Save Keith Hospital

The SA Government has decided against all advice to withdraw half the state funding for Keith Hospital. When told that the hospital would be forced to close without this funding, the Government representative replied "I don't care".

He doesn't care if a country town loses its hospital. He doesn't care that this jeapordises the lives of the people in the area and the thousands who travel the dangerous highways around Keith every week.

How is the Minister for Health possibly doing his job, when he is purposefully putting South Australians' lives in danger? When he is purposefully removing health services from what is, at present, a thriving and productive country town? Closing down hospitals is not in the best interest of the public, the economy, the state's health ... or the Government.

Keep our country hospitals alive.

Photo from www.hmcr.com.au - thanks to Hattam McCarthy Reeves for supporting the cause.

Postprandial Hypoglycaemia

During one of many, many coffee breaks, my clinical pharmacology supervisor mentioned a strange condition that really caught my attention. Maybe you have heard of it, but it was new to me and so I will share it with you because that's what I do. It's called "Postprandial Hypoglycaemia", and patients experience symptomatic low blood sugar within a few hourse of a high-carbohydrate meal.

Wikipedia seems confident that researchers know all about it, but my supervisor is also an endocrinologist and he tells me that researchers are actaully still arguing about the mechanism. He believes that it occurs when the stomach allows a high-energy portion of food into the duodenum instead of carefully rationing it out over time. This leads to a glucose spike, which causes a massive release of insulin - too much for the glucose that is present. When the insulin does its job, the blood sugar levels crash down and patients become fatigued, dizzy, light-headed and irritable.

Another theory is that a poorly functioning pancreas releases disproportionately high levels of insulin, to the same effect.

I asked, how does one treat such a complex endocrinological disorder? As it turns out, management is simple - eat frequent low-carb meals. Nice.

Paget von Schroetter

"What's Paget von Schroetter disease?" demands the consultant
"I ... I don't know" I reply
"I'll give you a minute to think about it" he says generously
"I might need more than one minute!" I fret
"Then you have five minutes and Google" he says, "Go!"

Just in case this ever happens to you, you will be able to tell him:

• Paget von Schroetter disease is a condition characterised by DVT of the subclavian or axillary veins
• It is rare, occurring mostly in young, healthy patients, males more than females
• It's caused by exertion around the shoulder girdle (although it can also be spontaneous)
• This causes vein damage, which leads to scarring, causing stenosis, leaving the section more prone to thrombus formation

I think he knew all this already, because he didn't actually ask me for the answer in the end. But now we all know.

Fractions

"So they've gone from having quartiles, to having duo-whatever" - student

"Halves" - consultant

"Yeah ... halves" - student

On Luck

Better lucky than good?
Or lucky because you are good?
Or only good because you are lucky?

Do "lucky" people actually have a higher allocation of luck than others?
Do they use more of their luck?
Or do they use it on bigger, more noticeable things?

On your "unlucky" days, do you have less luck than usual?
Or are you not noticing when you are lucky, and simply focussing on the bad?
Is it possible that your share of luck has been given to somebody else for the day?

Scholarship

I just sent in my papers for a fairly significant scholarship. This scholarship will mean an end to my poor-student status and allow me to stop worrying about sourcing funds for expenses such as electives, rent, textbooks, food and new socks. I should be euphoric. But intermingled with feelings of relief and hopeful anticipation, is a deep-seated resentment towards the organisation.

Applying for this scholarship ranks as one of the hardest things I have done in medical school.

The online application, which I completed just before applications closed, was a true test of a student’s ability to decipher unnecessarily overcomplicated jargon (and not even medical jargon). In the end I gave up and skim-read all of the questions before hastily adding my responses.

I was pretty excited to hear that I’d been awarded the scholarship “conditionally”, as all I had to do was provide a few supporting documents and sign a statutory declaration form. Easy.

Then I looked at the list of documents.

• A letter from the university (sounds simple unless you’ve met our coordinator).
• Copy of my birth certificate
• Centrelink income statement

Not too hard to find ... I kept scrolling down the list

• Tax office notice of assessment from 2008-09, and 2009-10
• Statement from an employer to prove I’ve been employed in a rural area
• Membership card from a rural sporting club
• PRIMARY SCHOOL REPORT CARD

Do they really need to know all of this??

I spent an agonising 20 minutes with the poor pharmacist who’d agreed to certify all of my documents, carefully checking and double-checking that we had everything on the list before I sent it off with all of my hopes and dreams.

And then I spent a good 20 minutes Google searching the organisation to make sure they weren’t just trying to steal my identity.

Unlucky

I was all out of good luck by Tuesday.

• I started out by losing my boyfriend’s house keys (which he found some 16hours later in the pocket of my jacket). 
• I went to Centrelink for an Income Statement, only to discover that I could have printed it myself from the website
•  I bought a coffee at the shopping centre and immediately tripped and spilled the whole thing. 
• I realised at 11am that I didn’t know where the 11am meeting was, or what it was about, and so spent 15minutes running around trying to find it and arrived late. 
• I went to visit a relative who’s having elective surgery ... in the wrong hospital. 
• When I got to the right hospital, I broke the controls for adjusting her bed. 
• My team came dead last in quiz night. 
• And then I had a coffee before bed and got to lie awake replaying the day in my head. 

Unlucky.

Lucky

On Monday night I had some great luck. My friends and I went to see a movie in the city during the Fringe festival, and instead of driving around for hours looking for a park like I’d expected, I found one immediately right outside the cinema. Then the popcorn boy accidentally gave me a discount because he thought I knew the person he was chatting to while he was supposed to be serving. Then after the movie, the driver of a very fancy Audi didn’t crash into me; he merely beeped his horn when I accidentally turned into his lane. Lucky!

Feet

Vascular surgeons have a special obsession with feet. Whether they're getting their noses in close to slimy toes to inspect ulcers or wrapping their bare hands around a stranger's foot to feel for pulses, they rarely let a patient into the ward without first thoroughly inspecting their feet.

One ward round we happened upon an elderly man who'd been admitted overnight and the surgeon asked, "do you mind if I look at your feet?"

 "Yeah, sure" he replied, "suit yourself. I've only got two"

After a few minutes of prodding and poking the man mused, "If you keep looking long enough, you'll find somebody that's got three feet"

Wouldn't that be the vascular dream?

Board Games

The first thing I noticed on my first day of placement was the cupboard full of board games in the doctor's office. Monopoly, Jumanji, Connect Four, Battleship, Memory, Draughts, 6 or 7 puzzles and a few card games - that cupboard was almost overflowing.

Clearly, I had hit the jackpot - did we do ward rounds, get coffee and then play games all morning?

But then several days passed with no games sessions, and it dawned on me that the games must be there for another purpose. And yes, as it turns out, the games are for the therapists and they do therapeutic things with them that probably involve the patients.

Fair enough. After a few days / weeks / months in a hospital bed, the patients probably get bored - much more bored than the doctors who have lots of actual jobs to do, or the medical students who have to look busy all of the time.

But today (when all of the doctors were busy elsewhere) I discovered a game that I hadn't seen in the cupboard before - a card game titled "52 Drinking Games".

Maybe they do have secret parties in that back office ...

What do fourth-years do?

Five weeks into my final year of medicine, and I am still puzzling over what to do. Not in a philosophical 'what am I doing with my life' way, but more of a 'what am I actually meant to be doing right this minute' kind of way.

In the beginning I would follow the interns eagerly, doing all of the jobs they gave me - filling out medication charts, taking blood, putting in jelcos and seeing patients. And then the Professor kindly gave me an audit project and for a while I dedicated all of my time to wondering what that was all about. 

And then we went from three interns to two, so I switched back to "helping out the interns" by filling out med charts, seeing their more stable patients and fetching coffee (we no longer have time for regular post-ward round coffee breaks). Not that anybody asks me to do anything, and they always look genuinely surprised when I do something, so I'm not entirely convinced that they need me there. 

So my working hypothesis is that fourth-years do whatever they want. 

I'll let you know how that works out once term ends and I get my first piece of feedback for 2011.

Princess Cake

When I asked Little Sister what kind of birthday cake she wanted and she responded with "Princess-themed!", I must admit I grimaced. I have a slight aversion to those cakes with an invariably creepy doll in the middle where the cake forms the skirt. So I had to come up with a better idea.

Finally, 6 or 7 hours and many frustrating moments later, I had created the masterpiece: a pink-and-white vanilla marble cake styled as a crown!

Behold!

PS Little Sister - happy 23rd!

No Daughter

"You didn't speak to my daughter - I don't have any daughters!" - 86-year-old man during ward rounds

"But I spoke to your daughter yesterday on the phone" - Registrar

"Which one?"

(registrar gives daughter's name)

"Oh yeah, and what did she say?" - patient, remembering that he does have a daughter after all