining to do.  My legion of fan has been baying for blood due to my extended absence from the blobosphere.  Here's the deal:

When the Australian dollar nosedived against the peso after a hijacked bus exploded at a tin mine in downtown Brussels, my finances took a battering.  I was sold so short that the debt collectors came knocking on my door before the rear-vision mirrors flew past The Hague.

So I cooked up an elaborate scheme whereby I sold my organs on eBay one by one - always to the same buyer mind you - an elderly squillionaire in Bombay who was naively seeking immortality.  Eventually the total mass of transplanted organs from me passed a critical point and my Theory Of Cumulative Metabolic Consciousness was proved correct when I suddenly found myself an elderly squillionaire in Bombay.

Getting a visa back to Australia was no obstacle.  I simply transferred all assets back to my old self who was still sitting on ice back in Adelaide before re-selling my own organs back to myself, resulting in me waking up cold, scarred, but my old self once more, and filthy rich.

Naturally this kept me quite busy so I didn't have time for blobbing, especially not whilst trying to work as an lazy intern in a busy hospital and being a marginally effective parent to the child progeny Hatchling.  So I apologise to those of you whose lives have been made more bare and stark.  I can only promise that herein I will imitate the sun, who doth permit the base contagious clouds to cover up his blah blah blah etc so it's all like "Here comes the sun, doo doo doo doo" you know?

I'm back.

Get out while you can

 

Get out while you can,
It’s not too late to start again.
For you know what you have known,
Nothing here can ever grow.

Wedding rings are broken wings,

You won’t need these things you’ll find.
Sail on my love and leave this place behind.

Leave before the tide,
Let the moonlight be your guide.
I want for nothing more 

Than for you to find a better shore.
Wedding rings are broken wings,
You won’t need these things you’ll find.
Sail on my love and leave this place behind. 

- Scott Wilson

Hyper-tension

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

 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

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

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

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:

1. Get a student to write the notes.  Concentrate on trying to figure out what the plan actually is.
2. 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.
3. 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.
4. 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.
5. DO NOT LOSE YOUR PATIENT LIST WITH YOUR JOBS WRITTEN ON IT.  Seriously.
6. 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.
7. 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.
8. Drink lots of water.  Do not eat the junk food in the office.
9. Stand up straight.  Sniff the morning breeze.
10. 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

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

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

Shock redux

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

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

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:

1. 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.
2. 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.
3. 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.
4. 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.
5. Insurance salesmen come in and give us lunches that look like they were catered by 15 year old boys.
6. 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

New Years Resolution

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

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.

1. Allowing the Hatchling to grab a steak knife off the table whilst distracted by one's own dinner.
2. 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

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

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

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:

1. Pride
2. Envy
3. Corduroy
4. Love
5. Depth perception
6. Embezzelment
7. Puns
8. Man-o-wars
9. Beft
10. Musicality
11. Vengeance
12. The Spanish civil war
13. Chocolate
14. Slip-slop-slap
15. Soviet monuments
16. Running writing
17. Writing running
18. Willpower
19. Blogging
20. Chronic condition self-management
21. Batman
22. Fashion
23. Sex
24. Arithmetic
25. Taxidermy
26. Comparative religion
27. Black powder
28. Bacon
29. Architecture
30. Flattery
31. Insolence
32. Procrastination
33. Politics
34. Fatherhood
35. 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

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

Patient

I have an unquenchable thirst.

Doctor

For power? Knowledge?

Bloody Oath

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

1. Most destructive relationship with clinical supervisor.
2. Most adorable baby.
3. Most patient wife.
4. Most prolific blogger.
5. Least sociable.
6. Most consistent seating position in First and Second year.
7. Lunch.
8. Fewest appearances in theatre during a surgery rotation.
9. Most arty tie.
10. Least kempt.

Assault and pepper

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

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

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

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

Out

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

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:

1. Genioglossus, which attaches to the mental prominence of the mandible and acts to protrude the tongue,
2. Hyoglossus, which attaches to the hyoid bone and acts to depress and retract the tongue,
3. Styloglossus, which attaches to the old-school stylus and acts to scratch up some wicked beats,
4. 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:

1. Tyrannoglossus, which acts to increase centralized control of government,
2. Populoglossus, which acts to decrease centralized control of government,
3. Socioglossus, which acts to move to the tongue to the Left,
4. 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

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

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

"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

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

Sticky dates

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

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

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

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

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

The most useful thing I learned in my recent six week stint with the psychiatrists is that psychiatrists are doctors too.  Here's the evidence:

1. They know all about "Code Brown".
2. They get really annoyed at inappropriate referrals, such as the person with confusion due to an infection that the ED docs think is bonkers and should get detained and given anti-psychotic medication rather than something more appropriate such as, say, antibiotics.
3. Their handwriting is illegible.

With regard to point 3, although it's illegible, it does have the benefit of being voluminous.  They write so much that often you are able to get the general vibe of their notes even though the actual words are gibberish.

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

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

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

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

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

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

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

Roof, Seville

I've got your deposit right here

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

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

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

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

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

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

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

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

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

Praise me

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

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

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

Nutri-brain

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

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

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

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