Who's on first?

We went to church this morning.

Which is to say, we went to a wedding, which was held at a church.  It was an Anglican service, so it struck me as bizarrely formal and packed with arcane regalia.  God help me if I ever go back in a Catholic church.

It was an unusual wedding.  The bride was an Anglican deacon.  And so was the bridegroom.  (And what's with that terminology?  Isn't a groom someone who brushes horses?) So there's probably an Abbott and Costello routine in there where the groom argues with the priest later on:
"I married my wife a year ago today."
"No, I married your wife. And you."
Hmm, perhaps not.

I worked a late shift last night so I was pretty wrecked.  During one of the many moments of religious contemplation, I closed my eyes and had a little quiet time.  Unfortunately for me, the Hatchling was sitting next to me, with an eagle-eye for detail.

"Dad!  WAKE UP!"

Made me feel so disreputable.

Meet me in the middle of the air

I am your true shepherd

I will lead you there

Beside still waters

Come and meet me in the middle of the air

I will meet you in the middle of the air

I will lay you down

In pastures green and fair

Every soul shall be restored

I will meet them in the middle of the air

Come and meet me in the middle of the air

Through the lonesome valley

My rod and staff you'll bear

Fear not death's dark shadow

Come and meet me in the middle of the air

I will meet you in the middle of the air

With oil I shall anoint you

A table shall I prepare

Your cup will runneth over

Come and meet me in the middle of the air

I will meet you in the middle of the air

In my house you'll dwell forever

You shall not want for care

Surely goodness and mercy will follow you

Come and meet me in the middle of the air

I will meet you in the middle of the air 

- Paul Kelly

I am, you are, we are Australian

The Hatchling valiantly did her best to get me to chuck a sickie today and stay home to play Lego with her.  I won't pretend I wasn't tempted.

Hatchling

I don't want you to go to work today.

PTR

I know, but I have to go. There will be sick people who need my help.

Hatchling

I have an idea! You could call them and tell them that the other doctors will see them instead of you!

PTR

Yes! Err, I mean, that would be unfair on the other doctors. Sigh.

Still, coming up on Anzac Day as we are, I really think she's demonstrating what being an Aussie is all about!  So proud right now!

And I'd like to mention a devious idea I had today - it occurred to me that if I were to get to work half an hour early, the other people on my shift would see me working hard when they got there and assume that I was on the early shift.  Then when the early shift left, I could stick around for another half hour tidying up loose ends then piss off home early myself.  I won't pretend I wasn't tempted.  So proud right now!

Once again, German has an unexpectedly apt word for what you have just experienced

Blutschlauchüberraschung (n.) - A feeling of wonder, as that elicited when emptying your pockets upon arriving home after an evening at work only to unexpectedly find a tube of blood, unlabelled, whose origin you do not recall.

Sweet cheeks

Here's a quick quiz for those contemplating getting into medicine as a career - complete this sentence:
"I wish to become a doctor because..."

1. I want to help people.
2. I enjoy challenges.
3. I got good marks at school.
4. I enjoy pushing people's guts back up into their bums.

Mark my words, if you're applying to medical school, you'll be asked that question, and the correct answer is 4. Bums is where it's at.  The panel will know that you're a pragmatist rather than an idealist and you'll be in like Flynn.

Almost everyone has a rectum.

Some people have prolapsed rectums that fall out of their bums.

A few people have rectum that flop right out if you so much as glance at them wrongly.

Which is fine, don't get me wrong.  Easy in, easy out, in general.  Problem is, if they stay out for a while they can start to swell up, then it's hard to push them back in.  It's like trying to thread a needle with a marshmallow.

If you find yourself having to push a swollen rectum back up someone's bum, here's a handy tip: if you sprinkle said rectum with some salt or sugar, water will be drawn out of the mucosal surface by osmosis.  This reduces the swelling and makes it easier to push it back into the bum.

Having said that, I prefer sugar to salt, for two main reasons.

1. You know how much it hurts when you get something salty on an ulcer inside your lip? The idea of giving someone that feeling in their bottom just makes me cringe.
2. I think using sugar instead of salt is safer, just in case someone walks by with a lemon and some tequila and gets the wrong idea about what's going on.  Could be an ugly scene.

So I use sugar.  A teaspoon or so will do.  Leave it on for a few minutes so it has time to shlurp that water out of that rectum.  But before you leap ahead and push it back into the bum, wipe the sugar off first.  You don't want to attract ants.

Any questions?

German is an incredibly versatile language

Manfraurektumverwirrung (n.) - The disorientation felt by the medical examiner during a rectal exam when they realize that the man's rectum feels much more like a woman's rectum because the man has had a total prostatectomy so there is no anterior firmness, so for a brief moment the doctor is concerned that they have made a terrible mistake and is fact examining the wrong patient.

Sincere gratitude

Thank you for laughing at me when I needed help.
Thank you for being incredulous that I couldn't read your mind.
Thank you for making me guess when you knew I didn't know.
Thank you for answering my question with a question
Thank you for questioning my answer too.

Thank you for being too busy for me.
Thank you for having heard more interesting stories far away, in another time.
Thank you for not meeting my eye.

Thank you for wandering and hiding and making me chase you.
Thank you for your affectation of indolence which told me what I needed to know.
Thank you for dismissing me.

Thank you for monitoring me.
Thank you for checking up on me behind my back.
Thank you for offering. I agreed, but then the offer changed.  Thank you.
Thank you for making me feel like I could do this.

Thank you for staring at me in disbelief.
Thank you for mistrusting me.
Thank you for threatening me.
Thank you for trying to take away my options.

Thank you for talking and talking and talking.
Thank you for not listening.
Thank you for not trusting me.
Thank you for bragging and strutting and pouting.

Thank you for grinning and smiling and acting like my friend.
Thank you for seizing the opportunity to belittle me.
Thank you for asserting your dominance.
Thank you for your misperception of my admiration.

Thank you for being lazy.
Thank you for making me do your dirty work.
Thank you for mocking and boasting and preening.

Thank you for trusting me.
Thank you for thanking me for what I have to give.
Thank you for listening to my opinion.
Thank you for sympathising.
Thank you for making me feel like a human.

Thank you for interrupting.
Thank you for correcting.
Thank you for not listening.
Thank you for looking so bored.
Thank you for making your obligations seem like favours.
Thank you for showing your contempt.

Where have all the nurses gone?

Doctors are a superstitious, cowardly lot.  So my disguise must be able to strike terror into their hearts.  Errr, no forget that.  Just think of the superstitious, cowardly bit.  There is no disguise.

Doctors are so superstitious that they do. Not. Ever. Use. The word. Quiet.  It's never a quiet day.  It's never quiet in here.  Even patients aren't allowed to say these things.  People will be quickly corrected.  It is in fact "steady", "ok", "not too bad", or (for the extremely bold or naive) "a bit slow".  Everyone knows that saying it is quiet invites the attention of the Gods, who will smite you most unjustly and spitefully.

Yet some things, when examined with the might and majesty of science, turn out to be not superstitions but cold hard facts.  Take, for example, the observation that when the nurses are hard to find, it means that the shit is about to hit the fan. After lengthy investigation I have determined that this is true, a truth that shines brighter than the sun, casting shadows on our minds so we knowest it even while our backs are turned from the light.

Sorry, got a bit florid there,

The facts are these.  Nurses, with their superior sense of hearing and touch, are able to sense the low-frequency vibrations caused by distant shit hitting the fan.  As the shit and the fan grow closer, the nurses become agitated and distressed, and will find ways to escape the impending disaster.

For example, today I saw a herd of fifty nurses galloping wildly in circles, biting and kicking at each other in dismay, before they suddenly veered away and plunged off a great precipice to fall hundreds of metres into an icy mountain river and were swept onward to the sea.  Soon afterwards, a busload of bespectacled teenage girls who were unable to weight bear on their mildly sprained ankles presented to triage.  With their mothers.

Another anecdote, if I may, for while the plural of anecdote may not be data, it certainly is "blog":

Last year, I myself witnessed a dozen nurses leaping above the water of their pond, shaking their golden tails in the sunlight.  Very soon, they were all lying helplessly on the bank of the pond, their scales glittering while their gills gaped and flapped as they slowly suffocated in their thirst for oxygen.  I stood above them and sang an old Scottish dirge but kept my sextant ready.  Sure enough, soon it was reported that there was no more instant coffee in the break room, and it was the weekend so the cafe was shut.

As you can see, even seemingly inexplicable occurrences have their origins in physicks.  The modern man of science must eschew superstition in all its forms if we are to struggle up beyond this primal muck in which we wallow.

I'm Bat-Man!

4 fattening foods to avoid this summer

Summer is coming, if you live in the northern hemisphere of Mars.  If you're worried about how to get that perfect spacesuit body, here are 4 fattening foods to avoid that you might not know about!

Lard

Lard is the big diet fad this year, as it's 99% sugar free.  Lardsicles, lardwiches, lardacinos - people everywhere are singing their praises.  But did you know that as well as being 99% sugar free, lard is only 1% fat free?  And scientists at Princeton have recently discovered that this may result in lard being up to 99% fat!  This may not sound too bad, but some of those scientist's friends have recently theorized that dietary fat may be an important contributor to total caloric intake, which itself is believed to be related in some as yet unknown manner to your energy intake/output balance, which Sanskrit manuscripts recently found in Paulo Coelho's underwear drawer attribute to how fat you are.  So try eating less lard and see if it helps.  You don't have to go entirely without though - colonic irrigation using lard is still okay.

Crushed Glass

Crushed glass is the big diet fad this year, as it's 99% fat free and 99% sugar free.  Glassicles, glasswiches, glassacinos - people are just munching that stuff up.  And sure, in the short term it seems like bleeding vigorously from the mouth and anus would be an easy way to lose weight.  But in the long run, perhaps in 2 hours, perhaps in 3, you'll end up in an intensive care ward getting parenteral nutrition while you wait for your entire digestive tract to be transplanted.  And do those bookish, bespectacled ICU-types really care about the state of your muffin top?  They do not.  They'll just pour those milkshakes into your veins and plump you up, up, up, up, up.

Water

The list of people who don't know that water is fattening is so lengthy, it would be easier for me to just give you the list of people who know that it is.  But that's just what they're expecting me to do.  Shhhhh...  They're listening... Just think of it this way - eliminate all water from your diet and watch your hips melt like ice.  Do it.

Cancer

It's becoming increasingly common these days for people to think that they can lose those summer pounds and tone those abs simply by eating cancerous facial tumours from Tasmanian Devils.  Facialtumoursicles, facialtumourwiches, facialtumouracinos.  Big mistake - for two reasons.  First, they are so delicious, especially with a garlic and cayenne aioli dip, there's no way you'll be able to stop at just one.  And second, you will of course be infected with Devil Facial Tumour Disease.  And while you might think that this would be a good thing, because the enormous and disfiguring facial tumours will physically prevent you from eating, unfortunately the cells will also disrupt the glomerular basement membrane of your kidneys, giving you a raging case of nephrotic syndrome.  You'll retain fluid in all your tissues and will swell up, up, up, up, up. I can't believe it's not butter!

So those are the four surprising foods you should avoid eating this Martian summer.  I expect you'll all be slimmer, less haemorrhagic, and much, much drier the next time we speak. But that's just what they're expecting.  Arrivederci Roma!

There's a word in German for that too

Stauchenhefeextrakttraummüdigkeit (n.) - The overwhelming exhaustion experienced after you see a TV news bulletin saying your sister-in-law died from eating expired Vegemite only hours after winning a Commonwealth Games gold medal in freestyle swimming, and you call your brother in great distress only to be informed that it is all an elaborate hoax masterminded by Roy Slaven and HG Nelson, and you can barely cope with the roller-coaster ride of emotion when you suddenly wake up and it was all a dream and you're already late for work.

Polysyllabic

Hatchling

Dadda, "eight" rhymes with "great"!

PTR

And "date".

Hatchling

And "gate"

PTR

And "ablate".

Hatchling

And "rescuscitate".

PTR

!!!

Science

Hatchling

Mama, do you know how to make science?

Smaller Half

How to make science? No, tell me.

Hatchling

You need, you need, vinegar! And bottle poda. And green colouring.

Smaller Half

Bottle poda?

Hatchling

Yes. And you put them all in, and it goes up, up, up and all over, like a volcano!

Smaller Half

Do you mean baking soda? 

Hatchling

Yes. Baking soda. To make science.

An unfocussed ramble after a minor head injury

The Emergency Department can be a rough and tumble place to work.  I've been spat on, called a "greasy white maggot", had my underwear filled with jelly while I've been distracted.  And that was just the nursing staff. You should see how badly I'm treated by the other doctors.

But last Friday evening was a first for me: I was assaulted!

As you have probably guessed from the fact that I'm making smart-arsed blog posts about it, I wasn't hurt.  But I was briefly shaken.  I won't go into details, beyond making the following observations:

1. Old people may be puny but they can still be bloody fast.
2. If the nursing staff warn you about a patient, they probably know what they're talking about.
3. It's a myth that if you get hit by a patient, you are allowed to hit them back within 3 seconds and claim that it was self-defence.
4. Shouting at demented people does not make them any less demented.
5. Buy low, sell high.

All important lessons to learn, mark my words.

It's (a little bit) interesting to reflect on the general public's impression of emergency department mayhem and how it differs from reality.  Talking with non-medical people gives me the impression that they think the most dangerous patients are:

1. Patients with mental illness.
2. Patients high on the street drug du jour.
3. Drunks.

In my experience, the most dangerous patients by far are little old demented people.  They are really unpredictable and can be extremely aggressive, and it's very easy to underestimate them.  So my list of the most dangerous patients would go:

1. Patients with dementia.
2. Drunks.
3. Guard dogs with bees in their mouths.

Note that patients with mental illness do not feature on my list.  That is mostly because they are seldom dangerous (except to themselves, sadly enough).

Anyway, I came home at midnight on Friday with a jaw that clicked a bit when I chewed but by Saturday it was fine.  Which was a good thing because I spent the whole weekend eating non-stop.  What better way to celebrate your Smaller Half's birthday than by performing disgusting acts of gluttonous consumption? I should have known better than to butter and eat two more bread rolls shortly after saying, "Oh my God, I have eaten about four times too much already".

My position was that I ate the extra rolls to ensure I got value for money.  Her point of view was that the rolls were free.  My point of view was, "Aha! Exactly!" - a winning argument in my book.  At least until I had to be taken to hospital with a bowel obstruction.

So actually my top three list of most dangerous patients should be amended as follows:

1. Patients with dementia.
2. Drunks.
3. Gluttons.

Make of that what you will.  I'm tired and it's time to go to bed.

Alternative pain scales

Fahrenheit Pain Scale:
If your pain was a number between 32 and 212, where 32 is no pain at all and 212 is the worst pain you've ever had, what would it be right now?

Complex Pain Scale:
If your pain was a number with a magnitude less than or equal to 1, where 1 is the worst pain you've ever had, and i is defined as the square root of an immense sense of well-being and fulfillment, what would its magnitude and phase be right now?

Vintner's Pain Scale:
If your pain was a volume of wine, such as a gallon, rundlet, barrel, tierce, hogshead, puncheon, tertian, pipe, butt, or a tun, where a tun would be the worst pain you've ever felt, how much wine would it be right now?

Sagan's Pain Scale:
If your pain was a number between 1 and billions and billions, where billions and billions was the worst pain you've ever had, what would it be right now?

Hertzsprung-Russell Pain Scale:
If your pain was a letter from the sequence M, K, G, F, A, B, O where O would be hot, luminous pain radiating in the ultraviolet, what would your pain be right now?

It's all Welsh to me

Had a med student trail me around for a few hours this evening.  He seemed like a decent guy, in that he was interested in discussing things other than medicine.  As a result, when he asked me to sign his "attendance book" (to prove that he bothered to turn up, a program probably instigated as a direct result of students like me who took the university's unofficial slogan of "Teach Yourself Medicine" rather too literally), I wrote some feedback in there to the effect that I thought his pronunciation was excellent and that I appreciated his willingness to contribute anecdotes from his extensive and esoteric background knowledge.

We had this strange conversation where somehow he ended up explaining the etymology of the word "dysdiadokinesia" to me.  Because it relates to Alexander the Great and his successors, I ended up talking to him about Ptolemy, and because that sounds vaguely like Potomac we ended up talking about the American civil war and Washington crossing the Delaware river.

Interestingly, when I got home I attempted to verify the etymology of dysdiadokinesia and found it less easy than I expected.  I ended up trying to use Google Translate to translate the word "diadochos" from Greek into English, but Google insisted that "diadochos" is actually Welsh.  Welsh for "diadochos" in fact.  However did we live before Google?

So then I tried translating "diadochos" from Welsh into Greek, and got "Διάδοχος", which I then translated back into English and got "successor".  The Diadochi were indeed the Macedonian successors of Alexander the Great, like Ptolemy (who ruled in Egypt).

But I'm still not so clear on what that has to do with dysdiadokinesia.  Oh well.

A word of advice

In a recent comment on my post regarding pain scores, the indefatigable Lumpage asked, "Uhoh, I set my pain scale between 0 and 10. Am I doing it wrong?"

No, Dr Lumpage, you're not doing it wrong.  You're just doing it different.  Which is my way of saying you're doing it wrong.  Stop - collaborate and listen.

You see, I don't offer the patient the option of a pain score of zero, for the following three reasons:

1. I have already asked them if they have any pain.  And I only ask them for a pain score if they actually have pain.  If they told me that they were in pain, and then told me that their pain score was zero, I think my brain would haemorrhage from sheer frustration. The medical history is a battle of wits.  Patients will delight in flummoxing you at every opportunity.  You must learn to close off every avenue of potential nonsense, building up your innate feel for these types of simple traps so you can conserve your energy for the real battle ahead: presenting the patient to your boss.
2. Having a pain score of 0 to 10 is actually an 11 point scale.  This sort of thing works well for humorous effect in rock 'n' roll mockumentaries, but isn't very practical when it comes to taking medical histories from patients at 4am when neither of you can think good.  Say the person's pain score improves from 10 to 5 after 4mg of IV morphine.  In my system that is a 50% reduction in pain.  In your system that is 5/11 or a 45.4% reduction in pain.  Which is frankly absurd. Especially since if the pain drops again by another 5 points to zero, that's another 45.4% drop, for a total of 90.8%, and they are now pain free.  What the fuck? Where did the other 9.2% of their pain go?
3. Is the patient alive? Then they are in pain.  Life is pain. Only the dead feel no pain. Or people that you've put a really good ring block in - you can just rip their nails out using haemostats and they don't feel a thing.  It's full on.  But aside from them, everyone else feels the exquisite pain of living, every waking moment, swimming in the agony of existence until they can swim no longer.

So, yeah, you're doing it wrong. 1 to 10, my friend. 1 to 10.

Non-renewable resource

"I'm so sorry for wasting your time."

It's surprising to me how often people say this to me at work in the Emergency Department.  Actually, it's not - it's surprising WHO says this to me at work in the Emergency Department, and WHEN, and WHY.

People never say this AFTER I have finished with them.  They always say it BEFORE-hand.  And the people who say it are usually the people who are absolutely not wasting my time.  These are the people that emergency departments exist to help.  They are most often elderly people who are quite frail and live alone, polite to a fault.  For example, they may have fallen down during a dizzy spell and been unable to get up again for some hours until they were discovered by chance.  You know - the people who could easily have turned up (or not) the next day - dead.

The other big pre-emptive apologisers are parents of very small babies, only a few months old, who have been dropped on their heads or have some kind of mysterious raging fever.  Again, people where things can go seriously wrong very rapidly, so coming to the hospital for a safety check is an entirely sensible thing to do.

Or the guy who broke a bone in his leg but didn't come to hospital for 9 days despite being unable to walk AT ALL because he thought it was just badly sprained and hadn't even taken any painkillers.  That guy apologised for wasting my time until I showed him his x-rays.

On the other hand, nobody has ever apologised for wasting my time when they have come to hospital on a busy Saturday night complaining of itchy arms.  And nobody has ever apologised for wasting my time for telling me that the pain in their ankle is so agonising that I can't even touch it, let alone expect them to bear weight on it, but who then, after being cleared of fractures with an x-ray, stand up from their wheelchair and walk unassisted out of the department.  And nobody has ever apologised for wasting my time when telling their child, who has bumped their arm and has a bruise, not to move it around like I am asking them to, just in case they hurt themselves.  These people do not apologise.

However, I can't complain too much.  Well, I can, and I just did.  What I really mean is that it is hypocritical for me to complain.  The person who wastes the most of my time is me.  And I don't even get paid for it.

Donate now.

There's a word for it in German

Zehennagelschnurrbartangst (n.) - The experience of, having hours earlier extracted an infected ingrown toenail from a patient, smelling the pus again, and worrying that perhaps some of it has squirted up onto your moustache without your knowledge.

Obligatory blog post about pain scores

PTR

So if you had to give your pain a score between 1 and 10, where 10 is the worst pain you've ever had, what would you pain score be right now?

Mrs Lumbago

10

PTR

So this is the worst pain you've ever felt?

Mrs Lumbago

No, it was worse this morning.

PTR

Ok, so if it was 10 out of 10 this morning, what score would you give it now?

Mrs Lumbago

10

PTR

So it's just as bad now as it was this morning?

Mrs Lumbago

No, this morning it was much worse.

PTR

Right. So the pain was at its worst this morning, 10 out of 10.  If 10 is the worst, what's it like now that it's a bit better?

Mrs Lumbago

10

PTR

Excellent. Excellent.

Dream envy

The Hatchling got up from an afternoon snooze the other day and I asked her if she'd had a dream.

"Yes, I had a lovely dream" - what about?

"Fairies." - what colour were they?

"Pink, like a pom-pom" - lovely - what were they doing?

"They were building a statue" - out of what?

"Out of pieces that one of the fairies brought along" - how did you stick the pieces together, with glue or with tape?

"They stuck'ded themselves together, like Lego" - and did you help them?

"Yes I helped because if you were the best friends of the fairies you could help, otherwise you could only watch, like the elves" - were there elves there?

"Yes, they were naughty elves who were slapping and punching each other, but some other elves were good and they help'ded us".

I felt kind of envious after hearing this.  It does sound like a lovely dream.  When I was a kid I mostly had dreams about giant yaks devouring the carpet from under my feet faster than I could run away. Still, it made me the man I am today so I mustn't complain.

Yaaaaaaaak.