Eye opener

My new team starts at 7.30 a.m. which is slightly challenging for me, but no more so than, say, waxing my eyebrows.  It simply takes an effort of will to haul myself out of bed.

But from time to time my willpower fails me and I end up running just a smidgen late.  I was late this morning.  I stylishly swerved my car into the carpark and trotted towards the hospital entrance.  Glancing at my phone, I realized that I'd missed a call.

Oh no!  Perhaps it was my new registrar and she'd called me up to urge me to redouble my efforts to arrive on time.  Or perhaps to tell me that the notes I took yesterday were so good that I'd better take the day off as a reward.  Better check my voicemail.

My voicemail had a call from an mystery number - a man's gruff voice:
"When ya git outta the shower washin' that beautiful body of yours, wanna give me a ring?  Thanks darlin'."

Hmm.  I guess it wasn't my registrar after all.

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.

Roof, Seville

I've got your deposit right here

My Smaller Half and I want to buy a house.  But we've hit a snag - we have no money.

Apparently a few years ago there was a big stink-up because some chumps in the USA borrowed more money than they could ever afford to pay back, plunging the world into a screaming spiral of horror and causing a number of billionaire sociopaths on Wall St to temporarily lose their jobs.  As a result, Australia's pinko government rammed laws through parliament infringing my democratic right to borrow more money than I could ever afford to pay back, thus grossly offending my inflated sense of entitlement.  This country is stuffed!

After ringing 4 banks and 3 other non-banks (by which I mean non-bank financial institutions rather than other non-banks such as ice-cream vans or Belgian pederasts) I resigned myself to having to live in penury for another 3 months until those juicy payslips giving me substantially less than I used to earn in my old job start rolling in.  But then I got put onto a mortgage broker in town who turns out to have all sorts of tricky tricks up his sleeve, so maybe we're still in with a chance.  Actually it's not so much that he has tricky tricks, it's more that he seems to motivated by wanting to succeed, whereas the loan processors at the banks and non-banks seem to be motivated mostly by malice and spite.

We had a two hour meeting with him on Friday where he sussed us out and did some brainstorming of possible ways around the road blocks.  It was really interesting to watch a professional from another field work.  It reminded me of nothing so much as a good doctor taking a really thorough medical history.

For example, it's important to know what medications people are on (for both doctors and banks, but I'm talking about doctors now).  So you ask them, and they tell you.  And then you typically ask them about a whole bunch of medications that most people don't think of as medications, like the contraceptive pill, asthma inhalers, anti-inflammatories and other analgesics, insulin, and so on.  It's easy to start thinking that people are pretty dumb for not telling you this the first time.

But lo, yesterday the shoe was upon the other foot.  He asked me if I had any debt.  No, I said, quite proud of myself.  Any credit cards?  Oh, yes, sure.  Any HECS debt?  Oh, yes, that too.  Oops.

And, just like a doctor, sometimes he used words and jargon that I didn't understand.  It's incredible how many times I've seen doctors walk up to a patient, dump a mouthful of polysyllabic Graeco-Latin blah-blah on them, then consider the job done.  It's excruciating to witness, and now I know how difficult it is to get it to stop when it's done to you.

It's really hard to ask questions about what something means when you can't remember what the thing was even called.  I'm sure he was horrified when I got my Third Party Mandated Lending Policy Exception mixed up with my Conditional Approval Pending Party People Mandate.  Or something.  It'd be like confusing your cardiorenal syndrome with your velocardiofacial syndrome.

I reacted by just calling the different things "The First Thing" and "The Second Thing" and so on.  I must try that on Monday morning when I turn up to my first surgical ward round of the year.  I'm sure it'll be looked upon kindly.

Praise me

I was feeling generous and expansive, so I was talking up my Esteemed Colleague who is going to be replacing me after tomorrow in this unit.  The registrar obviously found me unconvincing in my universally positive comments, so he asked me if there was anything bad about him. 

"Why yes," I said, "He compulsively makes inappropriate jokes."

"Oh," said the registrar, "He sounds just like you."

Nutri-brain

Registrar

So once the mRNA is produced, what happens then?

PTR

I have the word "ribosome" in my head.  But maybe that's just something in my breakfast cereal.

As it turns out, ribosome was the word I was after.  The other word that I was afraid I was confusing it with was "riboflavin", a.k.a. vitamin B2, which is essential to life because it makes your pee yellow.  All those nutri-grain ads on the idiot box when I was a kid nearly derailed my medical career.

My vulnerability to the all-pervasive cereal advertising industry in lieu of any kind of actual medical training is regrettable.  But still, I can walk the walk and talk the chalk or something like that when I have to.  Check out this picture from a talk I gave earlier this year on tuberous sclerosis:

It's complex but I think it captures the essence of what I was trying to say, which is that I had no freakin' idea of what is really going on but it's probably too complex to matter in an informal talk.

Not really

Checkout Person
That'll be $87.76

Smaller Half
The register only says $28.76

Checkout Person
Oh, you know what I mean.

I wasn't aware until now that I was an apologist for sexual predators

Nurse

There is a well-known case here in this city of a psychiatrist who had sexual relations with no fewer than five of his patients.

PTR

That's terrible.

Nurse

No, it's not.

PTR

?

Nurse

It's unacceptable.

Extreme child care

Most mornings, I drop the Hatching at child care then come in here to the hospital.  Yesterday morning, it was the child care workers who dropped the Hatchling - literally. 

I got a phone call around 10am, it was the child care boss.  My first thought was that she was ringing me up to rouse on me for not paying our bills.  This is a splendid example of a conditioned stimulus.  The first thing she said to me though was, "The Hatchling is fine.  There's been a bit of an incident."  Good first line - I guess lots of parents would assume that disaster had struck as soon as the child care centre calls them at work, so it's sensible to defuse things immediately.

But "an incident"?  That's too vague.  I suppose she said it was "a bit of an incident" so I wasn't thinking of sieges and hostage-taking so much as perhaps she's had her finger bitten or something.

Anyway, it turns out that two other kids mugged one of the child care workers while she holding the Hatchling, with the result that the Hatchling plummeted earthwards.  Fortunately she landed on the child care worker so there wasn't much of an impact.  Nevertheless I scurried up the hill to go give the Hatchling a cuddle.

As soon as I walked in the door the poor woman who'd dropped her burst into tears and started begging for forgiveness.  "YOU BITCH, I'LL SEE YOU IN COURT, YOU'LL NEVER WORK IN THIS TOWN AGAIN!", I screamed, spittle flying from my lips.  No wait, that was the feedback I gave my supervisor a few rotations back.  What I actually said yesterday was, "It's okay, she's not hurt, accidents happen, you must have got a real scare but it's all okay now."  That made her cry even more. 

Once the staff realized that I wasn't going to burn the place down in righteous fury they all got kind of manic with relief.  They launched into a detailed account of how it happened, where it happened, who was standing where, what similar incidents had occurred in the past, re-enacting how people had rolled around on the floor in desperation trying to catch the babies that were raining from the ceiling, and generally creating a ruckus.  It was quite a scene so I beat a hasty retreat, shouting reassuring words to them as I went.

I reckon they probably have a policy that if anything bad happens to any of the kids, they call the dad first.  Dad turns up, nobody is missing any limbs, so he jiggles the kid a bit and takes off again.  Saves time for everyone.

Bark, Flinders Ranges

Clouds in my coffee

In the middle of my day I found myself lost in a bureaucratic meeting.  People were talking words that I knew but their meaning was obscure to me.  There was discussion of leveraging client actualities, of service overlap, and of negative expression of emotion prior to an upcoming facility transfer.

So I wrote some poems in the haiku style instead.

There's a cardboard box in our doctors' office that has the coffee supplies in it.  On the sides are written poems in the haiku style about or inspired by coffee.  Coffee haikus - I hear you think - what a bunch of hipsters. And truly, there is no defence against such an accusation.  The ones I wrote are pretty damn good though...

A warm cup to hold
To take the place of a hand.
Welcome to the tribe.

Black? White? Some sugar?
Do you embrace or mask the
Bitterness of life?

The top 10 songs in which you can substitute "fart" for "heart"

1. My Fart Will Go On - Celine Dion
2. Unchain My Fart - Ray Charles
3. Two Strong Farts - John Farnham
4. What Becomes Of The Brokenfarted? - Jimmy Ruffin
5. Achy Breaky Fart - Billy Ray Cyrus
6. Good Farted Woman - Waylon Jennings & Willie Nelson
7. Fart Of Glass - Blondie
8. Fartbreak Hotel - Elvis Presley
9. Listen To Your Fart - Roxette
10. Sgt Pepper's Lonely Farts Club Band - The Beatles

Not thinking about elephants

Psychiatrist

Well, what would you like to talk about in today's tutorial?

Registrar

Oh, anything at all, as long as it isn't the Oedipus Complex again.

Psychiatrist

It's interesting, isn't it, how the Oedipus Complex often brings out these types of very strong reactions from people.  It just makes you think that Freud must really have been on to something.  I know you don't want to talk about it but there are some fascinating things to consider such as how...

[One hour and fifteen minutes pass]

... ending in the destruction of civil society and the slow rebuilding up again which is, of course, the tragedy of man's inability to process or work through the Oedipus Complex.

Urban legends

The Candyman
Legend:  If you look at your reflection and say "Candyman" five times, he will appear and brutally murder you.
Status: False.  This is actually the plot of a 1992 slasher film.

The Handyman
Legend: If you look at your reflection and say "Handyman" five times, he will appear and unblock your drains.
Status: False.  There is no way to summon a handyman when you need one.

The Randyman
Legend: If you look at your reflection and say "Randyman" five times, a sexually aroused man will appear.
Status: True.  But only if you're a highly narcissistic adult male.

Thatch, Kuala Lumpur

Clinical audit audit audit

Introduction
Although most medical students are accustomed to producing audits, few are used to audit auditing.  Thus, this audit audit audit audits audit audits to measure their compliance with the protocol suggested by the Trans-Tasman Council of Amateur Humorists (TTCAH) and makes recommendations to improve the audit auditing process.

Method
Ethics Approval
Ethics approval was sought for the audit audit audit because of the high likelihood of two adverse events:

1. That those exposed would find it so unutterably funny that they might bust some kind of internal valve from laughing so hard.
2. That those exposed would find it so unutterably tiresome that they might lapse into a narcoleptic coma and miss their next dental appointment.

The Ethics And Human Research Committee advised that ethics approval would not be granted for such diabolically try-hard self-deprecation as contained in this sentence and thus the final audit audit audit would contain no such sentences. Otherwise they said it would be fine.

Selection of audit audits
The auditor briefly considered a range of semi-humorous methods that may have been employed to find and select audit audits before deciding that it was getting reasonably late and he wanted to get on with the main business of making stupid jokes so he would just present the selected audit audit for audit as a fait accompli with a white wine sauce and simply post a link to it.  (LINK)

Analysis of audit audits
The selected audit audit was briefly reviewed to refresh my memory and some suitable categories were invented in order to produce a few graphs that were relevant to the audit audit.  These, coincidentally, are also identified in the TTCAH protocol for audit audits as being both necessary and sufficient for a late night blog post stretching one simple idea out to several hundred words, to wit:

1. Snappy title
2. Thin veneer of respectability
3. Classical allusions that are actually totally bogus
4. Leaving the door open for a sequel just in case it works this time.

Results
The audit audit audit revealed that the audit audit had been undertaken with due regard for TTCAH processes.  This is clearly illustrated by the following charts:

 Snappy title - check!

Thin veneer of respectability - check!

Classical allusions - check!

Sequel - check!

Recommendations

1. That I go to bed soon.
2. Bacon and cheese toastie.
3. More charts.
4. Sell! Sell! Sell!
5. Shift down a gear once you hit 2000 rpm.  This is also true of driving.
6. Winning the Victoria Cross twice.
7. Banana (serving suggestion).

Clinical audit audit

Introduction
As part of the final year of the medical degree at this Fine University, students are required to complete a clinical audit.  This audit examines the adherence of the auditors to the auditing protocol and makes recommendations to improve the auditing process.

Method
Ethics approval
Since this audit was conducted only upon the auditors self and was entered into voluntarily, no ethics committee approval was sought or, therefore, granted.

Selection of audits
A retrospective selection of all audits undertaken by the auditor during the 2011 was performed.  The auditor's email account and hard drive were searched for all files containing the words "audit", "overdue", "panic" and "apathy".  This resulted in the retrieval of several thousand files which would be impractical to search by hand, so they were further searched for the tags "piece of shit".  One record was retrieved, a clinical audit recently submitted by the auditor.

Analysis of audits
The audit was examined for the following key items, drawn from the guidelines to auditing published by the International Lazy Students and Bullshit Artists Association (ILSBAA):

1. Excessive verbosity clearly intended to boost word count.
2. References farmed from unreliable online sources such as Wikipedia.
3. Formatting and structure plagiarized from example audits provided to students.
4. Meaningless recommendations.
5. Precision in statistical calculation used to distract from data collection flaws.

Results
For each audit audited, a high degree of adherence to the ILSBAA protocol was found, as shown in the charts 1 through 5 below:

Discussion
Notwithstanding the recent episode where the auditors audit was submitted late for no reason other than his inability to submit the audit on time, the auditor found that the audit was conducted largely in accordance with the ILSBAA protocol, or else in a sleep-deprived stupor, which is also an approved method of production of student audits.  Acute observers may question why confidence intervals were not calculated and quoted above, to which the audit auditor may only quote Demosthenes in the Palladium when he was stabbed in the Ides by the Emperor Octagon: "Auditor, audit thyself".  Whilst the relevance, and indeed the veracity of this quote are lost in the dawn of time, it cannot be denied that they most usefully added some sorely needed bulk to this paragraph and furthermore avoided it being a one-joke section, albeit at the expense of some rather heavy-handed surrealism.

Conclusion
It is recommended:

1. That further audits by this auditor be audited to determine adherence to the ILSBAA protocol.
2. That this audit audit be audited.
3. That the audit audit audit be audited in order to complete the third repetition really needed to hammer the point home.
4. That you send money now.
5. That you read Dune by Frank Herbert.  It's full on shit, man.

Botanic gardens, Madrid

Lost

There's a scene in one of my favourite films, Star Wars, where Indiana Jones is describing how clueless his colleague is by saying, "You know Marcus.  He once got lost in his own museum".  Well - today I got lost in my own Emergency Department.

In my defence, it was only my second day.  Plus, there are extensive renovations happening so there are temporary walls being flung up that seem to move on a daily basis, opening up mysterious corridors haunted by bull-headed freaks (sorry - by surgeons) or sealing up unwary strangers inside wall cavities to be entombed forever. 

Also, when I was given a tour yesterday I got the impression there was (currently) only an A side and a E side (don't ask me what happened to sides B,C and D.  Perhaps a mad geometer proved them to have zero length, or perhaps they got together with Type 3 renal tubular acidosis and ran away to join the circus).  But it turns out that the A side has two halves which look really similar, like the Olson twins, so I went to the wrong one and walked around it several times looking like someone on one of Escher's endless staircases.

Plus, I was tired.

It's not the first time I've gotten lost (or as I prefer to think of it, afflicted by momentary topographical ambiguity) but it was the most embarrassing.  Not only did I run into two of my Esteemed Colleagues who had to free me from where I had become wedged behind a vending machine, I had in tow an unfortunate and quite distressed woman whom I was attempting to take to her husband who was a patient.  So at first I got just a bit sheepish when I couldn't find his bed number.  Then I got to side A part 2 and located his bed, flung back the curtain with a dramatic flourish, only to find it occupied by a complete stranger.  Awkward!

I recruited the help of some bemused nurses who checked the compooters and showed me that while we'd been careening around in circles in the wrong area, my guy had been transferred to the E side, which is where we'd come from.  It didn't take me too long to find our way back but I could only do it leaving the ED and starting again as if I was arriving in the morning.

Tomorrow I'm taking in a bag of breadcrumbs.

First depressions last

Like you, I've been feeling under the hammer a bit recently, what with the Hatchling to look after, a rogue assignment rampaging through my spare time, and some pesky Hittites to suppress.  Busy busy busy.

Or so I thought.

Today I met someone who is about to complete their big scary ED exams, they are also training for some intense athletic event, they have two kids, they dress with elegance and poise, and they are a really nice person too.  They probably also play woodwind in a symphony orchestra.

People like that should be banned.