Zai jian Whoop Whoop

"Reluctantly crouched at the starting line
Engines pumping and thumping in time.
The green light flashes, the flags go up.
Churning and burning, they yearn for the cup.
They deftly maneuver and muscle for rank
Fuel burning fast on an empty tank.
Reckless and wild, they pour through the turns.
Their prowess is potent and secretly stearn.
As they speed through the finish, the flags go down.
The fans get up and they get out of town.
The arena is empty except for one man
Still driving and striving as fast as he can.
The sun has gone down and the moon has come up
And long ago somebody left with the cup.
But he’s driving and striving and hugging the turns.
And thinking of someone for whom he still burns.
He’s going the distance.
He’s going for speed."*

I've filled up the tank, washed the windscreen, checked the oil, pumped up the tyres and at 12:30 tomorrow I'm hoping to walk out the automated glass doors that signify the entrance to Whoop Whoop Hospital and leave this town, driving off into the sunset**

It's a gruelling 9 hour trek down the Pacific Highway past many RTA speed cameras waiting to catch me.

Many call me crazy for attempting such feats after work, but seeing as I made it up here after only having had 4 hours sleep, I figure I can make it easily into Sydney before 11pm. I have my CD collection all mapped out so as to provide gentle light musci during the daylight hours and then the more harder techno/dance stuff hapening later in the evening in order to keep me awake (and bopping).

Dr V and I were just talking about our expereinces of this term. We were both worried about the 'other' university interns being a bunch of strange snobby old people.

Boy were we wrong.

We've had some great times up here, lazing at the beach, eating at every restaurant in town, hitting the only night club in Whoop Whoop, watching TV as a 'family' on weeknights, having our communal cooking times, watching my Britney Spears parody video without me around (so embaressing - haha)

I'm gonna miss seeing these guys so much, but it is time to head home ...
Home is a strange concept when you've lived out of home for a while. You make yourself 'at home' wherever you go and yet you don't really belong anywhere. Like wandering nomads, we 'terns get moved around and seperated from our 'homes' and form new ones... sometimes it's good, and sometimes it's not... this time... it's been good.

But you know what is NOT good? Getting needles!

This week I decided to fix up my immunity status and so got a Mantoux test done and a Fluvax and a tetanus shot. Thankfully I don't havce TB and whilst a tetanus shot is never fun, this year's fluvax is terribly painful and I still can't move my arm much (which is not good for someone who is currently working overtime and needs to be able to move his arm to put cannuals in)

Anyways, next stop... Sydney!

* Cake - The Distance
** Technically it wont be sunset cos I'll be driving south but these things are irrelevant to a good story.

The Blame Game

It's witch hunting time in the ole corale!

We gonna smoke us out some baddies, tar them, feather them then burn them at the stake. We'll hang, draw and quarter them then leave their rotting heads on the Tower of London to warn others of their folly.

Today it's "pick on the RMO's" day... and when it rains,... it pours!

Firstly I was asked by the nnursing unit manager to come into his office for a 'chat' (never a good sign)... he started off by saying he didn't want to tell me off, but was 'informing' me that I was the subject of a high risk category IIMS notification.

Now for the unaware, IIMS is a public hospital online complaint service for nurses. In theory... it's supposed to be an anonymous way you can rport any incidents that happen in hospital to make sure someone fixes them. In reality... it serves as a way for disgruntled nurses to exact their revenge on doctors anaonymously and make them feel more entitled than they really are.

And so today I found myself the target of such a complaint. To be honest there WAS to some degree an error on my part. I am happy to admit I shoudl have been more 'clearer' on the medication chart. But legally I purposelly wrote an invalid prescriptino on the discharge medication chart so that it would NOT be dispensed to the patient. However 2 pharmacists tried to second guess me and dealt it out anyway to the patient (but not the other dangerous drug which was below it written exactly the same way invalidly??) and so one of my IV drug user patients almost went home with a vial of Accuphase which he stupidly would have injected and killed himself immediately with.

Thankfully a nurse saw the vial in his medications and removed it. Probelm averted, crisis over right? Not by a long shot!

Because it's a 'potential' accident, it has to be investigated at the high admin levels and dealt with. Now I'm happy to cop my share of the blame... but I was told point blankly by the nurse unit mnagaer that it was in no way the pharmacies fault and it was all my problem as the prescriber (which is rubbish cos I've worked in a pharmacy and I know they are responsible too!)

So now I have to wait as the witchhunt goes on and I feel like Dr Death (the dodgy surgeon in Qld who was negligently manslaughtering his patients)...

I know that in hindsight it's probably nothing and will end up being nothing... but it makes me feel so dirty... I feel like I'm some kind of incompetent doctor whose doing more harm than good.

The first principle of medicine is "Do no harm"... this overides the 'doing good' bit... if you can't fix them... and least don't hurt them!

But now I feel (I know differently, but I still feel this way) like I can't even uphold THIS principle. Grrr!

Then I found out today one of the other interns who has been wokring harder than all of us got a rather blaise assessment by her lazy consultant. She had been putting in more hours than everyone else and had a huge patient load of over 40 for most of the 10 weeks and her lazy bum of a boss just couldn't be bothered to properly assess her. Understandably she wasn't happy...

We all had to front up to the Spanish inquisition this afternoon and get interviewed by the DCT (Director of Clinical Training)... it was a prety useless interview which probably had more anxiety attached to it beforehand than during the actual interview.

Then for grandrounds, we had another one of those "let's analyse a patient who died to find out which intern to crucify" and we dissected the case to find out "What went wrong?" (there was a powerpoint slide entitled this!) and generally just make the junior medical staff paranoid about initiating any management wihtout first consulting their superiors.

It's just been one of those days...

When you feel that you're being scrutinised for every clinical decision and no one gives a damn.

When you really just feel like GP-land would be the ultimate way to work.

When you really just need a good meal with some good friends.

So I'm off with the other 'terns for our end-of-term dinner. This will be our last big outing in Whoop Whoop so I guess my time up here is pretty much coming to a close.

Adios Whoop Whoop Base Hospital! Thanks Dungeon for your welcoming weeks into internship!

And watch out The Zoo! Here I come to cure your urology patient of their oliguria!

Wee!

Phone calls and Phood

One of the med students today said it was time for us interns to move on back to Sydney because we had tried all the good food in Whoop Whoop and found it lacking (meatballs and soggy noodles are not a real lunch.. even the crusty sandwiches looked nicer than the fake meat)

I must say, being fed lunch every day at hospital sounded quite good until they started trying to poision us with quiche (which was severly berated by the orthopaedic consultant as 'un-orthopaedic' cos it was vegetarian) and other assorted anomalies of cuisine.

I'm almost looking forward to buying my own lunch back in Sydney at The Zoo. I must try to convince some of my 4th year proteges to go and fetch food for me in return for me supplying them with teaching/tutorials/PR-exams.

Today Dr D was making a phone call to radiology and she trying to squeeze a Xray out of them. They asked which consultant the patient under and Dr D wasn't sure if it was Dr Rankin or Dr Wagner and so as she tried to explain it, it kinda all came out wrong and she said:

"I think the patient is under Dr Wa@#er?"

Poor girl!

Only 3 sleeps left till we all go home... it's gonna be a hot 8.5 hour drive and hopefully I'll beat Dr E and her bf L home in my speedy new car. Unfortunately I'm gonna miss the ultra low petrol prices up here (apparently the Qld government subsides petrol up here or something??) but I am def looking forward to seeing everyone back home again...

And especially get some of that good old bubble tea back into my GIT! Yummo!

Who are those randoms in the picture? Man I long for those kinda fun times in the Dungeon!

Rodeos and Rumps (Steaks that is!)

And so ends the last weekend in Whoop Whoop.

It's kinda sad thinking that in one week the feloowship of the house will be broken and we'll all go back to our own lives again.

After being kinda apprehensive about being stuck with 8 other interns I hardly knew, I've ended up making some really good friends who have been a blast to live with. We're all different but we all meet somewhere in the middle and have enjoyed our little trip up here.

To celebrate the almost end of our time, we threw a big party on Friday night but by the time I got back form my overtime shift at 11pm it was winding down a bit. Had an interesting conversation with an RMO about cheese and crackers though (apparently Arnott's crackers are the way to go with cheese) and found out that Snickers Pods should not be thrown into drunk men's mouths (we found a lot of crushed Pods on the floor the next day covered in ants).

The next day when the sun shone it's rays into the house we found the house was very messed up and stunk like rotting onions (which we found hiding in an open container somewhere), but with a touch of cleaning it soon went back to normal (although the smell still lingers in the nostril sometimes)

Then Saturday I really just bummed around the house watching Firefly on DVD and then the girls were keen to go to a local rodeo in town. The thought of watching people being mauled by bulls didn't appeal to me so I declined but thankfully they returend very promptly cos apparently they were too late for it or something similar... so the abdominal/orthopaedic trauam spectacle will have to wait for next time.

So instead of watching bulls we decided to go and eat steak at a local village pub. Dr E recommended this pub nearby so we went and ate one of the best steaks I've ever had (in the top 10). The steak itsefl was at leats an inch thick and had a rasher of bacon wrapped around it. It was cooked perfectly to specification and had a mushroom/pepper sauce drizzzled on top. It was served with fried sweet potato shavings and a side of fries with steamed vegetables (including bok choy!) and I was in heaven!

Went to church up here for the last time and said goodbye to the borhters and sisters we've gotten to know up here. I'm gonna miss them even though we've only known them for 10 weeks.

It's kinda interesting how in life we have new beginnings and endings on a daill basis. People come into our lives, we form relationships with them, we interact with them and then they leave again out of our sphere and into someone else's.

It's so transient and so temporal.

I have hardly seen any of the people I went to school with in years. In a few years time, my uni friends will disappear into their training programs and I'll never hear from them again.

All we really do have is today... life is fluid: it courses like a river, ever changing but always the same substance.

And where do we fit in to all this? Are we a constant amongst all this, interacting with other constants? Or are we fluctuating and adapting like social evolutionaries?

On that note, I think I'll go on a Maccas run.

An apple a day keep the doctor away?

Today I am am applying for health insurance.

And to be honest I dunno if I should.

I've always grown up being 'covered' by my parents insurance and now they've kicked me off their policy I have to either get my own or suffer the consequences.

It's kinda hard to see the point of it when:
a) I'm relatively young and healthy and really can't see myself sustaining any orthopaedic injuries seeing as I don't do anything that exicting.
b) you gotta pay them $600 a year for stupid stuff like "Bowen's therpay" (some alternative medicine thingy)
c) I could save the $600 a year and just put it towards my health (ie I'd need to sustain a decent fracture every 3 years to make it worht getting health insurance at my age)

I guess however the government's sneaky Medicare levy means that if I don't get it I have to pay more tax and then today my consultant told me a horror insurance story* and so now I'm worried about the rare extreme possibility of requiring emergency treatment.

So today I tried to apply online for a policy only to find that their stupid online rego system was stuffed (it lets you pay without a credit card then asks you for a credit card and wont let you go any further).

So then I called up and spoke to a human (very rare in today's phone call realm) who informed me that their computer system was down so I couldn't apply.

Like come on? I'm offering to pay them money... can't they make up something to take it from me?

I was seriously tempted NOT to get private insurance because under the secret doctor's code... we only charge each other the bulk-bill price! So I'll never have to pay a medical gap... but then again I know many docotors who wont tell their doctor they are a fellow practitioner because they fear the doctor will judge them differently so they forgo the $$ to get the respect.

Why do we insure stuff though? Are we THAT worried about losing these things (ie cars, houses, health) that we need to pay money not to lose money?

These deep existential questions are not something I really feel like answering today... so let me end today's post by offering you my fine remedy to preventing the need for health insurance in the first place:

"A tranquil heart gives life to the flesh,
but envy makes the bones rot...
A joyful heart is good medicine,
but a crushed spirit dries up the bones."**


* Apparently when he was a younger doctor he went surfing overseas and came off his board and implaed himself upon the fins 300 metres offshore tearing a giant hole in his leg and so he had to drag himself bleeding profusely back onto shore, only to find there was no other docotr on the entire island and help was 2 hours via boat away. So he got a veterinary assistant to stitch his bum/thigh back together (as he consulted via a mirror) and then he became septic and had to fly back to Australia to get antibiotics so he wouldn't die.
Then when he asked his insurance company to pay for his lost accomocdation (not even the emergency flights!) they refused becasue he had 'initiated his own treatment' and not waited for them to send a doctor (hello! he could have died)... so now he reckons he would pay $50,000 becasue apparently there's some random ICU-initiated company in Adelaide that fly Lear Jump-jets anywhere in the world to do medical retrieval for sick Aussies for the tidy sum of $50,000.
** Proverbs 14:30,17:22

Defence Mechanisms

Today in the dungeon we had an 'inservice' training thingy for the nurses on "defence mechanisms"...

It was supposed to help them understand how patients react to things in order to deal with them better.

Out of interest (and mainly boredom) I went along and found out the following things about how people "act to prevent a perceived harm to their inner psyche":

1) Splitting - this is a primitive response which evolves from basic classification of things as being 'black or white' and therefore the perosn cannot perceive people as being both good and evil at once. Therefore they treat some poeple very well and others awfully as they class them into one of 2 boxes. (ie you are nice to the people you think are nice and bad to the people you think are bad... pretty simple!)

2) Projective Identification - you project your feelings towards a certianperson onto another person and try to manipulate them so they act like that originial person so you can then 'have it out' with that original person thru this new person. (ie mistken identity and you dump your rubbish with one person onto another person rather than take it to the orginal person)

3) Denial - a river in Egypt (nah seriously.. this doesn't need explaining)

4) Repression - kinda like denial; but done so at the subconscious level (which is badder apparently - more 'primitive')

5) Displacement - your boss gets angry at you and you know that it's innapproprote to kill him so you hit the cat instead. Kinda like a conscious, less-primitive version of projective identification.

6) Reaction Formation - When you do the opposite of what you fear in order to ensure a good outcome (ie you go and become a 'Bible basher' becasue you have bizarre sexual urges which you fera you will act on)

7) Isolation of Affect - when you just completely disengage from your emotions (ie your mum dies and you're like "So what?")

8) Somatisation - you channel all that mental stuff into physical stuff

9) Conversion - kinda similar to above

10) Suppresion - a conscious form of repression where you konw it's bad and know that the best way to deal with it is to ignore/suppress it... ie when you get sent to Whoop Whoop for a rotation and know it's gonna suck so you just don't talk about it.

11) Altruism - where in order to deal with this stuff you do the 'right' thing as a coping mechanism... this is typified by 'classic-parenting' or "other-person-centredness"

12) Sublimation - you channel all your anger at your boss into a punching bag (a good alternative as opposed to that poor cat)

13) Humour - apparently the most highly evolved non-primitive defence mechanism (as if!)

So there you have it... aren't we all an intersting bunch of people. As the psychiatrist went thru all these mechanisms I began to envisage all my firends using each of these methods at various times and in various ways. In fact I see myself using these things to deal with work, girls, friends, family, etc...

It began to make me think... should I be using more of the less-primitive responses? Do I need to train myself in how to 'defend' myself better?

Bu then again... I think I'm not coping too badly... especially compared to our new patient who has taken to dropping his pants and mooning us all morning then streaking around the wards singing "Oh Danny Boy" and "Fire, Water, Burn". He also enjoys beating his fists against the perspex, karate kicking the walls and imitating the call of Lord Greystoke (aka Tarzan of the Apes)

Now HE has acopia*

*Acopia = lack of coping and a favourite diagnosis of Emergency Triage Nurses who have to categorise gomers coming in from nursing homes.

The Ironies of Life

I ended my last post questioning the futilities of life. I even made reference to death... and about 30 minutes after I wrote that post... I was called to declare someone dead.

It's moments like these you need Minties.

I joke about death... and then have to face a distraught family whose mother and grandmother has now passed away.

Isn't it funny how we sanitise and anaesthetise death?

We dress it up with euphemysms like "passing away" and "going to a better place" rather than say it...

DEATH!

It's such an awful horrid thing that we ignore. We don't like death so we stick our sick ones away from sight in hospitals so we don't have to see them until they're gone.

It's pretty awful to have to go up to the wards at 5am and go into the room with this dead body. Someone who 30 minutes ago was living and breathing is now a cold, lifeless corpse.

I undrape my stethscope and unfurl the black tubing to listen to her chest.

No breath sounds...

No heart sounds...

I felel her cold wrist and put my fingers to her neck...

No peripheral or central pulses.

I slowly pull back her eyelids, retracting them so that I can see her cold blue eyes.

Pupils fixed and dilated.

She's dead.

I fill in the certificate and hang around for the morning team to arrive and fill in the proper cause of death information. They had been expecting this. She had been fairly sick for a while. but still... one minute she was there... the next she was not.

And with that happy thought, I left the hospital, having survived a week of nights which seem to have been the quietest set of nights ever recorded in the history of Whoop Whoop Hospital.

The other irony that occured later that day was that after my discussion of 'old British gentlemen' I went to visit my nearby grandfather and step-grandma.

Now my grandfather epitomises "Britishness"... he still sees Australia as a part of Britain and nothing you can say will convince him otherwise. I joked with him about Australia becoming a republic and I almost got cut off from his inheritance.

I mentioned to him that I had never been to Queensland in my life so he decided we should go on a trip to see Qld for the day.

So off we drove listening to ABC radio with my grandparents wearing their old people's hats and driving way below the speed limit. We drove for almost 3 hours to get to the Gold coast. We stopped at the border and did the extremely touristy thing of standing with one foot on either side of the border (apparently this is often utilised by Mental Health Services who will transfer pateint's between states by offloading them at the border crossing and making them walk across to Qld who then pick them up in the paddy wagon and shoot them off to their own dungeons).

When we finally hit the Gold Coast, Grandad proceeded to say how tacky it all looked and how he thought it was awful (so why were we there?) and then we got out for 5 mintues (after 3 hours of travel) and we stood (not swam) on the beach whilst he berated how many Japanese tourists there were (interesting though how those 'Japanese' were speaking fluent Mandarin)
Then without so much as touching the water... we hopped back in the car and drove all the way back.

I know they're old so I'll excuse them... but seriously... who drives 3 hours to go to Australia's biggest beaches and then only stops for 5 minutes on the sand? Argh!!!

Since I finished nights I haven't been able to sleep properly... my cortisol keeps firing off too early and waking me at 4am... I had to drag myself through today and fell asleep as soon as I had eaten dinner.

But then again... it's good to be home... good to be back in the dungeon with my little funy farm.

I have my old dementing crazy ladies who do laps around the ward.

I have my psychotic Aboriginal men who claim racist abuse everytime we don't let them out.

I have my drug induced delusionals who just wont stay off their THC smoking.

And I have my eccentirc family of nursing staff who strangely enough, all missed me last week and were so glad to have me back (nothing against the relief intern).

Only 2 more weeks of this bliss left and then I have to turn into a surgeon... I can't think of any extremes more set apart than psychiatry and surgery... but then again... it shall be nice to be doing something as opposed to bludging all day.

Finally, I received some flack for my last post because I said I was dancing to my iPod (etc etc) and I would like to set the record straight:

1) It was hyperbole - there was an iPod.. I ate some chocolate to keep me awake... there was Coke.. but there was def no dancing... I was more an expresison of my mood than actions!

2) Even if I was dancing, that doesn't diminish my WASPness (White-Anglo-Saxon-Protestant)

3) "I'm a man who discovered the wheel and built the Eiffel Tower out of metal and brawn. That's what kind of man I am. You're just a woman with a small brain. With a brain a third the size of us. It's science"*

Stay classy San Diego! (will put some pics of my border run up when the computers will let me)

* Ron Burgundy (Anchorman: The Legend of Ron Burgundy)

Pink is for Party!

Tonight is my last night shift!!!!!!! Yeah baby!

And I've decided to lighten up and wear my pink Giordano polo (you know the one!) to work this evening... I think I've scared the nurses but who cares! After tonight I wont see them again!

It's time to celebrate... to 'boogie' (as Dr K would say) and to eat red frogs* (Dr M's way to unwind)

I don't know what it is, but I have some kind of magical presence on the ward which means I somehow manage to bring a stabilising force to patient's clincal condition. In 7 nights I've only had to pop in 4 or 5 cannulas (in total!) and managed to only have 2 MET calls. None of the other interns can believe my luck (they call it luck... I call it "the zone")

So tonight I have my Coke, my chocolate, my iPod and I'm ready to party all night long to Mandarin pop music.

Earlier this evening, all the terns were invtied to a pharmaceutical company dinner which was held at a local restaurant. For once the med students were barred from the free food (suckers!) and so us interns scored a free dinner at a very classy Italian place. However the old adage is true and there IS no such thing as a free dinner, no matter what those drug reps tell you.

We were conned into listening to an old cardiologist talk for ages on the wonderful new advances in lipid lowering therapy (oh the excitement is just killing me!) and when he had finished we were assualted by the cheesy drug rep who blabbed on for ages about his drug... except I noticed that his graphs were not to scale (54% is not 3 times the size of 27% no matter how much you fudge that bar column graph) and so I felt like we were being taken for a bit of a ride. There weren't even any "Numbers Needed to Treat" (the sign of any good therapies outcomes) which he assured me would be published in November (we'll I'll just have to wait till November before I prescribe it now, wont I?)

Then to top it off, he started becoming all chummy with us... some feeble attempt at repore which I'm sure they get taught at "Drug Rep College" which failed abismally because he started telling us about his wife's grandmas' funeral whilst still trying to sell us a drug... come on?

However during the night we ended up sitting next to the speaker who was what I would call a true 'physician'.

To be perfectly honest, I see medicine as a job and not much more. Sure it's fun and rewarding but so are many jobs... I'm not one for the whole "I am doing medicine cos I wanna help people" (although I did say that when I was 16 and wanted to get into med)... at the end of the day, I work for the hospital and they enter into a contract with me and pay me what's owed. I hold no huge altruistic notions towards the whole thing and am happy to take it or leave it.

However there once existed (long before drug companies and indemnity insurance took over) a type of doctor known as a physician. This sort of man (very few females were physicians in those days) actually cared for his patients and had all sorts of noble virtues which he endowed in his practice.

To him, medicine was both a science and an art.

Medicine was a honoured profession and whatever a doctor said was taken as gospel.

People worshipped the ground doctors walked on. Mothers urged their daughters to marry such men.

And this man tonight was one of them. He spoke of studying under Parkinson (of Wolfe-Parkinson White fame) and under Steele (of murmur fame) and under emminet British cardiologists who ruled the empire of their specialty. Of entire crowds of junior medical officers trailing the physician on his midnight rounds in order to eat the crumbs of wisdom that fell from his lips.

He had a sad look in his eyes as he spoke of a bygone era... a time when physicians were benevolent and medicine had a 'romance' to it (to quote his words). As he looked upon 21st century healthcare he saw a lost generation of doctors who would advance our field into the future. He saw a youthful workforce changed and demoralised by the litigation and lunches (from drug reps).

I felt sorry for him as he dejectedly spoke of our profession. He had seen what was before and what was to come and lamented. The future is not always brighter as the world woudl have us think. The way forwards is not always the way up.

The complacency of modern medicine is it's biggest weakness. We have extended people's life expectancy so that now 75% of those who have ever lived over the age of 75 are alive right now! Thats a scary thought!

So what are we to make of all this? Amidst the drug rep dinners and the aspiration-towards-something-more-noble, what should we do?

Well I think someone much wiser than me put it the best:

"Let us eat and drink,
for tomorrow we die"**


*Dr M has a rather disturbing relationship with red frogs. She buys packets of them and carries them around hospital to munch on. But at night time, rather than take a temazepam to sleep... she puts two red frogs under each cheek in her mouth and then goes to sleep whilst the red frogs dissolve overnight... apparently her mother initiated this bizarre ritual which we now think would be reported as a form of child abuse if done today.

** 1 Corinthians 15:32 - Paul argues that if death is really the end of things, then why not live life to please oneself? Thankfully the resurrection of Jesus gives us hope beyond the grave. Our lives now have purpose before we die as we live in light of that hope.

The Intern Strikes Back!

After having such an awful run with cannulas last night, tonight has been my turn to score some runs on the board.

Early at the end of my shift last night we had a MET call and I finally broke my ABG drought by getting a nice bright red arterial sample first go on some old lady who was sick.

Then tonight I had another old lady with resp problems and... you guessed it... first go ABG again! (slam dunk and hi-fives all round thankyou very much) I luv watching the bright red blood pulsate into the ABG tube... looks much more macho than the passively filled venous tubes that gently rise up against the negative pressured vacutainers.

Then nailed a 22 gaguge cannula into an old lady first attempt with not a drop of blood anywhere! Flushed like a dream and I was on such a roll!

That roll kinda got broken pretty quickly when I had to take 4 goes at cannulating a 22 yr old male (post MVA)... I can't believe that after being able to hit so many old poeple so easily.. I stuggled so much with a young healthy male's veins.

"God opposes the proud, but gives grace to the humble"

Hehehe.

Got a bit miffed tonight when I got hammered by a certain registrar (wont name names and it WASN'T the on call one) when I called them about one of their patients. This registrar had been bragging earlier about how they were a 'stone wall' (ie they would turf and not let any patients thru unless really needing treatment). So when one of their patients got sick and I was quite concerned that they needed an urgent revision of their operation, I got seriously cut down.

"Why didn't you ____ to the patient?" (I had forgotten one relatively minor thing - no thanks for the otherwise thorough assessment of the patient)

Didn't help that the symptoms the patient complained of had partially resolved by the time the reg got there. So I looked like a stupid intern who didn't know how to assess the patient (even though they DID have signs!) and so I got a rather abrupt phone call from the reg which although not overtly containing a rebuke was hostile enough.

Maybe I'm reading too much into that phone conversation... but I just got really peeved that I was made to feel so crap by someone who I'm supposed to turn to for help. I know they get a lot of calls to come and see patients who are otherwise well. But I was seriously concerned about this patient. And even if I AM a dumb intern, can't they at least be nice about it whilst we settle into our jobs as "referral screeners" for them on night shift?

I guess it was probably deserved anyway and I'm prob reading too much into things anyway. It's prob cos the night has been relatively hectic.

Apparently the evening RMO was swamped with MET calls and sick patients which meant by the time she handed over to me, hardly any of the ward stuff had been done which meant I spent 5 hours clearing the boards of cannulas, med charts, fluid orders and patient reviews. In and of itself, tonight has been again relatively quiet... but the backlog of stuff from the evening shift has kept me moving around for quite some time.

I think I've finally broken my body clock so that now I am sleeping solidly during the day and waking up at 4pm after a good 8 hours of sleep. Today I even made it to Grand Rounds at 5pm (only cos it was the Psych case presentation by one of my consultants) and then we all went out to dinner for Dr V's birthday (Happy birthday again Dr V!) I think it's gonna be weird now going back to normal sleeping patterns in a few days time... they really shouldput people on nights for at least 2 weeks to make the most of things... 1 week is just enough time to change your body clock then have to go back again. The previous RMO (Dr M) who did nights is now sick because she hasn't been able to sleep properly since she finished nights almost a week ago... I hope that doesn't happen to me!

Get well soon Dr M!

Time to go home and sleep

It's now the end of the night shift.
So I thought I'd put up some pics of our last trip to Byron Bay and the Lighthouse and some of the food we ate.

Also put up the first of the goatee pics to vote on (it looks better in real life) and a pic of the room I call home during the nights.
Got really bored last night and decided to enter a Pepsi competition because apparently they give away $400 cash every 30 minutes so I figured no one would ever enter at 3:3oam... but apparently they do... I've lost twice now! Grrr! I'll keep trying till I get the $400!

Cannulas and cars

I don't like cannulas (drips for the non-medicos)

After a quiet inital 4 days it's been on relatively smooth sailing tonight except for the fact that I haven't been able to get 2 cannulas into 2 old people.

The first guy is getting a PICC line inserted tomorrow which means he probably has shoddy veins anyway but the old cannula decided to die tonight so I tried and tried but couldn't get that little plastic tube into his arm. I looked all over his arms for a palpable vein but just could not find anything resembling a bump on his arm. So I witheld his IV antibiotics till the morning.

The second old lady I think has a chest infection from aspirating and so I needed to give her some IV meds and her wrist was seriously 3cm in diameter (I'm not kidding - I've seen newborns with bigger wrists). I had 4 goes on her and used all the 22 gauge cannulas in the ward. But again she had not a bump in sight for me to stick the tube into.

I feel quite bummed about it now. Like I even went to ICU to ask the RMO there for help but she was asleep and is only a locum (so very unlikely to give a fig about the plight of a poor newbie on his overtime shift).

I've always sucked at cannulas. I'd never even got one in successfully until AFTER I graduated from med school. I dread having to be asked to put one in. I get so angry at myself when I miss. I was even using my beloved Introcan passive safety Cannula (I reckon they are amazing to use).

Why am I so uncoordinated/unable to get these darn tubes in?

I feel like I am so not preparred to be an intern from our med school. I somehow managed to avoid ever seeing an IDC/NG tube ever being put in and so this week of nights I've asked the nurses if I can watch whillst they do it. If you aksed me how to do it I could quote you a textbook answer, but having never seen one done until this week I was pretty useless.

And that's how I feel right now... useless.

The enitre hospital is depending on me right now to get these people some venous access and I just can't do it.

And to be honest I dunno how I'm gonna improve... short of asking an anaesthtist to follow me round 24/7 to comment on my technique I think it's just gonna suck indefinitely.

It's times like these I get frustrated.

I know I'm not the world's best doctor. I'm awful with ECG's... not brilliant with Xrays and my practical techniques are non-existent.

But I used to at least think I was competent. But even that is now in dispute in my mind.

I really don't think I'm cut out for this at times. Like I could never be a med or surg registrar. I'm just not that smart to do so (even if I DID want to). To be honest, GP-land would be the only real option for me (or maybe psych?) cos then I wouldn't be expected to know much and I wouldn't have any real procedural stuff to deal with.

As much as I like to pretend it's about lifestyle, it's really about me realising my limitations... and realising I am just not good enough/competent enough to do anything else.

In many ways I've been so relieved that my nights have been quiet becasue if they were more busy I fear that my inadequacies would be more evident.

I'm kinda worried about doing Urology next becasue that will involve lots of cannuals and catheters (both of which I am not good at). Doing psychiatry has been fun and a nice gentle introduction to working life... but has been useless for preparring me procedurally for the skills needeed for internship. I think the next 10 weeks after Whoop Whoop will be another steep learning curve.

Today I washed my car. I realised that my baby has not been washed EVER and the build up of dirt was starting to show. But after a 20 minute run at the local car wash she's looking nice and shiny. Like the sleek blue machine that I fell in love with oh so many months ago.

Like seriously... cars are so much better than girls.
You don't have to talk to your car if you don't want to.
She always goes wherever you want to go with her.
Her CD player always has good music.
When it's hot she cools me down and warms me when its not.
She only costs about $40 a week to keep maintained.
She doesn't mind if other people tag along with us.
She doesn't expect phone calls.
She only takes 20 minutes to look clean and attractive.
She smells really nice.
She doesn't care if she looks fat.
She doesn't get 'that time of the month'
She doesn't send 'signals'

I'm smitten with my car... sigh

My head hurts!

I have a really really bad headache.

It's been here the entire night shift and I can't shake it with drugs (went to the Dungeon to raid their paracetemol supplies).

Thankfully it's 7am so in 1 hour I can go home and sleep it off.

I always have drug-resistant headaches. And the only way I can ever beat them is with sleep.

Right now though I feel like my head is exploding.

Everyone says that when you're doing the night shift, that the weekends are quiet because the teams aren't fiddling with their patients medications; but that the weekdays are hectic. Well so far this has proved to be unture and my Monday was quiter than my Friday and Saturday and Sunday nights.

The only thing worthy of mention was the demented old lady who kept roaming her ward asking for 'a crust' to eat. She bgean to ask me if I was in her 'group' and if I knew that she was anurse matron. I told her that if she was a nurse then I needed her to look after a special patient for me and directed her to her room and told her that this room was hers to look after. That worked for about 20 minutes and then I had to whack her with some good ole risperidone to knock her out for the night. I never got called to see her after that... haha!

Have developed a new loathing of the MET call system. It's totally based on arbitary figures and supposed to provide a saftey net to keep patients safe. Fair enough. But the nurses use it religously to 'cover' themselves medicolegally so it gets abused. Like earlier I had this lady with an unrecordable blood pressure. Now normally this is worthy of a MET call. Normally this SHOULD bring the crash cart racing and the med reg to review. But this lady is a known MET call frequent flyer who quite often has low BP's and her reg told me that she often has this and is asymptomatic.

But try explaining this to the nurses.

They refuse to accept this and keep inching towards calling a MET call. You can see how itchy they are to do it. It's like maybe they have an annual award/prize given to the nurse who calls the most MET calls.

Either way it's pretty silly when a doctor tells them it's ok but they still go ahead and call one.

I feel like writing something 'deep' on this blog today.. but my headache is preventing this. Tonight I shall try to blog earlier (and without a headache).

"You stay classy San Diego!"

Go-T

I have decided that being on night duty is a perfect oppurtunity to grow some facial hair.

I don't have any consultants to impress and any patients I see are all in the dark anyway so it's only the nurses who have to gaze upon the stubble on my chin.

So far I have a fairly tidy amount of itchy stuff on my chin and am attemtping some neat lambchops (sideburns).

Dr K was suggesting I could grow it for a week and then let the 'terns have a vote as to whether to keep it. However I think we shoudl make this a proper reality TV kinda thing and get you blog readers to put in your opinions and SMS your vote now (you can just leave a comment instead of paying for an SMS you cheapskates! - haha) So get your votes in now for "Goatee Idol"*

I think having facial hair makes me look more scary but less 'babyish' which may be useful seeing as I still look young as an intern even though I'm bald.

Last night I got less sleep because of a rather sick old lady with CCF and APO who was just looking crumbly. After whacking her with Lasix I realised I was gonna have to make a judgement call and call the registrar on call. Now it's never fun to call the night registrar, but particularly so when they are working ALL weekend on call and it's 4am. So reluctantly i paged her and she staggerred into hospital but thankfully I was justified because she later said the lady got sent to ICU so I guess I was vindicated for waking her up (this time!)

Currently drinking: Twinnings Green Apple Green tea (hot) and 2x Coke Zero 375mL cans

Currently listening to: Black Eyed Peas "My Humps" (awful lyrics but such an irritatingly catchy tune)

Currently thinking/procrastinating about : starting my midnight ward round

Currently scratching: my facial hair

*Subject to Terms and Conditions. The promotor accepts no liability for any goats harmed during the production of the above mentioned goatee and as such will not be held liable for any damages. Maximum call cost $0.55. Entrants under 18 years of age need parental permission before entering. Entires close 5pm 17/03/06 and no further correspondence will be entered into. Judges decision is final. Employees of the promoter and their immeadiate families are ineligible to enter. The promotoer reserves the right to ignore all entries and just do whatever the hell he likes with his facial hair.

Like really...who needs sleep anyway?

One down... 6 to go!

The first night of nights was extremely good. I did my little rounds at midnight and 6am and even squeezed in a 3 hour nap in between. The onyl mildly difficult/interesting part was when I called a MET call on a guy who was badly desaturating (and even then it was probably only asthma or something)

So fingers corssed the rest of the week shall be of a similar quality.

But instead of being a smart boy and going home and sleeping... I decided to nap for a few hours and then go to Byron with the 'terns for the day.

Dr D invited 2 of her tern frineds from Coffs to come visit and we cruised off to Byron in my car (listening to some very sublime Black Eyed Peas thumping out "My Humps" to all the local homies - oh so fully sick!).

Remembered to put sunscreen on BOTH arms today but still managed to come back with a nose redder than Rudolph the Reindeers. Swam in the lovely Pacific Ocean and ate gelato on the beach. Life really doesn't get better than this... or does it?

We topped the day off by going up to the lighthouse at Byron to watch the sunset with a picnic (wine and cheese) which was very picturesque. I so wish I could have stayed overnight there with the 'terns but unfortunately work beckoned. Grabbed a quick meal with them all before driving back in time for my current night shift.

Thankfully so far so good. The GP who does every 2nd weekend handed over by saying, "There's nothing brewing on the wards"... I like that... I like that a lot! That means hopefully no cannulas or stuff to do!

Had an interesting conversation with Dr K and Dr E today. Somehow the topic of chest hair/baldness came up and Dr E said "Well I married a man with chest hair AND who was bald... and now he's knocked me up!" (referring to her ever expanding belly)... who knows?.. perhaps there's hope for us balding men yet!

Starting to feel the tiredness/pain/abdominal migraine begin to set in from my lack of sleep. The Coke Zero is keeping me functioning... but not much else. Maybe I should put my iPod Shuffle on and dance around the room to keep me moving until my midnight rounds... hmmm????

3am (I must be lonely)

So far so good.

It's 3am and so far no one has died... no one has crashed and required a met call ... no one has paged me in 2 hours.

I could get used to this.

Spent today sleeping until 3pm and then did some shopping at the local mall.

All the 'terns, RMOs and regs went out for dinner tonight and I had another nice steak... but the conversation was very bizarre.

Dr H talked about her favourite pastime of "sticking one's hand up someone's armpit all day long" and Dr V began to tell us about "special thing that I do in the shower" (really... too much information!)

It's so quiet right now being in the hospital alone.

There's no beeping of medical machinery... no melodic pagers going off... no elevators 'ping'-ing their heralds... no med students discussing the latest Isaac's sign*

Just the dull droning hum of the airconditioning.

It's so black outside. No lights other than the glow of the LCD monitor and it could be anytime between 8pm and 5am... I have no idea...

Am very tempted to drink some Coke but am persuaded perhaps I should sleep and then go with the 'terns to Byron after my shift...

Bought a copy of "Backstreet Boys Greatest Hits Volume 1" today... how sad is that? But I must say I DO like some of their early stuff... it's great driving music... haha!

* Isaac's sign does not really exist. It was a construction of the USyd and NewcU students in order to trick Dr E's boyfriend L into looking it up. he became very worried that he did not know about Isaac's sign and it's relation to bacterial endocarditis so he spent an entire weekend scouring the textbooks/net for it only to find out it was an iatrogenic joke played upon him. I still laugh out loud when I think about it. Hehehe!

Sola ("All by myself")

Had a really good day today.

In order to get ready for my nights I stayed up till 4am last night watching dodgy payTV and reading books. Earlier that evening we had our communal dinner where Dr V reconstructed the "Hanging Gardens of Babylon" (ie he made Nachos which are comparable to an ancient wonder of the world)... they certainly lived up to their name and we even had a ortho reg and an ICU resi come to feast with us and drink beer too. We had some bizarre conversations about pregnant bellies (I'm having a competition with Dr E, who is pregnant, to see who has the bigger belly... I think she's almost beating me!) and surgical prefernces (Dr M wants to have a thyroidectomy so she doesn't get a catheter inserted... which given a certain pseudo-ex-mistresses prowess with female catheter insertion, is probably a good thing)... it's very cool just chilling with the rest of the terns after a hard days work.

And what a hard day it was!

After running the dungeon by myself for a day I was relieved to have 2 registrars yesterday to lighten the load. However it was magistrate day so they spent all morning in the hearings, trying to keep our patients locked up for another 2 weeks under the Mental Health Act. So meanwhile i had to run the ward on a semi-supervised basis. Then in the afternoon I got conned by the reg into filling out a huge set of documents about this pt's 'pain' history so he could get a referral to the pain clinic. It was more complex than the new industrial relations laws I tell you! Then as I was about to bolt out the door at 5pm I thought I'd just sign off the lab results sitting in my pigeon hole. As I got to the last page, my jaw dropped and my heart sank.

It was a potassium of 6.0!

One of our new pt's had been turfed from the surgical ward and that morning they had sent off his EUC's but forgot to tell us they needed to be checked. So only by chance did I actually see that this pt was HYPERKALAEMIC and no one had done anything about it. Like surely the lab could have a least given us a courtesy call saying "Oh hey by the way your pt is at high risk of dying sometime from a fatal arrythmia if you don't treat him"

So then instead of leaving I had to check the pt to make sure he wasn't indeed symptomatic, then run off another urgent set of bloods to recheck his potassium and then hand him over to the evening RMO. It was pretty scary cos sometimes I don't always sign off the bloods on the actual day and if I hadn't he may have been a lot worse off. But then again that's the crumbling system for you... it's bad!

Anyways, I have digressed form the main topic for today (what a long post this shall be... take a coffe break now if you're feeling bored)

Today I got up at midday and drove to Byron Bay for the day. Cos no one else was free (they were at hospital) I went by myself and had an amazing time.

Bought some fish and chips and ate them on the beach. Then dug out a book (C.H. Spurgeon's Autobiography which my grandfather lent to me) and read under a tree overlooking the sand and surf. It was so calm and tranquil.

The waves lapping at the shore...

The sun diffusing through the scant clouds...

The seagulls pooping everywhere and stalking the naive tourists...

The cool ocean breeze enveloping me as the day turned into evening...

As the sun set, I walked along the beach by myself enjoying the peacefulness that comes from being alone.

Time for just me.

It's nice to be living with everyone, but sometimes what you really need is a day like today. A day to be alone with your Maker and enjoy life.

A day to reflect on all the good stuff that's happening in your life and deal with the crap that's going on as well.

Once night had fallen, I went and had dinner (again alone) at Hogsbreath Cafe overlooking the water. Ate a massive steak, drank my favourite caffienated beverage then drove home in my nice new baby car listening to my favourite CDs.

When I got home... I found Dr S watching the "fashion channel" on TV. he claims it helps him bond with Dr M... but I think he just watched it for the chick's parading around in their underwear. Oh well!

Next post will be written during my night shifts... mehhhh!

Overworked and underpaid

Yesterday I got to do 4 jobs at once.

I was the resident medical officer for the dungeon, I was the admitting registrar for the dungeon, I was the inpatient registrar for Dr F, the inpatient registrar for Dr H and the inpatient registrar for Dr G.

What fun!

One of the reg's decided to get married and so is off on holidays for 2 weeks so I am filling in for him PLUS doing my own job this week.

Then one of the registrars took yesterday off (part time work or something?)

Then the other reg took off to training after the ward round and left me alone as the onyl doctor managing a 25 bed inpatient psychiatric ward.

I had to admit 2 new patients and fill in all their mental health forms. I had to prepare all the documents for the mental magistrate hearings today. I had to sedate an overly aggressive psychotic patient. I had to write all the med charts out and taper doses. I had to then attend to all their medical problems (ny original job) and then try to complete a 1 hour presentation for the RMO meeting today.

I should be getting paid more than the $22/hour they're giving me!

Thankfully I survived and it wasn't that bad. I actually made it out at 5pm on the dot and no one died (always a good day!)

Today is my last day in the dungeon for 10 days because I start 'night' duty next week and they give me 2 days off as 'compensation' (it's actually got to do with them not wanting to pay us too much $$ the stingy bums!**) to adjust to sleeping during the light and working during the dark. Sigh!

had to present to all the RMO's, Med students (MS's) and registrars today. Each week one 'lucky' tern gets to present an 'interesting' case which a certain consultant will then pick to shreds. Thankfully cos it was a semi-psych case he didn't say too much (except about the medical problems) Felt really self conscious though cos a lot of the reg's and the boss knew the patient so anything I said had to be 100% spot on or I was dead. I felt like it sucked but people said it was good. I always hate that... cos you don't know if they're just saying that to be nice/consoling whilst they think "Oh my... how awful was that!" or if they actually Do think it's good. Why can't people just say what they mean hey?

Got a bit miffed yesterday when the MS's ate all the 'tern's food before we got there. Lunch officially starts at 1pm but they stake a claim at 12:30 and yesterday lunch happened to show up ealry so when I arrived at 12:50pm there was not a scrap of food left. Totally cleaned out! "I'll get you evil MS's.... I'll get YOU!!!"

On the upside I got to try out the new staff cafeteria here which looks more like a McCafe than an underfunded public hospital staff feeding shed. Even in private hospitals I have never seen such extravagence. Pity they didn't realise that the new 'scenic' windows overlook the dungeon's courtyard with the crazy people running around... hehe!

** Actually I have developed a new loathing for medical admin. We had a 'meeting' with them on Monday to voice any concerns we had. We voiced our concerns about being unable to have enough time to finish our d/c summaries during working hours (rural hospitals are a lot busier than city ones) so we asked if we could come in and do overtime to complete them. We were told that we were 'expected' to have them done during wokring hours and even if we didn't it was part of our 'ethical duty' as doctors to complete them (unpaid if required) out of the goodness of our heart. What a load of c!@# I don't care what they tell us... I am an employeee... they are my employer... if I work, under Australian law (thanks Johnny for your IR law changes!) I HAVE to be paid for the work I do. They can't NOT pay us... it's illegal... but they think that because 90% of interns are eager to impress (to get onto their training programs - you have to suck up to the bosses to get a reference) we will cop it sweetly and accept this illegal behaviour. Well I wont! I don't give a stuff about my 'career'... I'm quitting in 2 years anyway! Thankfully I don't have any d/c summaries overdue but if i did... I would work and do them.. AND charge them for it! Grrr!

Don't Count Your Chickens

After having such a quiet 2 hours to start my shift tonight it all turned pear shaped rather quickly.

Got paged to go and declare a man dead after he had developed an ischaemic bowel. It was pretty sad to have to go up to a family I've never met before and do all the 'death' stuff with them. This guy was lying there all blue and cold and they were still just sitting there stroking his lifeless hand.

I felt so useless as I just checked his vitals and signed the forms. Another perosn shuffling off this mortal coil.

But that was the 'easy' part of the night.

I had cleared the boards and it was looking like another quiet night so I nicked off to the psych dungeon to take a break when all hell broke loose. My pager beeped "MET CALL WARD X ROOM X". I ran like the wind up 6 flights of stairs to find a patient in AF and me having to stab around for his radial artery to do a blood gas. I missed and felt really stupid as the resident had a go... but she too missed... it ended up we had to have 5 go's and finally use his femoral to get it.

Then as we were trying to keep him from crashing again, another pager beep informed us of another MET call and meanwhile nurses kept tryign to inform me of other sick patients.

I spent the rest of the night trying to tidy up the wards and keep people alive until I finished.

It's a seriously scary system we work in when I am running aorund 5 wards trying to keep people alive till the next shift.

So I've just handed them all over to Dr M the night 'tern and hopefully she can resuscitate them if needed until the morning teams come and fix everyone up.

But as I said earlier... in the end.. everyone dies...

"The rains came down as the floods came up..."

It's been raining here for 5 days non-stop now.

Apparently most of the roads are flooded over which in effect means we are trapped in Whoop Whoop until such time as the waters recede and allow us safe passage out of town.

Some of the other 'terns aren't too happy that they've been locked inside all weekend but seeing as I'm working 2 evenings this weekend it's been fine with me (who wants to go to the beach when it's raining anyway?)

In fact I really really luv the rain... the smell of it... the sound of it... the feel of it running over my bald head and down my nose... it's refreshing...

Rain brings cleansing and freshness to life... it washes away the old and brings life to the new.

Bring on winter!

I must say I prefer the weather in winter becasue I hate the heat and get sunburnt too easily.. but I must agree that I do get more down in winter (probably due to the lack on sunshine and a Seasonal Adjustment Disorder thingy going on) and statistically mid year is when all the interns become suicidal (or so the psych reg at the Zoo told us during orinetation)... so hopefully I'll see at least a little bit more sunshine before I bunk down mentally for winter.

Well tonight I'm working the wards and so far so good. It's been an hour and my pager is amazingly silent (I paged myself just to make sure!)... but I am also aware that now is the danger period when patients havent seen their regular arsenal of doctors for almost 2 days now and are getting ready to decompensate on me before the weekend is over.

This week I only have to work till Wednesday because then I get 2 days off to readjust my circadian rhythm for a week of the "graveyard shift"*. A whole week of seeing hardly anyone and sleeping during the day... what fun!

Last night one of the terns came home understandably upset after oone of her old ladies died on her. Even though she did everything by the book... sometimes poeple still die... we're not God... we're not able to bring people back from the dead... but it still hurts when we try our best and still come up empty... when we somehow 'feel' responsible for not 'saving' that person.

In the end I think it comes down to realising that without a doctor... many MORE people WOULD die. We need to try our best and save the ones we can... but realise our personal human limits and our own mortality.

It makes me long for that day... that day when things will be made right once more.

That day when death itself will finally be destroyed once and for all and life shall be seen in it's fullness.

I was reminded of that wonderful day last week when at church we looked at Revelation 1. There, a man appears... one who is so amazing in appearance that people fall down in terror when they see him... and he says "Fear not, I am the first and the last and the living one. I died, and behold I am alive forevermore and I have the keys of Death and Hades."

As a doctor we resuscitate people. We put bandaids on them to buy them time... but in the end they still die. It's not a question of 'if' but 'when'.

But I know a man who offers hope beyond this... one who has beaten death and destroyed it's power over our lives. He has given me a new life, that I too may rise one day and therefore no longer need to fear death in this life.

And I think that's something far better than anything this world can offer.

* Did you know that the term "graveyard shift" came about because people used to have to guard the graveyard at night from medical type people who would dig up bodies at night to do weird experiments on? How freaky is that!

Tiredness...

I think I have TB...

Or maybe lymphoma.

Then again maybe it's the psychomotor retardation of depression.

Either way I'm feeling really really tired for no particular reason this week. I even went to bed early last night and still struggled to get up today.

Last year (as a student) I would just take the day off if I felt mildly unwell. But now I kinda feel some bizarre sense of responsibility and so drag myself out of bed and force myself to get thru the day.

Using Coca-Cola and other legal stimulants, I managed to go thru the motions and even managed to suck up to the boss (good to keep the consultants happy).

But then as I was about to leave the evil nurses poured forth their usual load of rubbish and soured the end of a long day.

We had charted a new anti-psychotic for a rather aggressive patient who had been waiting 2 days for it to be approved by the government. Now that we had finally gotten it ready we charted it in the med chart to be given and as I was preparring to leave the nurses said they didn't 'want' to give it to the patient because they would need to monitor his vitals hourly for 6 hours.

Oh no! Heaven forbid they should have to actually get off their bums and DO some work. I'm SO sorry for actually assuming they had a job to do (for which they get paid more than me!).

They cited some concern about safety (um hello... that's why we employ a 100kg bikie to protect them!) and refused outright to give it. I so wanted to pull rank on them... but have heard horror stories of interns in Wagga who have tried this and ended up paying for it with a lifetime of Panadol-recharting-pages.

I reluctantly recharted it for the next day and then had to exaplin to my boss WHY we weren't able to give the patient his anti-psychotics today.

Needless to say I wasn't happy, the boss wasn't happy and the patient called us a bunch of unrepeatables.

Thankyou nurses ... for being so useful!

Not looking forward to the weekend. I have to work Friday evening then Sunday evening then I work 3 days next week before starting a week of night shift (11pm-8am)... kinda starting to wish I'd got a job at McDonald's flipping burgers...

Oh well!

The Nurse Strikes Back

Oh she's back...

And she's not happy!

After my ranting and raving the other day about a certain nurse in the Dungeon I was rightfully warned by some friends that paying out nurses online might not be a wise idea and might incur all sorts of retribution. But I have decided that I need to vent, for she hath returned to my world in order to torment me and causing much pain, suffering and gnashing of teeth.

I was enjoying my first day back at work and it was nearing the end of the day. My reg said he was off to organise his wedding reception so I said I'd cover the ward for him. No problems!

I get a call from the boss (who by the way gave me an "Excellent" on my mid term report - yay me!) who asks me to admit a patient directly from his rooms. Now it's not protocol to admit directly after 4:30pm but I was feeling generous so I said ok (as if I had a choice).

So I'm looking to admit this 86 yo lady in 30 minutes and make it out the door at 5pm so I can go for a swim before dinner. But then it happened.

I looked at the computerised whiteboard (due to privacy reasons we use an entire flatscreen monitor as a whiteboard - what a waste!) and saw that the nurse who had made my life hell last week was going to be looking after this patient.

I was waiting with the patients old file ready to get stuck into the paperwork as soon as she hit the ward. However when the patient DID arrive, the nurse (I shall call her Jeezebel for now) grabbed the notes off me (rather rudely) and began to pretend she needed to read them. She then proceeded to read a letter clearly marked to "Dr J" form my boss explaining what needed to happen with this patient. She then felt 'informed enough' to start telling ME what to do (as if I was unable to read the letter from my boss written to ME.

I needed to quickyl asses the lady (for legal purposes) but as I made for the patient's room, Jeezebel decided she had urgent business with the patient too and raced for the room too. Trying to pretend like she had work to do, she kept slowing down my interview and interrupting my history taking.

After finally getting through all that, I returned to the desk to write up my report only to find Jeezebel stalking/shadowing me and as soon as I put the notes down she pounced like a hungry predator, seizing the notes and flicking through them, scouring the pages.

"Oh look you haven't filled in a form 2 yet Dr J"

"Yes I'm aware of that thankyou... I have to write up these ADMISSION notes first and THEN I'll do the form 2"

"Oh ok...oh and you haven't written her up any meds yet..."

"Yes Jeezebel, I'm aware of that too... again, I will be doing that bit AFTER I have written up her admission."

"Oh and by the way you havent...."

It continued like this until I could finally distract her long enough to write my charts and run like hell out of the Dungeon and to escape 30 minutes longer than I had expected.

Apparently I am not the only one who has a problem with her. One nurse was telling me yesterday she swore at Jeezebel and walked out of a handover on her. Now if another nurse swears at you it's def not a doctor/nurse problem... it's HER problem...

Grr... anyways, its' time to finish my lunch break and go back down into the dungeon to face off with Jeezebel (who always happens to be on the afternoons for some reason).

Wish me luck!

Culinary Cruise

Weekend back in Sydney was amazing.

Spent the whole time eating I think.

Eating Thai with church buddies, eating brunch with my sister (and her cute Eurasian baby), eating Italian with hospital buddies, eating yum cha with med friends, eating Indonesian with mission people, eating brunch on Coogee Beach with other med nerds...

I think I put on all that weight I lost over 5 weeks in Whoop Whoop in 4 days in Sydney.

Sigh...

Was so good to see everyone again.

To share those amusing anecdotes common to all first year interns, to reminesce about our freedom as med students (and even re-live those viva-sessions at Kogarah Gloria Jeans)... was kinda weird on the Friday and Monday though becasue all my uni friends were now busy working at hospital. So unless my friends take the same weeks off I realised that my holidays will be pretty lonely from now on.

Being back in Sydney made me realise just how important family and friends are and was so encouraging to just chill with everyone.

Was also good to spend some of my pay on 'stuff'.... like the Firefly DVD boxed set (please bring it back to TV!) and the Serenity movie DVD (if you haven't seen it go rent it NOW!) and CD's and a new watch. Selling my soul at the temple of consumerism known as Westfield. It's amazing how discontent the shopping centre makes you.

I live my life for weeks being content with what I have but as soon as I step into their airconditioned palace I begin to sucumb to the cries for consumption.

"Buy me! I'm on sale!"

"You're life is second rate unless you buy _____."

I walk around 'wanting' more and 'needing' less.

Anyway, enough existential pondering. It's back to the real world of psychiatry and I'm glad to see that none of my patients have improved in the past 4 days and I still have little work to actually do.