Note to self

Just because it's the last day of rotation, doesn't mean it's Friday. Calling a vascular surgeon to make a referral and apologising for calling so late on a Friday doesn't make you seem considerate. You will seem disoriented and even saying clever things like "progressive carotid stenosis" and "possible need for endarterectomy" won't save the situation. You will get to fax your referral and wait in line just like everybody else.

Livatone Shots

Me, "Your liver function tests are a bit off. That's mostly because of your drinking"

Patient, "So you think I should take some of those Livatone shots then?"

Me, "No. I think you should cut back on your drinking"

PS I've been Googling Livatone shots, report to follow

Clinic Art

Some recent artwork from GP consulting:

Normal bowel (above) and diverticulitis (below)

Me, by my patient Brianna (4years)

This one is anyone's guess. Brianna wouldn't tell me. Possibly a diagram of the digestive system. Possibly a complicated break-in plan for the medical clinic. Or maybe I've got it upside down and it's an elephant fishing.

The more things change ...

I am quite enjoying my GP placement. Last week when I had an external assessor sit in for half a day and "inconspicuously" watch me consult, he said I was "pretty good for a first-term intern". And, safe in the knowledge that my terms this year are strictly laid out and non-negotiable, my supervisor recently asked if I'd like to stay for the whole year. Very encouraging.

And today I spent the afternoon with a Wiggles bandaid on my finger after cutting my finger opening a tin of Milo at lunch time. Then I had to leave a consult partway through because the patient couldn't take me seriously until I'd rid myself of my hiccups.

The more things change, the more they stay the same.

This is not a ghost town

A couple of shots from the town where I'm placed ...

... yeah that's my mailbox.

First Day

There aren't many occasions when you can use the excuse "but it's my first day!"

Today was my first day working as an actual doctor and getting paid to do doctoring. Although I'm contracted at a large regional hospital, my first rotation is in a smaller town at a GP clinic. In fact, the same GP clinic where I spent all of 2010. So I'm not new. The doctors all know me, the nurses know me, the reception and admin staff know me. I know how to use the computers and how to set up the right printer. Still, one of the practice partners spent several hours going through all that with me this morning.

After that I had an hour for lunch, and then when I came back they gave me a laptop and sent me home for the day.

Try as I might, I just couldn't throw in the "it's my first day!" excuse.

Oh well.

Finished

So, I've finished medical school. No longer a medical student, not yet a doctor, I am enjoying the blissful in-between stage where I don't know how to introduce myself but at least I've finished all of my assessments.

Our esteemed School of Medicine has lost a few fans this week. Our 6-weekly assessment forms which we are not allowed to touch or see, suddenly became our responsibility on the last Friday when our administrators decided it was our job to make sure they were all handed in ... by Monday. So they kindly provided 60-something students with a list of their incomplete assessments and told them to chase the forms up or else their graduation would be delayed. Well handled.

At least the week-long celebration known as "Grad Week" is run by students who want nothing more than to see their classmates / colleagues having a great time. Starting with a champagne breakfast this Thursday and finishing with a ball after the graduation ceremony next Thursday, the week is packed with various activities to entertain the new graduates and their families.

I'm most excited about seeing the printed version of the Yearbook which I've spent the year putting together with the help of an insanely talented classmate. It was a well-timed coincidence that the printer demanded an electronic copy during the last week of med school, because it's been a brilliant excuse to avoid schoolwork.

Luckily, I enjoy finishing projects slightly more than I enjoy procrastinating. And med school has been one hell of a project.

Needles

The only vein the anaesthetist could find to cannulate was on the patient's inner wrist - a location that can be quite painful.

From where I stood on the other side of the bed, I noted that the patient had a small tattoo on their arm and said cheerfully, "well you're obviously not afraid of needles in your arm!"

The patient just looked at me and then turned back to the anaesthetist, who deftly threaded the cannula into the small vein and undid the torniquet.

And that's when I saw the track marks.

.

Lolly Drop

When I was much, much younger, the highlight of the local picnic races was always the "lolly drop". It was far more exciting than the races themselves, or even the horse high jump.

A local pilot would fly over the paddock in a light plane and release hundreds of lollies as us kids waited anxiously for permission to run out and collect them. When those in charge decided we were no longer in danger of being killed by Minties falling from 3,000 feet, we would all sprint out and fill our hands, pockets and jumpers with lollies, eating them as we went. Nobody ever missed out and missed lollies could be found in the paddock up to a year later.

And then as the years passed, the picnic races faded away and the lolly drop became just a fond memory.

Until a few years ago, it was reinstated at the Keith Show. As sponsorship has increased (mostly from locals who remember the glory days of the picnic races), the lolly drop has once again become the highlight of the day for local kids ... and their parents.

Antigonish

Yesterday, upon the stair,
I met a man who wasn't there
He wasn't there again today
I wish, I wish he'd go away ...

Wheh I came home last night at three
The man was waiting there for me
But when I looked around the hall
I couldn't see him there at all!
Go away, go away, don't you come back any more!
Go away, go away, and please don't slam the door ... (slam!)

Last night I saw upon the stair
A little man who wasn't there
He wasn't there again today
Oh, how I wish he'd go away

Not sure why, but part of this poem by Hughes Mearns popped into my head today.

Uh-pinion

Comment on a news article about Australia's most admired women.

The list was compiled by surveying about 1200 Australian females, and included the likes of model Miranda Kerr, Olympian Cathy Freeman, actress Cate Blanchett, Fred Hollows Foundation director Gabi Hollows and our PM Julia Gillard.

I'm sure they all have very admirable qualities and I'm sure even the broad-accented Gillard knows how to use the word "use".

Time to find a new role model, Maria!

Zero

I can't pretend to be the greatest student in the world.

That said, when a fortune teller in Singapore told me I would top the class in October, I allowed myself to become quietly hopeful. As all my classmates started getting their grades for our first big assignment, I kept checking and re-checking the student system, waiting for my grade to appear.

And yesterday, it finally happened - a notification saying "New Grade - Evidence Based Medicine".

I hurriedly opened the link, to see ...

Zero! Reviewed by the Section Instructor and everything, so it couldn't be a mistake.

I quickly looked for an email telling me to pack my bags and find a different career, but there was nothing.

In a panic, I called the course administration unit to ask what to do about it.

"Oh, just ignore that" was the breezy instruction, "I accidentally put in a grade but yours isn't marked yet. I couldn't leave it blank so I put a 0".

Oh. Thanks.

Abbreviations

BPAD = Bipolar Affective Disorder

BPSD = Behavioural Problems Secondary to Dementia

.

Orientation to Time

Me: "What year is it?"

Patient: "Now what do you mean by that? What year is it now, or what year is it in October?"

Me: "Um ... what year is it now?"

Patient: "September"

I give her a point for knowing the month.

Me: "And what year is it?"

Patient: "Not a year I should be living in"

Me: "Do you know what day of the week it is?"

Patient: "Well it should be Sunday. But it's not. It's Tuesday"

Me: "Very good"

Subjective Cuteness

My dog Sprite is the cutest animal in the whole wide world. That has always been my firm belief.

But then I tried taking photos of our two dogs on the weekend.  My sister's dog 'Doggers' looks exactly the same in photos and real life. Sprite, not so much. Her photos do not look cute at all.

Doggers looks just like this in real life

Sprite, I believe, looks much cuter in real life

And then I had the shocking realisation - what if she's not as cute as I think she is?

And then another thought - it doesn't matter.

A Banana and an Orange

The "Frontal Assessment Battery" (FAB) is supposed to be an objective measure of the functioning of the frontal lobes of one's brain. The frontal lobes deteriorate in certain types of dementia and people become disinhibited, lose mental flexibility and are less able to conceptualise material.

I did the FAB test on someone who'd supposedly had a bifrontal lobectomy (both frontal lobes removed) and they scored points, which says something about either:

1. The brain's ability to compensate

2. The surgeon's ability to remove parts of the brain, or

3. The FAB test itself

I'm not a huge fan of the test itself. Some of the questions are quite difficult, because it's not clear what you are being asked. Take for example, question 1.

"In what way are they alike?"

1. A banana and an orange

2. A table and a chair

3. A tulip, a rose and a daisy

Try answering them now.

There is only one correct answer for each.

1. The only correct answer is "they are both fruit". "They both have peel" is a partial failure and you don't get a point. "They're nothing alike, what a stupid question!" will also get you 0 points.

2. A table and a chair are both furniture. Yes, they "both have legs" and technically they are both "optional", but only "furniture" will get you the mark.

3. A tulip, a rose and a daisy might be "strange bedfellows" to an avid gardener, but unless you say that they are all flowers you will lose a mark.

Not an impossible test, but hard work for patient and examiner. I've included the link above if you feel like testing someone you know ...

Circle of Life

When I was younger we used to have bushes around our house that had very pretty purple and white daisy-like flowers. Unfortunately the garden snails loved them, and whilst they didn't do much damage to the plants, it was really annoying to have an enormous snail breeding-ground right in front of the house.

So we acquired some ducks which, in case you didn't know, are snail-eating champions.

Unfortunately duck eggs are a funny blue colour and nobody ate them because we also had perfectly normal chook eggs to eat.

So we made cakes to use up the duck eggs.

And then we got sick of the ducks because they're messy and awful, so we sold them all. Nobody wanted a whole flock of ducks, but our Vietnamese neighbours bought a pair every week until they were all gone.

And then we pulled up all the plants.

And that, kids, is the circle of life.

Busting

Patient on Psychogeriatric ward: "I couldn't piss before and now I'm fuken busting for a wee"

Correctly interpreted by a nurse as: "I've forgotten where the bathroom is"

Firefox Fail

Just in case you didn't know, I am not somebody you want to have around your computer. I can crash the uncrashable, freeze the unfreezable, download viruses from perfectly legitimate sites and uninstall programs without your permission. So it's helpful when computers give very specific reports of what has gone wrong - like this one from 5 minutes ago:

Home

Just past 6 o'clock on Saturday morning, Qantas flight QF82 touched down on the Adelaide runway.

I left home in May and now, four months, three continents, ten countries, several travelling partners and countless eye-opening experiences later, I am home at last. Right up until the last day I couldn't imagine my little adventure ending ... an outlook which resulted in much scrambling to pack, finish assignments and do last-minute souvenir shopping (none of which I completed successfully).

Somebody asked if I'd returned as a whole new person and no, I don't think so - I think I'm the same old person who's now seen a lot more things. A lot of things that I'd never hope to see again, but have opened my eyes a bit more to the world. 

It's a big place.