Wednesday, October 27, 2010

Dog #2

Jack terrier boy from last week was at the show on the weekend. This time he correctly identified Sprite as a Fox Terrier and asked lots of insightful questions (including asking why I didn't read my Oxford Handbook from front to back - how was I ever going to finish it, if I just opened it at random?!).

"Does Sprite eat birds?" he asked
"Sometimes" I replied, "When she can catch them"
At that moment Sprite looked up at me and began panting, wafting disgusting dog-breath into my face. I grimaced and pushed her away.
"Does she have bad breath?" asked the boy
"She sure does!"
He nodded knowingly, "she's been eating birds"

Save Keith Hospital

Residents from Keith, Moonta and Ardrossan (South Australia) gathered at the steps of Parliament House in Adelaide today to protest some pretty drastic funding cuts to their community hospitals. I am not familiar with the other towns, but let me tell you a little about Keith.

I understand that this post may go into the “Too long – did not read” basket, but please dig it out again when you have time. It’s important.

Keith is based on the corner of the Riddoch and Dukes Highways in the state’s South East, and has a population of approximately 1,000 people. Between them, the Dukes and Riddoch highways account for 46% of fatal car accidents in South Australia, and Keith receives many patients from car accidents on these highways. The local hospital covers a region of 10,000 square kilometres and is the furthest that the rescue helicopter can travel into the South East without refuelling, making it strategically an excellent place to maintain a hospital.

Keith & District Hospital Inc. is classified as “Private”, however in reality it is a community hospital, and runs as a not-for-profit organisation. At a town meeting last week, where the attendance was greater than the town’s official population, local residents spoke of the hospital’s origins. The hospital itself was built by local residents, by hand, on a block of land donated by a local landowner. The community saved up enough money for Keith’s first ambulance vehicle using donations and fundraising. Even now the community works hard to keep the hospital operating – locals willingly donate money, time and labour whenever it is required.

But the “Honourable” Mr John Hill, state Minister for Health, has decided to cut state funding from $615,000 to a mere $300,000 per year. One of his reasons is that Keith Hospital receives the equivalent of three public beds’ funding, whereas only one public bed is usually occupied. This is mainly because the residents of Keith and district have had the foresight to take out private health insurance - the private bed occupancy in Keith is around 80%, compared with the state’s ambitious of target of 16% (and its current occupancy of 11%).

Did you know that the state health budget is equivalent to approximately $2,000 for every man, woman and child? How much to you think they spend in Keith - $500? $1,000? $3,000? No, it’s $85. Eighty-five dollars per person. Not exactly extravagant spending.

The reality is, Keith Hospital will be forced to close due to these funding cuts. And without a hospital, the area will lose GP services, it will lose ambulance services, aged care residents will be forced to move to the next town or further, and the town will die. Local residents cannot be assured of timely medical attention in the event of emergencies – and neither can travellers on two of the state’s most dangerous highways.

The Keith district is based on good, productive country and is occupied by good, hardworking people who value the town, community and their hospital. Mr Hill doggedly insists that he will cut the funding despite the community’s protests. We can only hope that he changes his mind, as he is literally risking lives with this decision.

Above: today's protest at Parliament House, Adelaide.
Below: Keith Institute full to capacity during the town meeting. All seats were full well before the meeting began, and people stood in hallways and in outdoor areas during the two-hour meeting.

Tuesday, October 26, 2010

Respiratory Revelations

After spending the morning studying (actually studying, with textbooks and notepaper and such), I drive to the next town for my scheduled afternoon session with the Respiratory Physician. I find the medical clinic where I'm told he consults, and after wandering around outside for 5 minutes I find a local surgeon who shows me how to find the front door.

It's a maze of a place, but I stumble across a desk complete with a friendly lady with a Bluetooth headset. She is very knowledgeable, and kindly informs me that the Respiratory Physician does not consult there anymore, and gives me directions to his new rooms.

I find the right street and drive slowly down, staring creepily out of my window as I search for a sign that says "Respiratory Physician". I see signs for accountants, engineers, mental health services, chiropractors and dentists, but not the sign I am looking for. So I turn around and drive back up the same road, even slower than before, pressing my nose against the car window as I search for the elusive sign. After turning around for a second time and starting my slow and creepy drive, I decide that it's probably better going on foot.

As soon as I step out of the car it starts to rain, so I run to the closest office and try to open the door. It is locked shut. As I turn away to try the next building, a voice comes from the speaker:
"Helloooo. Who's there?"
Honesty is the best policy ... "Hi, my name is S, and I think I'm lost".
She laughs.
When she has finished laughing, she directs me to the building next door - I was so close!

I traipse next door and find the place unlocked, but the receptionist takes one look at me and sends me to another building round the back, where the medical types must go.

And somehow I am still on time.

The patients are all follow-ups, so there is nothing terribly exciting about the session itself. I do, however, learn something amazing. I FINALLY learn how they test for V/Q mismatch (ventilation / perfusion mismatch in the lungs)! I’m sure I’ve seen it written somewhere, but I never really got it. Turns out, they get the patient to inhale a tracer chemical (using an inhaler device), and then use radio-imaging to take pictures of the lungs from different angles. And then, they inject a tracer into the pulmonary vessels and take the pictures again. And then they just compare the pictures! Here I was thinking it was either some voodoo magic or horribly scientific process. Amazing.

You learn something new (that you probably should have known all along) every day.

Showjumping #2

I went to another horse show last weekend. My supervisor gave me most of Friday off so that I could get there early, so of course he told everybody at the clinic that I was competing. This meant that when I came in on Monday they all wanted to know if I was World Champion yet, or if I had at least won first prize in every class.

They were so disappointed when I said no, I hadn't won a prize.

But they don't really understand. I've been to maybe five horse shows since Christmas, and I'm just glad to get out there and compete at all. My sister let me borrow her horse for the C&D Championship, and we finished with 8 faults. Hell, I didn't even fall off or get lost, two things that become all the more likely when you stop practicing. I would have liked to win, of course, but it's not everything ... and it's usually better when you've earned it.

Thanks, little sister, for lending me your strange and wonderful horse (in case you're wondering, he's mostly strange).

Monday, October 18, 2010


Less than 5 weeks to go until The OSCE. It’s probably time to start studying on weekends, but instead ... I’m going showjumping.

I took three horses to a local show yesterday (plus Elmo, but he’s retired) and it was so nice to be back competing! It’s great catching up with old friends who I’ve known since I was three feet tall and falling off my pony. And to be greeted by the experienced competitors who helped teach me to stop falling off my pony so much. It’s also a nice surprise to hear that some of my showjumping friends enjoy coming to this blog for a read – hi Netty!

Riding three horses was probably a little ambitious, as I am learning today. I have bruises from the saddle and some long-forgotten muscles are announcing themselves loudly whenever I move. But it was worth it. My “young horse” Floss, who is 9 but very inexperienced, tried her very best to be good and won herself a ribbon in the 85cm – 3rd place. Dear old Bojangles disappointed certain members of the crowd by chickening out at the first fence and hence not winning the 85cm, but with a lot of effort and concentration from both of us, he redeemed himself by winning the 1m.

I also rode my sister’s horse Taddy. We usually get along reasonably well despite him being a very strange animal. Yesterday he was incredibly excited about life and showjumping and was leaping and bouncing all over the place. I wasn’t quite sure how to handle this so he ended up rolling a rail in the 110cm jumpoff. He still managed to pick up some prize money though, taking out 2nd place.

I know I have to study now – only 4 weeks, 4 ½ days until the OSCE. So I’ve set a limit. Two more shows, and then my weekends are for study only. Both of them.

Photo not from this show - I was too busy! Bojangles and Taddy at the truck.

Sunday, October 17, 2010


I'm sitting in the back of the horse truck watching the showjumping at a local show. Two young children walk past with their dachshund puppy.

"Look dogs!" I say to our two very excited dogs, "a puppy!"

The children take this as an invitation and march up the tailboard into the truck.

"I know what kind of dog that one is!" declares the boy, pointing to Sprite who is a miniature fox terrier. "That's a Jack Terrier! Isn't it?"

"Um ... yes" I agree. I point to the puppy and ask, "and what's that?"

As he is thinking, the little girl gives me a look and says, "it's a DOG"


Wednesday, October 13, 2010


"I've seen it on a penis before" - student, talking about molluscum contagiosum.

"Yep - it's peri-orificial" - tutor

"PENIS!" - student
... then, "Oh. I thought you said peri-oral"

Tuesday, October 12, 2010


I love suturing. The opportunity doesn’t come up every day, or every week, and you have to really put yourself forward because I think the doctors really enjoy suturing too.

I’m getting to the stage now that when I see somebody come to the clinic or hospital bleeding, I will hover in the general area ... maybe I will introduce myself, assess the wound, set up the local anaesthetic ... and hover some more.

And then when the real doctor appears in between doing other very important tasks, I will be conveniently nearby with my rapport that I prepared earlier. The patient will ask, “so are you going to sew me up?” and I will look up at the doctor who will shrug and say, “if you like”.

And that’s how it happens.

I got to suture a 10cm laceration on a man’s arm last week because I hovered in the right place. I gave him 14 sutures – be probably needed 8 or 9, but it looked beautiful and he said he’d recommend me to anyone. I hope he recommends for the doctors to let me have a go, because the next day I got as far as injecting local anaesthetic into a boy’s thumb before the doctor whipped out the suture kit and sutured it all for me.

Thursday, October 7, 2010

The locum

"Dual heart sounds, no murmurs" he writes.

"Chest clear, good air entry" he writes.

I have a listen today with my pink stethoscope. I hear a loud systolic murmur that radiates to the axillae. I hear course inspiratory crackles over the right middle lobe and the lingula on the left.

This locum doctor made several thousand dollars over the weekend. Maybe he should buy himself a stethoscope.

And what brought you here?

"They brought me in by ambulance with the mask thing on, and when they tried to move me to the bed, the fat one trod on my foot"

96-year-old lady explains how she came into hospital with her heart attack.

Tuesday, October 5, 2010


My beautiful neighbour Dawn has agreed to take care of my little dog while I’m away on weekly study days. I leave my keys with her, and she calls around during the day to let Sprite out for a wee and a run around. Sometimes she takes the dog home while she does the gardening and they potter around together for a few hours. It seems to work very well for everyone – Sprite gets a run, Dawn seems to like her, and I don’t have dog wee on my carpet.

Last week I was fairly disorganised and had to run the keys over on the morning of the study day. Dawn wasn’t up yet so I left a note asking her to take care of Sprite, and went off to my study day, hoping for the best. I did feel pretty guilty about the last-minute arrangement, so I called around afterwards to thank Dawn. As I handed her a block of chocolate, she admonished me, “Don’t you ever do that again!” She informed me in no uncertain terms that she was more than happy to take care of Sprite and that I should never ever bring gifts.

I have the best neighbour.