Addendum

I've been thinking more about my previous words regarding virtual days versus real days.  I think the real nub of my gist is that any given day has only one paltry actual identity whereas it can have a multitude of virtual identities. 

For example, let's say I go in to work on an actual Wednesday.  Yawn.  How dull.

But what if that Wednesday was just a single day after a break, with a four day break afterwards?  Then that Wednesday is a virtual Monday, because it's the first day back.  But it's also virtual Friday, because it's the last day before a break.  And in fact it's virtual Maundy Thursday because it's the day before virtual Good Friday which will fall on actual Thursday.  That's three virtual days in one.

3 > 1, ergo virtual days are very physiological.

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.