Posts Tagged ‘Medicine’

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.)

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?”

Learn all the things

September 9, 2011

I feel like this post is written about my life.

Instead of cleaning, or buying groceries or going to the bank I’ve been occasionally doing some scribbling on paper.

Generally nonsensical statements. Like this one:

“Clozapine is generally therapeutic at serum levels above 350mcg/L and has a threshold for inducing seizures at 1000mcg/L thus why most patients are kept within the range of 350-600mcg/L. Levels above this require sodium valproate for anticonvulsant cover”

Which I read back later as:

“Some drug does something good at a level but something bad at another level so ask the ward pharmacist something when using the drug for something otherwise badness with the shaking and the seizing and something with probably family yelling and legal proceedings and oooh chocolate…I didn’t know I had chocolate in this pencil case…mmn”

There is definitely a split personality happening here.

One gets hypomanic and obsessive compulsively lays out the stationary into order of colour, then writes notes feverishly with excessive highlighting.

Then a few days later the other personality reads the manic one’s notes and scoffs, pours another gin and hops into bed with the electric blanket and a Charles Bukowski novel.

Unfortunately gin drinker is predominating.

how to write a form (or “the clinical years”)

September 6, 2011

I should be recording the events of this year.
This ridiculous, ridiculous year.
This year that started on the 10th of January, with one week holiday in June and 47 something weeks of uni with early starts, late nights, being stuck in surgery, being humiliated, being triumphant (in the smallest of things), being crushed, being humbled, witnessing the slowest of deaths, the swiftest of deaths, the slowest of births, the swiftest of births, the phelgm, the blood, the tears, the families (oh god, the families), the residents, the registrars, the consultants, the nurses, the hospital food, the free lunches, the hilarious patients, the sad patients, the angry patients, the stitch cutting, the blood taking, the holding of surgical instruments, the firsts, the moments of clarity (with their emphatic promises that you will NEVER go into that speciality/do that procedure/watch another one of those/do another one of those ever again), the learning. The godforsaken learning.
So much learning.
The fevered collection of tips and tricks scrawled onto scraps of papers, or hands.

How to organise your day as an intern, how to tick all the boxes, where to put the Xray form in, who to call when the login won’t work for the blood results, where to find staff phone numbers on the intranet directory, how to write a request form, a consult form, a *insert anything* form, where to get a coffee at any hour of the day, how to request an MRI or angiogram and actually get it, how to answer a question without actually answering it, how to look interested whilst mentally doing your shopping list, how to actually say something other that “um… increase in squiggly lines” when interpreting an ECG, how to placate to angry famillies/coworkers/patients/cafeteria staff, how to avoid killing someone.
That last one is reaaaaally tricky.
My expectations have shrunken so that instead of aiming to be super-mega-doctor. I’m going to start with “Not killing people” and then build on that.

I’ve noticed that all this learning, accumulating has become addictive. If I spend too much time off, wandering, floating through op shops, visiting family or reading books I actually start to get down. I get itchy, feeling like I should be doing more. Overwhelmed by this guilt of “Oh god. I could have learnt SO much in this day and I frittered it away”. There is something unsettling, unnerving about becoming aware of the potential of a days learning. What a day wasted can mean.

Despite this, there are days (often concurrent) when I live in my pyjamas, eat over the sink, forget to brush my hair and don’t go into uni at all. The perfect antidote.

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.

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?