What I go to shows for

I just spent the entire weekend at a local horse show. At the risk of sounding like a spoilt brat, I ... well I probably am. I usually spend the week 200km from home studying while Mum and Dad look after my horses – exercising, shoeing, feeding, washing, all the things that will put you off having horses. And then on weekends, I drive to the shows and hope to find my team of showjumpers there, all washed and ready to go. Most of the time it works out pretty well (for me), but I’ll have to admit that if I win anything it’s mostly thanks to Mum and Dad, and if things go badly it’s mostly because I’ve been at uni so long that I’ve forgotten what my horses even look like. So although I was surprised on Saturday to find that I only had one horse to ride, I couldn’t complain because (a) I had a horse to ride and (b) it was my favourite, Jangles.

We had a lovely weekend; my family, our horses and the little dogs. The dogs were both "adopted" by two little girls for the weekend, who also followed my sister around during all waking hours, all the while dragging around our two dogs. My sister claims to be neither a people-person nor child-friendly, but I think they wore her down in the end. Jangles and I only competed in small classes (95cm and 105cm) but we managed to win a 2nd prize each day, so I now have lunch money for the week ... things like this matter to a poor student.

"Pictures are better than words, and much more colourful" - old jungle saying

My little Jangles ... awwww. Makes me smile just to see him.

Jangles in action. Well done, little sister - good photography!

My little dog Sprite. Photo by the little girl who "adopted" her for the weekend.


My sister's dog 'Doggers', AKA the Fashion Police, barking at a man who chose to wear an orange wife-beater singlet and tight purple jeans. Sic 'im, Doggers!

Tired little dogs. When they aren't being adopted by small children, their job at shows is to guard the horse truck from "bogans", and they take it very seriously. They do sleep well at night though.

Parallel Consulting

I have my first day of real, live, “parallel consulting” today. I’m probably a late starter, but I’m still not sure if I’m quite ready. They find me a spare room (it’s equipped with all the finer details such as chairs, computer, and sphygmomanometer - very nice!), and then point me towards the patients.

And I get to meet a surprising array of patients, too. I see a high school boy who last night had his first generalised tonic-clonic seizure and now needs to be investigated for epilepsy. I talk with him and his mother for an hour and a half, mostly trying to remember all of my “nervous system” questions and neural examinations, and partly chatting to stall for time while my own brain slowly ticks over. I see a man from the local factory who has injured his sternomastoid muscle driving forklifts and needs to be put on alternative duties. A young man comes in with oral thrush, and apologises for making me go near his mouth. I apologise for eliciting his gag reflex by poking his tonsils with a large paddle-pop stick. I also see a young girl, who comes in with her mum, and talk about menorrhagia (ah, girl talk). It takes a while to get to the point, especially when the girl won’t talk at all and the mum begins with, “she’s been having trouble with her monthlies”. But we get there in the end. Finally, there is also a man with foot pain, who becomes inspired to go for a proper foot massage after my brief examination. He exclaims, “I thought it would tickle, but it actually felt really good!” I just want to wash my hands, or buy new ones.

And I like it. I like talking to all of them, and trying to keep them on the topic of medical problems. They seem to like having a captive audience with no apparent time restraints as well. Maybe I could do this.

Something that strikes me as a little worrying, however, is that although I am quite happy to ask questions, I really have no idea what to do with the answers. I’ve noticed before that when the doctor is in the room, patients will listen to my question, then turn back to the doctor to give their answer. The patients are on to me.

Happy Baby Day

I was a bit discouraged from O&G after the specialist session on Monday, but today’s session with the local GP yielded some happier stories ...

They’d been on holidays when she’d heard somebody calling their child “Ari” and fallen in love with the name. He had agreed that it was the perfect girl’s name; she liked it for a boy instead. And after 26 hours of labour, she won. I gave little Ari his 8-week check-up today ... I didn’t really know what I was doing, but he was pretty chilled about the whole thing. And he’s doing well.

Next patient: mum’s a cystic fibrosis carrier. Ultrasounds of the fetus had shown hyperechoic bowel, and amniocentesis results had been inconclusive. He was born several weeks early, severely jaundiced, and was flown to the city (400km away) for treatment. He had also developed neutropenia along the way, so it wasn’t a great start. I saw him today and he was teething, but not crying, just drooling all over his toys and my stethoscope. A very healthy and very hungry 6-month-old, in for his routine checkup.

It was happy baby day in my small corner of the world.

Puppy Dreams

After my boutique shopping experience this morning, I decided that I should probably do some reading before tomorrow’s PBL. Up until yesterday, every time my classmates referred to “Jessica Martinelli” (the current case), I thought they’d discovered a new cook book, so clearly I was way behind. Our study day is in my town tomorrow, and the last thing I want is to look silly in my own town, so it was time to do some reading.

Normally I have the study house all to myself, as my classmate here is struck by hayfever the minute he steps through the door. Today, however, two of the office girls were working there, frantically reorganising appointments and schedules. I thought, 'that’s fine, a bit of white noise should help me focus' (usually it does). So I sat out there with a Textbook and proceeded to Study.

But as so often happens, my self-diagnosed slow-onset narcolepsy began to creep up on me, and I thought I would sneak a quick nap. I am not a sneaky napper, as it turns out, because I am highly interactive with my dreams. I woke myself up twice – once because I kicked out, and the second because I dreamed of something hilarious and actually began to laugh out loud. The office girls, the height of discretion, pretended not to notice, but I thought it best to go home and finish my puppy dreams in private.

High Roller

I made a special trip to the neighbouring town this morning, just to shop at Cheap as Chips. If you thought this was the low point of the story, well, you're wrong. I had to make a special trip today because yesterday I reached the checkout and discovered had insufficient funds to buy two plastic containers. At Cheap as Chips.

We med students sure are high-rollers.

Oligohydramnios

Obstetrics and Gynaecology has always been high on my list of possibilities, but this morning it doesn’t really grab me as a future career. Not that it is boring or anything, although the pace seems nice and relaxed – 15minute appointments for returning patients, 30minutes for new patients, and plenty of coffee breaks. And there is a nice variety, from the very first patient who is in her early 20s and trying to conceive, to a lady in her 70s who is recovering from endometrial cancer. There are prenatal checks and postnatal checks. I am kicked by overexcited babies in the womb and garbled at by toddlers. The O&G specialist is very welcoming, we go through patient histories and he explains his practice. I want to see more, so I make the mistake of staying to observe an amniocentesis.

The couple comes in – they are in their early 30s and have a toddler at home. They are looking forward to a sibling for their other child, but the screening for Down syndrome has come back as high risk, so they want it investigated. There has been some trouble earlier in the pregnancy with a clot, and last week the woman noticed she was losing large amounts of clear fluid. She thinks maybe it was something to do with the clot, and is not too troubled because everything feels normal now. The specialist looks more concerned. So we go next door for the ultrasound. We all look up at the screen; see the little head, the little spine, the little heart. But the specialist sees more. He realises there is not enough amniotic fluid to take a sample. The lady starts to cry; she knows something is wrong, and deep down has known for some time.

The specialist explains that essentially, her waters have broken, and contractions will probably start within the next few days. Her 15-week-old fetus is going to be born early and die, and it cannot be saved. They discuss outcomes if the baby, by some miracle, makes it to term. It is more susceptible to infection during pregnancy, its musculoskeletal system won’t develop properly, and most importantly, neither will its lungs. It will not be a viable birth. So they discuss termination options. She cries, but she does not break down – she is saving that for later. Her husband holds her hand and asks all the questions that she cannot. I admire them both – their hearts are breaking, but they hold it together and learn about all their options before they leave. I hope they’ll be ok.

Haiku

It’s an interesting weekend on call. Two of the lovely ladies I saw in the GP clinic on Friday are brought in over the weekend, which is good and bad. They both seem happy to see me, although one of them starts to wonder if I am being overworked because she’s seen me three days in a row. This is a lady with an iron level of 2 (normal 10-14), CRP of 250, and possible bladder cancer, worrying that I might be getting tired. The other is an all-round worry wart who comes in because her rash isn’t better after one dose of oral prednisolone. The doctor makes her take a second tablet, she improves and is sent home. Very cute.

I get to admit a man with acute pancreatitis, a lady with diverticulitis, and chat to a 10-year-old girl with supraventricular tachycardia and a man with renal colic. I inspect a maggot-infested wound that I’ve seen a few weeks ago, the day the stitches came out when it was still beautiful and clean. I notice that our sweet, little old lady with mouth cancer is feeling much better, and is looking forward to moving back home. Lots of patients, lots of little stories, and the dreaded “DPS” is finally starting to make some sense.

Two of the patients have Sunday’s duty doctor stumped. They are both regulars of the clinic, so we take one each and read through their past histories. I take the 65-year-old lady with abdominal pain and hyponatraemia. She has significant history of UTIs, and PR bleeds a few years back, but nothing that really explains her current condition. She has a history of mood disorder, so it may be illness anxiety and psychogenic polydipsia. The only thing that really grabs me as I read through the notes, is the doctor’s documentation style.

Rash under left breast
Patient says it’s not itchy
It is tinea

I wish all the doctors would write like this.

Urology #2

Urology consulting isn’t nearly gruesome as urology theatre (much less blood and burning flesh), and it’s nice to meet some patients and see what they’re like in real life. I meet a 92-year-old lady who’s glad to be rid of her extensive bladder cancer, a 65-year-old man post-TURP who wants to know if he can have sex yet, and an 85-year-old who’s just been diagnosed with prostate cancer and wants to know how long he’ll live. I also meet a man who leaves the room almost the second the urologist informs him that he does not bulk bill. And a lady who is shocked to discover that smoking causes cancer of the bladder, and swears to quit today. I have to smile when a feisty older lady explains her tests, “there was things that they rubbed on yer, and all them things in the tunnelly thing” (ultrasound and CT scan). I ask insightful questions and the urologist gives me detailed answers about everything from operation procedures to medical treatments and pathophysiology.

But I still do not want to be a urologist.

Urology

I quickly skim over the page on TURPs in my textbook, realise I am running late and race in to the hospital, only to find the theatre change rooms and in fact, the whole corridor, completely deserted. But I bravely battle on, and before I finish changing into scrubs, my favourite nurse arrives and all is well. She even helps me put on my little scrubs hat so it goes all the way over my ears and doesn’t look dorky.

When I get to theatre I mention that I am pretty exciting about actually scrubbing in, and they all give me the “your puppy has been sent to the farm” look and inform me that there is no need to scrub for any of today’s procedures.

Maybe I look sad, or a little slow, but the urologist goes pretty easy on me. He doesn’t want to ask me what a TCC is, in case I don’t know ... but I’ve just done a urology PBL case, so I can confidently answer “transitional cell carcinoma”. He is amazed – “you’ll be alright!” he declares. It can’t be that easy, so I wait for the trap. But the urologist later admits, “I don’t ask medical questions anymore, because I don’t understand the answers”.

Urology surgery is incredibly brutal - the urologist wears a splash-proof mask, waterproof gown and gumboots, for starters. And when he threads giant metal instruments through the penis to the bladder or the prostatic urethra and cuts, probes and cauterises away, the blood (mixed with 1.5% glycine solution) flows and flows into the catchment area ... and sometimes onto the floor.

The TURPs are the worst. The smell of burning flesh is only noticeable after a few minutes of cauterisation, but it soon spreads throughout the operating theatre. On the big screen it looks, as the urologist puts it, “like shearing, but in reverse – from the inside out”, with the white cauterised prostate, pink flesh showing from underneath, the occasional bleeding vessel. Or in the larger prostates, the frequent, large bleeding vessels. After he cauterises the prostate with a wire loop, he uses a roller-ball diathermy to finish off the area, stopping any bleeding and making the surface smooth. And then the worst part – after flushing, he scoops up the chunks of prostate that he has removed and puts them in jars for pathology. I am surprised at the volume of material – small handfuls of prostate pieces. And they look and smell like bacon chips.

One man had developed bladder diverticulae due to an enlarged prostate that gave him chronic urinary retention. The prostate almost completely blocked his urethra before the operation, so the force the detrusor muscle had to exert in order to squeeze urine past this tiny opening had caused little outpockets of bladder to form in between bands of detrusor. Too look at, it is much like diverticular disease of the bowel.

It is all very interesting, but I can’t help but drift back to the anaesthetics. I put in some more cannulas, give jaw support to apnoeic patients, place three laryngeal masks and even get to inject some ... white stuff. And then the anaesthetist asks if I want to scrub in for a spinal block! My answer is most definitely yes (and not just because I desperately want to scrub in). He shows me how to find the right spot, inject the local and use that needle to mark the spot for the longer spinal needle. I get to feel the different grades of resistance as the needle passes through the skin, muscle, ligaments and finally the ‘give’ as it passes into the subarachnoid space. We remove the stylet from the middle of the needle, and I am relieved when CSF finally wells and drips out of the end and he can inject the anaesthetic. Then later in the list, another patient comes in who elects to have a spinal block – and the anaesthetist lets me do most of it myself (under very close supervision)! He then tells me it's probably the fastest student spinal block he's seen, so I watch nervously for signs of pain during the surgery, but it all goes well.

100% success rate on spinal blocks – much better than cannulation!

Quoteblog #3

Another week, another study day. I noticed today that our group has really come into its own and instead of sitting there terrified of our GP supervisor (who actually does know everything and hence asks us some pretty intense questions), we are all more happy to have a joke and a laugh. I believe we even managed to make him feel quite uncomfortable at times, but that’s probably just a side-effect of having 8 girls in a PBL group of 9. Somehow though, today was less fruitful for my Quoteblog – having 5 hours of psychiatry lectures *might* have had something to do with that. But here are some of the best from today:

“I’ve had patients whose voices have been telling them jokes, which they’ve enjoyed, and they’ve felt lonely once they’ve been treated and they’ve gone away” - Psychiatrist

“Psychiatry is a pragmatic sort of specialty. If a person’s psychotic, give them an antipsychotic” - Psychiatrist

Apparently we don’t need to know doses of antipsychotics. When asked if it’s because we can just look them up, the psychiatrist responded: “it’s because it’s just a bit too hard”.

“See, aren’t you lucky to have old people in your PBL?” - Student

“My mug is not a sex object” – Student

“[She] is the queen of dodginess” – Student, about another student

“If you have a fat patient, and there are many fat patients in Australia, make sure you don’t just palpate the fat and think, oh, the tummy is soft” – Surgeon

“You have to either postpone the gallbladder or the golf, one of the two” – Surgeon, on deciding whether to operate

“If in doubt, take it out” – classic surgeon wisdom

A Big Day

I breathe a sigh of relief when I arrive and the GP’s room is still empty, and I sidle in and sit there inconspicuously reading some old notes. And then the intern spots me, informs me that my doctor is currently doing ward rounds at the hospital and that I am oh, 75 minutes late. When I arrive he is halfway through ward rounds, and his assistant is the scary boss nurse. Gulp. I apologise, explaining that I thought we were at the clinic today. He says, “that’s alright – I thought I had a day off!”

It’s a busy day. I get to do a lot of paperwork (yay!), and when the doctor heads back to the clinic, he leaves me at the hospital to admit a lady who comes in with acute chest pain. The nurse does most of the work, preparing the admission folder and gathering equipment, but she is kind enough to let me take bloods and examine the patient. I try not to look silly, writing in the progress notes, and she waves a random paper in front of my face and asks if I’ll be using this in the next few minutes? I have no idea what it is, so I just say no-no you can take that for now, and I suddenly feel all important. That feeling lasts until I wander out of the room for 5minutes, return to find my patient missing, panic, and have the cleaning lady inform me that the patient has gone for her chest X-ray. Oh good.

I have 15 minutes for lunch, and in that 15 minutes the electrician arrives to test my oven’s temperature regulator. He concludes that it’s normal for an oven set to 150 degrees to fluctuate between 135 and 175, and that maybe I should “go to a search engine and type electric plus oven plus cook ...” sigh.

After lunch I enter the doctor’s office while he is in a consultation with a young girl and her mother. As I close the door the little girl asks, “is that another doctor?” and even after we all inform her that I’m not a doctor yet, the little girl declares, “she can check me.” Later, she is running around the office, and picks up a urine sample from the desk and asks what it is. Her mum tells her, “don’t be silly, you know what it is! Don’t you?” and the girl looks down and says, “my piddle”.

Not long after, a mother brings her 9-year-old boy in because he has an earache post-tonsillitis. The doctor asks, “do you feel ill?” and the boy agrees that he does. “In what way?” the doctor asks. “Um ... both?” hazards the boy.

I finish my day by seeing a man who has had an accident whilst making trainer-wheels for his grandkid’s bicycle, and sliced his thumb with a piece of steel. My GP is in a bit of a hurry, so he injects the local anaesthetic and then runs off to see another urgent patient. I am left behind in the rush, and next thing I know, a different doctor comes in and announces, “it’s just you and me! Let’s stitch up this hand!” So we take a suture each and start working from separate ends of the wound. This is my second effort at suturing a real live person, and it’s much easier once you realise just how hard it is to get through the skin. My sutures are a lot neater too. In the end, the other doctor has to go and pick up his daughter, so leaves me to do the last few sutures on my own. I feel so grown-up.

And I didn’t even know I was on call today.

Valentine

It’s Valentine’s Day. The media is all over it, of course, and for weeks we have been hearing about how special / romantic / over-commercialised / unfair the occasion is. So I won’t go there. I myself had a lovely day. I was home for the weekend, and brought home presents for Mum, Dad and my sister (Dad shook his and declared, “These are sharing chocolates, I can tell!”). So we all had chocolate for breakfast, I played with my little dog and then I rode my horses. It was all sunshine and happiness, and then I made the 2 hour drive back to my placement, and when I arrived it was pouring rain. True story.

But I digress. It’s Valentine’s Day. And I remember a conversation I had with a GP while I was on work experience last Christmas holidays - one night during that week, he and his wife sat me down at the kitchen table and told me exactly what sort of husband I should be looking for. It’s worth mentioning that this doctor is a long-time family friend, so it makes this situation a little less strange. A little. Apparently I need an understanding sort of fellow, who is a rich professional of some sort (but not a doctor), and happens to enjoy feeding animals and cooking.

Not quite as bizarre as my friend, who was waiting for a not-too-tall chicken-man to climb up to her bedroom window, rose in teeth with a lopsided smile. And well, she seems happy, so maybe there’s hope for me yet.

Oven Problems

One of the perks of studying third-year in the country is that we are supplied with accommodation, rent-free. My little house is incredibly cute ... two bedrooms, a study, wooden floors ... so I am most impressed with my situation here. There is only one problem – my oven is shite. It’s an el cheapo electric oven, which heats from a single element at the bottom and hence burns my food from the bottom without even beginning to brown it on top. I have been experimenting with various temperatures, placing baking trays on the bottom shelf, and finishing off the browning under the griller, but so far the results have been unsatisfactory.

And so I complained. You know the feeling, when your complaint seems totally valid and articulate – until you try and explain it to somebody in authority? The man at the council was very patient with me, listening to all of my oven problems, and in the end summed it up with, “so the problem is, it burns your food?”

Nevertheless, he did not give up on me and came to inspect the oven himself the following day, to assure himself that I wasn’t merely incompetent. When he saw that it was, in fact, a terrible oven, he promised to go straight home and ask his wife what to do. It probably helped that I described all of the marvellous things that I could (hypothetically) bake, “if only I had a decent oven”. His wife clearly didn’t have any solutions, because the next phone call I received was from the electrician, arranging a time to check the oven properly.

The council man phoned again this afternoon to see how I was getting on and we had a bit of a chat. When I told him that I was going home for the weekend, he declared, “I would too, with an oven like that!”

He gets me.

Doctor vs Patient

When the doctor knows his patient well, he gets pretty cheeky, throwing in odd comments and keeping the patient on his toes. The other day a man came in with a laceration to his calf, which needed suturing:

Doctor: “Can you get me a suture kit please?”
Nurse: “What, a sharp one?”
Doctor: “No that’s fine, just get me an old blunt one. Actually, just get a dirty one out of the ‘used’ bin”
Patient looks up, laughs uncomfortably
Doctor: “It’s cheaper that way”

He probably should have cut his leg in the morning. Almost all of the morning patients got new sutures.

But the doctor doesn’t always win. An older man, who was not in the best of health, came in the day after his birthday. The doctor asked if he’d had a quiet one, hoping he’d taken it easy. The patient replied, “I had a few quiet ones, yeah”

Everything is better when the doctor keeps it interesting, right?

Quoteblog #2

We had an Advanced Life Support session today using Sim Man. Before we started we had to sign a confidentiality agreement, so I can't really tell you what went on in there, but here are a few amusing quotes from the day ...

“It means business, my stethoscope” - Student

“She’s not very good at being a man ... she’s OK at being a woman” - Simulation instructor, about her co-instructor

“We’ll try not to kill anyone” - Simulation instructor. “Make it me, I’ve had a good life” - Student

"Give me adrenaline please, not atropine – it’ll give me more of a buzz” - ED Doctor

“Aaaaah! Stop! Get off! Get off, you bastard!” - Sim Man to his resuscitator

“I had chest pain ... turned out to be just a sausage roll” - Student, talking about her own experience in the Emergency Department

“Just a little prick!” - Student to Sim Man, cannulating ... “Mmmmm! Oooh!” - Sim Man

“You can monitor through the defibrillator, but you can’t shock through the monitor” - ED Doctor

“If you can do it right, then you’ll bamboozle them, and that’s a really effective way to get through an exam” - Respiratory physician re: spirometry

All in all, it was a Good Day.

Mouth Cancer

Don’t ever get mouth cancer.

There is a sweet, little old lady in our hospital right now. She drowses through most days and nights – sometimes for a change she will get out of bed and sit in her chair, but still she drowses. She can talk alright, but she can’t open her mouth very far. She gets mouthwashes every 2 hours, and she says it “stings like billy-oh”. She has mucositis from her radiotherapy, so her entire mouth is ulcerated and bleeding, and thick saliva strings between her lips when she talks. Her mouth looks like that of a monster, but she is a sweet, little old lady. And she cannot deserve this.

In our lectures we were taught the causes of mouth cancer, we memorised mnemonics; we learned to frown upon alcohol, cigarettes, and uh, ‘loose living’. I came to believe that everyone with mouth cancer had earned it, somehow. But this lovely lady ... she doesn’t deserve this. She can’t.

Disappointed Babies

I haven’t seen many babies so far, so I am looking forward to this afternoon with the GP-obstetrician. The day looks promising when the first patient comes in, a new mum with a 5-week-old son. As the doctor goes through his examination, all I can think is, “Look at the little baby!” so I am caught off-guard when he turns to me and asks what I would do next. “Ummmm ... would you measure it?” A good enough guess. And then I am asked to hold the baby while he examines Mum. I’ve not had much experience with holding babies, but I think I do ok. The baby does not hit the ground and does not squeal too much, which is encouraging. And then it gets hungry. “Uh, uh, uh” it declares, and mouths the empty air before spotting my bare arm. And then it gets frustrated, starts to squeal, because my arm isn’t giving it dinner.

No more babies until the end of the day. “You don’t have to stay for this,” says the GP. We have taken care of all his consulting sessions, and I have just (under his close supervision) sutured a man’s leg and sent him on his way. It's been a long day. The treatment rooms are empty. The nurses have left in protest – they don’t want to stay for this. I stay.

The young couple sits in the waiting room with their brand new baby boy. Their oldest, about 3 years old, runs rampant through the near-empty clinic. They are relaxed, and the baby is sleeping, for now. The GP has tried to talk them out of this procedure, but they have insisted, and so he will do it.

Dad brings the baby in – Mum refuses to enter the room. Dad is brave. He chatters away, jiggles the little baby and soothes it as he takes a secure hold of its little legs. The doctor prepares his equipment ... forceps, probe, scissors, bell, gauze, and lays a sterile sheet over the baby’s lower half, exposing only the area to be operated on. And then he begins the operation. The baby is unhappy with its situation, and begins to cry. Dad talks, soothes, and kisses the little face. I am surprised when the baby actually manages to fall asleep, but the Dad just grins, as if he expected it. Dad is not quite so happy when the baby wakes up and begins to scream in earnest. And now there is blood flowing from the baby’s sliced foreskin. I can see little beads of sweat beginning to form on the Dad’s face, when he suddenly declares that he needs to lie down on the linoleum, so I step in to secure the baby. I stand at the baby’s head, wrap my hands around his little knees, and find myself inches from the circumcision procedure. It’s not pretty, the baby doesn’t like it, but it is soon over and the baby is back sleeping in Mum’s arms. Dad is alright too, after his rest. I thought it would be worse.

Blueberry Muffins

I have just moved into a new house with an Electric Oven, something with which I am entirely unfamiliar. I have been trying to create blueberry muffins – I have made four different batches so far, with varying degrees of success. The latest was reasonably good, so I thought I would share my success story with you.

Ingredients
2cups plain flour
2 ½ tsp baking powder
¼ tsp carb soda
Pinch salt
2/3 cup caster sugar
1-2tsp grated lemon rind
1 cup blueberries
1 egg
1cup milk
90g melted butter

Method

• Preheat oven to 180C
• Sift flour, add baking powder. Realise you have forgotten to buy carb soda. Add another 1 ½ tsp carb soda for good luck. Add salt and caster sugar.
• Whisk together melted butter and egg. Retrieve milk from fridge. Sniff suspiciously. Pour into measuring cup. Sniff again. Rationalise that it is still mostly liquid. Whisk together with butter and egg. Pour onto dry ingredients. Fold together, careful not to over-mix. Notice lumps in mixture. Stir furiously.
• Add blueberries, fold in. Add another cup or two for good measure, fold in. Admire purple colour of batter.
• Spoon into lined muffin tins, until at least ¾ full
• Place in cursed electric oven, middle / top shelf. Place an empty baking tray on the bottom shelf
• Wonder where the lemon rind was meant to fit in
• Pace room, frequently checking muffins’ progress
• When they are just starting to brown on top, receive call from hospital
• Wring hands
• Remove muffins from oven
• Place muffins back into oven, switch oven off, drive to hospital
• Return approximately 2hours later
• Briefly admire perfectly cooked muffins, then ferociously consume several
• Congratulate self on culinary mastery
  

Quoteblog

I have the unsettling habit of recording the silly / amusing things that people say in my presence. Here is a snippet from the last three weeks:

“My Spiriva should be sitting on the counter next to my tobacco” - Asthmatic patient to her husband

“He had the miniature cockle vaccine” – Young patient’s mother

“Thankyou! That was very nice, you holding my hand like that” - Older gent after I’d taken his radial pulse

“I feel like a polar bear” - Elderly resident putting her dressing gown back on

“You cannot make an ear fall off, and you cannot make a nose fall off, no matter how hard you try” – Anaesthetist

"I have a working fanny" - this one submitted via SMS, allegedly a classmate. Context unknown.

On Call

I am “on call” for the first time this weekend. Of course, my being “on-call” doesn’t make much difference to the town, the hospital, or the patients. But it is important for me. I hover around the duty doctor as she does her ward rounds, and slow her up considerably by insisting on writing in all of the patient notes. She puts up with me, knowing or at least hoping that one day I will be more useful.

We get through the ward rounds, and then see to a man who came in by ambulance. “I’m never drinking again,” he states, “I feel like such an idiot”. He has been sitting in the trauma room all morning, apologising to everyone who walks past and feeling generally sorry for himself. The ambulance officers tell us that he cut his fingers (on purpose) on a broken bottle. He tells us that he tripped and fell on the bitumen in the car park. He later tells us that he was taking a supermarket trolley for a joyride, and it flipped over. Whatever the story, he is embarrassed. And he is sorry.

The thanks us as we unwrap his bloodied fingers, apologises for wincing in pain when we scrub the blood and bitumen away. The doctor asks if I am ready, and as I look at her warily she hands me a Chlorhexadine-soaked gauze. “Oh! I thought you were going to make me do a ring block!” I laugh, relieved. She just looks at me and says, “You’ll be doing that too”. Gulp.

Ring blocks are apparently quite painful, and this poor man is already feeling faint at the sight of his own blood. But he holds his hand still (whilst kicking his legs and crying “owowowowow” through tightly closed teeth). As I stick the needle in, as I aspirate, and as I force anaesthetic into his finger and watch it swell, he continually thanks me, and apologises.

I try and placate him. I tell him that he is being good, not moving his hand. I tell him that I appreciate him allowing me, the medical student, to take part in his care. Still, he apologises. In the end, the doctor says it best: “Hey - we’re not in any pain”.

Sticker

The Gribbles lady thought it was amusing when I proudly wore this sticker after taking a patient's blood. I thought it was embarrassing when I got home, 5 hours later, and realised I had worn the sticker for the entire afternoon's consulting.

Anaesthetics

I've spent an afternoon with an anaesthetist in theatre, so I am pretty much an expert now. I don't read up before our lecture, because I've been there and seen it all first-hand. I am ready for any questions that might come my way.

And so the "lecture" begins. It can hardly be called a lecture - there are nine students, sitting around the table, and an anaesthetist. This would be a scary situation, if I were less prepared. The anaesthetist rocks back in his chair and starts talking about the history of anaesthetics. The specialty has come a long way since medieval times, when copious amounts of alcohol were used to control the pain of surgery. I have seen a documentary on anaesthetics, so I know all of this - I could be teaching the class about Wells and his nitrous oxide, about Morton and his ether.

So when the anaesthetist turns to us and starts asking questions, I am ready. Here it comes, the first question: "What are the stages of anaesthesia?" Oh. I remember the intern trying to explain these to me. He couldn't remember them all and I made a mental note to look them up. And then I lost my note.

Never mind, next question: "What are the commonly used anaesthetic agents?" Oooh! Nitrous oxide gas! And ... clear stuff ... and ... uh, white stuff.

"Possible complications of anaesthesia?" I have spent whole minutes giving airway support, so I hazard a guess at 'apnoea'. What was that? There are more? Air embolism? Malignant hyperthermia, you say? What's that?
Oh ... time to go and study.

A Free Lunch

“Come to the tea room” says my GP, “lunch is supplied today”. So I follow him eagerly, like a student heading for a free lunch, and there it is – a fine spread of sandwiches. There is even a tray of delicate chocolates, and behind that ... oh. A drug rep.

Now this drug rep might be a nice person, and that thought plays across the back of my mind as we sit down and choose our sandwiches. And it is that thought that forces me to look up occasionally, nod and look thoughtful. He seems to appreciate that, even though he can see that I don’t understand the topic, or more importantly, don’t have prescribing rights. In fact, there is only one doctor in the room, and he just looks steadily at his sandwich as the drug rep makes his uncomfortable speech.

The tea room is strangely deserted, for a lunch break; one of the office girls sits chatting with her husband, an intern wanders in partway through, and a nurse fills out some paperwork. And I wonder, is there really no such thing as a free lunch? Is that intensely uncomfortable feeling really bad enough to be considered a “price”? Because I get that feeling every single day, and most of the time, I have to make my own lunch.

Cannulation

I was standing in theatre with my scrubs, booties and hat, feeling useless, so the anaesthetist decided to make me his project for the afternoon. He asked if I’d ever put in an IV cannula before and I answered truthfully, yes I had. I did not elaborate – I had done it twice before, once on a very obliging classmate who generously allowed me a second try after I’d tortured him on my first attempt, and once on my own mother. My mother is a registered nurse, and she gritted her teeth and coached me through the whole process in real-time. Obviously, no patient in “the real world” could be as resilient as these two. But I did not expect my first patient, a massive basketballer, to start retching into his sick bag the minute that needle went into his vein. Clearly I had much to learn about the real world.

The anaesthetist gave me a few tips for new players:
* Cannulate older people, they are tougher (“I don’t feel a thing!” asserted an older gentleman, after I’d poked a 20guage into his cubital fossa)
* Keep your opposite thumb well back from the cannulation site – especially for the hand veins. The thumb can still anchor the vein without getting in the way too much.
* Make sure you can see the chamber! You need to visualise the little flashback of blood that tells you you’re in the vein. I missed it once and accidentally went through the other side of the vein. I did manage to recover, but the poor patient flinched a bit!
* Practice at home. The anaesthetist went through a bunch of cannulae demonstrating the technique on a pillow, and suggested I go home and do the same.

It’s not the easiest thing I’ve done, but by the end of the day I was actually starting to enjoy cannulation. And I’m very much looking forward to the day when I can say, “what, cannulation again? I’m bored with this!”

A Flying Visit

"I'm flying to your home town tomorrow!" says the specialist I've just met, "would you like to come?" After checking that he is serious (two or three times), I reply with an enthusiastic "yes!" and without much further conversation, he hands me his mobile number and then carries on with his lunch.

And so the next morning he picks me up in his private plane, shows me how to close the door, and we are off. This plane is about the size of a car ... four seats, one engine. He jokes about the fact that his boat has more horsepower, and luckily my laugh comes out more surprised than terrified, so we are cool. The weather is fine and the little plane does its job smoothly, and about 20 minutes into that first flight, I am convinced that I will one day own a plane.

We are 5,500 feet above sea level on a Sunday, but I am ever the good student, and he the specialist ... I ask a thousand questions about his plane, he patiently answers them all in great detail. He points out landmarks which I pretend to be able to identify - "ah yes, I can see that town in the distance". I ask if the blocks at my feet are just footrests or if they actually do something, and he encourages me to press one ("gently though, just gently"). I gingerly press my left foot down, and the plane veers ever so slightly to the left ... I steer the plane! He then instructs me to please remove my foot so that autopilot can steer us back.

But they are brave, those country specialists, and on the return trip he decides that we probably won't die if I briefly take control.

"Have you ever flown a plane before?" he asks, then, seeing the look on my face, "No of course you haven't ... would you like to?" So I take hold of the controls, he turns off the autopilot and I am flying the plane! The autopilot makes it look so easy ... my flight course follows a serpentine loop as I continually over-correct our path, fail to account for crosswind, and drift off-course. He offers to put it back on autopilot, "if you're getting sick of it", but I am determined, and I keep following my wavering course. He then instructs me that I have lost 1,000 feet and should probably start climbing again, and it is about this point that I realise I am probably not a pilot yet. But he is a good instructor, and we are soon back up where we belong, weaving our way back to the airport. He offers several more times to put it back on autopilot, and I eventually acknowledge his subtle hints and relinquish the controls.

One day, I am going to own a plane.

A Room With A View

I sit in with the Gastroenterologist today. He spins his chair to throw me a friendly greeting, then turns back to the window. He faces the window and tells me about his family. He stares out the window and quizzes me about my background. Maintains perfect eye contact with that window as we chat about his career. The patients come in and tell him about their bowel habits, their stomas, their colostomy bags, their embarrassing accidents. He is sympathetic. He is attentive. He stares out the window. I sit there for three hours, 9 o'clock 'til 12 o'clock, wondering how he can be so entranced with his view. After all, his window only faces a car park.

And then we head to theatre.

12 o'clock to 9 o'clock (travelling forwards in time, unfortunately). 17 patients. The Gastroenterologist alternates between endoscopies and colonoscopies so the nurses have time to clean each instrument. And he stands there, staring at his monitor, for nine whole hours. He takes us all for a tour through the insides of his patients, flying through the oesophagus, down into the stomach and further into the small bowel. For the less fortunate, our tour begins at the rectum, the camera moving upwards through the gastrointestinal tract ... "we're in the sigmoid colon now" ... "can you see his appendix?". I am an eager student. I ask obvious questions. I try my best to laugh at his jokes. I stare at the monitor with its dizzying view, trying to keep up as the camera zooms about, moving backwards and forwards, around and around. And it isn't long before I feel the need to find a nice sturdy window with a boring, steady view - and just stare out.