Same Same

October 23, 2011

Walking on beach with husband, catching up on our respective days, late afternoon:

Him: …and we had FOUR hours of this lecture on motion and inertia. It was actually really interesting once you understood the forces of (insert physics gobbledegook)…and stuff.

Me: I spent most of the day learning why old people fall over.

Him: Which is essentially what my lecture was about!

(Cue detailed explanation of the physics of old people falling.)

Convo of the day

September 27, 2011

Patient being investigated for fatigue, vitamin deficiencies and abdo pain. Outpatient department:

Me: …and what’s your diet like?
Patient: Oh, I don’t eat.
Me: Sorry?
Patient: I don’t eat food. I’ve never really cared for it.
Me: Okay.
Patient: I’ll usually just have a juice. You know? Like one of those 600ml bottles with banana and chia seeds.
Me: *blinks*
Patient (oblivious): sometimes I can make one of those bottles last for three days!

Ethics: don’t be a shit person

September 20, 2011

One day, I hope to be a clinical educator and lecture medical students in ethics.*

I could save universities time and money with my easy one step process to ethical enlightenment.

Step one: Don’t be a shit person

I would have lecture slides each with various fonts stating “Don’t be a shit person”

(there would, of course, be hyperlinks to direct them to the definition of “shit person” and maybe a demonstrative youtube video)

Students could buy a pocket book from my online store to help them through various difficult situations in hospital.

Each page would say:

“Don’t. Be. A. Shit. Person.”

There would be an Iphone & Ipad app.

I’d also sell those silicone wrist bands with “D.B.A.S.P” on them.

Thus ending the tortuous pain of medical students everywhere who attempting to write 3000 word ethical essays analysing cases that could essentially be summed up into one sentence (see above).

*Not. Really. Unless I get to roll out the above plan. Then it’s on.

Friday Night Emergency Psych Admissions

September 19, 2011

Two patients:

One looks “crazy”

(unwashed young male, excessive scratching, fidgeting, creepy eyes, wiping snotty nose, picking ear, picking at skin, irritable*)

One doesn’t look “crazy”

(well dressed middle aged woman, well groomed, hygienic, no abnormal movements or speech, polite, cooperative)

Guess which one got a psych admission into the locked ward?

yup.

Because no matter what you look like

if you think  you’re a CIA agent with a GPS in your head

you’re in.

 

 

*otherwise known as the state one gets in when police have just seized amphetamine producing equipment from your apartment and you have a court hearing on Monday and would like a convenient psychiatric admission (for “like, seven days?”) to avoid dealing with those particular issues.  Oh, and you’re really high. And may have confused ‘Hospital’ with ‘Hotel’, “I really wouldn’t mind, like, a sandwich or something?”

Cafe Psychiatry

September 18, 2011

To thank dutchboy for continuing to cohabit with me despite frequent melodramatic outbursts, I booked us into a coffee appreciation breakfast. Our friends Jas & Kris had been and enjoyed it so much that they blogged about it here and here.

We love Canvas and the breakfast was beautiful, Brendan from deluxe Boutique Coffee Roasters was lovely, knowledgable, and full of interesting facts, and overall it felt very indulgent. Stephanie Lawson has a gorgeous cafe, and knows how to make people feel welcome. Just what we needed to get ourselves ready for a summery sunday full of assignments and study.

My favourite part however, was not the coffee, the decadent pastries, or the beautiful cafe decor. It was a fellow guest, straight out of Faulty Towers, or Monty Python.

Before I begin, let me preface by stating that this was a premeditated event.

You had to book.

And pay money.

Get a ticket.

Emails were involved.

And it was called “Coffee Appreciation Breakfast”

So,when the middle aged woman with chemically enhanced blonde hair,  younger-than-age-attire, who was running 20 minutes late, declared to the table that she “doesn’t drink coffee” because she “hates it” and she wants a “hot chocolate on skim” it was all I could do not to laugh. She. Was. For. Real.

She then proceeded to interrupt while the brewing and pouring went on, whilst  he was trying to explain various aspects of the house blend, describing the regions in Indonesia that produce certain types of flavours and the differences between a dry press and a wet press, the best grind for an espresso vs a drip filter vs a stovetop, with such gems as:

“Aw, that stinks”

“Yuck”

“Ohhhh I hate coffee”

Nibbling on a tart “Oh, at least these are good!”

The impeccably poised, patient and well spoken Brendan never faltered and is clearly much more sophisticated than dutchboy and I, who were resisting the urge to alternatively guffaw into laughter and fling our respective pain chocolat and croissant at her.

My cafe psychiatric diagnosis is Histrionic PD

So, thank you crazy lady, for the funniest pythonesque encounter I’ve had in a long time.

 

baby bird

September 18, 2011

it grabbed my eye as we were walking on the path towards the beach

this tiny little feathered thing

gasping for breath

wing torn off

covered in ants

we stood there sadly for a moment

I picked it up

it was gasping silently

no noise at all

tiny beak opening and shutting

little tongue stretching out

little lungs inflating (equally)

brushing away ants I looked at dutchboy

vet?

where?

it’s 5pm on saturday afternoon

god

but its breathing so hard

silently

that tree is really high

shit

we hurried back to our car

the tattooed boys outside the skate shop tell us there is a 24hr vet nearby

not nearby enough as I’d like

we both know its probably not a happy ending

but its breathing really strongly

and you can’t leave a tiny feathered thing alone

 

tiny silently gasping feathered things die on the side of a footpaths

all the time

but yesterday this one died en route to the emergency vet

about five minutes before we got there

its grey fuzzy head resting on my palm

we kept driving

partially because we didn’t know what to do with a tiny dead bird

partially because I knew the vet would have antiseptic wash

 

I scrubbed

(twice)  thinking;

something only seems ‘disgusting’ or ‘unsanitary’ after its no longer necessary

if its perceived to be necessary you just do it

(DREs, disimpaction, pressure wound care)

and try not to think about it later

there is a scenario often tossed around

in CPR talk

would you do mouth to mouth without a mouth cover?

the consensus is no

you don’t need to

its not necessary

just do compressions

But I think I would

not because of some morally upright stance

but accidently

because of naive adrenalin fuelled instinct that fails to take into account vomit

blood

infectious diseases

or

ant covered dying birds

 

Imprinted.

September 16, 2011

During my early childhood my father was occasionally burdened with caring for me solo (my mother probably had a pesky childbirth to endure, or a really long hair appointment) and he would take me on his ward rounds to see his inpatients. In the 80’s in that town most of the GPs looked after their patients whenever they went to hospital which meant getting there really early before work or late into the night after work had finished.

I remember the bright long corridors. The way the nurses shoes made a clacking noise on the lino. The ugly lino. The ugly carpet.  And the smell. Antiseptic. Old people. What I know recognise as the faint odour of infection and colostomy bags. I remember I couldn’t see over the foot of the hospital beds so I couldn’t have been more than three or four.  He would bring me around to the side of the bed, & introduce me to dying old ladies who looked like skeletons with crocheted blankets over their knees. They had bags hung up around them. Bags with urine hanging from their beds. There were brightly coloured boxes of wilting flowers on the bedside tables.

Then later there were mornings when my brothers and  I would sit, in our tiny school uniforms, dried toothpaste still on our faces, on shiny patent leather chairs in the reception of various funeral homes and crematoriums while he filled in paperwork and certified bodies for cremation. Swinging our scuffed black shoes, kicking the chair legs. Vases of ugly white flowers. A shiny brown laminate reception desk. A book of coffin pictures. At some point we got old enough to be allowed to stay in the car outside.

Home visits were similar to the hospital rounds except the houses were usually dark & had their own smells. Dinner. Baking. Musty carpet smell. Dark orange carpet was really in. People had brown & green velvet curtains. They also had tubes up their noses, metal oxygen tanks and worried looking wives or husbands. We’d look at ceramic collectables in cabinets while he examined the patient. Sometimes they’d pull out a box of  their grandchildren’s toys.

Later I had no reason to go to a hospital (or a funeral home) until we had to do our one hour a week clinical training in first year. I dreaded it. I hated the corridors. I disliked the uniforms. The skeletons with crocheted blankets. That smell. The ugly lino. It was a different hospital but it was just the same vintage. Everything was so old. I would get out of there as soon as possible. I decided would do my minimum hospital training and get the eff out of there. Become a GP and have a nice office without lino. I’d have potplants. Yeah, muthaf*cker.

But now…after this year…

Now its familiar. That smell. The tubes and bags. The hospital issue bedsheets. The ugly lino that cleans so easily. The consult rooms with ugly brown chipboard desks. I look at those desks and see my dad when he was roughly my age now, with his wire framed aviator style glasses and 80’s black doctors bag. We’d visit him in his rooms. He had a tall metal filing cabinet and next to it a desk. A desk just like that.

It’s comforting.

Out, out damn spot

September 15, 2011

Slip. Slop. Slap.

Except I didn’t. Well not when I was a teenager anyway. We lived at the beach. Being tanned was super cool. So we all roasted on the beach like rotisserie chickens. We would time how long we’d been sunbaking on one side to make sure we would roll over and “be even”.

This was before one of my classmates died of melanoma at 17. In our final year. During our HSC. It was balls.
We went straight from our final exam to his funeral and lined the street  in a guard of honour for the hearse to drive down.

I didn’t sunbake very much after that. Whenever I did end up in the sun I felt too guilty. So I covered up. But the damage is done. Well, was done, WAY before I woke up to myself. More that 5 serious blistering sunburns before age 15. Uh..Tick. Family hx of skin cancer. Tick. More than 50 moles. Erm…Tick. Pale skin, freckles, green-blue eyes. TICK, TICK and FRICK.

According to some studies, Australian 12 year olds have the same fine lines and wrinkles from sun exposure that European 30 year olds have.

Ugh.

Even though I get regular…ish skin checks my recent stint on Palliative care looking after metastatic melanoma patients left me a little edgy. Then a dermoscopy workshop where the facilitator strongly suggested I get a few, uh, slightly irregular pigmented lesions “looked at” (read: YOU HAVE CANCER. COMPLETE YOUR WILL & START DISTRIBUTING YOUR BELONGINGS) didn’t help.

So I got them “looked at”. Then I got them “cut out”. Then I got the “pathology back”.

They were all benign.

Phew.

But…

They were all junctional naevi with a higher risk of developing into malignant melanomas.

Yippee.

Where is that sunscreen?

Cheese & W(h)ine

September 13, 2011

A MAO Inhibitor nightmare.

Tyramine and ex-veganism aside, I love a good party.

Or evening get together.

Or random gathering.

Or predrinks.

Or afternoon nibbles.

Or wine & snack by myself…

Jo Goddard from Cup of Jo has a handy guide to creating the perfect cheese board.

I think a good platter needs a soft and a crumbly cheese, always a blue, a little pile of dried fruit (apple slices, apricots, raisons) and a little pile of nuts (walnuts, cashews, pecans) and some fresh fruit (apple, pear slices, strawberries, grapes). Crackers optional.

But what you really need is five or more friends (at least), copious amounts of wine in crystal cut glasses (50 cents each at your nearest op shop), and more food than you really need. And always a bowl of olives. With pits. Good olives.

Then talk shit and shove food in your face whilst shrieking and talking over the top of each other and cackling at the hilarious things you all say. Get all the hideous hospital stories off your chest. Spill a bit of wine in the kitchen.

Repeat at least fortnightly.

We have been.

On being a patient

September 12, 2011

Accessing health care when being a medical student is a curious thing.

We didn’t have a doctor as kids. My GP dad would occasionally dole out half-hearted advice while he was tiredly doing something else like “Have a glass of water” or “you’ve got blah blah infection – take this (out of date, leftover, with someone else’s name on it) tablet/cream”. I don’t remember taking a lot of paracetamol or nurofen. Or getting a lot of sympathy for anything. As a result when I moved out of home I never went to a doctor for anything much.

Over the last three years medical school induced hypervigilent awareness of my body  has led to many “oh GOD I have cancer IN MY LUNGS/STOMACH/TOE” moments. But despite this hypochondria, or maybe because of it,  I actually managed to delay seeing someone for a condition that I actually had. Oops.

EARLY 2010, LATE AFTERNOON, DR’s OFFICE, SUN STREAMING THROUGH WINDOW

Me: So just here for the pill again thanks.

Dr (making conversation waiting for script to print): soooo how long have you tricycled* this?

Me: Well…I don’t really tricycle…I just keep taking active pills to avoid it  for as long as possible until I get a breakthrough. Previous GP suggested that because my menstrual weeks are total write offs. Sends me batshit** crazy and makes life hell. So avoid. At all costs.

Dr: Hmmn. Do you have any deep dyspareunia, pelvic pain, low back pain, pain on defaecation or midcycle pain?

Me: Uh, yes. Yes. Yes. Yes. And yes. But probably not more than anyone else.

Dr: Even though you’re on the pill?

Me: err…huh?

Dr: Most women don’t experience that. I’m going to refer you to a gynecologist.

Me: Oh-kay.

Dr: Here’s your script. And referral. Go and see him.

Me (thinks): should I have a glass of water?

He gave me the referral last year. I ignored it. For nearly year. Until a weird week on women’s health. I had the usual experience of having my period (cue: hot flushes, chills, dizziness, inability to concentrate, tearfulness, and aforementioned Sx) but with the bizarre complication of simultaneously sitting in on consults listening to female patients describe in detail exactly how I felt. I mentioned this to my hospital partner who looked at me like I was crazy and suggested I go to a gynaecologist. Now.

Then I used the stupid referral. It had gathered dust and I made the appointment exactly 2 days before it would have run out.

The gynaecologist is lovely. Despite looking disconcertingly like George Costanza. We got intimate with the transvaginal ultrasound (not my first time so am a totally natural with the small talk) and he explained my pelvic pathology to me on the screen (because people do that when you’re a medical student…even when sometimes you want to just be a patient). He does lots of infertility cases and other obs/gyne things but his ‘favourite disease’ is endometriosis. Which is awesome because it’s my favourite too I have it.

Sooooo on George Constanza’s advice I booked in for a laparoscopy + diathermy. Feeling very strange about going into surgery having done my surgery term. It’s not just a list of distant unimaginable risks to me when I read the consent form because I know what the procedure looks like. I’ve seen them blow up stomachs with CO2. Seen them put people under. Seen the slack-jawed vulnerable look on unconscious faces.

What the consent form should say is:

Are you cool with getting naked, hopping up on a bed, having us knock you out with gas, shoving a tube down your throat, taping it to your mouth and then taping heaps of sheets to you, shoving some cameras and metal instruments in your gut, blowing your gut up with CO2 so we can see better with our camera, and then using a little burny torch thing to fry off all the pesky ectopic tissue off your bowel, sacral uteroligaments, ovaries and what not?  It’s totally cool though, we do it all the time. We’ll probably be talking about our weekends or what was on TV last night while we do it. We’ll try not to let you die, or cut off your ovaries while we do it. Rarely happens. Yup? Cool.

Sign here.

I kept thinking “oh, but this is where I tell YOU about the risks. I’m supposed to be sitting behind that desk…wha?”

Being a patient is WEIRD.

*taking three consecutive packets of active pills, and skipping the inactive, thus not having a period during that time. 

**like, actually batshit crazy. Think Exorcist. Followed by lots of apologising. 


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