Get out while you can

 

Get out while you can,
It’s not too late to start again.
For you know what you have known,
Nothing here can ever grow.

Wedding rings are broken wings,

You won’t need these things you’ll find.
Sail on my love and leave this place behind.

Leave before the tide,
Let the moonlight be your guide.
I want for nothing more 

Than for you to find a better shore.
Wedding rings are broken wings,
You won’t need these things you’ll find.
Sail on my love and leave this place behind. 

- Scott Wilson

Hyper-tension

Aah.  Today I got home at 6pm.  There's a small pile of late discharge summaries on my desk (the things we send out to the GPs telling them all the terrible screw-ups we made in hospital) but I have a new registrar arriving tomorrow so I seized the opportunity to be slack and took off.  My old registrar called me at about 5.45 asking me where I was and I was delighted to tell him that I was gone, all the patients were stable, and there were no new issues, goodbye and good luck.


I realized today that the suckiest thing about my job right now is not my job.  I actually kind of enjoy my job.  It's satisfying in that way that looking at a big pile of blood clots that someone has just pooped out can be.

No, the suckiest thing about my job is that when I get home it takes me about 4 hours to unwind.  I can't stop replaying the day in my head, wondering if I did this or that right, wondering what I forgot to do, trying to remember the detail of some x-ray or sputum culture in case I get asked about it the next day, trying to make sense of what's happening to me via the medium of sick people.  It makes me so tense that I lose my appetite and can't eat dinner, and I find talking to my Smaller Half and the Hatchling really hard.

I can usually stop this just before I go to bed.  Then I sleep (or not) and wake up tense again because I know that I have to go in for the ward round, which always brings a new shovel full of surprises.  So I can't eat breakfast much because I'm freaking out again.  As for lunch - ha!  The El Dorado of meals.  Much discussed, never seen.

I'm pretty sure that I've already lost about 5kg, especially when you factor in the brutal gastro that I caught in the first week on the ward.

So basically what I'm saying is that I've developed some kind of panic disorder precipitated by work.  From what I can gather, everyone does in this business when they first start.  It's just that people don't admit it.

Bee

 Oh. So. Tired.

Did another 13 hour cover shift yesterday (Sunday) and was busy busy the whole time.  Nothing too scary or deadly but it was exhausting.  It's a bit horrifying to realize that it's Monday and I feel like it's Friday.

The highlight of the shift was getting paged to go to a distant ward.  I walked in and the faces of the nurses behind the desk lit up like it was Christmas.  "Here's the doctor", they said, "He can help!"

At that moment I felt so proud.  The doctor is here to save the day.  "What seems to be the problem?", I asked in my most nonchalant manner, as if I've been doing this for years rather than two weeks.

They looked at each other eagerly, then turned back to me and asked, "How do you spell abscess?"

Telemedicine

On Thursday I was sitting in the ICU playing phone tag with my registrar and the cardiology registrar regarding one of my patients when my mobile rang:

PTR
Hello?

Caller
Hi, this is Kathy, could you please re-send that order for the iron infusion?  It's gone missing in pharmacy.

PTR
What?

Caller
The iron infusion for Mr Gibson.

PTR
[Desperately flipping through my patient list looking for a Mr Gibson and freaking out because I know nothing about him...]
Mr Gibson?  Where is he?

Caller
He's gone back to Caloundra.

PTR
Caloundra? I'm in Adelaide.

Caller
Is that Dr Hamface?

PTR
No, sorry, you have the wrong number.

My week so far

On Monday I kept telling myself that I just have to get through this year.
On Tuesday I kept telling myself that I just have to get through this rotation.
On Wednesday I kept telling myself that I just have to get through this week.
On Thursday I accidentally went to a nude beach.
Yesterday I kept telling myself that I just have to get through the day.
This morning I am telling myself that I just want to go back to bed.

Status idioticus

Thanks for your supportive comments to my previous post.  Since then things have improved a billion percent plus or minus 999,999,999 or so.  I'd like to think that it's because I am a winner, but that's only partially so.  Sadly, I still haven't managed to have any Vitamin C(ricket) but life can't be perfect.

Monday was not good.  I was there for 12 hours straight, didn't get to eat anything, didn't get to drink anything, if I hadn't been running around like a madman you'd have thought I was fasting for surgery myself.  Perhaps I'd be more productive if I wheeled a drip-stand around with me, with cool refreshing sea-water flowing into my veins, and a nice fat urinary catheter to cut out those pesky bathroom stops.

Things got off to a poor start when the Hatchling woke umpteen times the previous night.  I then managed to somehow miss half of the plans during the round and never quite caught up.  It didn't help that my RMO (the person between me and the Registrar, who is the person between the RMO and the consultant, who is the Big Boss) is away this week and there's no reliever so I'm kind of flying blind.

I failed to arrange some urgent consultations from cardiology and anaesthetics to prep a patient for surgery on Wednesday (today) because I simply couldn't get anyone to return my pages.  Either that or I wasn't in one place long enough to actually take a phone call.

Then the consultant surgeon came and asked me some questions about my patients and it turned out I had no idea about them because again I sleep-walked (slept-walk?) through the round, so he deservedly rebuked me for that.

Then I had two code blues (dramatic emergency for crashing patients) in 4 hours plus another patient started having massive rectal bleeding so I had to quickly arrange a whole bunch of stuff that I previously had no idea about.  And because of that, I fell further behind and the consults never got done and as I was sitting at my desk at 8pm scribbling out blood forms for the following day my Registrar came in and revved me about needing to get my shit together.

So I went home and the Hatchling was screeching because she hadn't eaten and was sick and was driving my Smaller Half bonkers because she's been just as busy as me and by bedtime I was pretty much ready to run away and join the circus until I realized that I already lived there.

Tuesday was better though and today was better again.  Here's some tips for new interns on how to make it so:

1. Get a student to write the notes.  Concentrate on trying to figure out what the plan actually is.
2. Review your patients yourself.  For surgical patients you need to listen to breathing, check IVT/fluid balance, check calves for DVTs, check the surgical wound is clean and ensure that they have correct anticoagulation.  This will put a cap on how much of an idiot you look like when the consultant starts quizzing you.
3. When your registrar starts flinging around multiple, ambiguous or conflicting instructions, make him clarify himself (or indeed herself).  He may in fact get annoyed that you "waste his time" by doing this, but if you don't you'll regret.  This is no time to be meek.
4. Page people once.  Give them 5 minutes to answer, then go through Switchboard to call their mobile.  Why we have a paging system when I am the only person who seems to actually use it is beyond me.
5. DO NOT LOSE YOUR PATIENT LIST WITH YOUR JOBS WRITTEN ON IT.  Seriously.
6. Ask for help within a few seconds of getting baffled or confused or being unable to find something or not knowing how to do something.  Sure, you might look silly, but at least you'll be able to go home at a sensible hour.  This is no time to be proud.
7. Write down everything you do in the notes.  Writing it down often makes you remember what else you should be doing as well.  Which may well make you yoyo back and forth between the patient and the notes, but hey, what's the alternative.  This is no time to be super-organized and work hard through med school so you know what you're doing.  It's too late for that shit.
8. Drink lots of water.  Do not eat the junk food in the office.
9. Stand up straight.  Sniff the morning breeze.
10. Be strong.  Be energetic.  Be determined.  Know yourself.  Be the ball.  Keep left.  Buy low.  Sell high.  Take the All-Bran Challenge.  Squeal like a pig.  Something's gotta work!

I just wanted to say good luck, and we're all counting on you.

Low

Someone commented recently that I hadn't been posting much, and then posted a link to a blog about Antarctica.  Well, Antarctica sounds pretty good right about now.

Never in my life have I felt so disorganized, so incompetent, so useless, so tired, and so over my new job which I just spent the last 4 years "preparing" for.  Time to get some rest and go back and do it all over again tomorrow, hopefully slightly less ineptly than today.

Aptitude

I'm great at never and always.  It's sometimes that I have trouble with.

Shock redux

And another thing.  One of the patients mistook me for someone he was once previously hospitalized with, who was getting electroconvulsive therapy.  Presumably this is another hint that I need to get my hair cut.

Shock

First real day of work today.  For some reason I got mistaken for an electrician (???) by the theatre nurse.  Soon the anaesthetist knew, and it didn't take long before she was answering the phone saying, "Well the new intern is here, I could get him to do it.  Yes, that's right, the electrician. Hahaha!"

Ha ha ha.

Dysorientation

For the week before D-day - when I'll be expected to actually do real doctory-type stuff - I am being subjected to a brutal program of "orientation".  It's bewildering.

The general gist of it seems to be:

1. A senior doctor comes in and tells us that we can do it, not to be scared, and to call them for help if we get worried about a patient.
2. A junior doctor comes in and tells us war stories about the past year and all the freak-out moments they've had and how you get shouted at if you call a senior doctor.
3. A cyborg administrator comes in and tells us that even if you are on the roster to eat the bits of capsicum out of someone's poo that you'll get paid a 15% penalty rate only after the fourth piece and it's a Sunday in Aries rising and your supervisor authorizes said payment in their own cerebrospinal fluid.
4. Some of the interns start backchatting the hand-hygiene apparatchiks with an argument that would seem to suggest that because self-defence is okay that recreational murder should be permissable too.
5. Insurance salesmen come in and give us lunches that look like they were catered by 15 year old boys.
6. And then it starts all over again.

I get the impression that in the far-distant Neolithic era, the orientation program involved mostly useful stuff like being told how to use your pager and where to park your car.  Then the lawyers got involved because if they could show that at some stage we were warned not to kill people, that when someone unfortunately died they could point the finger and scream "We told you not to let that happen!".  Then the new interns freaked out and complained that they weren't supported enough so they brought in the senior doctor to play nicey-nicey.  Then the interns found that they were being shouted at because they were labouring under the mistaken belief that senior doctors want to be their friends, so they brought in the junior doctors to tell horror stories.

I don't know why she swallowed a fly.  Perhaps she'll die.

Ceiling, Seville, Spain

New Years Resolution

First thing in the morning, I'm going to pour boiling water over the salt again whilst verifying my answer to that tricky problem that I worked out previously.

The least bad parenting win

There have been a couple of parenting lapses in Chez PTR recently.  I won't reveal who is accountable for what, but I'm interested in your feedback on which lapse is more irresponsible.  Once you've read the descriptions, please vote in the poll to be found for a limited time only to the right of this page.

1. Allowing the Hatchling to grab a steak knife off the table whilst distracted by one's own dinner.
2. Allowing the Hatchling to eat dead bugs off the floor whilst distracted by the cricket (not the bug, the sport) on the television.

Please encourage your friends to vote.  If I end up being less irresponsible I will buy myself a coffee mug saying "World's Greatest Dad".

It's just not croquet

Gee I miss Peter Roebuck. 

Not personally of course.  For those of you scratching your heads, he was an Australian cricket analyst of English extraction who flung himself to his death out the window of his hotel room in South Africa a month or two ago after he was questioned by the police regarding an allegation of sexual assault.  A sad story - and who knows what really happened?  Not me, that's for sure, but he was a great cricket writer and for that I miss him.  He tended to write sprawling articles reflecting on the events of the day and how they may enlighten us to the struggle inside the players' heads, and thus inside our own.

After the annual Christmas gulag I've finally allowed myself to relax enough to sit back on the couch and listen to the Oz summer of cricket on ABC's Grandstand.  The Hatchling seems a bit bemused by it all but she applauds along with the crowd whenever there's a dismissal.  She keeps me busy enough that I miss a fair bit of the action, so I have to check the scoresheet online once she's gone to bed. 

And in the morning, I get up and look at the Sydney Morning Herald website to see what Peter Roebuck made of the day's play.  But he's dead.

I would have liked his opinion on the latest shenanigans involving the Decision Review System, which has been blocked by the Indian voting bloc and would have avoided a couple of howlers by the umpires already in this Test, versus, ironically, (or is this just Alanis irony) India.  There has been some interesting discussion on the radio about it but I feel like everyone so far is missing the big picture, and perhaps Mr Roebuck would have been able to sit back and ponder the big issues to my satisfaction.

I feel that everyone is obsessed on the idea of "getting it right".  We have the technology to find out what really happened so we should use it to ensure that the game reflects as accurately as possible the "true" battle between the two teams without the shadow of the umpires eclipsing the brilliance of the performances. For example, they are shocked at the idea that in one country the DRS might have 150-fps cameras whilst in another only 30-fps cameras.  This inequity cannot stand, they cry.

And if this was medicine, I'd agree with them.  It's important to get medicine right.  Or stopping an airplance falling out of the sky.  That's important too.  Or even designing a voting system for the Americans so the less adept of them can actually vote for the person they intend to.  Those things matter.  But cricket is - gasp! - a game.

I'm pretty sure that cricket players would scoff if the ballroom dancing fraternity insisted on using high-speed infrared cameras to figure out who had the "best" tango.  They would point out, I am sure, that in cricket there are rules that clearly define the circumstances of whether someone is in or out, and we should strive to use all the investigations at our command to ensure the game follows its natural course.  They would say that ballroom dancing is subjective and that the judge's decision are interpretive, whereas cricket is all about hard facts and numbers and is thus amenable to technological intervention.  To which I would reply that to a man with a hammer every problem resembles a nail.

My opinion on the matter is that this is a game, a.k.a. a sport, and human error is what it's all about, for the umpires no less than the players.  Variations in umpiring from country to country, from game to game, or from day to day have as much relevance as the weather, which is to say that they are hugely important and help to make the game as interesting as it is.  High-speed cameras and remote bowler-assassinating drones are all well and good for spicing up the viewing experience for the audience.  But please, please, leave them out of the game itself before it gets sterilized and vaccuum-packed, like every other part of Western culture.

Vale Peter Roebuck.

Christmas jeer

My Aged Mother said to me this morning, "You know, PTR, we do pretty well at Christmas, don't we?  A lot of families just get totally drunk and get into beating each other up but we're not like that."

Part of me feels proud that she's right, but the other part of me feels sad that our threshold of success is so low.

Investigative phrenology

My parents had a small phrenology bust sitting on the mantlepiece in the seldom-used dining room, where the shiny table, uncomfortable chairs and musty lounge-suite also lived.  I was poking at the lumps and bumps in the Hatchling's head and wondering what the significance of them might be when I started wondering if perhaps the entire scientific bulwark of phrenology might be undermined by interpersonal variation in the character of each region of the skull.

A small amount of experimentation on myself involving three D-batteries, a wire coat-hanger, and a couple of largish gramophone needles enabled me to map out the contours of my own cognition.  A fascinating GAAAAAAAARRRGHH process indeed.  Since I'm not much of a artiste on ye olde computer I googled up a numbered version of the phrenology head (pictured above), which you can correlate with the list below:

1. Pride
2. Envy
3. Corduroy
4. Love
5. Depth perception
6. Embezzelment
7. Puns
8. Man-o-wars
9. Beft
10. Musicality
11. Vengeance
12. The Spanish civil war
13. Chocolate
14. Slip-slop-slap
15. Soviet monuments
16. Running writing
17. Writing running
18. Willpower
19. Blogging
20. Chronic condition self-management
21. Batman
22. Fashion
23. Sex
24. Arithmetic
25. Taxidermy
26. Comparative religion
27. Black powder
28. Bacon
29. Architecture
30. Flattery
31. Insolence
32. Procrastination
33. Politics
34. Fatherhood
35. Erbium

What I find fascinating GRAAAAAAAGHH is the fact that every single experience, thought, emotion and memory that I ever have had or will have can be expressed as a combination of items from the list above.  For example, last week when I graduated with a medical degree and stood proudly on stage as a doctor, that experience was basically 1 + 18 + 23 + 26 + 28, or more descriptively, Pride + Willpower + Sex + Comparative Religion + Bacon.

You should try it yourself.  It could change your GAAAAAAHKK life.

McFly

It's funny that more people aren't named after insects.  Insects are pretty common. If a person can have a colour as a surname (Black, White, Green, Brown, etc) which is a pretty abstract and subjective notion, why can't they be named after insects?

The only insect surname that I can think of right now is Slater.  It's a good name.  But why not Millipede or Cockroach or Ladybug?

One day I'll write a novel and all of the characters will have insect surnames.  I think it'll really be big.

True story

Patient

I have an unquenchable thirst.

Doctor

For power? Knowledge?

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.