Showjumping

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.

Dog

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"

Oh.

Ahem

"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"

Suturing

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.

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.

Neighbours

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.

Chinese Takeaway

Having lived here for 8 months now, I decided it was time to try the local Chinese take-away. I’d had a few unsuccessful attempts earlier in the year before learning that the owners were on holidays, but I was ready for take 2. So I called.

“Hello?” a lady’s voice answered
“Hello” I replied, a little disconcerted
“How are you?” she asked conversationally
“I’m well thank you, how are you?”
“Yeah good”
... awkward pause ...
“Um, I’d like to order the honey pepper prawns, thanks” I ventured
“Honey pepper prawns?”
“Yes. Um wait ... where have I called?” I asked, suddenly scared that I’d called a home number
“Chinese, yeah” she assured me
“Honey pepper prawns please” I repeated
“Is that all?”
“Yes”

When I arrived, I had the exact change ready, and handed it over ready to go.
She stared at the change in her hand. It wasn’t too complicated. A $10 note, four $2 coins, one 50c coin and two 20c coins. You’ve probably added it up already - $18.90. Exact change.
“You’re missing one” she said, shaking her head and staring at the money in her hand.
“No I’m pretty sure that’s exact change, $18.90” I assured her – I was starving and just wanted to go home and eat.
She held out her handful of money and I placed it all on the counter to help her count it out, and yes, it still came to $18.90. Finally she accepted that the $18.90 that I gave her was the right payment for the $18.90 meal.

And then I got home to discover I’d just bought the most expensive container of cabbage, sprinkled with 8 or 10 prawns, ever. That’ll teach me.

The many grades of moron

I had a GP consulting session today. I was doing well - I did proper cardio, respiratory and GI examinations for health checks, talked to a lady about her new anxiety medication, did an antenatal check, and even did a pap smear - no problems.

And then, halfway through a consultation, I turned off the doctor's computer with my foot. Oops.

I am not a moron

I feel amazing today. I am on top of the world. I know medical students aren't supposed to have too much self-esteem, but I'm going to just come out and say it anyway: "I am not a moron". Man that feels good.

We had practice OSCEs on Wednesday night, which I was absolutely dreading because at our practice OSCEs earlier this year I was absolutely hopeless. I believe one station I got 6/30 for, and 5 of those marks were for empathy. This time, however, I passed most of the stations and actually did quite well. Amazing! I have learnt something!

And then the next morning we had a practice written exam. I had no expectations because I'd been concentrating so hard on panicking about the OSCE, but I even managed to do OK in that. Sure it was formative, and self-marked, but it made me feel good.

So this morning I marched into clinic, suggested Pregabalin for somebody's neuropathic pain, diagnosed lateral epicondylitis, wrote several sick certificates and sutured somebody's hand. Should I be this excited about being able to do stuff and not looking stupid? I don't care, for today, I am not a moron.

Actually ... maybe I should wait until midnight to say that. The day is still young.

Cartoon from http://www.toonpool.com/cartoons/Illiterate%20Moron_55117

Quoteblog #9

“I had a bad tummy-wog and I got over that – now I have this sniffle-nose!” – 81-year-old man giving his recent medical history

“You’re having a rough trot, aren’t you?” – Nurse to 93yo lady with bilateral pneumonia
“I’ve been on better trots” – patient

“My nightie’s all scrunched up and it’s hurting my tail” – elderly female patient

“I yell, I think, when I’m on the phone” – nurse. She does.

“In [my town] I don’t quite know what that means (being well-connected). Like you know somebody that’s got lots of sheep” – rural student

“I don’t do vaginas unless it’s recreational!” – male student starting O&G rotation

“And this poor little med student’s waiting for Dr C” – nurse giving commentary as I waited outside a consulting room.

“What drugs do you need?” – Renal physician to renal transplant patient on follow-up
“Nothing. Oh, a bit of heroin I suppose” – patient

“I’ve been haemorrhaging for three years” – patient with persistent haematuria post-TURP

“I can’t handle these crackpot f-ing midwives” – GP after an argument in the delivery suite

“It fuctuates" – Patient, regarding his blood pressure.

“So multiple sclerosis is like, I don’t know, acne” – neurology professor

Nobody

I brought my skeleton, 'Nobody', home for the weekend for a bit of anatomy review. For most of the weekend Nobody sat in a lounge chair, until Sunday afternoon when it was time to load him into the car and head back to placement.

I was in the backyard chatting with Dad and casually holding Nobody in my arms when a family friend pulled up in her car. "I was just passing through and thought I'd stop in and say hello and IS THAT WHAT I THINK IT IS?!"

Nobody knew exactly what to say.

Long-Distance Partying

My friends all went to a wine and cheese night a while ago. I didn’t go because I couldn’t justify driving the extra 900km that week, but one friend was kind enough to call me from the party and let me know what I was missing. I got to talk to each of my friends in turn, including my sister who often stands as my replacement at such functions – Version 2.0, if you like.

And I almost felt as if I were there. In truth, it felt as if I was sitting in a corner, and people were coming over to talk to me one at a time. We would chat for a while, then they would say, “Oh look here’s Michael, you should talk to him”, and then they would leave me and re-join the party. It was almost as if I could just stand up and join the rest of the group any time I wanted. What a strange feeling.

Thanks, my friends, for sitting in the corner with me.

Image from http://explosm.net/comics/2137/ ... obviously

Wine

He tells me in his thick Italian accent that he was feeling quite sick over the weekend, but now he is feeling much better. He slept very well last night, thank you. His appetite is much better too.

"I had second helpings of dinner" he says, "and half-"

He stops mid-sentence, leans forward and whispers, "half a glass of wine"

When he sees that I am not cross, he goes on to tell me about his brother's mother-in-law back in Italy, who is 94 and has a glass of wine every morning before breakfast.

And as he leaves, he turns around and waggles his finger at me. "Remember what I said about the wine", he reminds me, "it will put some colour in you".

And maybe I will have a glass ... just not before breakfast.

Fourth-Year Rotations

Our Year 4 allocations came out today. When it was time for choosing rotations, I already had my two elective blocks completely planned – Term 4 in Zambia and Term 6 in Cambodia. This had nothing to do with my organisational skills – I had stuck like a leech to two incredible classmates and they did all the hard work for me. I stuck my holiday block in between to allow time for travel and sleep.

And apart from that, I thought, who really cares? As long as I got an anaesthetics term, of course, because last time in theatre the anaesthetist let me give all the drugs and one time he let me do a spinal block.

I couldn’t make myself gather any excitement for the rest of the terms, because what could be as exciting as overseas electives and holidays? And today my allocations came out. And I thought, “Well - that serves you right”.

Term 1: Vascular surgery. By all accounts it’s a good rotation, not too much work and apparently the vascular surgeons aren’t even very mean as far as surgeons go. And it sounds kind of cool. But when you really think about it, I think it’s going to be all about ulcers ... and I don’t like ulcers.

Term 2: Clinical pharmacology. Oh God why? Oh, right. It’s because I need to study pharmacology otherwise I will be a terrible doctor. I see.

Term 3: Microbiology and Infectious Diseases. This one caught my attention because in my previous degree of Medical Science, I absolutely loved microbiology (nerd). I’m not sure how much I’ll like it as applied to sick people with infectious diseases.

Terms 4-6: Zambia, holidays, Cambodia! Hooray!

Term 7: Psycho-Geriatrics. If I turn out to be a GP (very likely), I will be overrun by old people and eventually they will need my expertise with dementia and UTI-induced delirium. I’m not even doing this one for myself – I’m doing it for you. Yes, you.

Term 8: Anaesthetics! I would start sucking up to the anaesthetists immediately, but it’s more than a year away and they’ll probably forget me – and I’m not sure my new-found skills in psycho-geriatrics will be able to help me.

So here’s to fourth-year - just four months and some deadly exams away.

Smoke Alarm

A few months ago I came home to find that not only did my house have an alarm system, but that the light was flashing in an alarming manner. After establishing that my house was not on fire and that my possessions, although stewn randomly about the place, had not been rifled through by Others, I called the security company. Security Man and I decided that the best thing would be to punch in my security code a few times until the light stopped flashing, and I did so with great success.

But I was left with a niggling feeling that perhaps my house was not adequately guarded against fire and burglers - hence the addition of a vicious guard dog, pictured here making a practice kill on some rope.

Well good news, everybody! My smoke alarm works just fine - and it has spectacular lights and noises! I should go and tell the neighbours ... haha, just kidding, they already know.

By the way - dinner’s ready.

Tip of the Day - Orthopaedics

I held tightly to the Cobra retractor as the orthopaedic surgeon wielded his bone-saw and the patient’s blood splattered up my arm and across my face.

And I nodded to the scrub nurse, ever so grateful for her advice: “Wear the mask with the visor today – orthopaedics gets really messy.”

Track Pants

It was track pants day at the Psychiatrist’s office. I didn’t get the memo, despite having called ahead to confirm the session. Luckily for me, the psychiatrist himself wasn’t aware of the occasion either, and neither was his receptionist – we all turned up wearing slacks.

But the patients sure got into the spirit. I sat there and silently noted as every patient, their minders and family members filed in wearing track pants. One lady was more enthusiastic about the event than most, and wore at least two pairs – you could see the first pair/s scrunched up underneath the outer pair. It must have been a struggle to get them all on, and I had to admire her dedication. The outer pair was bright red and clashed spectacularly with her big green coat and purple ugg boots. What an excellent effort.

Language

The patient is complaining about his injured arm. "Coz it fuc-"

The doctor cuts him off, "Language - there's a lady present!"

"Oh, sorry" he says, repentant, "it ... it pisses me off."

Handy Hints

The general surgeon finished his tutorial last week with this handy hint:

"And you don't need a condom, as long as you have a pencil!"

He was talking about chest drains, I think.
Shame it probably won't turn up in the OSCE.

Training

On Friday I drove 50km to attend a video-conference that did not exist. Three days earlier I turned up to a women’s health clinic for an afternoon session, only to find that it had been a morning session. The day before that I turned up at the clinic at 9am, only to discover that the doctor was at the hospital - and had been since 8am.

And still I do not call ahead for my sessions.

I am living proof that operant conditioning does not work. Or at least, that it does not work on me. And I think it’s about time that the world around me adapted to my untrainability and chose to use classical conditioning instead. I’m sure that if I was given a biscuit every time I called ahead for a session then I would do so more often.

But how exactly do I begin to train the world?

I’m going to need a lot of biscuits.

Ralph

Today in the operating theatre, my name is Ralph. And it's all because the scrub nurse has the same name as me, and on the rare occasion when I am asked to do something, she gets confused.

And so I am Ralph.

Mornin' Sam. Mornin' Ralph.

The Toe

"Go and spend ten minutes with this lady" says the doctor, "tell me what the deal is."

Neither of us have seen her before - she only came into hospital yesterday. I pick up some blank paper and stride in, ready for anything.

She is propped up in bed, a frame keeping the sheets away from her feet. Cellulitis, maybe?

I ask what she's in for, and she draws back the sheets to show me her right foot. Or rather, the fourth toe on her right foot. Or rather ... I think it used to be a toe.

It is black, it is shrivelled, and it smells terrible. There is pus oozing from its base, and it looks as if it's hanging on by a thread - one good twist and the toe would be gone. Her foot is red and hypersensitive - she gasps and draws back as I touch her other toes. The infection is spreading, but I take heart in the fact that the pulse is strong.

She doesn't want to lose her toe. I hope she keeps her foot.

Oh Sh*t

The psychiatrist quizzes his schizophrenic patient about olfactory hallucinations.
"You mentioned a burnt smell"
"Yeah ... and a sh*t smell"

Yes, concerned readers, he did recommend EEG

Rats

An elderly patient has been admitted following a cardiac arrest, but her main problem now is confusion. As I walk past her chair today, she hails me and asks, "Do they smell like rats?"
"Um ... do what smell like rats?" I ask
"The rats themselves?"
"Which rats?"
"The rats you people have got"
We eventually decide that neither of us can smell rats right now, and agree that "those men" must have got rid of them. What a relief.

Traveller

A 74-year-old lady sits in front of me with a giant stack of papers for a travel insurance claim. She's done a lot of flying, has seen many different countries, and loves to travel. Wow, I think, this lady must know a lot about the world.

She tells me how she fell ill in Dublin, and about the 'wonderful doctor' who made a house call to her hotel. "And he only charged 100 Euro! What's that, about $40 Australian?" No, I inform her, it's more like $140 Australian.

She doesn't think the doctor is so wonderful anymore.

Back Pain

Doctor, "How's the pain?" - referring to the crushing chest pain the elderly lady been admitted with.
Patient, "Oh, it's bearable"
Doctor "where is the pain now?"
Points to her lower back
Patient's daughter knowingly, "Oh yes, that's your back pain"

Asthma

“Why are you in hospital?” I ask the man in Bed 9

“Asthma” he replies, and looks at me expectantly.

Um ... ok.

Then he realises I want the full story, and delivers it in one long speech.

He’s had asthma for 2 years. He takes asthma preventers and an asthma reliever. Two weeks ago his GP did an asthma review, told him he definitely had asthma, and gave him an asthma plan. Oh and gave him a new asthma medication – Spiriva.

“Spiriva?”

“Yeah. For my asthma”

“Spiriva is usually for ...” (COPD) “... never mind. How often do you use your reliever?”

“3-4 times a day. I need it when I laugh at something on the TV, or put my bins out”

Oh dear.

I look him up on the GP system. There are the notes from his “asthma review” appointment.

Reason for contact? COPD.

CoC Presentations

We gave our Continuity of Care presentations today. They were more entertaining than any of us expected, but that wasn’t the best part. One of our classmates brought a giant box of Cadbury Favourites – that was the best part.

In between presentations, she rushed around offering everyone chocolates and we all reached in and rummaged around to select one. When she reached the examiner, she angled the box so he could see better and gave it a shake.

*shake shake*

He peered in, searching for a good one.

*shake shake*

He reached up tentatively to take a chocolate, just as she gave it another shuffle.

*shake shake*

Several chocolates spilled out of the box in front of him, one falling with a splash into the examiner’s coffee, much to the student’s embarrassment.

“Oh no,” lamented the examiner, “two marks forward and one mark back.”

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.

Organisational Skills

You may have noticed, but I am slowly growing tired of turning up for sessions that don’t exist. So today I decided to be organised. The session with the anaesthetist this morning? I checked his calendar yesterday and found that he’s on a rostered day off. I had my place spotless for house inspection. The 2pm GP tutorial? Called ahead – it was actually at 3pm, so I had plenty of time to prepare. AND, I submitted my (grumble grumble) portfolio three days early!

And now I’m trying to order my takeaway dinner before the place has even opened.

Today, I’m so organised, it hurts.

Crash Report

At first I thought, cool, that's new - I've never had this error message before!

But now I can't open Firefox. Time for a virus scan?

Oven Master

On a happier note, I seem to have finally mastered my dodgy electric oven. The secret? Switch oven on, go do something else for an hour or so, and then return and do your baking. I also leave a baking tray on the very bottom shelf so that my food isn’t burnt to a crisp from the bottom up. I consider it a win. Mmmmm, cake.

Post-Holiday Blues (reprise)

I got a lot more response from yesterday’s post than I expected –not in the comments section, but in personal messages and chats both in person and online. It seems that it’s not just me, it’s not just the students in my region, and it’s not just the rural students who are feeling isolated and overwhelmed. Even the city-based students can lose contact with their peers, miss out on social events and have trouble getting to the extra-curricular talks and events. From the friends who call me frequently, to those I chat with online from time-to-time, to those who interact mainly via Facebook, we are all lacking in friendly human contact and suffering from fractured social circles since basically the start of Year 3.

Should this be comforting? Possibly. At least I’m not alone in my aloneness. But I find it more worrying than comforting. Why didn’t they warn us that this would happen? That the close friendships we’d forged during the stressful first and second-year would be torn apart as we were thrown into different rotations and geographical locations for the even more stressful third-year. That the people we’d come to rely on wouldn’t be around to help with homework, make you dinner or give you a hug when you needed it most.

And here I am whining because I’ve been sad and it’s all the School of Medicine’s fault. I think I need a dog. And a hug. What do you need?

Post-Holiday Blues

I have been feeling a bit sorry for myself since the holidays. During the three-week break I managed to spend a lot of time with my family, my horses, my little dog and my friends back in the city. I had a birthday, I got presents, I went shopping, and I felt loved. Then I came back to my placement - back to work and back to the reality of assignments, exams and other assessments.

And I was lonely.

I know that a lot of the other rural students are feeling the same way. It doesn’t help to know that the student society is running events that we can’t possibly attend, and that our city-based friends are carrying on with their social lives, attending trivia nights and having group dinners and breakfasts. It did help marginally to see our classmates on the big screen during a whole-class video conference, to sneakily chat on Gmail and to wave at the camera.

But the only thing that really snapped me out of my little funk was a 3am phone call from some old showjumping buddies, inviting me to the casino. They didn't know that I'm placed 500km from said casino, but they have no idea how much it helped to know that old friends still think of me occasionally.

We probably all have a few old friends who could do with a phone call ... some of them might appreciate being called at a more respectable hour, but it's always nice to be remembered.

(Photo stolen from www.bluesbrothersgallery.com)

8 months

He’s “just in for a checkup”, his mum tells me as she brings the happy little 8-month-old into the room. I ask about his history ... he had a low birth weight, he’s been lying on the 3rd centile for all growth parameters, he wasn’t feeding well at the start and he’s had a hydrocele. Sounds like there’s a lot to “check up” on.

He’s picked up a bit lately though – started feeding well, he’s been putting on weight and he’s obviously pretty happy about life. I do his weights and measures, and we note that he’s now in the 50th centile on the growth charts, so he’s caught up well. The doctor examines the testes – everything is normal and the hydrocele is gone. And then he has a listen to the boy’s lungs. It tickles and the boy starts a little staccato laugh.

The doctor then tickles the boy’s tummy, and chuckles when the boy bursts out laughing again. And then they just keep setting each other off, the baby’s bleating laughter like a little lamb and the doctor’s deep chuckle. They keep it up for a few minutes and then the boy keeps looking at the doctor with his bright eyes and big smile, kicking his legs and waiting for the laughter to start again. I’ve never seen anybody have so much fun in a doctor’s appointment.

Beautiful ... necks

Because distended neck veins and goitres are all the rage this season.

Picture with thanks to Facebook ads.

The day that wasn't

All I had scheduled today was a GP tutorial from 2-4pm, and a video conference of the fourth-year elective presentations at 5pm. So technically, I had the morning to study and become an expert on all things tutorial-related and otherwise. That didn’t happen.

The tutorial was postponed until 2.30pm, so I did have time to read through the case and prepare some notes. Our GP is usually a few minutes late, so my classmate and I wandered in just after 2.30pm to find his office still empty. We both got out our Oxford handbooks and continued our medical education while we waited for him, until after an hour when I started to wonder if he was coming at all. My classmate wisely suggested that we wait another half hour since the doctor had patients booked in for 4pm. He did struggle in a bit after 4pm complaining of a terrible headache, so we gently excused ourselves and jumped in the car to travel to the next town for the video-conference.

At first I had been rather annoyed to find that our students’ society had scheduled the fourth-year elective presentation on a weeknight during term, because the rural students had no chance of attending. So I was pleased to hear that it would be broadcast to at least one town in our region, and I was keen to attend – especially because elective preferences are due in a few weeks. So imagine how irritated I was when we arrived to discover that the video-conference had not in fact been organised, and since it was after 5pm none of the IT staff could be contacted. Luckily somebody in the audience thought to record the audio, so that should be thrilling listening if we ever get hold of it.

And then we went to McDonalds and they had run out of commemorative World Cup soccer glasses.

Can we rewind? Please? I think this day could be done better.

Dog Parties

Saw this in a bookshop in Melbourne ...

I didn't want to flip through it in case somebody saw me, but I imagine the title is fairly self-explanatory.

Jersey Boys Fan

My Mum has been wanting to see “Jersey Boys” the musical for years - so when we checked into our Melbourne hotel and discovered that it was playing just around the corner, we went straight out and bought our tickets.

We managed to score some special tickets in the Dress Circle, which caused Mum much angst as she then had to find an outfit suitable for such seats. So it was a great moment when we arrived to discover that she was dressed exactly like everybody else, and we could relax and enjoy the show.

Jersey Boys is about Frankie Valli and the Four Seasons, a 60’s rock band, who were inducted into the Rock and Roll Hall of Fame in 1990. The story basically follows the band from their formation in the 1950s to today, and the actors perform some of their most successful songs throughout the show.

After seeing the performance, I only have one regret: I didn’t enjoy it as much as the stranger on my right. She would start clapping before the singers asked us to, she would sing along to all of the songs, she was marvelling over her purchase of a Jersey Boys hoodie, and for the whole performance our entire row of seats was literally rocking as she danced in her seat. Somehow now I don’t think you are getting the full experience unless you see a show with such enthusiasm. I might try it next time.

Journey

I don’t watch much television any more, mostly due to the whole having-to-study-so-I-don’t-look-stupid thing. But when I did tune in over the holidays, I was horrified by the abuse that was dished out (mostly on reality TV), time after time, to a poor innocent word – ‘journey’. I make a conscious effort to not use this word on a daily basis, believing (don’t stop) that maybe I can make a difference, and that eventually this word will have some kind of meaning again.

But I am just one person, and I have yet to see things improve for this poor overused word. I hear it used on television, in lectures and in “motivational speeches” (don’t get me started on those). It is time for us all to join the fight, and endeavour to protect ‘journey’ for future generations of word users.

Examples of inappropriate use include:
“It’s been such an amazing personal journey”
“Her journey does not end here”
“This is the beginning of a long and arduous journey”
In any other sentence heard on Masterchef, Australia’s Got Talent, Australian Idol, Today Tonight, and well, television in general.

Examples of more appropriate use:
“Let us journey forth to the cafeteria!”
“Journey’s version of Don’t Stop Believin’ is much better than the Glee version”
"Nobody in the band 'Journey' is particularly attractive"

Try and count how many times you hear this word in one day (I personally can’t be bothered) - you might be surprised. And let me know if you hear it used appropriately, so that I too may be surprised.

Cherry Ripe Slice

I went out to breakfast with a friend the other day – his shout, because my birthday is sometime this month. I waited at the table while he went up to order, and then we chatted while we waited for the food to arrive. After about 5 minutes the waitress came up and said, “firstly, you didn’t say what type of coffee you wanted, and second, we don’t have cherry-ripe slice today.” So I re-ordered my coffee and, wondering why my friend had ordered us dessert for breakfast, told her that we probably didn’t need a cherry-ripe slice this morning.

When she left I made sure my friend wasn’t upset about missing out on the slice. Sure he was, because he hadn’t ordered it. We chased down the waitress, who then realised that she hadn’t gotten a drink order for my friend. “So what would you like?” she asked, to which he replied, “Chai latte please”. “Vanilla or spiced?” “Spiced.” “So a chai latte, spiced ... ohhhhh.”

Band Heroine

I am truly no musician. I did learn piano for a few years in primary school, but now my keyboard lives under my bed at home. Still, whilst visiting some of my city-based Med friends during my break, I decided to give Band Hero a go.

I sat in front of the plastic drum set and set the difficulty to medium and we rocked out our first song. Paying heed to my friend’s advice that “drummers don’t think”, I managed to score 86%! A High Distinction!

Having found my true calling, I stuck with the drums for the next song, then became thoroughly confused when the guitarist started playing my solo. “Which side am I on?!” I demanded, and was surprised to learn that my part was actually on the right of screen, not the left as I had been playing previously.

I didn’t even get close to 86% for the rest of the evening.

Vet Trip

We were all dozing in the lounge-room after dinner the other night, when an ad came on TV for the show Border Security, and the sniffer-dogs were searching people’s bags looking for drugs. Suddenly my Mum sat up and said, “you should take Doggers tomorrow – see what’s in my purse”, and then when back to dozing. Upon further questioning I discovered that she actually meant, “take Doggers to the vet for his vaccinations, and check if there’s enough money in my purse to pay for it”. Which is lucky, because I wasn’t sure how he’d do with sniffer-dog duties.

So I took him and Sprite (my dog) for a walk to the vet’s office. We didn’t have an appointment, but luckily it was a slow day. I stopped Doggers from peeing on things until the Vet was ready, then led them both into the small surgery, which smelt very strongly of antiseptic. They weren’t too bothered about the whole thing, sniffing around the surgery and trying to say hello to the groggy cat which had had an operation earlier that morning.

I actually had to hold Doggers down for his injection – not because he didn’t like it, but because the vet’s assistant came in halfway through and he started wagging his tail and tried to jump up and say hello. It was all very quick and painless really.

Later that night when Dad came home, I mentioned that I’d taken Doggers to the vet. “Oh good” he said, “so he’s got his microchip?” Ohhhhhh. That’s what I was meant to do?

The "Volunteer"

I spent my entire afternoon at the hospital yesterday. Mum works there, you see, and she thought it would be A Good Thing for me to come and help tidy up a few of the rooms for the up-coming accreditation visit. Sure, I thought, it’s raining, and what else am I going to do with my holidays?

But of course it was a Saturday, and footy was in town, so in the end I only ended up dusting one of the back rooms. The rest of the time (5 hours, all told), I was looking at X-rays. Before lunch, Mum was called in to X-ray a footballer’s thumb. We couldn’t see a fracture, but when the doctor came in he gave me a mini-tutorial. Which bone are we concerned about in this type of injury? (scaphoid). How long before we X-ray it again? (10-14 days). We had a chat about electives and medicine and he taught me how to reduce a dislocated shoulder (morphine and midazolam to relax the patient, then externally rotate the shoulder, pull it downwards until it pops back in, then place that hand on the opposite shoulder).

After lunch Mum was called back in – to X-ray a dislocated shoulder! How perfect! Well not so much for the patient, because he was in a lot of pain, but I got to cannulate him for the medications and watch as the doctor reduced his shoulder. He did it exactly as he’d explained, and it was very quick, very neat, and very much appreciated by the patient (“f--k yeah!” He exclaimed when he felt the ‘pop’).

It must have been a rough game, because we also X-rayed an ankle (probably ligament damage), and a thumb which had an obvious fracture. I did a bit of dusting in between patients, but in the end I really didn’t get much done. Mum probably knows now not to bring a med student to do the dusting – they’ll just wander off and find patients.

Dog Karma

My sister's dog ('Doggers') really enjoys shirt-fronting the chookyard fence and barking at the chooks. In turn, they fluff up their feathers and try to peck his nose if he gets too close. This is all well and good, as long as there is a fence between them (my sister recently reinforced the fence - not to protect the chooks, but so her poor little dog didn't get pecked).

Today, one of the chooks was on the wrong side of the fence. Doggers saw this as 'open season', and promptly chased after it - they ran into the bushes, and over my own yelling I could hear the skwawking chicken and thought it was all over for the poor thing.

But it managed to fly back over the fence and Doggers emerged from the bushes ... disappointed, a little bit sorry ... and with a large chook poo splattered across his back. Dog karma.

Elmo's Hospital Visit

I rode my horse to the hospital this morning. The hospital in my home town has a large aged-care component, and Friday is excursion day for the residents. Today they excursioned to the grass area near the hospital’s heli-pad to meet Elmo.

And Elmo loved it. There is nothjing he likes more than the adoration of a large crowd, and being a large, black, shiny horse, adoration is what he got. We cantered a few circles but spent most of the time moving between the residents so that Elmo could have his nose patted. Here are some of the comments he received:

“He’s very black isn’t he – even his darn legs are black!”

“Oh you’re beautiful. You should have Princess Diana riding you”

“Your dressage is world-class”

“Look at him in his fancy clothes” (he had his show bridle on)

“This is the most exciting day of my life”

“How old is he, I wonder?” (3 times in the space of two minutes, and yes, all from the same resident)

“Come to mummy. You’re a good girl for mummy, aren’t you Elmo?”

“You’re such a good dog”

"Forgive me - I'm a little short-sighted - what's his name again?"

The Cut Lip

The three-year-old had fallen off the trampoline and cut his lip quite badly. The doctor had some trouble assessing it – “No no no you can’t look at it, it hurts!” but his Daddy held him still. It was his lucky day – the GP proceduralist and the GP anaesthetist were both on duty. They decided to give him intranasal Midazolam before injecting the local anaesthetic into his lip ... this was also quite difficult – “No you can’t put that in my nose, I don’t want it!” but his Daddy held him still again. It was worth it – within minutes the boy was laughing and pulling faces at everyone in the room (see diagram).

As we were preparing the suture trolley, the boy looked over at me and asked, “is that lady going to do it? Is she going to fix my lip?” After being told that the man doctor would be sewing his lip, he spied my stethoscope and exclaimed, “Daddy look, that lady has pink on her!” I came over and said, “that’s my stethoscope, I chose it myself”. He asked if I liked pink – I told him I loved pink, and then asked what his favourite colour was. He thought for a moment, “ummm .... pink!”

He wasn’t too happy about having his lip sutured, but with the nurse, the anaesthetist and his Daddy holding him still, it was all over in a flash. As his Daddy was finalising the paperwork, the boy started pulling at his lip. Everybody in the room drew in their breath, anxious to stop the boy from destroying our hard work. When his Daddy told him not to pull the stitches, he said, “but there’s a bit of dirt on there!”

He was adamant that he should walk out of the trauma room and not be carried. His Daddy carefully shepherded him out as he drunkenly weaved his way towards the door, barely avoiding crashing into the doorframe on his way out. Looking after a drunken toddler was probably not the Sunday morning anyone had in mind for this family ... but at least they can remind him about it at his 21st.

Paediatrics Presentation

I’ve been working on this assignment (or at least thinking about it) for weeks. I’ve been through all the textbooks, printed out, highlighted and annotated all the latest articles, and written and re-written my handout. Last night my Mum and a workmate came and stayed at my house, and I subjected them both to the 12-minute speech. Time limit is 10minutes, so I asked which parts were the most boring so that I could cut them out. Unfortunately I had bored them into stupor and they couldn’t help, so I cut out the sections that I could get away with.

This morning I did everything right – I printed my notes and emailed my presentation to myself, just in case my USB failed. We didn’t get our usual few hours to prepare our presentations this morning, so I double-checked my Powerpoint (and added an extra picture) at lunch time. We all drew a number from a pile, and for a terrifying minute I thought I might have to go first – until somebody agreed to swap with me and I became second-last.

And I’m glad I did. I sat there and listened to my classmates’ fascinating presentations (no sarcasm, they were very impressive presentations). Then I got up and delivered my speech and blitzed the questions/discussion. And then I realised that I am now PRACTICALLY ON HOLIDAYS! What a wonderful feeling. I’m sure that actually being on holidays will be so much better, and I can’t wait.

Study-brain

Three days until holidays! Excitement!!1! Paediatrics assignment (mine’s on scoliosis), PBL, progress reports, tutorials, all due this week? Not quite so much excitement.

It’s been a long year so far. I came down for orientation in early January, and apart from the odd weekend away or a lucky day off, I haven’t had a holiday yet. I’m not getting sick of it, but it’s a long time to be consistently eager and on the ball. This is why my brain retired for several days the other week – for a couple of sessions I could not answer even basic questions (example, the organ responsible for breaking down red blood cells is the spleen, NOT the liver).

I have managed to regain study-brain for the time being, but it’s a tenuous hold, and I can’t imagine it sticking around after Wednesday’s mass of deadlines. I hope nobody asks me a question on Thursday ... unless it’s about scoliosis, because I’ll have a three-page handout all ready.

New Favourite Patient

A two-year-old girl was brought in last night with an asthma attack brought on by a viral infection. I didn't get called in, but the duty doctor gave me the history and asked me to examine her on this morning’s ward round. She’d obviously responded well to her Ventolin nebs – she was running around the room jumping on the chairs, grabbing her dad’s legs and then taking off to run about the room again.

I called her over and asked to listen to her chest. She really liked my stethoscope, so she approved and lifted up her singlet so I could have a listen. All clear, no wheezes this morning. I told her they were good lungs and she smiled and ran a lap of the room. I called her back and asked to look in her mouth, and she opened nice and wide and stuck out her tongue for me, even though she thought it was pretty funny. And then I asked, very nicely, if I could look in her ears. She came over and actually knelt down next to me, brushed her hair back and sat quietly as I looked in her ear. I was so impressed that I just sat there and smiled after that, until she looked at me and said, “udder one?” Then she turned around and sat nice and still while I checked her other ear. What a great patient!

Later on we returned with a ventolin puffer, a big spacer and a paediatric mask so we could teach mum how to give asthma first-aid. Once she had a good grasp of the procedure and understood how to wash the spacer, put it together and check if there was ventolin left, we called the little girl over to practice using it. She was happy to stand there and breathe quietly as her mum held the mask in place and counted her breaths. So very cute ... my new favourite patient.

Laughter

Laughter is not always the best medicine. Sometimes we use a smile or a laugh to create a bit of a rapport with the patients and prove that we’re not just robots trained to poorly recite the Oxford handbooks. Sometimes it’s nice to get a patient to smile after a tense or teary consultation. Sometimes a patient will tell a joke of their own accord, and it’s only polite to laugh then.

But sometimes, it’s just not appropriate. When a patient is expressing their distrust of the medical profession and says something like, “the doctor ignored my shoulder pain and it turns out I was having a heart attack” ... well, then it’s probably time to put on your empathy face.

Turns out, there are people out there who don’t realise this.

Micro Horses

We had a patient transferred back from a city hospital today who’d had a microdiscectomy for treatment of Cauda Equina syndrome due to L4/5 disc herniation. She was “my” patient, so I spent a fair while looking up her long and complicated history, but I finally got my head around it all. The nurses didn’t. I sat there listening to their handover as they tried to remember what this lady had - “So, she hurt her back ... while riding a micro horse ... and holding a quarter”. Close enough.

Quoteblog #7

“There are surgeons out there who I wouldn’t let operate on my pet gerbil” – anaesthetist
“I didn’t know you had a gerbil!” – student
“Not anymore, somebody operated on it” - anaesthetist, sadly

“It’s bizarre how much the patients value putting a face to the person who’s about to render them unconscious” – anaesthetist

“I don’t want to be cooking. Or cleaning. No, no, no, no, no” – student

“The good thing about the Australian medical system is that none of us trust each other” – GP

“You’ve gotta remember, nobody really cares!” – GP after we corrected him on statistics

“An idiot can ask more questions than a smart person can answer” – GP

I Am The Yoyo

As I left the GP tutorial this morning, the doctor told me that we had blood results for the patient who’d come in with subfertility. I’d seen this lady on my own first, and she’d burst into tears as soon as she entered the consultation room because she so desperately wanted this baby and it just wasn’t happening. The blood results showed that she wasn’t ovulating, and the doctor sent me away with my morning’s homework – go read up and see what course of action we should take next. So I spent a few hours with the O&G, gynaecology, women’s health and medical books, came up with a few more tests and a treatment plan. I went through them all with the doctor, he agreed with some of them and we decided on an action plan. He told me that she had an appointment this afternoon and that he’d call me when she arrived.

I was with a different doctor that afternoon, but I knew she’d understand if I ducked out to see this patient. I arrived early and sat in her office so I could inform her of this. 5 minutes went by, then 10 ... the intern wandered in, also looking for my doctor. I mentioned that maybe I should check she wasn’t at the nursing home, but he said no, she was supervising him, she’d be in the clinic. 10 minutes later he was called away, and I snuck over to the computer and checked ... our doctor was doing the rounds at the nursing home.

I hurriedly informed the intern as I ran out the door, and drove hastily to the nursing home. The doctor was there, completely understanding of the situation as I explained ... and the next minute one of the nursing home workers knocked on the door and asked for me. The clinic receptionist was on the phone ... the GP from this morning wanted to speak with me. I was put on hold, but I remembered immediately that I was meant to be seeing that patient, my doctor was hurrying me out the door, and then I was driving back to the clinic.

When I arrived at the clinic I knocked on the door of the consultation room and was greeted by the doctor who cheerfully informed me that my patient had come and gone, but that he’d started her on the treatment plan we’d come up with. Oh, good. Nothing to do at the clinic, so I headed back to the nursing home.

The GP was still sitting there doing paperwork, and she laughed when I told her of my adventures. We had a little chat about how I was going – I mentioned that I was looking forward to holidays, but still had a massive assignment (Paeds presentation, for those in the know) before I could relax. She asked more, and I told her it was due next Wednesday and I mentioned who the markers would be. When she heard their names (a physician and a paediatrician), she gasped and told me “go study!”. I laughed and said I was happy to spend the afternoon there, but she told me no, she was serious, I had better go study right now.

So I marched back to my car, which probably would have shied and run away if it could, and drove back to the clinic to hide myself away in the study room for a few (very productive) hours. Yes, I am the yoyo.


Here is a totally unrelated link, you should click it.

Car Space

The people of this town are used to driving long distances, used to driving in tough conditions, used to driving every day. But they are not used to driving in tight spaces. The roads here, even the back residential streets, are wide enough for a Rodeo ute to do a U-turn (maybe I’m exaggerating, but the roads are wide). This is apparently necessary because most people believe that their cars are several metres wide.

If there is a car parked on the curb, leaving oh, say 10 metres of free space next to it, most drivers will veer across to the other side of the road to make doubly sure that they clear it. Cars coming in the opposite direction will wait patiently and only drive forward once the other car has cleared that unnatural obstacle. And it’s ok, because nobody here is in a hurry.

Compare this to the city, where they cram in as many lanes as possible, cars park so that they take up half a lane, everybody does 60-70km/hr and cars miss each other by millimetres (or not). A certain relative of mine was driving in the city on her learner’s permit, concentrating hard so that the cars on her right didn’t clip her. Her passengers noticed a strange clunking noise, and after searching the car and turning off the radio, somebody finally looked out the window. In her effort to avoid oncoming traffic, she had been clipping the mirrors of all the parked cars to her left ... clunk, clunk, clunk, not missing a one.

Stories like this inevitably make it back to these country towns and become legend, and I believe this explains everybody’s wariness of parked cars. I can’t think of a better explanation.