It's from Belarus?

Elderly patients often ask to see my ID badge so they can get my name.  At first this made me a bit twitchy - were they preparing affadavits against me even as I was treating them?  But then a couple of patients sent thank you cards to me at the hospital afterwards, which was really nice.  Thanks for not fucking up.  So now I'm always happy to let them peruse my ID badge.  After all, maybe they'll send me chocolates, or offer to adopt me!

So the other day, an old chappie asked me how to pronounce my name, and as I leaned forward, he reached up his trembling hand to my badge.  But not my ID badge, which hangs at my waist - he reached for my swipe access card, which hangs around my neck.  It's just a white card with my position description on it: RMO, for Resident Medical Officer.  

And it suddenly occurred to me that my patient thought that my surname was Rmo.  How cool would that be, if you were Dr Rmo?  At least, it would be until you progressed higher up the food chain.  Unless you were like Major Major Major Major and thus destined to never be a colonel because the army didn't want to lose the only Major Major it had.

Darts

I was chatting recently with a colleague who has kids older than the Hatchling.  He said to me, "Does she like it when you play music on the radio?  Does she tap her feet or wiggle around?"  When I said that she did (don't all kids?), he said, "You know what you should get her into? Darts."

This left me reasonably flabbergasted.  In the hiatus left by my speechlessness, he filled me in with more detail: "The great thing about darts is that it really gives them something to carry with them as they get older.  It's great for their confidence, their posture, and they really love it.  Seeing them get so excited as they go off to their darts lessons, it's a real hoot."

I began to make two main points, in a Kevin Rudd kind of way, the first being that giving a three year old child access to darts seemed like a good way of not ever having to look after a four year old, and the second point being that I certainly would get the Hatchling involved in darts just as soon as she weighed 120 kilos and had a beard.  There were also other subsidiary points involved, in a Kevin Rudd kind of way, but then I realized that in fact I wasn't speaking at all but simply lost in my rich inner world, and my colleague was still talking to me.

He was saying, "My daughter started darts when she was three - she's still doing it now and she's twenty four.  It used to be ballet of course, and now it's more this hip-hop stuff, but she still loves it", and I realized that he wasn't saying "darts", he was saying "dance".

The reason I had mis-heard him is that I pronounce "dance" to rhyme with "pants", whereas most people in this neck of the woods pronounce "dance" more like "dahhhnce", like "dahhhling, would you like to dahhhnce?  No tea and scones for me, mater, I'm orf to play on my grahhhnd piahhhno."

Anyway, having figured that out, I'm glad I hadn't launched into my two-fold refutation of the wisdom of getting pre-schoolers playing darts.  He would have thought I was a complete nut.

Fund-raising ideas

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

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

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

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

Wake me up before you go-go

Oh woe is me! Here I am at work at the godforsaken hour of 4 a.m., finally taking a well-earned break, but tragedy of tragedies, I can get no respite!

Unfortunately one of the orderlies happens to share my first name (actually we both use it at the same time so it's not really sharing) so he has a propensity to chat at me. And he is taking his break at the same time as I am taking mine. Sad face. 

His opening gambit was to observe that in the days before mobile phones people used to talk to each other. I assume this was intended to guilt-trip me into putting down my phone and talking to him. But I am made of sterner stuff than that. I simply agreed and kept on reviewing the fascinating bullshit on Facebook. 

Then he tried to engage me football which of course failed because I have no interest at all in football. So he tried asking my opinion of the upcoming war in/on Iraq mk III, which I am parlously ill-informed about, and said so, so that went nowhere. The whereabouts of his plastic cutlery - nope. The verdict on Oscar Pistorius - nope. The inability of the South Australian government to build good roads - nope. The fact that one of the nurses just walked in on him in the dunny. Nope. His insightful observation that I look tired. Grrr. 

It's not that I'm above talking to him because he's 'only' an orderly. It's just that I'm tired and need to rest and talking is not restful to me. And yeah I guess he isn't exactly scintillating. 

I am a rock. I am an iiiiiiiiiiiisland. 

Overestimation

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

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

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

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

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

Great Old One of the Cthulhu Mythos, or Pharmaceutical?

1. Lythalia
2. Rokon
3. Cynothoglys
4. Lapatenib
5. Inpesca
6. Romiplostim
7. Cyproterone
8. The Worm That Gnaws In The Night
9. Zindarak
10. Irinotecan
11. Zonisamide

Answers
Great Old One: 1, 2, 3, 5, 9
Pharmaceutical: 4, 6, 7, 10, 11
Both: 8

The story about the time I got baked into a pie

One day, your Mama was making a really big pie for us all to eat for dinner.  She used a bathtub to bake the crust until it was lovely and flaky and crisp.  Also, on the stove was a great big pot of boiling yummy pie filling.  Mmmmm.

I was leaning over the bathtub, smelling the delicious hot crust, when Mama turned and took the big pot of filling off the stove.  As she turned around again to begin to pour it into the bathtub, she bumped it into my back and knocked me into the pie crust without even noticing!  She poured the pie filling into the tub and covered me up with it, then put the pastry onto the top of pie, and popped it into the oven to cook, with me stuck inside.

An hour later, when the pie was piping hot and ready to eat, Mama came looking for me.  She asked you if you knew where I was, but you didn't.  "Dadda, Dadda, where are you?" you called.  Finally, you and Mama were getting so hungry that you couldn't wait any longer, so you decided to eat.  The great big pie went up onto the kitchen table and Mama cut it open with the big sharp knife.

She was very surprised when out I popped, all covered with flaky pastry and pie filling.  Wasn't that a funny thing to serve for dinner?

The story about the time your pram rolled away

Once, when you were a tiny baby, we took you to the markets to go shopping and your pram rolled away!  What happened was that I was pushing your pram with you inside, then your mama asked me to choose some mandarins.  So I let go of your pram, took a shopping bag, and started to choose the juiciest, yummiest mandarins.  But I didn't notice that your pram had started to roll away.

It rolled past the fruit shop. It rolled past the vegetable shop.  It rolled past the mushroom shop.  "Hey that pram is rolling away!" called the stall-holders.

It rolled past the chocolate shop. It rolled past the coffee shop.  It rolled past the deli.  "Won't somebody think of the children?" wailed the balloon-twister.

It rolled past the fish shop. It rolled past the chicken shop. It rolled past the bakery. "Oh the humanity!" cried the shoppers.

And it rolled all the way over the lift, and rolled right through the open doors.  And then, you reached out your tiny baby hand and pushed the button for the 3rd floor, where our car was parked.  Up, up, up, went the lift, and when it reached the third floor, your pram rolled right out the door and into the car park.

It rolled past the red car. It rolled past the yellow car. It rolled past the white car. But it didn't stop.

It rolled past the blue car.  It rolled past the black car. It rolled right up to the grey car and, bump, it stopped.

And your mama and I brought our shopping back to the car. Mama was cranky with me even though I had chosen very good mandarins because I was supposed to be looking after you and I had lost you and I didn't know where you had gone.  But then, when we got back to our grey car, there you were, in your pram beside our car, waiting happily for us to get back.

And we were so happy that we gave you lots of cuddles and kisses and nobody was sad or cranky anymore, and we all ate mandarins together.

Paddling

Consultant

And what other regular narrow-complex tachycardias do you know of?

PTR

Atrial flutter - but this is too fast so it isn't flutter.

Consultant

Unless?

PTR

Unless... it is flutter.

The Hatchling can read - kind of...

[Scene: sitting in the hospital cafe, the Hatchling points at a sign on the wall] 

Hatchling
Dada, look! "C", "O", "F", "F", "E", "E"! 

PTR
Good reading, sweetheart!  And what word do all those letters spell? 

Hatchling
Emergency? 

PTR
Close enough.

Painbook

As has been observed before, Facebook is a stinking heap of shite, which is why I seem to be irresistibly drawn to it, like a dung beetle when the moon is full.  A quick perusal of my news feed shows me that 95% or more of the posts are:

• Videos of people's ugly kids.
• Self-evident platitudes from Paul Coelho typeset in bold over a picture of a sunset.
• Quizzes urging me to find out which inanimate object or abstract category I am most similar to.
• People bitching about football.
• People bitching about television.
• Clearly fabricated heart-warming stories about returned veterans who rescued rabbits from snow-drifts then had their legs ripped off by crocodiles moments later only to have their houses renovated by rehabilitated Malaysian slum-kids.
• Desperate pleas to adopt yet another enormous and demented-looking canine.
• Gloating about holidays.
• Exaggerated news stories about scientific breakthroughs, implying that treatments for cancer and rocket-cars are just around the corner, again.
• Desperate pleas to vaccinate your ugly kids.

I'm not saying that I'm blameless here - I've blotted my escutcheon from time to time with at least one of the sins above.  But I've just spent 20 of the richest minutes of my life scanning for comments that I've left on other people's items, and I must say, the quality of my work is impeccable.  Here is a selection of some of the comments that I left over the past weekend:

• "Those are lyrics from a Starship B-side"
• "Your appearance is illegal in Queensland."
• "What if you force-fed the glitter to the celebrities, then took their livers to make sparkly foie-gras?"
• "That depends on where that finger has been I guess."
• "Racial profiling is so 2001."
• "I'll bust my ass in your cap."
• "This sack does not contain legal tender."
• "Which one are you again?"
• "I think it's a Bavarian flipperwaldt. Or possibly Hanoverian."
• "Look ma, no hands!"
• "An extra eyeball!!!!!!"

In many cases they garnered two or even three "likes", thus simultaneously sating and stoking my narcissism.  But not only did they briefly embellish my own self-regard, they also provided a breath of fresh air to the conversation they were lobbed into, in much the same way as a drunken smart-arse at a pub, reeling from person to person and belching into strangers' faces can change the atmosphere in an instant.  My final observation though, is that they are stand-alone works of beauty and truth.  My challenge to you is this: the next time you feel the need to leave a comment on any type of social media, why not use of these modern classics instead?  And not just social media - you could send one on a post-card to your Mum, you could spray-paint it on a billboard of Tony Abbott, you could blurt it out during an early morning surgical ward round.

Every comment dies. But not every comment truly lives!  

The Smiling Assassin

One of bosses at work is known as the Smiling Assassin. Not the most original nickname, I'll grant you. But it's very apt. He will stare you down, and take you apart piece by piece, while grinning affably from ear to ear, as if he's your best friend in the world. 

Contrast this with one of the other bosses, the Inquisitive Assassin. He just keeps asking you question after question. What do you mean by this? What did the patient say about that? What other things might you consider? What's the evidence for that management plan of yours? Where exactly did you get your degree from anyway?

Then there's the Frowning Assassin. She will also show no mercy, but instead has a big scowl on her face the whole time. She's either perpetually disgusted at what you have to say, or very hard of hearing. 

Still, she's easier to deal with than the Surprised Assassin. Every time I speak to him about a patient, he reacts by jumping up, mouth wide open, eyebrows lifted, hands waving in the air like a jack-in-the-box. It's very unnerving, especially when he maintains that expression and pose while telling you why every thing you have said and done for the last three years was wrong. 

Once you've faced him down, you then might have to deal with the Weeping Assassin. He just sits there sobbing, presumably reflecting with a broken heart on the dreadful fate of the poor patients that we are trying to manage as we struggle along in our ineptitude. 

The last of the bunch is the Thoughtful Assassin. He sits there, rubbing his chin in contemplation, giving nothing away, just taking it all in. Then, when you've said everything you have to say, he kills you. Actually kills you dead. His favourite method is to wait until you turn away, then he stabs you in the back of your calf muscle with a poisoned umbrella. For the more senior registrars, he will use a more complex plan, as they are naturally wary from seeing so many colleagues fall along the way. For example, recently he obtained advance information on an incoming patient transfer from a regional hospital, and planted an explosive device in the handset of the telephone in the doctors' office, keyed to go off when the pager number of the relevant surgical registrar on duty is dialled. Kaboom. Whereas with the interns, he usually doesn't even let them finish their first sentence. He just has an accomplice in a nearby building pick them off with a sniper rifle. 

The Thoughtful Assassin is on duty tomorrow. I think I might call in sick. 

The day that you realize you're married to a psychiatrist

[Scene: On the couch, watching an advertisement for the forthcoming movie, Dawn Of The Planet Of The Apes] 

Smaller Half
Why do they keep making the same kind of film over and over? 

PTR
Aheywha? 

Smaller Half
They keep making these films about Man versus the Other, and the Other must be destroyed, but of course in the end it's Man who is the Other. 

PTR
Well thanks for ruining it for me.

Commentary commentary

And that's kick-off!

If you've joined us late, welcome to the exciting commentary between David Basheer and Craig Foster, who are commentating the World Cup match between Australia and Spain. This is expected to be challenging for both commentators, but possibly more so for "Foz", who, despite his big-match experience has been known to lose his composure and forget the big-match plan.  The challenge for Basheer, of course, will be to rein in his co-commentator and exert some control over the pacing of the commentary itself.

And yes, Fozzie is already starting to let his emotions get the better of him.  It's an exciting match, to be sure, but he needs to remember what his producers told him before the match: he's not part of the crowd now, he's part of a professional team delivering commentary to an Australia-wide audience, and to do that he just needs to relax a little and sit back - talk us through the action, try to provide some inside knowledge and perspective rather than simply rushing headlong into the play.

Basheer is having a good match though.  Each time there's a turnover from Fozzie, Basheer slows it down, uses his brain, constructs some good sentences by linking up words together to form coherent concepts.  It's a pleasure to watch him commentate, regardless of the result.  Oh! And that's an aggressive challenge from Fozzie during a key play, and Basheer is down! No, he's okay, back up again quickly and trying to get back into the action.  Fozzie needs to watch himself, if he gets too excited he could find himself on the bench for the second half.  The last thing the commentating team needs is to be down a man.

And that was a key moment, almost a blunder - Fozzie briefly referred to a player as Xavi when he was in fact Xavi Alonso, but immediately recovered and continued play.  An easy enough mistake to make, but it will get pounced on at this level and exploited.  I must say, the improvement in the Australian commentary team in the technical skills of name identification and pronunciation is remarkable.  We're simply commentating so much more fluently than even four years ago.  Some of the really tricky foreign phonemes have been rolling off the tongues of the team all tournament long.  Xavi is a case in point - that X, that V, neither of which are handled in the same way as they would be in Australia.  It's clear that both commentators have really done their research.

Oh dear, that's a let down - both commentators momentarily lost control of the situation when Australia conceded a sloppy goal.  Fozzie simply lying groaning on the floor, and Basheer sitting mute at the microphone.  This will be added to stoppage time at the end of the match.  The crowd back home will be disappointed in that - nothing but dead air coming over the audio.  They'll have to lift their game for the second half.

How interesting it is to reflect on the difference between the Australian style of commentating and the English.  Martin Tyler, the English great, seemingly ageless, able to stay calm and offer clear, dry, abstract commentary at all times.  Perhaps too calm for some, especially in the Australian leagues where the audience seems to require more overt barracking from their commentators, perhaps reflecting an underlying lack of faith in the team or lack of enthusiasm for the game.

But the team, Fozzie in particular, seems to have steadied their nerves now. Listen as he describes a poor sequence of Spanish play in objective teams, and then adds that it's disappointing to see that, whereas in the first half it would have been framed as an Australian triumph. He's acting much more in concert now with Basheer and it's clear from the way they hand the commentary back and forth, smoothly switching directions, effortlessly weaving anecdotes and analysis in between play-by-play descriptions  Surely if they keep up this level of performance they'll break through soon!

And here, Australia on the attack again, listen to Foz, he's really flying now. Back to Basheer, who rapidly disposes back to Foz - Foz to Basheer again, watch them go.  Basheer with a little metaphor there, very tricky, no, he's mixed his metaphors, but Foz has scooped it up and recovers well with some alliteration, but that's an opportunity lost.

The underlying structure and organisation of the team is emerging now as the game develops late in the second half.  Foz is taking over more when the ball is in Australia's half, with Basheer doing duty in Spain's half.  It's a good system which give some balance to the listener, and I think the producer has allocated their roles well.  When the ball is near the Spanish goal, Foz does become hysterical and incoherent, so Basheer is better placed to take over here, notwithstanding the screams and grunts that can be heard over the top of him.  And when Spain gets a good attack rolling you can hear the strain and desperation in Foz's voice but he retains control with occasional backup from Basheer.  How much influence, I wonder, has Les Murray had on this system, with his vast experience of managing Foz's enthusiastic ramblings on television?

And here we are, only two minutes of stoppage time added.  Both commentators, I'm sure, will be relieved to reach the end of this game.  You can hear them tiring, the energy is simply not there.  I can't help wondering if perhaps they didn't push just too hard in that first half when they were so hopeful.  I think it left them lacking legs in the second half when they really needed to keep the listeners involved after Spain's second goal.  Their talk became just a little lacklustre, lacking imagination and not as crisp as it really had to be to perform for a full 90 minutes at this level.  Nevertheless they put in a spirited performance which is so much a part of the Australian way of commentating.  I do wonder, though, if this might be the last time we see them commentate at a World Cup.  Sad to think that this could be the end of an era.

There's the whistle!  That's full time!  They push back their chairs, turn off the microphone, and take a deep breath. Another splendid performance from SBS's commentating team.  They're swapping shirts now, another one for the pool room.  Thanks for joining me, I'll see you next time with more commentary commentary.  If you have any commentary commentary commentary, leave a comment below.

Placebo effect

The placebo effect is oft misunderstood.  Strictly speaking, the placebo effect is the subjective or objective improvement in a patient's health after being administered a deliberately inert treatment which they believed would genuinely benefit them.  The label tends to get stuck on any number of unrelated though equally baffling phenomena.  Here's a few examples of similar effect which are in fact not placebo effects:

The nocebo effect. This is the subjective or objective deterioration in a patient's health after being administered a deliberately inert treatment which they believed would genuinely harm them.

The albedo effect.  This is the subjective or objective improvement of a patient's surface reflectivity after being adminisered a deliberately inert treament which they believed would genuinely make them more shiny.

The gazebo effect. This is the subjective or objective transformation of the patient into an outdoor, open-walled roofed area, usually octagonal, after being administered a deliberately inert treatment which they believed was a psychedelic drug.

The Placido effect.  This is the subjective or objective improvement in a patient's singing voice, particularly in the tenor range, after being administered a deliberately inert treatment which they believed was a gift from the Aoedean muse.

The libido effect.  This is the subjective or objective improvement in a patient's sexual drive or endurance after being administered a deliberately inert treatment which they believed was an aphrodisiac.

The bushido effect.  This is the subjective or objective improvement in the patient's ability to temper his violent martial instincts with forebearance, serenity and insight, after being administered a deliberately inert treatment which they believed was prescribed by the long-dead Japanese author and diplomat Nitobe Inazo. To be honest, it doesn't really come up that often but I thought I'd include it for completeness.

So the next time you go to your doctor complaining of having changed into a pavilion, belvedere, rotunda or pergola while you were tripping, and he mistakenly suggests that perhaps it was due to the placebo effect, you'll know precisely what to say!

No Known Drug Allergies

One day, when I have a bit more spare time, I'm going invent a medication which could be plausibly abbreviated NKDA, such as norketodopamine. (Does that name even make sense? Don't ask me, I'm a idiot blogger not a biochemist. But if you can have owlbears, I can have this.)

Then I will discover that it is not only therapeutically vital for the treatment of depression, acne, obesity, ischaemic heart disease, or some other such common condition, but also lethal if treatment is abruptly ceased.

And all over the world, pharmacists will have conniptions because patients will be bringing in prescriptions for norketodopamine re-supply, but the script will also have written, in the little box for Allergies/Adverse Reactions:

(Wait for it)

(You can see it coming, can't you?)

NKDA

That will be briefly amusing for me as I lounge on my Throne Of Spleens, contemplating my empire and watching the dancing girls.

A modest proposal for the solution of my employment woes

[Editor's note: this was written more than a year ago, and was recently unearthed from the dusty archives of my "Drafts" folder.  History does not relate the ultimate destiny of the young poet who scribed it to his beloved, so many moons ago blah blah blah but I forgot to hit the "Publish" button. Enjoy.]

Man, the last hour of work is always a real struggle.  Yesterday I powered through the first 11 hours of my shift with (relative) ease.  I was an admitting machine.  Ask ask ask. Talk talk talk.  Examine examine examine. Write write write write write write write write write write WRIIIIITE!!!  It's a doctor's life.  But the last hour, from 11 to midnight, was a killer. 

In all honesty, it was not a killer.  Nobody died.  I've had many many worse hours of work.  But it just sapped my energy and enthusiasm.  Lately I've really been struggling with my response to people who've had lifelong illness or disability.  I think my parental paranoia gets hyperstimulated by it and I start to dwell on the difficulties that these people and their families must have faced.

Then I get all shirty about how objectively wonderful my life is and why I'm not subjectively more over the moon about it all. But that's not important right now. What I'm talking about is how if I'd had that same patient earlier in the day I'd probably not have been so bothered about him.  But by the time I was tired and looking forward to going home, I was all fragile, like a beautiful butterfly or a little crispy cookie.

I think to address this, all my shifts should be one hour shorter.  Of course, it's possible that the same situation would recur, and I would once again become all dysphoric and whiny in the 11th hour of work rather than the 12th.  In which case I submit to you that the best thing would be to shorten my shifts again by another hour.

Eventually I hope to be working 1 hour days.

Dice man

Necessity is the mother of invention.  And boredom is the father.

Having to do solo ward rounds on the weekend is pretty easy.  Most patients don't need radical changes of plan over the weekend, and in any case the services often just aren't there anyway.  So most of the time you can make sure that nothing disastrous has happened and write, "Continue current management" as the plan.  All well and good.

But last year I was having to lead lots of ward rounds with me, the intern, and a med student.  My registrar had been off sick a fair bit and two mornings a week she was in theatre so I was "in charge" those days too. There's only so many days in a row that you can stall and do nothing before even the med student starts to look at you funny and (presumably) wonder if they couldn't do a better job themselves.  (I know this because I was a med student two years ago and frankly, the residents then were two-bit dumbo nothings. Not like now.)

So I needed some means of coming up clinical management plans despite not actually knowing anything.  (Necessity).  And one afternoon I found myself with 10 spare minutes while waiting for a phone call.  (Boredom).  Invention!

Presenting PTR's Patented Platonic Prismatic Planning Pthing:

I took one of the blue rubber cubes that come with ABG syringes.  On each of the six sides I wrote a clinical plan.  When you find yourself needing a quick change of direction in management, simply roll the dice and do as it says.  Here's a quick guide and accompanying commentary:

1. ICU.  You should call ICU and ask them to review the patient.  All patients benefit from an ICU review.  Even if they are completely clinically stable, ICU loves to be called so they get the chance to review patients before they get really sick.  It gives them something to aim for.
2. Discharge.  Everyone hates to be in hospital.  Everyone has to go home sooner or later.  We need the bed for the people who will be sick tomorrow.  Are you getting the hint?
3. Psych.  "You don't have to be crazy to be a patient here, but it helps!"  People who are sick in hospital often feel sad or withdrawn.  It's a reasonable reaction to a significant stressor.  But who is to say where the dividing line is between hidden relief at missing a day of work and crippling depression with suicidal ideation? Who is to say where the line is between an intermittently irreverent blog and complete psychotic breakdown?  A psychiatry registrar would love to get involved.
4. Nursing home placement.  Everyone hates to be in hospital.  Everyone has to get old sooner or later.  We need the bed for the people who will be sick tomorrow.  Are you getting the hint?
5. CTPA.  A honking great CT scan of the chest with plenty of radiation and some intravenous contrast to boot.  All to rule out some speculative nonsense diagnosis which was never going to be true anyway.  CTPAs are a great way to buy yourself extra time.  The radiology registrars need the practise, and for added fun you can remove the patient's IV line before the test so the radiologists can keep up their clinical skills by reinserting it themselves.
6. Palliative care.  Everyone hates to be in hospital. Everyone has to die sooner or later.  We need the bed for the people who will be sick tomorrow.  Are you getting the hint? 

Try it out yourself and let me know how it works out.  I'm thinking of developing a similar one for use in the Emergency Department so I'd love to get your ideas.

PE self-test

A pulmonary embolism (PE) is a dangerous, potentially lethal medical condition that is notoriously variable in its clinical presentation, hence is difficult to diagnose without performing invasive medical imaging. PEs occur most commonly when a blood clot travels down the pulmonary artery to the lungs, blocking circulation and thus preventing the lung from being able to absorb oxygen from the air properly. Not the sort of stuff you expect to see in a late night TV advertisement.

Yet a few nights ago I found myself watching an ad wherein an attractive young couple switched off the light in their bedroom, only to turn it back on again a few (subjective) minutes later, evidently much to the young lady's disgust. She then proceeded to harangue the young gentleman about his PE, urging him to seek assistance, whereupon the contact details of a suitable company were placed upon the screen. This all made no sense to me at all until I later discovered that PE is also an abbreviation for premature ejaculation.

It occurred to me that this type of mix-up must happen all the time, with potentially dire consequences. A patient turns up to hospital suffering PE and somewhere along the way there is bound to be some confusion unless everyone is clear exactly what is going on. So I have compiled this short quiz to help you test your knowledge of PE. Simply read each statement and decide which type of PE the statement applies to. Good luck!

1. Pregnancy can cause PE. 

2. A brief period of mobility in bed can cause PE. 

3. Patients with PE can appear breathless, tachycardic, and sweaty. 

4. PE can manifest within seconds, with little warning. 

5. A prolonged period of immobility in bed can cause PE. 

6. In PE the primary problem is often venous.
7. PE can cause pregnancy.

8. In PE the primary problem is seldom Venus. 

9. PE can cause sudden collapse and unconciousness.
10. PE is often preceded by the appearance of a hot, red, swollen extremity.

I will post the answers in a comment below in a week.

On being farty

Today I am farty.  Yesterday I was not.  But at the stroke of midnight, something changed: I am now farty and will be farty (at the very least) for the rest of my life.  Some of you who read this may be surprised to hear that I'm farty.  Perhaps you know me personally and I just didn't have that air about me.  Or perhaps you're surprised that I'd be talking about it like this; for some reason, being farty seems to something to be ashamed of in modern society.

In our grandparents' era, being farty meant that you were of a particular level of maturity.  People gave you respect.  You had responsibilities.  You had solidity in your life. Sure, you might be slowing down, people might have thought of you as a bit of a pompous gas-bag but that doesn't mean you weren't still full of beans.  But these days, and I am a case in point, being farty just means that you're older but perhaps not wiser.  People's lives are much more fluid these days; I had a whole other career and trajectory before I even started to study medicine.

There's a pressure that comes with being farty.  I'm hoping that I can ease some of that pressure by trying to keep things more fluid, while also striving for solidity in the future.  I guess what I'm really trying to say is that I don't think it's helpful to label yourself as farty, or not-farty - surely everyone is farty in some way, at some time, even if they'd like to pretend otherwise. Farty is a just state of mind. Before I was farty I fell into the trap of thinking of it as the end of something rather than the beginning.  Being farty is nothing more than a sign of more surprises in store.

Am I really farty? The answers, as Bob Dylan said, are blowin' in the wind.