Only plastic surgeons should

I had a mandatory training review today, involving a fairly tedious 30 minute phone conversation with an Authority Figure to make sure I am Ticking All The Boxes.  It got off to an awkward start when the first thing he said to me was, "How was your morning?", to which I replied, "Pretty good, I spent half an hour BLANK". (BLANK, of course, replacing what I actually said, for reasons soon to be apparent.) He made a Concerned Noise and said, "I was once told by a plastic surgeon that only plastic surgeons should BLANK", causing me to execute a series of daring evasive manoeuvres to throw him off my tail.

But it made me think that you could write a good exam question about it.  Here goes:

Q314. Only plastic surgeons should:
(a) Wear shoes with such pointy toes that you are mistaken for an elf.
(b) Remove large sebaceous cysts from the face.
(c) Buy a Lamborghini rather than lease it.
(d) Sexually harass a subordinate.
(e) All of the above.

Feel free to leave a comment below with your guess as to correct answer, or to suggest a better alternative.

Mulch

Tonight I cleaned out my manbag.  No, that is not a euphemism for sexual intercourse.  I just figured that I looked like a bit of dill walking down the street towards work holding my stethoscope in one hand and balancing a sandwich, an apple, and a carrot in the other.  Well, to tell the truth, I had been thinking that for several months now, but I finally got around to cleaning out my manbag because my Smaller Half strongly advised* me to do it.

Which is nice, because as of tomorrow I will be able to put my stethoscope, sandwich, apple and carrot into my bag before I leave the house and my apple won't roll off the front seat of my car and onto the floor either, which can only be a good thing health-wise.  But, as I've already mentioned, first I had to clean it out.

My manbag management protocol is pretty much the same as the way my brain works.  I just jam into the top whatever seems useful or surprising that I've come across, and slowly things work their way down into the darkness below where they are forgotten or else take on a strange life of their own.
I found stuff in the bottom of my manbag going back to February 2013, which sounds bad but there is stuff in the bottom of my brain going back to the mid-70's.  Here's a highlist list:

• 8 pens
• 3 torches
• 1 tourniquet
• 1 butterfly needle
• 3 paperclips
• a document telling me that I officially don't have tuberculosis
• almost 50 pages of patient lists, notes and discharge summaries
• identification badges and access cards from 3 different hospitals, none of which I actually work at anymore
• notes and summaries I had scribbled about such diverse topics as sudden cardiac death, management of diabetic ketoacidosis, differences between atypical antipsychotic medications, and "cultural safety toolboxes"
• about a dozen phone bills, electricity bills, reminder notices, final notices, and termination notices
• 20 or so payslips, unopened
• "Where Late The Sweet Birds Sang", by Kate Wilhelm - winner of the 1977 Hugo Award
• A nice stripy blue wool scarf
• an empty shopping bag
• several used-looking tissues (shudder)
• a partridge in a pear tree.

About a third of it I kept, about a third of it needs to be shredded as its mere existence grossly breaches just about every confidentiality requirement I can imagine, and the other third I just ate with a nice chianti.

So tomorrow I will be able to transport my lunch in a snug, marginally hygienic bag.  It's exciting.  And I will start to fill it up all over again.

*directed.

We're all in this together

Well my friends, I see your face so clearly
Little bit tired, little worn through the years
You sound nervous, you seem alone
I hardly recognize your voice on the telephone

In between I remember
Just before bound-up, broken-down
We drive out to the edge of the highway
Follow that lonesome dead-end roadside south

We're all in this thing together
Walkin' the line between faith and fear
This life don't last forever
When you cry I taste the salt in your tears

Well my friend, let's put this thing together
And walk the path with worn out feet of trial
'Cause if you wanted we can go home forever
Give up your jaded ways, spell your name to God

We're all in this thing together
Walkin' the line between faith and fear
This life don't last forever
When you cry I taste the salt in your tears

All the hour there's a picture in a mirror 

Fancy shoes to grace our feet 

All there is is a slow road to freedom 

Heaven above and the devil beneath 

We're all in this thing together 

Walkin' the line between faith and fear 

This life don't last forever 

When you cry I taste the salt in your tears

- Old Crow Medicine Show

One dollar - the untellable story

Once again I am back, the turmoil of life having started to abate.  We moved to a new house, in a new city, in a new state, and started new jobs, and the Hatchling started school, and I had an enormous mechanical claw grafted to my spine which appears to have developed a habit of shoplifting fruit.

So I thought to myself tonight - "Self," I thought, "- Self, why not do a bit of blogging?"  So I opened up one of my old notebooks where I keep ideas and found this one:

One Dollar

"Hey! Come back you bitch!"

Clearly at the time I wrote this I was under the impression that this would remind me of some sort of concrete event or thought, but sadly this is not the case.  I have no idea whatsoever what I might have been thinking of writing.  Sorry you. Sorry self. Sorry bitch.  Your tale remains untold.

However, in the interests of not entirely wasting your time, here's a segue .., see if you can figure out the theme:

Last week we went out to dinner to a fancy-schpanzy restaurant with some old friends.  I came out of the bedroom wearing a tweed jacket, because old people dig that kind of shit.  The Hatchling looked at me and said, "Hey! Come back you bitch!"

No, of course she did not.  She actually said, "Dadda, you look very curious." I thought she meant that I looked odd or peculiar so I did my best offended act and instructed her to clarify herself, to which replied, "You look like you are going to solve a mystery!"

Teaching

So this patient has a blood pressure of 175/115. Is that high or low? Anyone? High or low? High? Anyone else? You all agree? High or low? This patient, big fat bloke in fact. Is that a problem? Actually he's a Pacific Islander. Is his blood pressure a problem? Anyone? What do you think? Does he need tablets? Anyone? Anyone else? What about that table up the back there, you haven't said much. What? What? Sorry I can't hear you, say again? Yes, that's a good thought, although phaechromocytomas are rare. What else?

On zederisms

A recent comment confused me. As usual.

Bruce Hamjangles accused me of promulgating zederisms.  Despite googling the word, I had no idea what a zederism was.  Turns out it's a neologism for spelling words with a 'z' (pronounced 'zed') that would be normally spelled with an 's' in standard Australian English.

Guilty as charged.

But before you pass sentence, hear this.  I only did it because blogger.com insists that 's' is wrong and puts a little red squiggle under the word.  A little red squiggle which I find so annoying that it's psychologically less damaging for me to just cave in and use American English's 'z' (pronounced 'zee').

Bruce Hamjangles also used the word "ġeār-dagum" which I am unable to shed any light on at this stage of my existence.  Do not doubt, however, that I am devoting myriad resources to decoding this apparent keyboard face-plant.

Out.

Comic road kill

Knock knock.

Who's there?

Cow.

Cow who?

What did the cow find when it crossed the road?

I don't know, what?

This joke.

How to just pop it back in

A lot of readers have been asking me for advice recently on how to reduce a proximal dislocation of the 5th metacarpal.  It's an unusual injury, the more common outcome being to simply smash the metacarpal into pieces - the so-called "auctioneer's fracture", but sometimes the metacarpal is simply too strong, too stubborn, or too ignorant to break, and a dislocation occurs - the so-called "meteorologist's dislocation".

It is easily recognized clinically by the appearance of firm lump on the dorsal surface of the hand, preserved motor function of the fingers, and an unequivocal description in the radiologist's report.

Reduction of the dislocation (or more colloquially, "popping it back in") can be achieved by following these easy, easy steps:

1. Ask your boss to help you.
2. When your boss tells you to simply do an ulnar nerve block at the wrist, tell him (or her - this technique works equally well with supervisors of either gender) that you have not done this before.
3. When your boss suggests that you use Google to learn how to do it, use Google to learn how to do it.
4. Ideally, your source of instructions on Google should be a PDF document, preferably authored by a doctor-sounding person.  Watching videos on YouTube lacks gravitas, while learning medicine from a blog post is simply preposterous.
5. Print out the instructions and place them out of your patient's eyeline but within your line of sight.
6. Locate the distal flexor carpi ulnaris tendon.
7. Using a 22 gauge needle or smaller, penetrate the skin deep to the tendon on the medial aspect of the wrist and advance the needle approximately 10-90 mm.
8. Infiltrate 3-5 mL of a mixture of 1% lignocaine and 1 tsp cream of tartar.
9. As the patient's vasovagal response begins, slide them gently onto the floor.  When supine on the floor, ensure airway patency.
10. Press the emergency button on the wall.
11. While the patient is unconscious, grab their 5th digit on the affected side and pull firmly and steadily while applying firm pressure on the dorsal surface just distal to the wrist.
12. Feel the bones crunch as they slide back into place and vow to never eat turducken again.
13. Revive the patient.
14. Reassure staff who are now arriving in response the emergency alarm that everything is progressing exactly as planned.
15. Apply an ulnar gutter slab from below the elbow to even more below the elbow, applying three point pressure to keep the metacarpal enlocated, or better yet delegate this to a nurse, student, or nursing student.
16. Write a blog post about it, making it seem like it really happened. 
17. Profit.

Boustrophedon

The other day I got a call from my doctor.  It might seem strange that I, as a doctor, have a doctor.  But it's actually a really good idea.  As I like to say to people who are easily confused, "The barber cuts the hair of everyone in town who doesn't cut their own hair. Who cuts the barber's hair?"  If the barber cuts his own hair, then he doesn't cut his own hair, then he does cut his own hair, ad infinitum.
Obviously, the barber lives in the next town over and travels to a third town to have his hair cut by a barber friend of his who is completely hairless, and he also owns one of those creepy hypoallergenic cats that feel like they are made of scrotums.  So it makes sense for me to have a doctor because that way I have two doctors looking after me.  But that's not what I'm here to talk about.

So my doctor called me, and asked me to come in because my latest cholesterol test was abnormal.  Now this was a surprise because I had already checked my result through the simple expedient of many years ago romancing and marrying a person who had ambitions to be a doctor themselves (not a barber - and thus making a third doctor who is looking after me) and asking them to look up my results, and so I knew that my results were completely normal.

Nevertheless, I dutifully went to my GP. I sat down in the consulting room and she told me that she wanted to see me because my cholesterol had suddenly and unexpectedly increased to a dangerous level.  I expressed my surprise at this, and she pointed to the computer screen where the pathology results were displayed in serial form:
Total cholesterol
7.8    7.2    4.8
and at that point, she said in a horrified voice - "Wait, I think I was looking at the wrong one.  4.9 is the most recent one isn't it? Since you started the statin."

What she had done was assume the results were listed from newest to oldest rather than oldest to newest.  On the face of it, this seems pretty dopey, especially as each column has the date printed at the top.

But it's actually an easy mistake to make, as that is indeed the way that some pathology companies list their data so she would have been used to just looking at the leftmost column, whereas I am used to the one I am familiar with from work, which does it the logical way.

I say logical because we read from left to right, so it makes sense for new data to be added to the right of the old data.  You may accuse me of cultural imperialism, but if you usually read my blog from right to left, esnes ekam t'nod sekoj ym rednow on s'ti.

In fact, I have made the same mistake in the past, but in reverse.  I was working in ED and got a different company to fax me some old results.  I read them the wrong way around and rushed off to try to figure out why the person's blood tests just made no sense at all.  How embarrassing.

But not as embarrassing as the time I checked a patient's blood test results, which gave a reading of 55378008 ng/L, but I had glanced at the paper upside down, so unfortunately broke the news to the patient that they were boobless.

Much safer

Hatchling

What is a war?

PTR

A war is what happens when army people from two different lands get together and fight each other, usually because they are having an argument about something.

Hatchling

So they fight with swords?

PTR

In the Olden Days they fought with swords, but now they use guns.

Hatchling

That is good, because swords are very pointy and you might accidentally hurt someone.

Eleven incredible facts that will change the way you blah blah blah.

1. Pizza Hut was founded closer to Cleopatra's lifetime than to the era of the construction of the pyramids.

I mean, this stands to reason.  We've all seen pictures of Cleopatra lounging around on some boat on the Nile, floating past the pyramids, so clearly they already existed by the time she came on the scene.  Mind you, it was in a movie.  Probably fucking Kubrick, faking Egyptian history just like he faked the moon landings.

2. More pictures are taken today of Justin Beiber than were taken of Justin Beiber in the whole of the 18th century.

Again, pretty obvious.  Justin Beiber was only born in 2008 so not many photographs of him COULD be taken in the 18th century. Especially since photography wasn't invented until the 19th century. Duh. Sub-prime crisis notwithstanding.

3. The gap between the invention of the written word and the very first tweet was a mere 5200 years.

Around 3200 BC, the Sumerians discovered that by scratching their names into wet concrete they could eternally preserve their ill-fated teenage romances in the sidewalk outside their houses.  Then in 1976 Tim Berners-Lee invented Al Gore and tweeted "Watson, come in here, I need you. LOL!!!" using his fax machine. This EXPONENTIAL development in communication was mostly funded by the military - loose lips sink ships?!

4. The average smart phone of today contains more explosive power than the Saturn V rocket than lifted Stanley Kubrick into space.

Point that browser to AddisonMashley.com - the website that lets you hook up with hot chefs suffering from endocrine disorders.  Conversely, I pointed my Saturn V there and it just crashed.

5. George Washington, first president of the United States, despite being "Father Of The Nation", had no offspring.

That is, none I could track down with a cursory reading of Wikipedia.  Next time I should look at the page about George Washington I guess.

6. Egypt's Sphinx was largely built with the aid of woolly mammoths.

Really, it's true.  At least it should be.  It would explain the nose. Or not, I suppose.

7. France was using the guillotine when Star Wars was released.

Although it was called "La Guerre Des Etoiles", which literally translated means something like, "I Played The Guitar On The Toilet", perhaps explaining the lingering popularity of the guillotine. Nevertheless, for a few months in 1977, it became fashionable among those about to be decapitated to say, "If you strike me down, I will become more powerful than you can possibly imagine."

8. My daughter is literally older than sliced bread.

The Hatchling is five.  My bread was baked just last weekend.  No comparison.  But incredible to think about, really, when you consider that before sliced bread was invented, a sandwich could only be made by layering two whole loaves on top of each other, which was almost impossible to eat, moreso if you were only five.

9. If you were born in 1800, the world population has septunkled since your birth.

The population of Earth has increased from 1 billion to 7 billion in that time. This figure, however, doesn't take into account the precipitous crash in the world population of Tyrannosaurus Rex over the same time.  Tragically, by the dawn of the 21st century, less than 1000 T-Rexes were alive in the wild.  

10. There are whales alive today that have never read Moby Dick.

Despite some bowhead whales living off the coast of Alaska being up to 200 years old, and thus having had plenty of time to read Moby Dick, especially when you consider that almost none of them work full-time and in fact receive substantial government hand-outs so don't exactly have many demands on their time, researchers estimate that the majority of whales derive their at-best cursory knowledge of Moby Dick from the 1980's animated children's TV show, Star Blazers, in which the sunken WW2 battleship Yamato is converted to a starship and sent off on a desperate mission to save the earth - a fact which probably tells you more about whales than the aforementioned TV show does about Moby Dick.  Let's see how they do with Yann Martel.

11. If all of this year was represented by the Mesozoic Era, Easter would have been at the end of the Triassic.

200 million years is a long time between chocolate eggs, mass-extinction or not.

Fresh out of ice-cream

An anonymous commenter on my previous post made me wonder if there is any documentary evidence of zombie Lego Friends with hypercholesterolaemia having fought in the Vietnam war. Perspicacity such as this can't be ignored, so I scoured the classified microfiche banks in my basement and discovered this picture.

The thicket in the background places the subject probably somewhere around the Mekong delta. The rifle is an M14, dating the picture to roughly 1965-67, unless the zombie Lego Friend was serving in the US Marines or Army Engineers, in which case it could date to as late as 1974.

As you can see, the zombie Lego Friend is carrying a large  supply of fish oil, known to help lower elevated triglycerides. While elevated triglycerides are not a typical feature of familial hypercholesterolaemia, it's better to be safe than sorry.

Finally, whilst it is impossible to definitively identify which zombie Lego Friend this is, the style and colour of the remnants of hair strongly suggest that this could be the undead form of Olivia, previously known primarily for her mobile ice-cream shop, powered by bicycle.

No doubt she roams the delta still.

This week I have been mostly thinking about

Overheard

Patient

Antipsychotics are bullshit!  You know, what happened to people with schizophrenia before antipsychotics were invented? Huh?

Doctor

Well, most of them probably died very young from exposure, malnutrition, violence, suicide, disease, or else were locked up for the rest of their lives.

Patient

Oh.

Custodian

Hatchling

I really really like your watch.

PTR

Me too.

Hatchling

When you are dead, who will get to have your watch?

PTR

You will, I suppose.

Hatchling

I can't wait! I can't wait!

Thoughtful propaganda

Hatchling

Dadda, when I am grown up and getting married, can you please try very very hard to not be dead so you can hold my hand and walk with me past all my friends at the wedding?

PTR

I would love to do that, it would be the best thing ever.

Hatchling

So you have to eat lots of healthy foods and do lots of exercise too.

PTR

Fine then. Fine.

Whoever smelt it...

Smaller Half

There's a funny smell in the kitchen.

PTR

Like what?

Smaller Half

Like there's meat in the bin that's gone off or something.

Hatchling

I think it was Dadda.

PTR

What?!

Hatchling

You always make funny smells, Dadda.

PTR

And how is that?

Hatchling

When you're cooking, of course!

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!

Nothing beats fish-fingers

Rock-paper-scissors is a good game to play with a four-year-old.  It's simple enough to remember when you're exhausted, yet also boundlessly entertaining enough to keep them occupied trying to outsmart you.  But it's just not good enough for some.

Probably the best known rock-paper-scissors extension is rock-paper-scissors-Spock-lizard, as illustrated below.  It's tolerably amusing, I suppose, if you happened to be trapped in a broken subway with four (other) sweaty nerds.

Tonight while playing rock-paper-scissors with the Hatchling during dinner, she was riding high on a string of 5 successive victories, when she suddenly innovated.  My Smaller Half had played scissors - the Hatchling played a single extended finger.

"What's that? A sword?", I asked.
"No, a fish finger!", she said.
"Okay. So how does it work? What does the fish finger beat?"
"The goldfish", she replied, waving her flat hand held vertically, rather than horizontally as in paper.
"Right. And what does the goldfish beat?"
"Fish food!", she said, forming an inverted cup with her fingers pointing downward to the table.
"Okay, and what does the fish food beat?"
"Nothing!"
"What? There's not much incentive to play that then.  Does anything beat the fish finger?"
"No."

A pretty bizarre variant - it's basically two parallel games.  Rock-paper-scissors runs independently and as normal in its cyclical structure. And from time to time you can, if you wish, go skewing off into the fourth dimension and play the other fishfinger-goldfish-fishfood game, which is strictly hierarchical and entirely lacking in strategy of any kind.  Basically if you're playing this game the fish-fingers stretch out in front of you to infinity unless you decide for some reason to deliberately throw the game by playing goldfish or fish-food.

As for what happens if there is cross-over between the two games, at this stage the science is unclear.  Does fish-food beat paper? Do scissors beat gold-fish? I'd suggest treading carefully until the full ramifications have been worked out by the experts.

Nevertheless, as mentioned above, rock-paper-scissors-fishfinger-goldfish-fish-food captures some essential truths about life:

• it's repetitive,
• you cannot win, unless your enemy chooses to lose,
• you don't want to be fish food,
• nothing beats fish-fingers.

I think this is going to catch on and be a Big Thing.  Might get some t-shirts printed.  

But remember kids - don't play for money.

This week on MasterChef

Another amazing week of culinary feats this week on MasterChef!  Let's look ahead to the highlights:

• On Monday, watch the contestants scurry to cook a meal in just 45 minutes, using only ingredients that start with the letter Q.  Jessica prepares a quail and quinoa quesadilla, while Kha plans a quince quiche with quark, but runs into a quirky quandary.  Who will win the day?
• Tuesday: Mystery Box!  The contestants are always pushed to the limit by the Mystery Box and tonight is no exception. They are required to design, prepare and serve a seafood luncheon to the missing aviatrix Amelia Earhart.  Georgia and Jamie team up to scour the floor of the Pacific Ocean for fresh ingredients and the wreckage of her plane.  Do they have what it takes to succeed?
• On Wednesday, the budding chefs are challenged to a contest of basic skills.  They are given 10 minutes to remove and fillet their own leg, something most of them have never done before. Reynold concocts an impromptu blood sausage before lapsing into unconsciousness, while Jarrod panics and cuts off his left arm by mistake, necessitating a visit to the MasterChef nurse.
• On Thursday, the contestants visit the training venue of the Australian Paralympic basketball team for inspiration.  In a poorly timed challenge of questionable taste, they are required to prepare and serve a three course service without using their hands.  Jarrod comes roaring back into the competition as the only cook with two functional lower limbs.
• Finally, they are divided into two teams for the weekend brunch challenge. The Red team must cook in an atmosphere of pure oxygen, while the Blue team must cook with no oxygen at all. Can you guess who dies in a fiery explosion, and who succumbs to hypoxic brain injury?  And will it affect their chances in the ensuing elimination challenge?

For recipes, filleting tips, and lessons in basic chemistry, why not visit the MasterChef website? Tune in tonight to watch our search for Australia's 2015 ...  MASTERCHEF!