Quoteblog #8

“You have a small cancer on your skin” – Doctor
“Eh?! I don’t smoke, not since I was a girl!” – Elderly patient

“I think most doctors could be good patients if they just keep their mouths shut” – Clinical educator

Me, sneezing, “I beg your pardon”
Elderly patient, “Don’t beg – you’re old enough to steal”

“There was a big move 10 or so years ago to keep the cervix – it was fashionable” – Gynaecologist, on things only gynaecologists would know

“I don’t do prostates – I’m a gynaecologist” – Gynaecologist

“I used to think ‘oh big deal, the miracle of life’ ... but actually, it’s pretty badass” – male student

“I am a pink lady” – male student, reading a sticker attached to his foot

“Just lick it a little bit” – girl to male medical student (talking about lip balm, I believe)

“I wouldn’t mind a zombie apocalypse” – male student

“I’m ready to be blown!” – female student

“Yeah, it’s pretty easy to piss off a midwife. You point your vagina the wrong way, and you’ll get a good talking-to” – Psychiatry consultant

“Are you really sure you wanted to kill yourself or did you just want a sandwich?” – Psychiatry consultant

“REAL maple syrup?! Did Centrelink come in today?” – friend looking at my groceries

"They performed an autopsy on my leg" - elderly patient after a skin biopsy

A Spoon

I am sitting in with the paediatrician when a couple comes in with their 6-month-old baby girl. She has been referred on because of “failure to thrive”, meaning that she just isn’t growing as much as expected. The registrar does the physical examination including weight and measurements while the paediatrician takes a history. The girl is not chubby like you’d expect – we can see all of her ribs and even her hip bones. Her weight has fallen below the 3rd centile for her age, and length has dropped a centile, although head measurements have been increasing as expected. The poor baby is malnourished, although she is happy and bubbly and her parents obviously love her very much.

The mother tears up a little as she gives the girl’s history – lately she’s been breastfeeding for almost 24 hours a day and she’s exhausted. The paediatrician knows that there isn’t enough breastmilk for the baby anymore, and asks if she’s getting anything else to eat. Apparently they have tried giving her porridge, which she likes. The paediatrician enquires how much, and Mum replies, “a spoonful”. “What size spoon?” the paediatrician asks, because it is important. “You know, a spoon – a spoon like you get in cutlery sets.” “Yes, but a teaspoon, or a dishing up spoon, or a dessert spoon ...?”

In the end they decide that it is a dessert spoon, and the paediatrician gives very specific instructions about what the baby should eat every day. She gives the instructions twice and then writes them down. And then she goes through the written instructions again. It might be enough ... good luck, baby. Good luck.

One Hand

I met a man with one hand the other day. I was sitting in with a specialist, and was looking down at my folder when the patient came in.

When I looked up, there he was – a big fat man slouching on the chair, and his right arm (on the other side to me) ended at the elbow. The sleeve of his dirty green windcheater wrapped neatly around the stump of the elbow, and I couldn’t walk around to inspect more closely, so I had to be content with sneaking discrete glances every now and then.

This man was a long way down the Autism scale, and I quietly tuned out of the consultation to ponder his situation. How did he lose half of his right arm? With his mental condition, he probably hadn’t had a dangerous job or hobby (his parents were present and over-protective, even in the consultation). Perhaps it was congenital? Was he born with half an arm? What other congenital problems did he have? What a puzzle.

And then the consultation was over, and the man reached for his Medicare card – with his right hand. It was there all along, just bent around at an awkward angle. I was kind of disappointed.

Annoying

In a recent conversation with a friend I mentioned that it was better to be annoying on purpose than annoying by accident. He laughed at me because he thought it didn’t make sense – how is it ok to be purposefully annoying?

I couldn’t articulate it at the time, but I think I have it now. If you are going to annoy somebody on purpose, you probably already have good rapport with the person – you know what pushes their buttons, so to speak. And when they’ve had enough, they can say “cut that out, it’s really annoying”. And you can say “I know ... sorry”, laugh about it, and you’re still friends.

But when somebody is annoying you and they don’t even know, what can you do? You could say, “please stop talking about yourself” or “please stop smelling so bad” or “don’t stand so close to me”. And they might say, “what? I don’t” because they don’t realise it – and you haven’t achieved anything. Or, maybe they would suddenly realise how annoying they are and be hurt and sad. And you would feel guilty and would have to walk on eggshells around them forever. Or they could reel off a long list of things that annoy them / everyone about you. It’s a minefield.

So my only logical solution is to annoy your friends and acquaintances, on purpose, on a regular basis. That way, they will be so relieved when you stop that they will fail to notice the things that are inherently annoying about you. A foolproof plan.

Mini Mental Examination

The elderly lady in Bed 20 had come in with abdominal and lower back pain and had been in hospital for several days. I was sent to assess her during ward round, which proved to be an interesting experience. She thought she was feeling OK ... wasn’t sure if she had abdominal pain ... couldn’t remember if she’d opened her bowels. I struggled through the history and presented it to the duty doctor, who immediately went and got a completely different but similarly confused story.

Later I was sent to do a mini mental exam on her. It’s basically just a series of questions to check if somebody is oriented to time and place and to assess their cognitive function and memory. We did really well for the first few questions – she knew exactly where she was and she even knew that it was a Thursday. But when we came to the date ... “I don’t know”. Month, season, year ... “I don’t know”.

And from then on she seemed to stop trying. “I’m going to say three words, and then ask you to repeat them back to me. Ok? Apple, penny, table. Can you repeat those?” She replied with, “Oh I don’t know who he is, I know he’s a doctor here but I don’t know his name.” We probably would have both liked to finish there, but we had to persist until she learned all three words, for recall later. This took some time.

Later on we came to the part where the patient has to follow a written instruction. On the paper was the phrase “CLOSE YOUR EYES”. I pointed it out, and asked if she could follow that instruction. She read it out loud several times with no troubles, but couldn’t register it as a command, just kept reading it out loud. And then when I asked her to write a sentence, anything of her choosing, she wrote “close your eyes”. I had to give her that point.

It was a genuine struggle to get through the examination, but of course you have to finish it or the result is meaningless. When we were done I thanked her for her time and hurried back to the haven of the nurses’ station to tally her score. It didn’t take long. She got seven out of thirty. When I told the doctor her score, all he asked was, “did you do it in English?”

Exercise

I have recently gained temporary custody of our family’s two little dogs, and have joined the smug league of Healthy People who wake up before sunrise and go outside to Exercise. The exercise is mandatory so that the dogs don’t get bored and dismantle my house. I’m pretty sure the air of smugness comes automatically.

A pot-bellied young man came to the clinic the other day complaining of back pain after lifting something at work (not part of his usual repertoire). I did a full musculoskeletal examination – it took a while to find his muscles but he had a legitimate muscle strain – and then the Doctor came in and helped me with the Workcover certificate.

We advised him not to do any heavy lifting this week, so as not to aggravate his back injury. He paused, and said “well I was going to do my laundry today, but that will have to be postponed”.

The Doctor and I looked at this soft boy and mentally conceded that lifting a wet towel might have actually finished him off. I wanted to tell him that when his back was better, maybe he should do some bloody exercise so he wouldn’t hurt himself lifting next time ... but instead I wished him a speedy recovery and smiled as he walked out the door. Now what’s the point of being a smug Exerciser if you can’t lecture people about it?

Bells

As the paediatrician helped undress the 11-month-old for examination, she noticed the little girl had anklets on. Upon closer inspection she realised that the anklets were covered in tiny silver bells. Curious, she asked the girl’s mother about the jewellery. “Oh yeah,” Mum said, “that’s so I can keep track of her as she and her sister run about the house”.

Bells – they’re not just for cats anymore.

Image from http://aesop.magde.info/

How to get noticed in: small group lectures

• Arrive 5 minutes late
• Open the door a fraction, poke your nose in and look around just with your eyes. Nobody ever gets curious about half-open doors.
• Whisper, “excuse me” while the speaker is talking, just in case there is somebody who hasn’t looked at you yet.
• Make eye contact with everybody as you make your way to your seat, making sure to whisper “excuse me” and “thank you” as you pass.
• Leave your phone on Loud, and make sure somebody calls you after 15 minutes or so.
• Apologise to everyone, making a grimacing face as you do so – that way they know you’re sincere.
• Answer the phone anyway – that way everybody knows how important you are.
• If necessary, repeat all of the above steps upon re-entering the room.
  

Thank you, blonde lady who came to the lecture today. Yes, the 11 of us in the room noticed you - well done.

Electric Blanket

I finally took the plunge yesterday and bought an electric blanket. I’ve been putting off this purchase for months, even though my parents insisted that I’d need one, and I had my reasons. I’m sure I did have a few reasons ... although the only one I can recall now, is that I’ve never used an electric blanket before so do I really need one? But then I’ve never lived in this cold little town, in such a miserable winter, in a little wooden house with no insulation before either. And no matter how warm I was when I went to bed, I kept waking up cold, and that’s not a pleasant way to start the day.

So I took my $47 to Target and came home with an electric blanket. I was so excited that I re-made my bed to include my new purchase the minute I got it home. At first I was unimpressed with its temperature, but of course the real test was going to be the Overnight Challenge. And let me tell you, that thing is amazing! It’s like my entire bed is the warm spot!

I can’t believe I didn’t get one weeks ago.

Roadside Manner

Most of you probably think that roadside wees are the domain of shameless young men, full of beer, who simply pull over by the side of the road and wee on a post / tree or their own ute / shoes. But this is not entirely true, and there may come a day when highly dignified people such as you or I have one too many cups of tea before setting off on an afternoon drive through the countryside and find ourselves, shock horror, without amenities! I’m joking of course - this would never happen to me, but it might happen to you, and so I have compiled a short guide on how to best conduct oneself if this situation arises.

• Make sure there is very little traffic on the road
• DO NOT put your hazard lights on. Somebody might think you are in need of assistance (let’s assume that you do not require assistance)
• Choose a bendy part of the road, so you are not visible for a long time in other drivers’ horizons.
• Park on the inside of a curve – if another driver is distracted by your antics, s/he will more likely understeer, so you probably won’t be squashed
• Make sure there are lots of trees (unless you are an exhibitionist, in which case you are probably ignoring all of this advice anyway)
• Don’t zip up / pull up too fast (see here for a warning example)
• If somebody drives past, pretend to be chatting on your mobile phone - they won't suspect a thing
  
• Never lock your keys inside your car

I know there are a few things to remember, so perhaps you can print out this list and stick it to the dashboard of your car, or laminate it and hang it from your rear-vision mirror. Either way, I do hope you enjoy your drive.

Rapport

I called my next patient into the room. She stood up, eyed me suspiciously and said, "You're not Doctor P!" I gave my usual introduction, I'm the medical student with Dr P this morning, do you mind if I see you first and then the doctor will come in after a few minutes?

She relented, and insisted on filling me in on her entire past medical and surgical history before sitting down, so that I understood exactly what I was dealing with. After all, she was very complicated and should only see 'real' doctors - there wasn't much I could help her with.

Some patients can rattle off their medical history like a well-rehearsed speech. This lady had clearly delivered her speech once or twice before, and she got me up to speed within a few minutes. Amongst other things, "I've been pregnant at least twice, if not three times". I didn't ask her to clarify.

In summary, she was booked to have a colonoscopy, but she's had some bad experiences with operations in the past and just wanted some reassurance today. After I'd talked her through the procedure, she looked at me as if I'd just appeared, and said, "I'm so sorry I was rude to you before, love. I really didn't mean to offend you."

I waved off her apology - I wasn't offended (after all, people are rude to me all the time), but she insisted, no really - I think you're lovely. Aw, shucks.

Good Dog News!

I got some terrific news from home today – I’m allowed to have our two dogs here with me for a week! Yes it’s just a week, but it’s something. I think Mum was a little tired ... here’s our conversation:

Mum: “You’ll have to walk them twice a day”

Me: “Oh man!” (as in, oh man, does she think I don’t know this?!)

Mum: “yes they’re a lot of work you know”

Me: “what about food then, I suppose they have to eat as well”

Mum: “Oh I have two tins of dog food, I can send that with you”

Me: “do dogs need to drink? They don’t, do they?”

Mum, catching on: “yes they do ...”

Me: “Like, every single day, or is weekly often enough?”

Mum: “Oh weekly should be plenty”


Yeah, they'll be fine.

Dr V

“I’ve had an X-ray of my knees” the patient tells me.

I search through her file for the results, but can’t find any. I notice that she had an X-ray of her wrist last month, and ask her about that.

“What? No, I’ve never had an X-ray of my wrist” she insists

I read out her name, address and date of birth from the report. “It says it was ordered by Dr V ... have you been to see Dr V in the last few weeks?”

She thinks for a while, and then her face lights up, “Oh, is he that big handsome fellow?”

Sigh.