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.

Code Blue

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

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

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

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

I wonder who would come.

Recovery

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

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

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

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

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

Immunisations

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

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

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

Med Ball 2010

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

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

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

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

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

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

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

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

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

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

The Couple

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

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

Tom

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

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

Tom beamed proudly back at us. So cute.

Out of Pocket

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

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

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

The Photo

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

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

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

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

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

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

Convenient

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

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

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

Quoteblog #6

“High jump was my absolute low point” – Student

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

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

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

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

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

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

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

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

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

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

Grumpy

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

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

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

Yes

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

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

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

"WHY?" ... "yes"

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

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

And I thought she was confused.