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.”