Bin Day

Thursday is bin day! I think it's safe to say that I've never been so excited about bin day ever, not even at the start of the year when I had a whole house to myself and bin day made me feel ever so grown-up. No, today is very special.

You see, on Christmas day, we had prawns. We shelled them and ate them with our hands, dipping them in Great Grandma's secret-recipe seafood sauce, and life was good.

Come time for the post-lunch post-nap cleanup, and Dad warned us several times to tie a piece of string around the bag full of shells. But we were complacent and responded with 'Yes yes, it's too hard to find a piece of string, it'll be fine, we'll just tie a knot' etc.

Fast-forward five hot summer days, the prawn shells have been simmering in the sulo bin right outside the front door, and Little Sister and I have been holding our breath every time we've left the house because it genuinely smells like a very large and very sick sea-creature crawled in there and died a terrible death and is now decomposing in the most aromatic way it knows how.

Hooray for bin day!

2010? You still there?

My alarm went off at 7am this morning (I can't remember why it was set for 7am, but never mind) and just as I lifted my hand to hit snooze I thought no, I'm going to have to get used to getting up early, because my first rotation for fourth-year starts in LESS THAN A WEEK.

And then I thought, what the Hell happened to 2010?! I documented a good deal of it here - it wasn't easy, most of it wasn't much fun and I definitely wouldn't want to do it again, but couldn't it have gone a little slower?

It feels like just a minute ago I was trembling before the almighty OSCE, 30 seconds ago I found out I'd passed the exams, and wasn't it Christmas just now? And here I am training myself to wake up early so that I can start rotation with a surgeon who a friend of a friend heard first-hand say he likes to make students cry. It's goodbye to being a third-year, protected by the nurses, doctors and patients, and hello to being a Final-Year Medical Student, almost an intern and someone who "should-know-this-by-now".

On the plus side, I opened an anatomy book yesterday and it was all news to me, so there must have been a holiday in there somewhere.

A Good Match

Little Sister works for a wine company, and as such is our family expert on wine. She supplied all of the wine for our family Christmas and had carefully matched the wines to the menu, right down to the breakfast champagne.

At about midday, Dad was cooking some prawns for lunch and turned to her and asked, "what would go well with garlic and chilli?" because he just knew she'd have a good wine to match.

Little sister, searching around the kitchen, replied "I don't know ... tomato sauce?"

Merry Christmas, Dickhead.

Two days before Christmas I stepped out into the fresh morning air, ran back inside for a jumper, and then stepped back outside into the fresh morning air. I was to have breakfast at the markets with my sister and a friend before stocking up on fresh fruit for Christmas. The Sun was shining, the air was crisp, and I had woken up before 9am. Life was good.

And then I saw my car. The driver’s side window was smashed and there was glass all over the driver and passenger seats, glass on the floor, glass on the dash, glass on the road. I remembered the loud bang the night before, the hysterical laughter and the squealing of tyres that had followed.

I checked my car – radio: present. Emergency $5: present. UBD: present. Pink bow on gearstick: present. Nothing was stolen – somebody had smashed my window for fun.

So I filed my first ever police report, had the window replaced, and mentally wished that dickhead a Merry Christmas. I hope they choke on their damn pudding.

PS: I hope the rest of you have a wonderful Christmas!

Prose

I used to write stories
In poems - they'd rhyme
I would show them to friends
And they'd laugh

So I never write stories
As poems these days
I use sentences now;
Paragraphs

And I think it's much better,
Less easy to judge
Takes less planning, less angst
And less time

Most important of all
I have found, is that now
I do not have to think
Of a rhyme

Snails

I meet my friend's 4-year-old niece when she and her grandma pick us up from the airport. She greets me by handing me a lollipop (orange, because she wanted the purple one). On the car ride home she chatters away, telling us all about her Daddy's garden - "there are snails in the garden and they eat the tomatoes and they eat the capsicans"

My friend tells her that I ride horses and have horses at home.

"I have horses at my house" she counters

"Really? Do you have horses too?"

"No," she admits, "I have snails"

Unexpected wealth

It's great to discover that you have more money than you thought.

For example, for the past two days I was convinced that I only had $3 in my bank account, whereas in reality I have $3.49!

Glasses of water all round, my shout!

Moving Out

Well, the time has finally come – the "school year" is over and I am cleaning out my house. I will miss my little council-owned house/cottage. It is exceptionally cute with wooden floorboards, a cheesy name (Bedsyde Manor), a random assortment of curtains, and a giant backyard.

Apart from having to pack and clean, another challenge this weekend is to eat all of the food. On the plus side I've already taken all of my chocolate to my sister’s house, so I’m pretty sure that’s been eaten - along with my biscuits and lollies.

Cleaning out the freezer is an interesting task ... yesterday I had Tom Yum wonton soup with extra wontons. Today I had satay chicken stir-fry. Tomorrow I think there are prawns. Sunday is a mystery ... I still can’t figure out what’s in that container. And on Monday I shall eat the frozen banana.

Cleaning out the fridge is much more fun. Beers!

Eeeeew

According to the referral letter, she’s 27. She has vague (but strong) abdominal pain, has been on painkillers but hasn’t had many investigations. The gastroenterologist isn’t really sure why she’s coming to see him. She looks about 50 as she trudges in wheeling a pram. Another lady who is not introduced (sister, maybe?) wheels in a second pram.

The two children have open, bleeding sores on their skin. One has fistfuls of Vegemite crusts which she greedily pushes into her mouth. As I watch she picks at a scab on her hand until it too is bleeding.

The gastroenterologist asks the patient for her weight. She hands me her coffee, “hold this for a minute” and jumps on the scales. I can feel my skin crawl, and I know it is beginning to blister and break out into sores. Gulping, I try not to look down, I just imagine the sores spreading from the coffee mug all the way up my arm.

I am infected and I know it, it’s probably the plague, but I ignore my deepest instincts and do not amputate my own arm. In fact, it’s not until the patient stands up to leave that I slather my hands and arms in alcohol handwash. It might be too late.

Diversional Therapy

Towards the end of the year, I spent the afternoon with the doctor at one of the local nursing homes. Not long after we’d arrived, the residents started their afternoon of “Diversional Therapy” ... those poor bastards.

We could hear it loud and clear from our room down the hall – even with the door closed. The Diversional Therapist, a middle-aged lady who was probably perfectly pleasant, sang in a loud, flat voice all of the songs that old country people must know. “Waltzing Matilda” followed “Road to Gundagai”, which followed some song about “Reading, Writing and ‘Rithmatic”.

Occasionally, unenthusiastic drones from the residents themselves would accompany the “therapist’s” recital.

As I sat there slowly going insane, I wondered how it was even possible for the residents to maintain a semblance of cognitive function. Clearly they were a resilient lot.

Next thing I knew, a shrill rooster call pierced the air, followed by another and then another. They were coming from a female resident down the hall, and went on for the rest of the afternoon, occasionally interjected by her requests for somebody called Julie to “turn off that awful music!”

So that was third year

Well, I'm finished. I found out this morning that I have taken my last ever exam for medical school.

In a good way.

As it turns out, I somehow got more than 65% in the rather horrendous multiple-choice exam on Monday. By how much, I may never know ... but that's fine with me. I'm finished!

I celebrated by ordering new contact lenses, helping my friends study for tomorrow's short-answer exam, and then having a beer with my sister before refusing to go out to a pub.

Party central, right here. Happy Wednesday everybody!

Pick-a-Box

Then there was the MCQ exam. I'd prepared well for this, by doing other multiple-choice exams and trying to remember the answers. The day before (on a beautiful Sunday), I'd huddled in a tutorial room with some friends and we'd worked through several of the past exams. We couldn't agree on all of the answers, and some of them we decided were ridiculous questions, but at least we tried.

I started out the day by locking my shoes in the bedroom and finished it by pouring popcorn all over my lap in public, so it’s hard to say how the middle bit went. But I can tell you that all of the questions we weren't sure about in practice were repeated verbatim in the exam, and all of the questions we thought were easy had been changed slightly so that they became tricky.

If I got more than 65%, then I won’t have to sit the second written exam on Thursday. Given my success in practice exams (50% on a good day), it’s most likely that I will be sitting the second exam.

Of course, I won’t find out until tomorrow, so today is to be spent in ... I’m going to call it purgatory.

Who smiles during the OSCE??

PTR does. PTR smiles during the OSCE. I followed him around, station by station, and became more and more perplexed as he would read the instructions, give a big grin, and enter the room. And as each station ended, out he would come with a big smile on his face as if the station was not only easy, but also funny. Then it would be my turn, and I would read the instructions (nothing funny there), I would do the station ... and I can assure you, none of them were particularly humorous or easy.

The OSCE was strange. In 20 five-minute stations, we were to be assessed on the clinical skills we have obtained over the past three years, and prove that we are doctor-like enough to pass through to fourth year. Armed with only a stethoscope and a biro, we were to face off against the unknown horrors behind each door, ready to prove our knowledge of obstetrics and gynaecology, medicine and anatomy, psychiatry, pathology and perhaps pharmacology.

Well as it turned out, most of the stations were about counselling. I used my stethoscope once, and that was on a dying mannequin. Sure, I’ve been tested ... just not on anything I’d prepared for. Can I read an ECG or an X-ray? Can I do a proper cardiovascular or respiratory examination? Can I suture or cannulate? Can I perform a Pap-smear or a DRE?

Probably. But the school of medicine will never know.

Maggots

An 86-year-old gentleman I saw at the hospital came out with this charming quote:

“it was the maggots, I reckon, gnawing in there and giving me all the pain”.

I was going to share it without context but you might enjoy his story as well ...

He’d been burning off his paddocks in readiness for summer when he noticed that there was a bit too much smoke, so he jumped in the F-100 and went to investigate. Partway there the smoke became so thick that he couldn’t see at all, and he ended up crashing into a fence and bailing out of the truck.

“What happened to the truck?” we asked out of curiosity
“Oh, that went up. So did the petrol tank next to it” he said.
He escaped with only a scrape on his shin, probably from a metal dropper.

The scrape he ignored for several weeks until the maggots moved in. Even then he didn’t want to see a doctor, but his wife insisted – apparently she was sick of having a maggot-infested wound in her bed.

The doctor at the clinic sent him straight to the hospital for proper wound exploration. The poor on-call doctor managed to pick out more than 100 maggots from a deep hole on the man’s shin which, on the surface, was only as big as a 10-cent piece. They had eaten their share of necrotic tissue and then started invading the healthy tissue underneath, creating a large pocket under the skin.

I saw him the next day when his wound was being re-dressed. The hole in his shin was significant, but it all looked healthy and the doctor had managed to scrape out all of the maggots. I asked if there was any pain and he said “no, not today – it was the maggots, I reckon, gnawing in there and giving me all the pain”. Good to know.

Cat Poo

Going through my PBL notes today, I found this:

Alcohol: no alcohol is best
Pets: don’t eat the cat poo
Caffeine: 1 coffee max. Reduce soft drink intake

It must have been a funny joke at the time, but now I have no idea why I felt the need to add the line about cat poo. Do pregnant women have cat poo cravings?

And I thought the famous "pickles and icecream" cravings were disgusting.

Vampire

She was referred to the general surgeon with non-specific abdominal symptoms.

She was playing with her daughter one day and suddenly became nauseated, and since then has had nausea on and off.
My brain: nothing. No idea.

She’s been feeling exceptionally cold
My brain: ooh - maybe she’s a vampire?

She’s been off solid food and can only drink liquids
My brain: she’s probably a vampire

She’s suddenly repulsed by the smell of garlic. She even feels like vomiting when somebody says the word ‘garlic’
My brain: she’s a vampire she’s a vampire she’s a vampire

The surgeon wasn’t sure about a diagnosis and booked her for endoscopy. After she left he turned to me and asked what I thought.
My brain: vampire vampire vampire vampire vampire
Me: I, um ... I really have no idea

Quoteblog #10

“I’ve seen Arachnophobia and Charlotte’s Web as well” – Clinical Educator on why he doesn't like spiders

“Oooh, hello, that’s my bum!” – Surgeon, overly excited about his phone ringing in his pocket

“I like firm things!” – female student ... then, “ohhh, I shouldn’t have said that”
(She was referring to her firm jeans)

“You were tickling them, you weren’t blowing them!” – female student on how to blow whistles

“You can eat me under the table any time you want” – One male student to another, hopefully talking about food

“No, no – my waistline is outside the Australian Heart Foundation’s recommendations” – Cardiologist after being offered a cupcake

Do dogs eat cake?

I made cupcakes tonight for tomorrow’s PBL day.

Sprite was immediately convinced that dogs could eat cake. I fed her sausage and she was like, “No ... dogs don’t eat sausage. They eat CAKE.”

So I let her try some. She took the cake delicately from my hand, set it on the floor, and contemplated it for a while. But she couldn’t back out now – she had to eat it. And that’s when she realised that maybe dogs aren’t meant to eat cake. Mlup, mlup, mlup, she worked her jaws as the cake turned soggy in her mouth and stuck to her teeth. But she battled on bravely and choked it down.

She went off for a drink and I thought she wouldn’t come back, but a minute later she sidled up to my chair and looked up as I ate another cupcake. More? I don’t think so Sprite. But she turned her head, dialling up the cuteness until I couldn’t resist, and I fed her more cake.

And now she is an expert on eating cake. She doesn’t even go “mlup mlup mlup” anymore, she eats it like it’s food.

Even when I was out of cake, she wasn’t fooled. She could see the stack of patty pans on my plate.

Dogs can eat paper.

Cardiac Revelations

Aortic stenosis murmurs sound different to mitral regurgitation murmurs!

I discovered this last week when I listened to a gentleman's heart and heart not the "whoosh whoosh" of mitral regurgitation but a little "vrmmm vrmmm" which happened to be aortic stenosis. It sounded like a little motor trying to start up between every S1 and S2 (because we all know that both AS and MR murmurs are systolic).

I was so amazed that I told the on-call doctor (who already knew this amazing fact) and she made me go and listen to everybody with a heart murmur. And I excitedly hurried off to do exactly that because heart murmurs are now amazing.

God help me, I'm becoming a nerd.

Orrina

"I have seen fomme in my orrina" says the Italian man

"Your ... orrina?" I reply, puzzled. Between his thick accent and ill-fitting false teeth, communication has been a struggle.

"My orrina" he gestures vaguely at his abdomen, "You know, with the toiletta"

"And how long has there been foam in your urine?"

Accommodation

I have my accommodation sorted for next year. The original plan was to share a townhouse on the university campus with my boyfriend, but then he told me how much rent cost these days and I changed my mind. Sorry.

It’s been four years since I’ve paid rent – this year my rent is free because I’m on rural placement, and for three years before that I worked as a Residential Coordinator on campus and hence rent was incredibly cheap. But I remember how much I struggled to pay rent as well as buy food every week back in the day when I paid full rent on campus. Taking into account the fact that rent has increased alarmingly each year since then and Youth Allowance has not, I was terrified at the thought of trying all that again.

And so my little sister, who has an actual job and lives all on her own, offered to take me in. We came to an agreement in a series of long phone calls interjected frequently with important information such as “my dog is so cute! She’s laying down” and “so is my dog! He barked at somebody today”. The agreement is fairly simple ... I just have to pay a bit of rent and make a lot of food.

Mum thinks it’s a terrific idea. She hasn’t said so but I know it’s because 1 – I can ‘keep an eye on’ little sister and 2 – I won’t be living with a boy. Little sister thinks it’s a great idea because 1 – Food, 2 – Oh my God we can share clothes, and 3 – I think she’s sick of living alone.

There are many potential disasters, and I know this, but it still seems like a pretty good option because we get along really well in between fights, and also I’m on Youth Allowance and she isn't charging too much rent.

Things look all too simple at the moment because both of us are living alone and have forgotten how annoying house mates can be. But I have been responsible and produced this list of possible cons:

1. Little sister’s house is miles away from uni. This will probably start to annoy me after a few weeks or months.

2. “Sharing clothes” means different things to different people. Little Sister is already prone to sneaking items out of my wardrobe and not returning them for months or years, so I hope this new arrangement means that she’ll return them sooner because they’re legitimately borrowed.

3. I don’t particularly enjoy cooking, especially “real food” such as is expected at dinner time. I do, on the other hand, excel at making cakes and biscuits, which I enthusiastically pointed out. Little sister’s reply was “um ... we’re going to ... we kind of need to eat vegetables sometimes”.

4. I’m going to have to hide my chocolate stash REALLY WELL.

5. I'm adding "arguments over the bathroom" because this is inevitable.

Stay tuned next year to hear how we get on!

Dog #2

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

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

Save Keith Hospital

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

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

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

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

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

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

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

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

Above: today's protest at Parliament House, Adelaide.

Below: Keith Institute full to capacity during the town meeting. All seats were full well before the meeting began, and people stood in hallways and in outdoor areas during the two-hour meeting.

Respiratory Revelations

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

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

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

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

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

And somehow I am still on time.

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

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

Showjumping #2

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

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

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

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

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)