Archive for March, 2011

Anaesthetist’s Hymn

March 26, 2011

Sometimes I really get why people want to do anaesthetics ūüôā

Mental Health Q & A

March 24, 2011

Me: …and do you have children?
Patient: through rape?
Me: ohhh…
Patient: …two.

I haven’t done my mental health rotation but it appears to be creeping, along with tissue boxes, into every clinic so far. Its not just the mental health of the patients I need to read up on. I need to do more mental health study so I can sort myself out after just listening to the patients.

I can be empathetic at the time, keep the conversation going, say the right thing, blah blah blah and go home feeling okay. But a few days later I snap because the toaster is full of crumbs or the washing machine will only wash on ‘hot’…and find myself in a total mess over it.

When really I’m not pissed off about crumbs at all. I’m pissed off that the lovely 74 year old lady who detailed her rape, child abuse, unsuccessful marriages and car accidents to me a few days ago, had to get such a shit lot in life. I’m pissed off that the kid I wrote up for a case study on pneumonia had a file three inches thick with incident reports about being beaten by her uncle and drunken parents with an iron bar. WTF. It pisses me off. I want to do something about it. It’s unfair. Its shit. So I kick the stupid washing machine.

I’m interested to know WHY when people tell you intensely sad things there is a 48-72 hour lag time until the weight of what they’ve said starts to drag and seep into your day, pervading everything. Until you can’t even make toast.

I hear compartmentalising is the done thing. Does anyone have tricks on how to DO that, exactly?

Careless Surgeon

March 21, 2011

Because I’m on surgery this rotation:

Stepping on toes

March 21, 2011

Uh oh.

I recieved an polite email from an acquaintance who is a chiropractor regarding the studies done that show the minimal risks of spinal manipulation of the neck. I was slightly confused until I  read further down what had happened.

A few months ago, a close friend and I were having dinner. She mentioned how much she hates having her neck ‘cracked’. I told her about a funny lecture we had from a radiologist who declared that we were never to go and let a chiro or osteo touch our neck unless we ordered an ambulance beforehand – he’d seen way too many vertebral artery dissections leading to strokes and death all from patients having their necks ‘cracked’.

That was the radiologist’s opinion. He got a laugh out of the lecture theatre and then continued to show us head CTs of strokes.

I didn’t think anything of our neck cracking conversation until I opened my email recently. My close friend had been with this acquaintance a few weeks ago and had complained of a headache. The acquaintance had casually attempted to put her neck back into alignment. My close friend protested a little too much and then spilled the beans on what I’d told her.¬†Thus acquaintance felt it necessary to defend profession and send email.

AWKWARD.

Is this a trend to come? My instinct is to keep my mouth zipped from now on, and not mention any of my opinions to anyone ever again, even if it is just over dinner (a slightly lonely prospect). Yet at the same time, I feel that if my friend was inherently uncomfortable about a procedure, then she should not have to protest and cite arguments to avoid it happening.

Still, I feel awful about stepping on toes. No one would like to feel like their profession and livelihood is being derided. That was never my intention. Yet no matter how many ways I phrase it in my reply to this acquaintance, I still sound like a stuck up medicalised square. I think I’m going to stick with “Thanks for the info. I found it a great read”.

Then avoid eye contact at birthday parties for the next ten years.

Niece

March 20, 2011

My niece was born a few months before I started medicine so I tend to be simultaneously amazed at her development, whilst comparing it disparagingly to my own. It occurred to me that she would be four by the time I graduated, and would be someone I could have a CONVERSATION with. It blew my mind at the time. It still does. As uni revealed itself to be, uh, quite difficult, it occurred to me that she may be much older before I actually graduated. I began to count time by her clock.

In two and a half years she has learned to hold her head up on her own, to focus her eyes, to follow sounds, to grasp objects, to roll over, to crawl, to gesture, to feed herself, to communicate using language, to walk, to scribble, ¬†to crack a joke, to demand things of bigger people, to hop on one foot, to hide her messes, to use a potty, to hold her pencil properly, to dress herself, to refuse to wear things she ‘no LIKE!’, to have a voice, to name everyone in the family, to have a proper tantrum, to stomp, to dance, to jump on beds, to slurp spaghetti, to burp loudly, to use a mobile phone, to work the ‘moooo-veee’ machine, to twirl around with a big full skirt, to get dogs to ‘sit DOOOOWN’, to jump through puddles in big yellow duck gumboots and to laugh manically whenever someone on TV gets hurt.

Two years ago I couldn’t locate a femur. Lately, I’ve been allowed to see patients on my own. Without anyone. BY MYSELF. Having a chat, taking their history, doing a rudimentary exam and playing ‘doctor’. Of course I have to then get the registrar…who then has to go and get the consultant. But for those few moments when it’s just the patient and I, I feel like my niece when she’s clunking around the house with ladies size 8 shoes, a mobile phone and a handbag, announcing to everyone she’s going “OWT”. I feel a little teensy bit grown up.

Then later when talking to the reg or the consultant…and we’re actually having a medical conversation about the patient, a disease process, a prognosis…it catches me: I know these words, these nuances, these unsaid implications. I’m having a CONVERSATION.

 

 

“Fried brains” or “The Afternoon Outpatient Clinic”

March 18, 2011

AFTERNOON, SURGICAL OUTPATIENT CLINIC, AFTER  LONG DAY AND PARTICULARLY LONG CONSULT (>1Hr)

Cool Reg: *yawn* Sorry that went on for ages, was there *sigh* anything you didn’t understand?

Me (trying to appear interested): *yawn* um…what is *stifled yawn* Ionised Calcium measuring…and *yawn* stuff?

Cool Reg: Eeeer, *yawn* its like, you know, *yawn* a measure of, like, *sigh* caaaaaaalcium that is in ion form, not…well not NOT an ion. You know?

Me *blank stare* Cool.

Cool Reg (trying to appear in teaching mode): its a bit of a estimisa….estimaa….estimasization? ESTIMATION! Fuck. I can’t even speak.

Me: argghhhh can we just go? Or eat muffins?*

Cool Reg (visibly relieved): ohhhh yes.

 

* this was not as ridiculous a suggestion as it sounds, as the awesome clinic nurse bakes muffins or biscuits for each clinic. So we simply went into the next room, ate muffins aaaaand continued on. The looooong afternoon clinic. Sounding just slightly like zombies.

Rhinoceros Unicornis

March 17, 2011

Endocrine Surgeon: …another concerning risk at the moment is the potential damage to your parathyroid glands during the thyroidectomy.

Patient’s wife: What are they, doctor?

ES: Well, our med student can answer that.

Me: hmm? urh, well, they, uh, regulate calcium in the blood and…uh…

ES: Yes! (Spins on chair) Did you know they were the last organ to be discovered?

Me: No…wow.

ES: What year were they discovered?

Me: ummm…I don’t know.

ES: I want you to find out what year, who discovered them and what colour the animal was that they were discovered on.

Me: haha. Seriously?

ES: uh, yes.

Patient: Was it a monkey?

ES: No.

Patient’s Wife: A dog?

ES: No. Stop narrowing it down for her.

So far I’ve got:

The parathyroids were discovered by Richard Owen in 1850 in an Indian Rhinocerous (Rhinoceros Unicornis, now the emblem of the International Association of Endocrine Surgeons) that died after a fractured rib punctured its lung and was bequeathed to him by some Zoo in London. He used to get all kinds of animal carcasses offloaded to him for his research. His wife apparently walked in to find the Rhino lying in her hallway. She was pissed. He also critiqued and argued with Darwin. He was badass.

Parathyroid glands were then first discovered in humans 30 years later in 1880 by Ivar Sandstrom, a swedish medical student. This piece of information upset me somewhat and led to feelings of  incredible inadequacy. Not only have I failed to be involved in research thus far, but I have almost certainly missed the boat in terms of discovering new organs.

But back to the Rhino. I know it had been living in the Zoo for 15 years before its death. The Zoo had paid 1000 guineas for it. It fell and fractured a rib leading to a punctured lung. It then vomited slimy blood streaked vomit for weeks leading up to its collapse and death. What I CANNOT find, no matter how many google searches I run, is WHAT COLOUR THE FREAKING RHINO WAS.

It’s not black. Its not albino either.

Endocrine Surgeon smiled and said “Well done. But no. Not black. Not albino. More research. You’ll understand why its important when you know the answer.”

Anyone have any idea?

Is this some sort of in-endocrine joke that I’m not getting?

 

added to note:

I’m an idiot who read wikipedia wrong in my haste yesterday;

This prehistoric-looking rhinoceros has thick, silver-brown skin which becomes pinkish near the large skin folds that cover its body. Males develop thick neck-folds. Its upper legs and shoulders are covered in wart-like bumps. It has very little body hair, aside from eyelashes, ear-fringes and tail-brush.

I still don’t get the joke.

Distracted?

March 13, 2011

Accomplished:

– cleaning of new yoga mat (read: dunking of mat in bath of soapy water to avoid faceplanting it during next downward dog, as have done for last two classes. Note to self: new yoga mats are super slippery if not cleaned before use…)

– have become a ‘bike riding person’. complete with super cute basket that detaches for grocery shopping.

– cycled to amazing cafe twice this weekend for chai with friends.

– cleaned out wardrobe and jewellery and created ebay selling pile

– managed to ignore ebay selling pile for entire weekend, even though must step over it (due to its enormity) to get into bedroom.

– eaten more blueberries than ever. pondered why I used to baulk at paying $3.99 for a punnet when I am regularly paying $5.00 for bread…which I do not enjoy as much as blueberries. ahh blueberries. the bluest of fruits.

– painted most of furniture that stood still long enough white.

– went spontaneously to neighbourhood party. have awesome neighbours. made friends.

– had strange haircut experience with a hairdresser who, whilst philosophically talking about colour therapy told me that, for example, I would not be able to pull off like, spiky red hair as I’m not “like, out there” and “daring” enough and then queried why the back of my head was “flat”.

– discovered the bakery of my dreams. and then the second bakery of my dreams…and then third. This new suburb is almost 50% bakery.

– oh yeah, MOVED HOUSE. To the beach. Spontaneously. One weekend. Marvelled at ability to look at rental on a thursday and be sleeping in it two days later, on the Saturday night. Its easy to move quickly when you’re escaping a hothouse.

– explored two new suburbs

– have become an early riser thanks to surgical schedule.

– have decided not to become surgeon. thanks to surgical schedule.

– have seen babies born by caesarean, and the most impressive sacral pressure wound. Am embarrassed to admit that the pressure wound took my breath away more. But in fairness, birth and caesareans are spoken about. Nobody talks about pressure wounds. Not like these ones. No way.

– have started to suck the marrow out of the weekend (a strange metaphor for a vegetarian, but none else does it justice).

– have taken a lot of baths. because we (finally) have a bath. I’m ashamed to admit, it feels like we’ve “arrived”. Now when my mother tells me to “go and have a bath” after a long hysterical conversation about some trivial thing thats got me in a fit I can actually go and do it. Instead of dissolving into a heap of tears sobbing “buu…uut I doo…on’t HAVE one!” I freaking love baths.

– started yoga and ‘power pilates’. the yoga is lovely. however may tone down the, er ‘power’ after weekend of neck pain and discussion with former physio turned junior doctor. have started to reconsider the wisdom of putting my neck out (so to speak) to get into positions for a class being led by a (lovely) junior instructor with a 12 week training course behind her. But there are foot rubs at the end…

 

Not Accomplished;

– estudiar

–¬†√©tudier

– s.t.u.d.y

 

My father did say, upon taking in the surroundings of the new place, the cycle paths, old fashioned grocery stores, the proximity to cafes, vegetarian restaurants and the beach, “Make sure you don’t get too distracted”.

Distracted? From thyroid cancer, trauma algorithms and diabetes? Never…

So Ronery…

March 13, 2011

This year is hard. Not because of the hours. The workload. The early mornings. That’s fine. Whatever.

It’s hard because none of us can get our shit together to have coffee or decent catchup when we used to run each other multiple times every day. I miss locker room chats, library chats, before lecture coffee chats. I miss seeing my friends. We’re all split up and doing long hours, looking stupid, learning heaps, getting stressed, comfort eating, being grilled on shit we should know but don’t, and running up and down the stairs every day because those goddamn lifts would have to be the slowest in the southern hemisphere. Some of us are within walking distance of each other but shut up in different clinics, different rooms, different wards. Occasionally waving hi in the corridor. Others are up to three hours away at different hospitals.

Its great and a huge sigh of relief after pre clinical years, but it’s strange to go from learning the same thing every day as a cohort to being split into pairs or groups of three. Sometimes you’ll go the whole day only seeing your partner, or if you get split up, then only seeing your registrar, occasionally your consultant and the interns. I don’t think I really contemplated how big of a change clinical years would be…I’m a teensy bit jealous of the first years and second years with their days off, and their bbq and beach filled facebook photo albums.

But then I did get to take staples & stitches out of a weeping arsecheek wound last week.

Who needs bbqs?