Code Blue

We had another training session with the Sim Man (simulation dummy) this week. The aim is to train us to cope with a patient whose condition suddenly deteriorates, so we know what to do in an emergency.

Even though it’s “just a dummy”, the pressure is on to save that life and look good in front of your classmates (and the Emergency doctor and other tutors). In one scenario, the students in the room could call a Code Blue and have other classmates come in as the “code blue team”.

The ED doctor was preparing us for this role, and gave us the instruction, “when you come in you’ll say ‘we’re the code blue team, how can we help?’ and they’ll say ‘ablablablabla’” So we were ready to rescue them from that inevitable disorganised panic.

So what happened in practice? We burst in, said “we’re the code blue team!” and saw that the situation was perfectly under control. After a few minutes of watching, my classmate helpfully suggested, ‘have you guys called Code Blue? Maybe we should do that”.

I wonder who would come.

Recovery

I found Recovery Room fascinating in first-year. Patients were wheeled out of theatre as comatose bodies and left with the nurses until they woke up. The nurses would call each body by name as they took obs, pulled the slimy laryngeal mask out of the body’s throat and wiped sticky phlegm off the body’s chin. And then, like magic, the body would suddenly transform into an actual person who could see and understand and communicate - it was amazing!

After that, I presumed, they were released back into the wild.

Last week, I saw what happens AFTER Recovery Room. One of my classmates needed a bit of facial reconstructive surgery following a ferocious netball match. Another classmate, as her “next of kin”, was too scared to leave her alone after surgery and so she joined us for tutorial.

She wandered into the room, a dreamy expression on her face, sipping chocolate milk through a straw and smiling vaguely at everyone. It was difficult to concentrate on tutorial, and we continually stole glances at our loopy classmate as she happily munched on a chocolate biscuit and stared about the room, stopping every 10 seconds or so to give the ceiling a good perusal.

It was hilarious watching her. I wonder if I could specialise in post-recovery room care ....

Immunisations

I am sent to check a 12-month-old before her immunisations. I kneel down next to her in the treatment room and get a bit of a history from Mum and Grandma. The little girl wrinkles her nose and gives me a cheeky grin. She’s been well apart from getting ‘the snuffles’ last week, but she’s over that. She reaches for my stethoscope and I hand it over (they’re unbreakable ... right?). She’s feeding well, eating solids as well as formula, and she can feed herself but not with a spoon. She demonstrates by placing a good portion of my stethoscope’s tubing in her mouth – it makes her drool. Yes, she’s feeling well in herself, she’s a very friendly and happy girl. She reaches up for me to hold her, reaches for my ID, my pen, my earrings. I need to check her over. She is happy for me to take her temperature, listen to her chest, look at her tonsils. She is all good for immunisations.

And now the horrible part. She needs three injections – one in each arm, one in the leg. There is only one nurse at the clinic today, so I offer to help out, and after being coached thoroughly in paediatric immunisations (don’t go in to the bone!), I give one of the arm injections. My happy little girl screams, cries, and then looks at me accusingly, and I feel like the worst person in the world.

Then she is given a jelly snake – she actually licks her lips before eating it – and everything is right in the world ... I am forgiven. And as I’m wiping drool off my stethoscope, I’m glad we’re ok.

Med Ball 2010

So ... Med Ball 2010 was fantastic. I’ve been looking forward to this year’s med ball since just after last year’s med ball, and whilst not everyone from our group was able to make it, we did manage to put together a table of 10 really ridiculously good-looking people for a night of mayhem.

I made the 400km drive up and made the best decision ever in staying with my sister at the same hotel as the ball. All 5 girls from our table congregated there to get ready, and my sister had a little production line of hairstyles going – and might I say she did a brilliant job! Champagne had started at 2.30pm, so we were all fairly cheerful and ready for a party by the time the boys arrived at around 6pm.

There were no tickets, so nobody had much idea as to when the Ball officially started, but we decided as a group that sometime between 6.30 and 7pm would be an acceptable time to arrive. On arrival I reached for a Coke, hoping for a bit of caffeine, but had it wrestled from my hand by RT who declared that my first drink at Med Ball could NOT be a soft drink and that I was to drink champagne instead. And that was the last glass of soft drink I saw for the night.

The ballroom looked magnificent ... I’d had some concerns about an “under-the-sea” themed Med Ball, but it didn’t look at all like a school formal or a 16th birthday party; it looked very classy. And everyone looked gorgeous (apart from a few young ladies who misinterpreted “black tie” as “dress like a hooker”, but they might know better next year). So many beautiful dresses and sharp suits! Well done Flinders Med – you’re a very impressive bunch!

The awards were very well done, although most were focussed on the first- and second-years (such as “McDreamy award” and “Walking Harrisons”). This meant that our last year’s McDreamy, MT, went unchallenged and undefeated – reigning champion of McDreaminess for our year level, congratulations! One of the third-years from a different table presented the “best dressed” awards for third-year (congratulations JG and MM) after reading the following medical poem:

“Your love is like bad medicine
Bad medicine is what I need
Shake it up, just like bad medicine
There ain’t no doctor that can
Cure my disease
Bad, bad medicine”

Profound, and I think it really struck a chord with all the med students in the room, especially those at our table who later on were up circle-dancing and air-guitaring to numbers by the same artist. The dance floor soon filled up, and the completely random music selection and occasionally malfunctioning speakers really got the party going. And I’m actually not complaining; I was happily dancing under a crackling speaker for a good portion of the night.

The hotel staff started to usher us out at midnight, and so the crowd straggled across the street to the after-party. Our table was a little late, as we reconvened in the hotel room to discuss the night’s plans over another glass of champagne. And so by the time we ventured across the street, one of our classmates had already been arrested ... the story is a bit vague, but from what I gather he was refused entry and took a swing at the bouncer. To his credit, he usually gets kicked out hours before the party starts, and so midnight was a good effort. The party was thinning by the time we arrived, but we found a number of people who’d skipped the Ball itself and gone straight for the after-party. We enjoyed a couple of hours there, dancing, drinking, deciphering drunken gibberish and occasionally arm-wrestling.

All good parties must come to an end, and in the outer suburbs this happens relatively early. The bars closed at 2am, leaving us out in the cold with no place to go. We met up with our eloquent classmate Anonymous, who despite missing Med Ball and most of the after-party looked most resplendent in a three-piece suit. I think the policemen were quite disappointed that he did not end up breaking out in dance right there on the street – they had offered to sit back and watch while he did so.

And so ended the night, with Med Students huddling in the street before dispersing into the darkness. My sister, one of my classmates and I headed back to the hotel to fall asleep surrounded by champagne glasses and bobby pins, with a sparkling view of the city out the window. An excellent night.

The Couple

I saw a gorgeous old couple in the nursing home this morning. As I followed the doctor around, we would pass them sitting in the communal lounge, watching everybody go by and commenting in what they probably thought were low voices. They would sit there and make insightful social commentary such as, "that man is very tall", and "oh look there are three of them now", all the while eyeing us to make sure we hadn't heard.

I passed them again when I was sent to assess a patient ("that one's on her own now"). It took maybe 15minutes and when I passed their way again they were sitting in their same chairs, heads lolled back and mouths wide open, both of them snoring away. So cute.

Tom

I met a cute little Asian boy in ENT consulting this week. He was just so happy to be there - he dragged his mother into the consulting room, climbed up onto the chair and sat there beaming.

The ENT specialist started reading from his notes, "and now we have Tom. Tom is a mouth breather ... and he snores"

Tom beamed proudly back at us. So cute.

Out of Pocket

The patient started to shift uncomfortably towards the end of the specialist consultation. "How much is this going to cost? The bills are really coming in, you see"

"Well I'll bulk bill you, so you won't be out of pocket for this one" he says kindly.

"Oh, I don't pocket them - I have to pay them!"

The Photo

It’s been a long day. After hours and hours of ethical discussions and two PBL tutorials, our little med student cohort joined up with a few other medical students and pharmacists to play a game of netball. This involves a lot more running around and puffing than I remember, and after playing two quarters (not in a row), I was rather fatigued. And so, it was time to head for home – a 50km drive which I quite enjoy.

I was driving along, singing loudly and badly to music I don’t play in public, when I noticed that the local factory looks very pretty with all its lights on. I thought you might enjoy seeing a picture, so I pulled over and took a few shots before turning to climb back into my ute ... only to discover that it was locked. Keys in the ignition, radio blaring, doors locked.

I immediately called my sister, who’d been in a minor accident today, and she felt much better about her day. And then I started making a series of frantic phone calls to classmates and friends in the district before sitting in the back of my ute, wrapped up in my sleeping bag and hiding from the rain until friendly help arrived.

No cars stopped to offer assistance. At first I was disappointed, and then I realised that a mean-looking ute (such as mine) parked on a country road at night does not really attract passers-by. I sat there for maybe half an hour, shivering in the cold and listening to the music blasting insolently through the cab, before the first help arrived. It was the boyfriend of a girl I used to ride horses with, and I had high hopes that he might be able to break into my ute. Out came the coathanger, but no amount of manipulating would make it lift the lock.

Soon another friend arrived with a warm jacket and a torch, and we dismissed the boy with many thanks and sat in her car to keep warm. Eventually two very dear classmates arrived from the neighbouring town, bringing with them a spare key to my house, and we ventured there to retrieve my spare car key. I will be forever in their debt for making that 100km round-trip – pleasant drive that it might be, they had originally planned to go to the pub.

The photo? I don’t think it was worth it.

Convenient

Today, the whole class heard a lecture about the massive end-of-year examinations. The lecture was delivered via teleconference so that all sites could watch it at the same time. The year-level coordinator gave the lecture from the very building in which our cohort was congregated for our weekly study day, so it would naturally follow that this would be very convenient for us.

Well that’s not quite how it turned out. While the rest of the class was watching the year-level coordinator deliver this very important lecture, we were in a separate room continuing on from the morning’s long* ethical debate. We will be able to watch the lecture on DVD in our own time at a later date. That’s convenient.

* Words can describe how long the debates were … but I would need a lot of words.

Quoteblog #6

“High jump was my absolute low point” – Student

“It’s a very sexy cough” – Student
“and [my husband]’s not here to enjoy it” – Other student, disappointed

“That item on the high-left is a nipple, in case you’re wondering” – Lecturer
“Aha! I’ve seen one of those before!” – Student

“Michael Jones, where are you??” – Student looking at blood-gases

“I now follow the guidelines, like a good boy” – Lecturer

“Some of them are really really bad at it and they have no idea how to get pregnant” – O&G Specialist

“In relation to the chap, I must admit I’m not an andrologist” – O&G Specialist

“The trick in General Practice is to get everyone out the door as quickly as possible, but still make them feel special while they’re here” – GP supervisor

“I was just thinking, how quick you’ll learn to be a doctor when there’s no such thing as a 5-day week!” – elderly patient I looked after over a weekend

“I just made it!” – elderly lady walking back from the toilet. She was so proud.

“I had an operation for a defibricator” – patient in heart failure

Grumpy

The RN on duty is in a bad mood. The few patients on the ward are time-demanding, and she’s trying to get everyone their medications. I cop her wrath when the doctor sends me to request maxalon for a patient. Doesn’t the doctor know she’s busy, all these other patients need their medications too, everyone needs something right now ... but she obliges, after I’ve listened to her lecture.

Later on I am sent to assess a patient who presents with acute chest pain. She beats me to the room and persists with taking the history, firing away with disjointed, demanding questions, blocking me from reaching the bed. She is not keen to help me with the ECG – it would be faster to do it herself, but “you’ve got to learn somehow”. It’s a struggle, but I keep smiling.

Around midday we are both left behind in a room after the patient has been transferred. She huffily begins cleaning up. I pick up a pillow and change the pillow case. She looks up, smiles, “thank you!” And for the rest of the day she is lovely. If I’d known it would be so easy, I would have changed a pillow-case first thing.

Yes

"Why are you in hospital today?" I ask the little old lady

She looks up at me, smiles, makes eye contact, and says, "yes"

"But why are you here?" ... "yes" she smiles

"WHY?" ... "yes"

I smile, lean in close, and shout in her ear, "WHY ... ARE ... YOU ... HERE?"

"Oh, I got up after my afternoon nap and I was shaking all over, I just couldn't get warm" she says in her soft little voice.

And I thought she was confused.

Skills

We are discussing a PBL case with one of the GPs, when he begins a little speech: There are a lot of skills, peripheral to your examination skills and your history taking skills, that are really good to work on. And here at this clinic and this hospital, you will have more opportunities than your city colleagues to work on these skills.


Whatever it is, I’m sold. I must work on these skills.

One of these skills is changing colostomy bags.


I look up. As far as I can tell, he is serious. I recall that we have a patient in the hospital who is seeing the stoma nurse next week to learn all about his colostomy bag. How fortunate!

Sandwich

“You can only have one roll each, otherwise there won’t be enough”. We’re not used to these restrictions here, and I’m pretty hungry, but I acknowledge that it will probably be enough. I select my roll, and I make a good choice – chicken and lettuce, plenty of butter on the roll and generous with the pepper. I am impressed with the first bite and go back for another but there, millimetres from my previous toothmark ... is a fuzzy little caterpillar. The poor little thing must have feared for his life for a moment there. I show my coordinator, and she flicks the poor caterpillar into the bin and attempts to confiscate my sandwich. No thank you very much - with the very hungry caterpillar out of the way, that sandwich is all mine. Om nom nom.

Gastroenterologist

We had a session with a Gastroenterologist for one of our study days. He sure was a good teacher. What did I learn?

Gastroenterologists are not like most surgeons. In contrast to the “If in doubt, take it out” mantra, the gastroenterologist declared, “If it’s in a bucket you can’t put it back”.

Gastroenterologists are not haematologists: “This is a bone marrow. Who knows about bone marrow? I don’t”

Gastroenterologists can be generous: “Everyone deserves an ultrasound”

Gastroenterologists can also lose their train of thought: “Now where was I leading? Heh heh.”

And they can be a little strange. Student: “Do you just have naked large lady on there?” Gastroenterologist: “Yeah, I’m a bit like that”

Small Pleasures

• Suturing
• Early minutes
• Cups of tea
• Finishing assignments
• Long weekends
• Real mail
• Hugs
• Sunshine
• Sitting with my dog
• Playing on a playground
  
• Classmates getting excited about my shoes
• Correctly answering a specialist’s question
• Sleeping in
• Successfully cannulating a patient
• Patients who refuse to see students (= coffee break)
• Old ladies complimenting my hair
• Patients who make jokes
• Doctors who make funny jokes
• Discovering that people read this blog
• Hearing that some people actually like this blog
• Eating chocolate like it's actual food
  
• Getting dressed up
• Or putting on my pyjamas as soon as I get home
• Hearing from faraway classmates (they’re all far away)
• Going home to see the family
  
• Eating someone else’s cooking

Sometimes, I'm easily pleased.

My Old Lady

“I’ll let you see this lady. She’s pretty much a ... I’ll let you decide what she’s like” – and with that the doctor is gone, leaving me to see his 9am patient. It quickly becomes clear that she’s a lot of work. I’ve been in hospital, I’m better now, they’ve changed my medications, no I don’t need a script, I’m 87 you know, I’m meant to see a specialist what’s his name, no I already have a referral, and an appointment, look at these hands, no can’t you see that one’s weaker, I’m left-handed you know and I write with a special pen, oh, what am I here for? My leg’s red.

So I look at her leg. She’s had an ulcer for about a week but it’s going well, I’m just worried that the redness is cellulitis. She’s quite happy to scratch at it with her long yellow fingernails, but I ask if it’s painful all the same. Look at me! she exclaims, pointing to her (tear-free) eyes. But is it sore there, on the red bit? Oh, no, just the ulcer. The doctor agrees that it’s probably red from scratching and she should use a cream, but wants me to prescribe antibiotics just in case.

What is she allergic to? Oh, lots of things, I have a whole list but I left it at home, I can hardly take any medications, how could I remember what happens, it’s years ago, I’m 87 you know. I look up her recent prescriptions – they are many and varied, so we take a chance with Cephalexin.

She needs an ankle-brachial index done. I ask if she’s ever had her blood pressure taken on her leg? No. Ultrasound of her leg veins? No. Doppler, that sound familiar? No, none of that. I look up her notes. She’s had three colour dopplers on her left leg, but now we need to check her right. The nurse gives me a warning look when I request it, “she probably won’t let me!” But we have to try. As the nurse slips the sphygmo cuff around her ankle and begins to pump it up, my patient begins to howl. This old lady must hate me by now.

I have been despairing over this lady for almost an hour, and I must be getting a little terse. She doesn’t really like doctors and nobody likes medical students, so she must be eager to be rid of me.

But as I stand to usher her out the door she smiles and says, “when that nurse was pumping up that cuff on my leg I could feel my boobs getting bigger!” I suggest that maybe she should wear pressure stockings just for that reason, and she breaks into a hacking laugh and pats me on the arm before toddling out the door.

That 30 seconds was the best part of the consultation.

I'm glad she saved it for last.

The Hand

He’s doing a silly little job at work, nothing difficult, nothing laborious, just putting up an antenna for the break-room television. The drill bit slips and attacks his hand, drilling a hole in the webbing between his thumb and forefinger, angling down towards the wrist. His mates take him straight to the medical clinic - it's an emergency - but the nurses only glance briefly at his hand before sitting him down on a bed to await the doctor. Screaming children are given injections, old ladies’ leg ulcers are dressed, and he sits there bleeding. He probably wonders why he’s left to wait.

Finally some girl comes and introduces herself as the medical student. She quickly inspects his wound, asks him to wiggle his thumb around despite his pain, and starts drawing up injections. She looks him in the eye and tells him the local anaesthetic will hurt. He flirts a little, realises it isn’t helping, and sits back and grits his teeth. When his wound is properly numbed he watches, fascinated, as it is first rinsed and then scrubbed with antiseptic. He dabs at the blood running down his wrist.

Like many of the local patients, he asks whether she’s going to be a doctor or a nurse, and seems fairly impressed when he discovers that she will one day be a doctor. He is quite proud of himself when she puzzles over how best to suture his complicated-looking wound. And then the actual doctor arrives with instructions, “you’ll want to put one suture from the outside part here, to this part, and then ... actually I’ll do this one, you watch”.

He is much relieved.

Quoteblog #5

These are all courtesy of the pain management / musculoskeletal doctor who gave us a whole-day tutorial yesterday. Whole day tutorial, and it didn't even get boring!

“Students like food, pens, and testing reflexes”



“Every OSCE I mark, you get 10% for being a human being. That means you only have to get 40 out of 90 to pass”



“You don’t expose, you fail”



“All you get from stroking the insides of a patient’s thighs is trouble”



“And I don’t give a stuff about her breathing of course, unless she stops and then it just gets messy”



Neck exam on student:
“Ooh that feels nice” – student
“You’re not supposed to say that to your teacher!” – Lecturer, then, “Why don’t you come lie down”
“You’re not supposed to say that to your students!” – other student
“Face down please” – Lecturer



“A Trendelenburg gait looks like a constipated swan”



And one from dinner: “You’re asking orthopaedic surgeons to walk and chew gum at the same time?”

Red Herring

A patient comes in with chest pain.
"Have you had any paracetamol?" asks the nurse
"No, I took some Herring" patient

Bad Doctor

In my humble opinion, all of the doctors who I’ve worked with here are exceptional. Not every patient will like every doctor, but that’s to be expected, and most people can find a doctor that they really like. It kind of increases my confidence in the medical profession to hear how highly some patients regard their chosen doctor.

So it’s disappointing to hear about people’s bad experiences with doctors. Take my friend in the city, a gorgeous girl in her early 20s, who was sent home from work with a bad cold. She went to see a GP in her suburb, and the consult went something like this:

Young male doctor: “So when was your last PAP smear?” My friend sheepishly admitted that she’d never had one, and he offered to do one that day. (Note: most of the doctors here will offer to book a later appointment for this procedure, and the male doctors will give the patient the option of seeing a female doctor. And they never begin a consult like this). My friend was a little shocked, and firmly declined this procedure. After that he decided to finally ask, “so what brings you in here today?” My friend informed him that she felt unwell with a headache and a sore throat.

His next question? Try and guess from the choices below:

a) How long have you felt unwell?
b) Is it getting any better or worse?
c) Have you tried anything for it?
d) Are you sexually active?
e) What's your favourite colour?

You probably think I threw in the last couple for a laugh, but no, this doctor chose option D. My friend says that during the consultation, the doctor asked her a total of seven questions relating to sexual activity, when all she had was a sore throat and a cold.

He ended up prescribing her antibiotics, but as he handed over the script he told her, “I wouldn’t be in a hurry to start taking this – you’ll probably just get thrush”.

She called me a few days later to tell me about it, and then asked if I thought it was weird, from a medical student's point of view. I think it would be weird from anybody's point of view.

It's All Relative

I'm chatting with a friend online on a Sunday afternoon.

He's had the week off. I had last weekend off, but I had a big assignment due so I used it to study.

He spent his Saturday at a football match with a friend. I spent 10 hours at the hospital.

He slept in this morning and is wondering what to do for the rest of the day. I snoozed my alarm once and then went in for ward round, and I'm hoping not to be called back in this afternoon.

When I tell him that I only spent three hours at the hospital this morning, he replies, "oh. Easy morning then".

Yeah, sure.

Concussion

A family brings their teenage son in with “delayed concussion” from football on a Saturday afternoon. The younger brothers and sisters, Mum and Dad are all crowded around, anxious to help out in any way. I struggle with his history in so many ways. For starters, I’m a bit of a novice with head injuries at this stage. And then there’s the casualty nurse occasionally popping in to interject my question with a similar but wordier one before the patient can answer me. Not to mention the boy’s mother, who is worried about her son and tries to answer all the questions for him. And then there’s the boy himself, who obviously has amnesia and can’t remember anything of the game or afterwards. As we wait for the doctor to arrive, I ask him a few questions.

“Who did you play today?” I ask

“I can’t remember his name” announces the boy after lengthy deliberation

“Do you know where you played?” I ask, wanting to know which town the game was in

“It would have been the wing” – the boy hazards a guess at his usual position

Hard to say whether we would have this much trouble communicating without his head injury, or if he is trying to compensate for his amnesia, but it's pretty serious and the doctor doesn't waste much time before calling an ambulance to ship this boy off to a bigger hospital.

As we're waiting for the ambulance to arrive, the doctor sends me back into the room to assess the boy's lower limb reflexes. He has a lot of trouble with the instruction "just let your leg go loose", and we struggle for a while as he first lifts his leg straight up and then forces it down on the bed, but eventually I manage to bend his knee for a patellar tendon reflex. Everything is normal until we get to the Babinski. I turn the tendon hammer around and use the scratchy end on the sole of his foot. As his left big toe curls upwards his girlfriend, who has just arrived, mumbles, "that's so weird". She has no idea.

Viral Infection

We had to give a PowerPoint presentation a couple of weeks ago on a selected cardio topic. I chose 'cardiomyopathies', and although I was nervous about presenting in front of the big-shot cardiologist, I think I went OK. But I was shocked and dismayed when I took my flash drive back to my computer afterwards and was rewarded with the following message:

The shock came mostly from the fact that SOMEBODY ELSE had given me a virus/worm. I am normally quite capable of destroying my own electronics without any outside assistance. In fact, once I managed to shut down the entire university intranet while I was living on campus. Don’t believe me? No, you know me too well. It was twice. Twice, I single-handedly shut down the university intranet by inadvertently picking up a virus in my travels. I was banned from connecting for quite some time, and I had to study using books, just like the olden days.

I have since learned all about anti-virus programs, so don’t worry – I’m pretty sure this one’s no longer contagious.

She Was Mine

There aren’t many patients in the hospital, but they are all demanding our attention this morning. Ward round is disjointed, and the doctor sends me to assess patients and report back just so we can get them all seen. There are patients coming in and patients being shipped out – the one pair of ambulance officers seems to be constantly marching our halls.

An obese woman presents to casualty with 9/10 retrosternal chest pain. She came last night and was given antacid and sent home, but the pain has returned and now nothing is helping. The doctor is busy, very busy, so the patient is mine. I take her history and discover that, but for the fact that she’s never had heart problems before, she has EVERY SINGLE RISK FACTOR ON THE PLANET for a heart attack. Diabetes, hypertension, hypercholesterolaemia, obesity, family history, and of course she’s a smoker. Still I’m not sure – she has a long history of gastro-oesophageal reflux, and she says her pain is alleviated by sitting up and (eeew) burping, so maybe it’s the same old thing?

I ask the doctor what to do but he is still very busy, and he tells me to do the full workup and then come back. So I examine her and find nothing remarkable, place the most beautiful cannula (I'm so proud) and take some bloods, and do an ECG. Her troponins come back borderline, but the ECG shows ST elevation in the posterior leads. The doctor sees this and suddenly she’s not my patient anymore, she’s Priority 1, she gets morphine and maxalon and clexane and she’s sent away with the Flying Doctors to the city.

But for that brief moment, she was mine.

More or less anaesthetics

I have a “Pain and Anaesthetics” tutorial scheduled, which sounds pretty serious, but my classmate assures me that it’s just a regular theatre session with the anaesthetist. So I turn up a little before 8.30am, change into scrubs and wander out to theatre to find the nurses frantically drying condensation off the walls, windows, equipment ... everything. The air-conditioner has mysteriously broken overnight and the operating theatre has turned into a warm humid cave.

The doctors haven’t arrived yet, and eventually the girls make an executive decision to move theatre into our trauma room, and we wheel trolleys of sterile equipment, linen etc down the hall. Our hospital is not exactly state-of-the-art, but trauma room, as one nurse put it, is “like operating in the third world”. There is barely room to fit all of the equipment, and we are claustrophobic before the list even starts.

The GP surgeon eventually turns up a little after 9am, and speaks to me briefly before walking off in an unknown direction. One nurse tells me not to worry, “you’ll never work him out”, but I tell her it’s ok - I’m with the anaesthetist today. And that’s when she informs me that there will be no anaesthetist for today’s list, and suggests that I run away now.

But it’s too late. I’ve already been seen.

Quoteblog #4

“Cataract operations last 15 minutes. You can duck out 4 times an hour to go to the toilet if you want to” - Opthalmologist

“And just remember when you’re answering these questions and you can’t think of any more, just say idiopathic” - O&G Specialist

“And if you forget one, you’ll have so many others, the examiner won’t even notice” – O&G Specialist

“I had an operation on my appendocyte” patient

“Oh God ... footballers” – Orthopaedic surgeon

“Oh my GOD! That’s very very small” – clinical tutor inspecting a student’s skin ‘lesion’

“Enjoy your oddity” – Pathologist’s advice to medical students

“Their urine will be radioactive for a few days after ... it’s a β-emitter so it won’t even clean the toilet properly for you” – Pathologist re: diagnostic test

“The second tray is for the religious – vegetarian, whatever you call it” – Lunch lady segregating the sandwiches

“I like dots. Dot, dot, dot, dot” – Student showing off her PowerPoint presentation

“Whether she’s got a shed of a pelvis, doesn’t matter” – O&G Specialist on the value of pelvimetry

“You can decide whether you’re an intelligent doctor or just a poor donkey eating grass” – O&G Specialist gives us some options

“There’s no person – male or female – without any problems, and they’re not all PMS” – O&G Specialist

How do they know?

How do they know I'm ridiculously intelligent and HOT?

That's it, I'm covering up my webcam.

Orthopaedic Consulting

The patient is waiting in a separate room, his X-rays already up on the viewer. The other student and I hover behind the orthopaedic surgeon as he inspects the images. I know that I should be looking carefully for the pathology – after all, the surgeon might ask for a student’s opinion, and I wouldn’t want to look silly. But something keeps catching my eye. Just below the pelvis, where one would expect to see only ... well, soft tissue, there is a cluster of bright white rings and bolts. This man is pierced. And not just once, no – there must be at least 10 of the things, creating a rather distracting focal point of the image.

Fortunately, the surgeon doesn’t ask for our assessment right then and there, he just goes through the consultation and sends the patient on his way.

Later, in the privacy of the surgeon's office, we have a look at those X-rays. The surgeon points out some discrete lighter patches around the hip joint, and asks what we think they are. I’d honestly not noticed them before, and the other student can’t answer either. The surgeon informs us that they are clips to stop bleeding arteries, indicating that the man has had surgery in the area before – probably a hernia repair. Oh, right. How boring.

The surgeon then waves his hand vaguely at the image of the man’s crotch area, “and what’s ... all this?” “Piercings”, I announce confidently. The surgeon briefly ponders what possessed the man to get this done. I point out that the man had a wedding band, and suggest that maybe his wife made him do it. The surgeon gives me a blank stare, and I know I’ve gone too far – I probably shouldn’t be speculating on a patient’s intimate life with a prominent surgeon who I’ve only just met. He then says, “there are a lot of things I don’t understand about ... life”, ruminates some more on the issue and then blurts out, “could a wife REALLY make you do that?!”

Later in the session we have a short break between patients and the surgeon reflects on the morning. “We’ve done a fair bit today” he says, “we’ve done acute knee injury, supracondylar fracture, axillary nerve, rotator cuff injuries ... and piercings”. Clearly it’s had an impact.

Computer Genius

She’s making a newsletter for work, and she’s run into some computer trouble.

“It won’t type in this box, look!” as she bashes random keys.

The cursor tracks along the screen, and a red squiggly line slowly grows, but there is no text. I lean over, change the font colour from white to black, and save the day.

For almost a minute, I am a genius, and the failures of the week fade to the back of my mind.

Small victories are still OK.

The War

There was a war on, and all of us were required to fight. I didn’t know many of the other 'soldiers', but I know a few of my classmates were there, so that was comforting. We had a few drills, where we had to run to the store room, take up a mask and a rifle, and line up on the hill ready to shoot. On command we would lie down on our bellies and army-crawl forwards towards the “enemy”.

The masks were all standard, but there were three types of rifle – some with a golden butt, some with a wooden butt, and there were a large number of completely plastic rifles. On the day we were finally required to fight, I was one of the first to reach the store-room and had first choice of the rifles. I immediately picked up a golden rifle and realised it was terrible, so I selected one of the wooden ones, but took the time to pick one without a wonky sight. Clearly the plastic ones were not first choice.

And as we were in the midst of the battle, I turned to one of my classmates who just happened to be there and said, “this would be a great excuse for an extension on Wednesday’s assignment”. And she laughed.

Crazy dream. Point of the story: if anyone wants to start a war with our cohort, let me know by Wednesday.

Image from http://trombonestuff.blogspot.com/2007_06_01_archive.html
Not sure about original source

Big Scary Student

I’m in theatre with my GP supervisor today, and he’s got a full list of skin excisions to do (our day ends up running from 9am-8pm). Somebody switched the on-call roster, and he’s been on call all night, so he’s sleep-deprived, grumpy, and late. Adding to the general awkwardness, he’s injured his foot and has to limp around in a giant moon-boot. I do my best to be helpful, drawing up local anaesthetic, cutting sutures and generally staying out of the way. And I’m doing well – we all are; eventually he starts to smile.

During a break between patients, he ducks across the hall to radiology to have his foot X-rayed. I’m in theatre preparing to draw up some more local anaesthetic, and I realise we’re out of 1% xylocaine. What to do? I ask the nurses, and their advice is to go ask the doctor.

So I venture across the hall to Radiology and see my doctor leaning on a chair strapping on his big moon boot – obviously he’s just had his X-ray. He seems to catch my eye, so I stick my head around the corner and ask quietly, “we’re out of 1%, is 2% ok?”

He looks up in surprise, loses his balance and topples over backwards. As in, completely over backwards, and the next minute he’s lying on his back with arms and legs sticking up in the air. I can only look on in dismay – he’s going to be furious, the rest of the day is going to be hell, and it’s all my fault. So I am much relieved when he dusts himself off and laughs, and then proceeds to tell all of the theatre nurses about his accident. Very much relieved.

Although, I must have look quite terrifying when I approached him, because he asked me later, “were you wearing a mask?” For the record, no, I was not.

Relaxed

He's a regular to minor surgeries. Today he's here to have three of his skin lesions excised - one possible basal cell carcinoma in the crease of his nose, another behind an ear, and a possible squamous cell carcinoma on an eyelid. He doesn't seem too concerned, but then he's taken his hearing aid out so I can't really ask him. He doesn't even grimace as the local anaesthetic is injected, although I'm sure it must sting his nose at least.

Before long, there's an area sheet over his face and the doctor is working on him with a scalpel. As the doctor excises the second lesion, the nurse hears a strange noise. "Is that ... is he ... ?"

Yes he is. He is asleep, and snoring.

Medical Specialty Aptitude

I took a "Medical Specialty Aptitute Test" a little while ago, just because I thought it would be interesting. It's quite slow to load and has hundreds of questions on many pages, so it took quite some time to complete. And after all that, the results weren't what I was hoping for and so I have decided that it's a load of rubbish anyway. Since my hopes and dreams (currently) involve me becoming a GP and maybe also doing anaesthetics, I was rather disappointed with the following results:

1. Radiology

2. General Surgery

3. Thoracic Surgery

4. Pulmonology

5. Haematology

6. Radiation Oncology

7. Infectious Disease

8. Nephrology

9. Nuclear Medicine

10. Obstetrics / Gynaecology

Where was GP? Number 33. Anaesthetics? 28. I'm probably mostly puzzled by Pathology appearing at number 17.

I suppose the quiz has some sophisticated method of determining your aptitude based solely on your personality type. And if you're the type of person who gets fed up with slow-loading million-question quizzes, maybe you should be a surgeon or a pathologist, and stay away from too much patient contact.

Not happening. Look out, patients!

Tracker

It’s amazing what I've discovered by installing a tracker to this web page. I may not know your name, home address or favourite colour, but I do know that you use IE 8.0 / Firefox / Chrome, and your computer is running Mac OS / WinXP / WinVista / Win7 and that you visited my site for 0 seconds/ 4min 13seconds / multiple visits spread over more than one day. It’s nice to see that some people, not limited to but including my Mum, make return visits. And I seem to have been visited by somebody on every continent already, which is nice, although I’m pretty sure most of them arrived here quite by accident. Here are some of the Google searches that have led to my occasionally peer-reviewed (PTR, Puddle, Vonbon) and vaguely semi-informative page:

“schoolgirl had chest examined with stethoscope for sore throat” – UK

“pinkstethoscope Champ” – UK

“champ pink stethoscope” – New Jersey, US (is there a champion pink stethoscope out there somewhere? Is it mine??)

“cystic fibrosis stethoscopes” – California, US

“dirty stethoscopes” – Utah, US

“urologist nurse gown” – Florida, US

“which way do you insert the stethoscope” - Massachusetts, US (more than once, and then they tried “insert the stethoscope”. I hope they found what they were looking for)

“which way do stethoscopes go in your ears” – California, US (at least they know it goes in the ears – good start)

“pink urine scrub solution” – Israel

“stethoscopes ashamed” – Iran

“Thomas Jefferson stethoscope” – Philippines

“anaesthetist rocks” – Cape Town, South Africa

Thanks for visiting! I'm sure that you don't find all / any of the right answers here, but I hope you have some fun along the way.


“We’re supposed to do that, when we find what we're been trackin!”
Copper, The Fox and the Hound

Mock OSCE

Somewhere, someone in the PRCC committee must have read that a good way of terrifying your medical students into submission is to stage a mock clinical exam (OSCE) eight months before the real OSCE. That way, your students will realise that they are in no way ready to face the challenges that lie ahead, and after a brief period of major depression, will become “consciously incompetent” and work really hard for the rest of the year. I suppose that’s the theory.

Personally, I crashed and burned today. I started on a rest station, but somehow did not become magically more prepared by sitting there staring blankly at the wall for 15 minutes. My first real station involved a child with a bright red rash on both cheeks. Most of the children I’ve come across in practice so far have been injured, not sick, so I was unprepared for this. And in my panic, my brain shrunk to the size of a pea and when consulted, would only scream “IT’S LUPUS!” Operating without my brain was difficult, although it might have made me a nicer person. I ended up with a mark of 5/20 for this station – 4 of these marks were empathy points.

The rest was not quite so bad, in that my brain decided to re-join the party, and I managed to at least pass the remaining stations. I even did quite well in managing a patient with acute pyelonephritis, although it probably helped that we’d been told to expect a station on genitourinary infection, so I couldn’t really get too far off track. Surprisingly, we all lost marks for not eliciting a positive ‘loin punch’ by lightly punching the patient in her already-painful kidney. The trade-off was, I got almost perfect empathy scores.

After a lengthy group de-brief, my classmate and I drove back to our own town to try and console ourselves, and that was when we encountered the lowest point of our day.

Neither of us could open our beers.

Belly Button

I saw another hernia repair last week. This man had both a para-umbilical and an epigastric hernia, but the surgical registrar doing the operation decided he could repair both using the same long, squiggly incision. The operation itself seemed pretty standard (I’ve seen two now, so I should know) – poke the omentum back in, block the deficit up with some mesh, sew the hole up, and then close the skin. The registrar could probably do with some more suturing practice, because a lot of his knots were tightening before the actual suture was tight, and I had to cut them so he could try again. But eventually he managed to close up the abdominal wall, just like a real surgeon.

Then it was time to close the skin. The incision was long and squiggly, so it wasn’t very easy to line up, and it caused the registrar much frustration. Eventually he had it lined up as best he could and began to staple the poor patient’s skin back together. The theatre nurse, newly graduated, timidly asked the question, “pardon my ignorance, but will he still have a belly button after this?” The supervising surgeon answered, “yes of course – in fact, the way [the registrar] is going, he’ll probably have two!”

"That's Horses"

The alarm goes off at 4am on Saturday, and I force myself out of bed and head outside to feed the horses. I haven’t had much sleep because my sister’s dog has been running laps of the backyard barking at mice ALL NIGHT, but at this time of morning it doesn’t make much difference. Once everything is ready, I wake up Dad and we load the horses (and dogs) and head to State Championships. It’s a 2-hour drive and I think about catching up on sleep, but my little dog is on my lap smiling at me and I know that if I close my eyes she’ll try and kiss me, so I stay awake. We arrive at 7:30am, just as they announce that the course is ready to walk. I drag Jangles off the truck and quickly brush and saddle him, change into my riding clothes and literally run to the oval to walk the course. I have a strong history of losing my way during competitions, so I take the time to memorise the track perfectly, planning my turns, visualising where we will be galloping to make good time.

Jangles warms up beautifully. Mum has been exercising him at home, and he feels good – fit and full of energy. We are reigning state speed champions, and we have a good chance of going back-to-back. The course is not ideal – lots of long stretches and very few turns, but I have confidence in Jangles.

Jangles does not have confidence in himself. We approach the first fence and he carefully jumps over, making an extra special effort not to touch the rails with his toes. I ask him to speed up and he does, a little, as we head towards fence number two. We find a good take-off spot, but at the very last minute Jangles decides not to jump this fence, and our chances of winning disappear in front of my eyes. I line up for a second try, but Jangles has already made up his mind and he refuses again. We are eliminated. All that is left to do is make the walk of shame out of the arena.

I check my watch once I have packed up for the day – it’s 9am. Sigh.

As they say, “that’s horses”.

Doctor Actor

I am a bit slow on my lunch break and have to rush back to the clinic. As I am power-walking to the doctor’s office, I almost crash into her running in the opposite direction and she admits that she’s running late and hasn’t had lunch yet. “What were you planning to do for the next hour and a half?” she says, hoping I’ll find something to keep myself occupied. I admit that I’ll probably be packing for the weekend (State Showjumping Championships tomorrow!). She leans in close and whispers, “I’d pack and get out of here”, then stands up and says loudly, “I’LL SEE YOU AT THE NURSING HOME AT 3:30!”

Not my favourite actress, but definitely my favourite doctor.

"which way do you insert the stethoscope"

Some poor individual in the US stumbled across this site after Googling “which way do you insert the stethoscope”. I feel that s/he probably didn’t find the required information here at the time, so here it is for future reference.

I will begin by stating that the Stethoscope is generally an external device, and if you were looking to use it for an invasive procedure, you should probably re-think your choice of instrument.

According to WikiHow, you should insert each of the two ear pieces into your ears, directed forwards. This is always a good start, but don’t panic if you’ve gotten this wrong. If you have accidentally lodged the ear pieces in your eyes, simply stretch them (the ear pieces) further apart and try again. If you happen to have inserted the ear pieces into your nostrils, open your mouth and use your nasopharynx as an amplification device. This has the disadvantage of transmitting the sound away from your auditory system, so you will need a friend to listen at your open mouth and describe the sounds to you.

Once you have determined which end you will use, the rest is relatively easy. The bell & diaphragm are situated on the other end of the stethoscope, and are intended to be placed upon the patient. Ensure you expose the patient’s chest so that you are listening over bare skin – a polyester shirt can mimic coarse crackles but you’ll look silly when the real doctor comes and declares the chest to be clear. If you have forgotten to warm up the ‘patient end’ of the stethoscope, you may hear a high-pitched screech from your patient. This is best heard with the diaphragm, which is optimal for listening to higher pitched sounds.

I hope that this has answered your question, oh poor lost soul. If you still lack confidence with this device, try draping the stethoscope around your neck and walking very fast so as to look very busy and important, and hopefully nobody will ask you to stop and use it.

Beer Connoisseur

I was sitting in with the general surgeon this morning, and a well-dressed lady answered the “do you drink alcohol?” question with, “well yes, I make home-brew. But it’s light – I use 200 grams of sugar instead of a kilo”. The (German) surgeon made a face, “does it still taste ... alright?” She replied, “Well nobody else likes it, but that’s OK”.

Eeew.

Steak Sandwich

I only have $11 in my account, but that doesn’t matter because I’ve left my bank card at home anyway. I have a few minutes to run and grab lunch, so I scrounge through my bag for loose change and come up with $6-50 in silver and head for the local deli. The woman behind the counter sighs impatiently as I scour the menu for something I might be able to afford. I can only judge by names though, because they haven’t written the prices anywhere. I decide on a steak sandwich with the lot, and she shouts the order to the kitchen staff before turning back to me and delivering the bad news, “$7-50 thanks”

Oh. “How much is a steak sandwich with ... not the lot?”

She sighs again, scowls at me and says, “$6-50”

I am pretty embarrassed but much relieved, and I order a steak sandwich with not the lot. She shouts out to the kitchen again, “she wants a plain steak sandwich now! Take out the bacon!” There are other customers by now, so I don’t tell her that I actually do really want that bacon but just can’t afford it. But I don’t stay there to eat my lunch – there aren’t any tables for one, and I don’t want to be told off again. I take my little paper bag and have my solitary lunch in the study room at the clinic.

It’s lonely at the bottom.

"Gen Surg"

Today was my first day of theatre in the neighbouring town – I had to drive the 50km because the general surgeons don’t operate in my town on convenient dates. I forgot to call last week to check what time to arrive, so I asked a classmate who said “arrive at 8am for ward rounds”.

I got up super early and got there at 7:30am, just in case I also needed scrubbing training (scrub nurses are sometimes very particular about this). For some reason my swipe card didn’t work for the car park, so I had to park my precious car on the road, but that was ok. And then, because I don’t know my way around the hospital, I thought I would use the bathroom in the Clinical School – my swipe card worked this time, but then I forgot how to turn off the alarm, which started bleeping and soon moved on to wailing before I managed to subdue it. Not a good start.

I finally made it into the hospital at about a quarter to eight, and set off in search of the surgical ward. This happened to be the only ward with no lights on and not a soul in sight. Feeling more than a little lost, I wandered around until I found a friendly nurse, who sent me to the change rooms to put on some scrubs. After I’d put on said scrubs, I realised that I probably wouldn’t be going to ward rounds, so I found my way back to the break room and waited for somebody to tell me what to do.

This took about an hour and a half – the theatre list didn’t start until 9am. There were 14 people in theatre for the first operation (hernia repair), and I think five of us were students. Having made it this far, I put my hand up to scrub in, and joy oh joy, found myself holding the suction to keep the diathermy smoke away from the surgeon’s eyes.

The next operation was a laparoscopic cholecystectomy, so there was nothing to do except sit quietly in the corner and watch the operation on the screen. And by the time that was finished, it was 1pm and time for me to head back.

Was it worth it? Well ... no.

Sympathy

He has severe cramping abdominal pain, which is causing him to retch and vomit up bile. He lies in the foetal position on the bed in casualty, sweating profusely and moaning about his pain, which he describes as “11/10”. He has had this pain before, and has been investigated by the best, but no cause has been found. He insists that the Maxalon won’t help his nausea, and the Buscapan won’t ease his cramps. He wants something stronger.

We give him drugs, run a drip and put him in a bed. He keeps moaning and complaining, expecting sympathy.

The nurse has had children, and I’m having cramps of my own.

Today, sympathy is not forthcoming.

Musical Theatre

Customarily, the anaesthetist is in charge of the music in our operating theatre (see here for his other responsibilities). Yesterday, however, the O&G specialist decided to break tradition. When the anaesthetist stepped out of the room for a cup of tea, and the registrar was operating, he chose to plug his own iPod into the sound system. Starting with the Bee Gees, he decided to showcase the very best of his collection and educate the ignorant youngsters. We heard Alice Cooper, Abba, Sherbet and the Eagles during that operation.

The second he scrubbed in and started on the next operation, however, the anaesthetist wandered over and searched for the most embarrassing songs. That’s when Barry Manilow and the Pussycat Dolls came out and the specialist hastily explained that he had set up “home sharing” and blamed most of the songs on his wife and eldest daughter. But the war had begun. It was a highly entertaining, if long-running, theatre session as the anaesthetist and the O&G specialist battled to embarrass each other as much as possible with each others’ iPod playlists. Good times.

Dilatation & Curettage

She sits in her theatre gown next to a stack of gossip magazines. Her fetus is 17 weeks to date ... and 12 weeks to size. It is not small for its age – it has died. Five weeks ago. The lady smiles at me as I bring over the cannulation tray, looks away and grimaces as I insert the needle and thread the cannula into a vein in her hand. Looks down as a drop of blood escapes and drips onto her white hospital-supplied dressing gown, smiles through my apology and tells me not to worry about it.

I wonder how long she’s known. Apparently she’s had no symptoms of miscarriage – no pain, no bleeding. Did she feel any different? Did something happen five weeks ago? I wonder what her story is, but this is not the time or place to ask.

The nurse leads her into theatre, and she calmly greets the team and goes through the paperwork. She succumbs to the anaesthetic easily and without a hitch. I manage her airway, insert the laryngeal mask and ventilate her until her lungs remember what to do. It doesn’t take long.

The Obs & Gynae registrar gets to work on the “D&C” (dilatation and curettage). Immediately when she inserts the speculum, the whole theatre is overcome with the horrible smell. Even the theatre nurses, who are usually immune to bad smells, have to cover their noses. It is not death: it is decay. I am glad to be helping the anaesthetist as we get to stay at the lady’s head – the registrar must grit her teeth and complete the operation. Suction loosens the placenta and begins to dismantle the decayed fetus. The curette drags out tiny body parts – we recognise a foot, a head. The registrar finishes as quickly as she can, tidying up the uterus with more suction. The lady is at high risk of sepsis, so the anaesthetist hurriedly administers IV antibiotics, and they organise a script for her to take home as a precaution.

The operation finishes, anaesthetic is stopped, and she wakes up smoothly with tears in her eyes.

She is still crying when I see her later in Recovery.

Maybe she knew all along, but now it is real.

Tag & Test

I got an email last week saying that the electrician would be around to tag and test my air-conditioner. I wouldn’t have to be home; the PRCC administrator has my key and she would be there. I didn’t have much time to tidy my house before I flew out the door, so I closed the doors to my bedroom and study – a perfectly acceptable variation of ‘tidying’, in my books. The air-conditioner is in the living room, so they would have no need to access the other rooms, right?

Wrong.

When I got home, every single electrical appliance in my house had been tagged and tested. They had been into my study, climbed over my piles of books, and tagged everything from my computer to my external hard drive. They had been in my bedroom, dragged my phone charger out from underneath my bed and tagged that. They had been through the bathroom, retrieved a hairdryer from the furthest recesses of the bathroom cupboard, and tagged that as well.

The only thing that didn’t get tagged and tested? THE AIR-CONDITIONER.

Giving Birth

We all went through labour today.

After a little introduction and a lot of handouts, we had a brief chat about what to expect in a normal delivery. The lady brought out a model pelvis and a (plastic) baby and showed us how the baby’s head has to twist around on its way out – transverse, to oblique, to antero-posterior. It looked like a tight fit, and a lot more complicated a process than it first appears.

Then we all gloved up, lubed up and assessed the dilation of various cervixes. Nobody thought it was strange when the lady brought out a box of plastic vaginas, and we all paired up and started feeling cervixes ... it wasn’t particularly realistic, with the hard plastic models, but we did our best. One girl offered to make it more authentic for her partner: “Do you want me to lie down and put it between my legs?” But nobody got the giggles, and nobody became embarrassed – until the electrician came to repair the air-conditioner. Six students with their fingers inside of model vaginas suddenly appeared in his line of vision, and it was all he could do not to run away before adjusting the temperature.

We finished the day by taking it in turns to “give birth” via a semi-realistic plastic model pelvis. One “Mum” had to push the baby through the birth canal, the “midwife” would assist by demonstrating panting and inject the oxytocin, and the “doctor” would be in charge of the whole situation. By the time we’d finished, the role-playing was becoming scarily enthusiastic – possibly scariest for our poor classmate, The Only Boy.

Giving birth

Yes, yes it is. It's a box of ... yeah.

Pain Threshold

She has a tiny spot on her nose, and she needs to have it biopsied for her own peace of mind. She freaks out about the pain of the local anaesthetic, the pain of the actual biopsy, the pain of the blue sheet over her face.
“You’re going to have to be brave” says the doctor
“Well I gave birth to my two children without anything much, so I should be fine” she reasons
“Wow. I would have had an epidural, for sure” marvels the (male) doctor
“Oh, I had one of those”

Day Off

4pm Thursday, and I realise that I haven't asked for Friday off yet, even though I've already planned to drive to the city. We're finishing up at the nursing home, and the Doctor says, "you might as well go home now".

I bring up the courage to ask, "umm, it's MT's* birthday tomorrow, and ..."
"Go" she says, then a pause and, "Can you go now?"
"I'm meant to have a session with you tomorrow" I add
"It's alright - I'll cover for you. You go have fun"

She likes MT. Happy birthday.

*not his real name

Paediatrics

I love seeing babies and children come into the GP clinic, but I thought maybe the paediatrician would get all of the horribly sick children that just make you want to cry. Maybe that’s what it’s like normally, I don’t know. This morning’s session was full of happy, bouncy little kids with little problems like eczema, atopy, or a sore foot. It was great. There were only a few patients, but we had the extremes – a 10-month-old boy who’s been quietly tracking along on the 3rd percentile for weight, and a 2-year-old who weighed 17kg and was almost off the chart. Both were reasonably healthy – the little one was atopic, and the big one was running around the room non-stop despite his sore foot. Although I did discover that 15-30minutes is plenty of time to be spending with an individual child, especially those in the “why” stages. One little girl came in with her mum and baby brother and kept interrupting the consultation with “but Mum, why are there two ladies in here?” (me and the paediatrician), “why is there a television?” (video conferencing unit), “but why – where is her terputer?” and finally, “Do you have any lollies or stickers?”

Team Building

I thought I’d escaped all the team-building, soul-searching, hand-holding, introspective fluff that I’ve suffered through over the years. After all, I’m in the country now - surely we don’t do that kind of stuff out here? In the past I’ve dutifully listened to talks on ‘eating frogs’, filled in personality wheels and personal priority charts, even walked around a room driving an imaginary laughing car. Doesn’t that mean I’ve done my time?

Apparently not.

Today our PRCC group spent the day at a police-run outdoor adventure park. I had high hopes – I really thought it was going to be good. Like, an adventure, or something. After the first few hours of the usual spiels about teamwork (and communication, commitment, cooperation, respect, attitude), I realised that I had been wrong. There were some good points – the lady read us a fantastic kids' book called “The Short and Incredibly Happy Life of Riley”, which I recommend you all go and buy. And the cake we had at lunchtime was delicious. But the rest ... no. I discovered years ago on a similar training day that I’m a “rhinoceros”, task-focused and extroverted, and that’s been my excuse for not enjoying such exercises as staring at my navel and analysing my personality. But we didn’t sort ourselves out according to the animal kingdom today. We were all expected to be into this. We were all expected to use words such as “journey” and “growth”. We were all expected to report back on the pearls of wisdom that we had gleaned from today’s journey, articulate the ways in which we had grown inside due to the challenges we had faced, and all in all cram as many clichés as we could into that never-ending conversation.

And we only got to climb two trees.

Gentlemen

The older showjumpers do tend to form their own boys club, even if it’s all in good fun. I’m sitting in the competitors tent on the weekend, when one ‘gentleman’ declares, “Women – they're alright to look at, but not much good for anything else”
The others see me sitting there, “what do you think of that, doc?”
“Oh it’s alright ... we’re trained to forgive the old senile ones their indiscretions”
He looks offended, and warns me, “I’ll remember that”
I just turn around. “No you won’t”

Mundulla Show

All week I’d planned to drive up on Friday night and spend an extra-long long weekend at Mundulla for their 100th annual show. Come Friday, however, it was obvious that I wasn’t going to make it, so it was a 5.30am start on Saturday for the 200km drive to the show. I arrived still conscious, which is a bonus, and then checked the programme only to find that my class would be the final event of the day.

This wasn’t really something to complain about – it gave me a chance to actually see the show, which was very impressive - Mundulla has about 350 residents, but Saturday saw almost 4,000 people enter the showground. This little country show was thriving – trade sites, sideshows, livestock, all manner of horse events, ute muster, vintage cars, pet show, vintage tractors, motorbikes and of course the indoor exhibits. They even had a Grand Parade, just like the Royal Shows, which included all the champion livestock and machinery. Well done, Mundulla!

I’ve been a fierce competitor in the “Watch the Clock” speed class for the last 7 or so years, but I’d only managed to win it for the first time last year, and I was eager for a repeat performance on Saturday afternoon. A $200 sports watch as first prize is great incentive to try your best! And it was a good start – up until fence number 5, I was making good time. But then I made a tight turn up to number 6, and everything wasn’t perfect, so little Jangles decided not to attempt that one. Precious time lost circling around for a second attempt meant that I wasn’t even good enough for a minor prize. My little sister, on the other hand, decided just that afternoon that she would enter the competition, did a lovely round, and won first prize. Some people.

Sunday was Championship day. We started the day off with a ritual that is unique to Mundulla – the “Blessing of the Horses”. The local pastor looks for anything with a reference to horses or animals and gives a brief service, and sometimes some of the dear old ladies of Mundulla will tell us some horsey tales from their youth. We used to sing, until the locals realised that us uncouth horse people don’t know any of the words. And then we take some time to remember fellow competitors and dear old horses who we’ve lost over the last year. It’s always well-attended, partly for the novelty factor of bringing your horse to “church”, but most of us wouldn’t dare miss it.

Jangles is B Grade, and not quite brave enough (or big enough) for the A&B Championship, so he had the day off. Which left me with little to do but help out in the arena, which means “pick up rails and move jumps” (or “yearly exercise”). It’s a great judge of character. You will see the spoilt young riders and rich owners watch a rail fall in front of them and not think to pick it up. Or the “ordinary people” of showjumping, who have worked so hard just to make it to the show and will still always run in to help re-set a jump. We certainly have an interesting mix of characters in our sport, and whilst not everybody wants to work, it's hard to be intimidated by the high-fliers when everybody is sunburnt, covered in dirt and has horse shit on their boots.

We had a terrific change of weather on Sunday night. All day it had been hot and sunny, but just on dark we began to hear the rumble of thunder in the distance, and soon we had a magnificent storm passing over the showground. The lightning was soon accompanied by a downpour of rain, which left the horse yards all muddy, but on the plus side, it washed the dust off everyone’s windscreens.

The storm was over by morning, and Jangles finally had his day on this, the fourth and final day of the show. Some people had left to make the trip home, but there were still plenty of competitors left to take part in this morning’s classes. Jangles was in the mood to go showjumping today, and he cantered around in his best textbook style (yes, they have showjumping textbooks, and they are very interesting). He won both of his classes – next stop, State Championships at the end of March!

Little Sprite, ready to face the day ... unfortunately, I'm not ready to wake up yet

Truck park during Sunday night's storm

Grand parade Saturday

"Blessing of the Horses" - Sunday morning

"Blessing of the Horses" - Sunday morning

Warm and Squishy

The nurses have all warned me about The Endocrine Surgeon - “he’ll expect you to know your stuff!” Well I haven’t been feeling well, so I only had time to cram for my session today. I’ve heard a lot about his thyroid surgeries, so I read up on thyroids in my anatomy text, my second-year notes (which consist mostly of unrelated drawings) and two of my clinical textbooks. It’s a bit rushed, but I think I’m ready. And then I get to theatre, and see that the list consists of all breast surgeries and a hernia repair. Oh dear.

He doesn’t ask me a nasty, tricky anatomy question straight out like I’ve been warned. He waits until partway through the mastectomy, points to the muscle layer and says, “This is the pectoralis major muscle here. What lies directly beneath it?” I’m not sure if this is the famous First Question that he has reserved for me, so I hesitate, then realise he is waiting and say in a small voice, “pectoralis minor muscle?” Yes. Yes it is. And I am on edge from then on, because (a) it must be a trick, the hard question must be coming, and (b) the nurses still look like they’re ready to swoop in and rescue me.

Between patients, the nurses make me go and get a coffee because everyone else is. And my GP supervisor (who is assisting the surgeries today) quickly gives me some answers to some breast-related questions that the surgeon might ask.

Sure enough, as I am scrubbing for the next operation, the surgeon comes in and asks me to list the reasons for removing a fibroadenoma of the breast.

Thanks to my timely GP tutorial, I can answer:
· Symptomatic (I.e. painful)
· Fine needle aspiration results showed some suspicious cells
· Lump is growing in size
“Very good”, he says, “and interestingly it is the same for thyroid nodules”.

He starts letting me do a lot more then, like cut sutures and hold retractors. During a partial mastectomy he hands me the offending fibroadenoma, so that I can feel its bossilated surface for myself. I marvel at its surface (yes it’s bossilated, but very shiny), its texture (very hard), and silently at the fact that it is warm and the surrounding fat is squishy. And then further marvel at the fact that I wasn’t expecting it to be warm and squishy.

Later, he is repairing a paraumbilical hernia (hernia at the umbilicus, but apparently only congenital ones can be referred to as “umbilical hernias”). He pokes and prods the herniated omentum, trying to force it back into the abdominal cavity, and eventually gets it all back in. Then he invites me to put my finger into the hernial orifice and feel the abdominal wall from the inside. How strange it is! I can feel the muscles, and the fat, and even a loop of small bowel. And OH MY GOD IT’S WARM AND SQUISHY!

I thought the warm and squishy theme might end after lunch, when we started consulting. After all, my specialist consulting experiences so far have involved me sitting in the corner trying to stay awake enough to ask and answer questions. But The Endocrine Surgeon follows up a lot of his mastectomy patients year after year, so of course there are a lot of breasts to examine. I learn his technique, learn to identify ribs, normal breast parenchyma, and fibroadenomas (“like a marble under a newspaper on the kitchen table”). He also tries to teach me how to feel axillary lymph nodes, because apparently in slim people, he can feel normal lymph nodes 70-80% of the time. I can’t feel them at all, but I try ... digging my fingers into a large lady’s damp armpit until he finally allows me to give up. Mmmm. Warm and squishy.

How Embarrassing

I have a very embarrassing personal health problem. I have been struggling with it for a few days now, and there’s no point in dancing around the issue, so here it is: I have a cold. As a med student I now feel quite ashamed of myself – I’ve been seeing people with terrible illnesses, researching Medicine like it’s going out of fashion, and now I’ve gone and caught a cold, and probably from someone at the supermarket.

It’s been trying to sneak up on me for a few weeks, and I’ve been fighting it off with Vitamin C and chillies and such, but it just wouldn’t go away. And as I was debating whether to just give up and let this cold run its course, or keep fighting it and hope it gives up first - the cold got me.

Yesterday I had to call in sick to the clinic. I actually went there in person. The girl in the office called out a cheerful, “hi! How are you going!” and when I could only reply with “ummm”, she decided that I probably shouldn’t be allowed near patients, and sent me home.

So I dug out all of the cold-beating remedies that I could imagine. I got into the vitamin C tablets, the Strepsils, and the grapefruit juice (a new one for me, but it tastes good), cracked open a box of 3-ply tissues and settled in to make some chicken soup (recipe below). A hot shower, some ugly trackies and heat pack helped soothe the aching muscles. Rum made me feel better about the state of the world.

Realising how miserable I become when struck by a simple cold, well ... hopefully I’ll be more sympathetic when somebody comes in with a serious problem, like a sore throat or dizzy spell. For now though, I’m just trying to re-learn the art of nose breathing.


“Becky’s Kill-Anything Chicken Soup”
8 chicken legs, skinless
8-10 cloves of garlic, chopped
2 chopped onions
4-5 chillies, chopped. Leave the seeds in.
2 tsp (or more) grated ginger
Oil
2L chicken stock
3 carrots, chopped
1-2 handfuls of corn
1cup macaroni pasta

Heat the oil in a large saucepan and brown the chicken

Add garlic, onion, chilli and ginger, and brown also.
Add chicken stock, carrots and corn.
Bring to the boil, add water if needed
Simmer 15-30min
Take out the chicken, pull the meat off the bone, shred into small pieces and return to pot
Add macaroni and simmer 15-20min until pasta is cooked
Add salt and pepper to taste

Fun fact: This recipe was created by a girl “Becky” and passed around via spam fwd. Becky created this recipe for her Mum, who “has an auto-immune disease”, so Becky “needed to think up a way of boosting her immune system”. Now I love my immune system, but the second it turns against me ... well, that’s when it’s had its last dose of chilli chicken soup.