Bloody Oath

I'm a doctor.  *boggle*

At the qualifying ceremony we all had to stand up and read out this thing called the Physician's Oath.  As Physicians we had to promise to be good guys and to always do our best and where-ever there's injustice, you will find us, and so forth.  Unfortunately it wasn't the pithy old Hippocratic Oath in which you vow solemnly to put African wildlife in boxes.  No, this was lengthy and sounded like it was written by someone with a Diploma in Public Health and a shiny pair of pants. 

As a result, my mind wandered.  I started thinking - which is always dangerous.  I thought to myself, Hey!  Hey Self!  You've got this degree: Bachelor of Medicine, Bachelor of Surgery.  Is that two degrees or just one?  And how come you know a little bit of medicine but almost no surgery.  And how come I'm taking this Physician's Oath but not a Surgeon's Oath?  Maybe nobody has written one!

Ladies and Gentlemen, in the red corner, may I present...

The Surgeon's Oath

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE SURGICAL PROFESSION:

I am honoured to make this declaration in front of such of my family and friends that I still have, my colleagues whom I have not yet backstabbed, and teachers and mentors that I have been sucking up to;

I commit myself to practising surgery with speed, speed, and ... um ... speed;

My relationship with my patients will be built upon masculine slaps upon the shoulder and brisk promises to have them back on their feet in no time;

I will value all aspects of my patients - cash, credit, and other convertible assets;

I will not permit considerations of gender, race, religion, political affiliation, sexual orientation, nationality or social standing to influence my duty of care - but I should mention that if I do you on my private list I can get it done next Thursday even though the public waiting list is chockers until September 2013;

I will work with my patients to enhance their quality of life and provide support both in times of suffering and well-being - unless it's outside my specific area of research interest in which case I'll just expect the intern to handle it.

My commitment extends to the health of the community, valuing the diversity of people within in it as valuable providers of novelty ethnic food and taxi drivers to/from the airport;

I will support my colleagues working in health care, and treat them with honesty and respect, if they are both senior to me and within earshot; otherwise - shrug...

I will contribute to a work environment that fosters learning and cooperation.  I commit myself to passing on my loudmouthed opinions on topics of interest to me such as luxury watches, sportscars and Fascist politics whenever I have a sharp instrument in my hand, as have those who have gone before me;

I will acknowledge my limitations and mistakes, should they ever occur, preposterous as that may seem to all of us here today in light of my obvious talents;

I will strive for satisfaction and enjoyment in my work but reserve the right to brutalize those in my power should I be having a bad hair day;

I will maintain balance in my life, drinking both red and white;

May these affirmations guide, strengthen and inspire me in practising the art and science of surgery.

Sticky dates

Centrelink, from whom all benefits do flow, is ever so slightly frustrating because their payment timetable does not accord with my Smaller Half's pay week.  This means that I need to analyse her paysheets and divvy them up into the overlapping fortnights into which Centrelink carves up time.

A similar situation exists in the unit that I'm with at the moment at the hospital.  Rather than having a weekly schedule so that I can turn up to the operating theatre and say, "If it's Wednesday you must be Mr Farkas", they have a four-weekly schedule.  So there are meetings that happen on Wednesday of Week 2, or Friday of Week 4.

Although this complicates my life slightly, I can cope with it.  It gets annoying though because there are other meetings/events that happen on the third Thursday of the calendar month, for example.  So there are clashes with the four-weekly timetable which means that things are Never As They Seem.

Again, this is something that a somewhat intelligent and sophisticated person such as myself should be able to deal with.  Unfortunately the Big Boss Surgeon is quite old and grew up in Tsarist Russia and still denounces the Gregorian calendar as a communist conspiracy.  As a result, whenever he's around we all have to pretend that it's thirteen days in the future.  This meant that not only did I have to come in on a Sunday, I also missed out on my birthday.

I got so fed up with this that last week I didn't bother to go in at all.  When I turned up this week I was going to tell them that I'd been at home preparing for the Mayan apocalypse, but since I'd been using a reconstruction of Antikythera Mechanism to calibrate my diary I'd erroneously thought that it was going to happen on November 3 2011 rather than December 21 2012.  Unfortunately I'd forgotten that it was Daylight Saving so I was an hour late and they'd already finished the ward round and gone off for coffee so I missed them entirely.

Frosty

So today's lesson for beginners is this: when the surgeon walks up to the team and asks, "Is everyone good?", the wrong answer is, "I'm great thanks!"

They are not interested in you.  They are asking about the patients.

Timing is everything

Registrar

So what structure do I need to be careful of when operating just here, PTR?

PTR

The facial artery?

Registrar

No.

PTR

The external carotid?

Registrar

No.

PTR

The cervical branch of the facial nerve?

Registrar

No, the marginal mandibular nerve.

PTR

?!?

[Enter Consultant]

Consultant

So, PTR, what structure should the Registrar be careful to preserve in this area?

PTR
Hmmm.  The marginal mandibular nerve?

Consultant

Yes, that's right. Excellent!

[Exit Consultant]

PTR

So - what's this marginal mandibular nerve then?

Play it as it lies

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

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

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

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

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

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

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

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

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

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

Scrubs

I went to a hospital that I'd never been to for a theatre session today.  It went really well, the surgeon was happy to answer my questions ("Let me ask you about my cat" - he looked surprised) and so was the anaesthetist, and they both asked me questions that I could kind of figure out the answers to with a bit of prompting from them and guesswork from me.  There was no afternoon tea, but the anaesthetist was due back in town by 6.30pm so we had to cut some corneas - haha, just a little ophthalmology joke there!

The one thing that was a bit substandard was the scrubs.  (Scrubs are the pyjama-like garments worn by doctors and nurses in operating theatres.  Contrary to American television, it's not usual to stroll around the wards in them unless you want to look like a plonker.)  Down here on the coast the scrubs are nice thick cotton, worn soft by hundreds of laundry cycles, and they are a lovely royal blue that really suits my complexion.  But today in this other hospital the scrubs were thin, pale blue, and enormous.

Being thin is bad.  Operating theatres are cold.  And nobody wants to see the outline of my underwear (as far as I know).

Pale blue is bad.  It's a sickly colour, not like the robust masculinity of royal blue.  It makes me look a bit jaundiced.

Enormous scrubs are bad.  Down here I take size XL, mostly because of the extra leg length and the extra room for my rippling biceps, Lefty and Righty.  I put on this pair of thin, pale, XL scrubs today and I looked like some kind of anaemic hip-hopper.  The shirt came down to my knees and I had to do a Harry Highpants up under my armpits to stop the pants dragging on the floor.

At that very moment the surgeon came into the change-room and was subjected to my complaints about the size, texture and colour of their scrubs.  He seemed very impressed with my taste and style to be honest.  Those are things that you just can't teach, apparently.  He's on the board of his surgical college and it seems they are seeking persons with just my blend of aristocratic splendour and the common touch to be the next generation of enlightened surgeons bringing their magic to the masses.  Now my name is right up there on their lists.

Operating theatre

Being assigned to shadow a surgeon when they operate is very exciting, in much the same manner as falling off your bike is exciting.  There's a brief moment when you think you're flying, then you smash face-first into the ground and get gravel in your hands.

In my experience, surgeons will ask a few anatomy questions in order to demonstrate how stupid you are and then you get to talk to the anaesthetist for the rest of the time.  This morning though, the surgeon was a chatty guy who proceeded to talk to me the whole time.  Sure he was mostly asking me question in order to make me look stupid but as it turns out I had pretty good answers to some of them.

He asked  me:

• Where is the dorsalis pedis pulse?
• Where is the posterior tibial pulse? ("posterior to the tibia" is not the answer he wanted)
• Why do we operate on varicose veins?
• What is a varicose vein?
• What is an ulcer?
• What is inflammation?
• What is a cat? (Yes, he asked me to define a cat.  He was making a point about how difficult it is to define common things that you know well.)
• What is a car?
• What's the capital of Slovakia?
• What's the capital of the Czech Republic?
• What's the capital of Rumania, Bulgaria, Scotland, Holland, Belgium, Denmark, Norway, Sweden, Finland, Brazil, Paraguay, Uruguay, New Zealand, Canada?

I did pretty well with my capitals - he called me a "Man Of The World".  That gave me enough confidence to dispute his claim that New York City is not in the state of New York, which led to him not wanting to play the capitals game any more.  I also did pretty well with my medical definitions, which he fiendishly countered by telling me that my answers were very clever but he thought they were probably clever by accident rather than by design, which strikes me as being unfair.  I didn't do very well with my definition of a cat but that actually made him happy since it suited his rhetorical purpose.

I didn't know that the main reason to operate on varicose veins was as prophylaxis for venous ulcers (which is why we got into the whole ulcer discussion).  I told him that the main reason was cosmetic, which led to him spending the rest of the morning asking if I thought the elderly fellow on the operating table was going to win any beauty pageants, so I said that the elderly fellow should take kindly the counsel of the years, gracefully surrendering the things of youth.

Exit stage left.