The Movie Show with Dr J

First on our list tonight is the much anticipated film adaptation of Dan Brown's bestseller airport thriller "The Da Vinci Code". Director Ron Howard, best known for his work on Russell Crowe epics, has attempted to make both a faithful and financially viable version of the novel that has taken the world by storm with its controversial claims about the church and its quest to suppress femininity.

Now I only very recently read the book myself having been convinced that if I didn't read it prior to seeing the film I never would. So with the novel fresh in my mind I went with 2 other terns to see if the movie which got canned and Cannes would have anything to offer.

To be honest... it didn't.

Tom Hanks looks like he's not even trying to act in this extremely lengthy blow by blow account of the book. Ian McKellen really should stick to Hobbits and X-Men (see below) and the bits they cut out and added didn't really work.

The only redeeming feature of the 3 hours was the refreshingly beautiful Audrey T who kept me entranced long enough to stop me from nodding off. I haven't seen her most famous work "Amelie" but will definitely need to stop by my local Blockbuster now to become better acquainted with this French belle.

The second movie in our review list this evening is "X-Men 3: The Last Stand". Now I've never really watched the TV cartoons or read the comics, but the prior 2 movies in this trilogy have been of substantial quality (and of course star the ever fabulous Famke Jannsen and Anna Pacquin).

So late last night (when I should have been sleeping for my overtime shift today) I snuck off to see a late session of this action comic adventure.

And it delivered. It restored my lost faith in cinema after the Da Vinci Con.

The plot was slightly poorer than the previous two, but the action and style made up for it. Not too overdone with action, it allowed sufficient character development without allowing one to feel bored.

The only saddening thing is that this will inevitably be the final installment in this series which means that for a closing chapter it didn't quite close off the ends I would have liked it to. There's too much left lying undone and too many characters fates uncertain.

But then again, in reality who ever lives happily ever after?

A Glimpse of Freedom

Yesterday was one of those awesome days.

Somehow I managed to score my ADO and so I had an entire 24 hours to myself on a weekday with no commitments.

So what did a busy intern do with his day off?

Not much to be honest.

Woke up late and watched the season finale of Lost from America which ended with all 3 flatmates yelling and screaming at the computer screen in frustration as our questions were kinda answered with more questions and the depressing fact of a 1 year wait for the new season.

Went into the city to meet Dr E from work for lunch and then a 'shopping' trip. Ended up getting some new shoes for work, a new leather 'man's' wallet (time to ditch the teenager surfie brand thing) and those longsleeved Giordano T's I've been waiting to get (seeing as my pseudoex-wife didnt get them when she was in HK recently)

It was nice to just meander aimlessly like a cow around the city streets and actually get some sunlight to prevent my Vitamin D deficiency induced rickets.

Went out for dinner in Newtown for Thai with some mates before graduating from theological college for my correspondence course.

Days like these make up for days like today where I am stuck in hospital from 8am till 11pm dealing with old sick people who are moaning on and on...

I've realised that I am developing an intolerance for sickness which is kinda bad for someone working as a doctor. I get really annoyed when people page me cos the patient's condition is declining. My altuism from yonder years has dwindled and now all thats left is a resentment for making me have to write in the notes or stab someone with a cannula.

Only another 30 days till my next ADO...

Research Girl Part 2

Time: Early Thursday afternoon
Place: My ward
What: Pager goes off. Intern answers his page. Reg calling from theatre. "We've got another operation you NEED to come to... the ball's in YOUR court this time." [click]
End transmission.

Time: 20 minutes later
Place: Paediatric operating theatres
What: Consultant and reg hunched over small child dissecting ureters to prevent reflux. Attractive young blonde research assistant known to intern standing in corner looking bored. Enter intern, who is given smirk from reg beneath her surgical mask. Intern walks over to aforementioned research girl and begins to ask trivial questions in order to establish rapport.
Reg and boss start muttering in low hushed tones that intern cannot discern. After 15 minutes of light conversation, intern is called to scrub in and help close up the wound. Blonde girl comes over to continue conversation with intern and registrar. Post-op intern has to leave to admit patient whilst reg is left with research girl.

Follow-Up:
D/W Reg later that day. "Did you put in a good word for me?" "There was no need to J, she was already taken with you! Haha!" Intern turns red at this point.

"Oh and the boss said if you stuff this up, he'll fail you on this term...
No pressure or anything!"

NB in response to many questions raised by previous post:
1) nurse was NOT attractive and already 'had a man'
2) research assistant looked very attractive but then again, surgical scrubs and masks can hide many flaws.
3) Reg C is married.

Bump Off Lover

No need to call homicide.

This is the name of the new drama/horror TV show I have been watching over the last weekend starring Chang Shao Han (this very cute pop star from Taiwan)

Bump Off Lover is this really addictive TV show about this twin girls whose mother is a school principal. Their chemistry teacher tries to hit on Twin A and so Mummy fires him. Chem teacher isn't happy so tries to kill Twin A but mistakenly kills Twin B (cos they're monozygotics) and meanwhile twin B was trying to commit suicide with her secret boyfriend because life as a teenager was awful etc etc. So the end result is this really addictive drama with stalkers who portray their menace by making their car power windows go up and down repeatedly to the sound of Jaws-type violin music.

Unfortunately the entire thing is in Mandarin and as my Chinese is getting progressively worse, I am having to rely upon subtitles which means I have only watched the first 2 hours of it and am dying to see the rest.

Will the killer be revealed? Is it really the chem teacher or is it someone more sinister?

The Love Boat

Seems everyone is keen to jump on the band wagon to get me hitched.

I confronted my registrar after yesterday's incident and asked whether she ever needed a surgical assistant in the first place. Apparently not. And apparently it was the anaesthetist's idea to make the call in the first place.

Grrr!

We have a patient who needed a catheter put in yesterday. He was writhing in pain from a full bladder and so I asked the nurses to put in a tube (3-way catheter). Apparently they are qualified to put in a 2 way but not a 3 way even though they are exactly the same size tube and length... I tried to explain this to them but they just couldn't process such complex information as "It's exactly the same as a 2-way" because they kept saying "No one on this urology ward is trained to put one in" (in that case which ward WOULD be trained if not the Urology one?)

So I got the stuff ready and went to shove a tube up a guys penis to help him pee. I squirted in 2 tubes of ligno gel (a tip my reg taught me to ensure the pt doesnt feel pain is to use more than 1 tube) and prepped the area. In went the tube... out came the wee. Too easy!

"Oh thankyou doctor! That was the best one I've had put in so far!"

"Really? All I did was put in anaesthetic?"

"Oh those nurses didn't use anaesthetic... they told me there was none for this."

"Um well there is... and they should know that..."

[24 hours later]

Relaying the story of my heroic catheterisation to the nursing staff when one pipes up "Yeah you certainly impressed him... he keeps talking about it and asked me if I had a boyfriend cos he wanted to set me up with YOU!"

Now it seems even my patients are getting in on this conspiracy to set the single young docotr up with anything with a XX chromosome.

What's with this? Do I have a sign over my head saying "Please set me up, I'm a socially inept male doctor who needs assistance from people with his love life"?

This never happened when I was a med student. Why now? When I have the least time of all?

I was set up I tell you!

Today I was cruising around my hood in my homie style scrubs just chillin with Reg P when my pager went off.

I picked up the phone and dialled the foreign number.

"Uh, is that Dr J? Dr C your registrar asked if you can come to the Private Hospital Theatres to provide an extra pair of hands for Boss D who's operating"

I put the phone down and tore off down the maze of corridors to assist my Boss.

Dr J to the rescue! I had never been called to 'assist' in the private hospital before! Usually this is a privilege reserved only for the registrars.

I flew into the OT feeling kinda out of place in my pale shabby blue scrubs whilst everyone else was wearing neatly pressed dark navy blue private hospital scrubs. Oh well.

I donned the ninja-like face mask and entered thru the anaesthetic bay doors ready to scrub in for the awaiting surgery.

"Oh hi J" said Dr C looking up from her small paediatric operating field, "It turns out we don't need you after all... but while you're here you might as well stay and watch the surgery"

Kinda disappointed, kinda relieved I stayed to watch some kid get her urological plumbing rewired to stop her refluxing.

However half way through the operation my registrar started twitching her head sideways whilst staring at me.

Not sure if she was having a sore neck or some kind of choreoathetotic seizure disorder I just ignored it. But then she kept staring at me and nudging her head as if pointing to something of interest. I looked to the direction of her flailing head and noticed a girl dressed in scrubs looking kinda out of place in the OT (newbies always stand out by their timidness and standoffishness from the action) I glanced back at my reg and shurgged my sh0ulders not quite sure what she was referring to about this girl.

However my reg kept persisting in flicking her head until I finally went up and asked the girl "Hi I'm J the Urology intenr, who are you?"

Turns out she was a research student from my old uni who was investigating the pharmacotransmitters in the bladder (yes rivotting stuff I know!). At this point as I was talking to her I saw my reg give me a big 'thumbs up' discreetly and grin behind her surgical mask.

I gave the reg back an evil greasy glare.

After some small talk with the research student, the operation finished. She collected her specimens and went home whilst I waited for the reg outside the theatre.

"Dr C you are in sooo much trouble!"

"So Dr J, what did you think? The anaesthetist thinks you should go for it too!"

"Hang on, I've only just met her and for all I know she may already have a boyfriend..."

"No she doesn't... we've already found out for you... and she'll be here every Tuesday and Thursday... want us to page you everytime she's here so you can help us operate?"

I felt so used!

Service with a Smile

Last night the old Uro intern C and myself were treated to dinner by our registrars.

We decided to start the night off with some drinks at the pub-next-to-the-Zoo and then made our way down the road to a nearby Lebanese restaurant for 'the Banquet' option.

It looked good. Lots of food and nice atmosphere... but all that came to a crashing halt when the rather inexperinced waitress manged to tip the tabouli all over me and my work bag.

This led to a number of comments about the waitress being nervous around me and therefore having some sort of attraction towards me (pfft!)

However this hypothesis became a theory when she later almost spilt another dish when she was leaning over my shoulder and so we concluded either it was her first night or something about me was causing her to flip and lose her cerebellar fine control and have dysdiadokinesis (just wanted to use that word cos its so cool)

It was very intersting to see the reg's outside of work. Most of the dinner conversation revolved around the topic of urine and humerous anecdotes abounded (like seriously... even 3 yr olds can laugh about wee).

I must say I am very thankful for my reg's. My expereince of surg regs as a student was not always favourable (ie the "unit" who failed me in my last term of medical school in plastic surgery... grrr!) but theese 2 are really nice in different ways. Dr P alwasy stands up for me if I'm being given crap by other teams or staff and will support me on my decisions (if they are well made) and Dr C offers me cake when I'm pulling my hair out in frustration (I'm serious... she went and fetched me a piece of cake.. how nice is that?)

I was initally having great fears about being hammered by my surgical regs and cowering in fear as they told me off. But these 2 have been very understanding (esp cos I was coming from psych) and are always fun to talk to. So it was really nice to have a meal with them and just 'bond' (if surgical regs can ever be said to 'bond')

The deepest the conversation ever got all night was the following existentialist question (which I think really captures the deep issues in life):

"If you owned a restaurant, what food would you serve and what would you call it?"*

* the restaurant next door to where we were eating is owned by our Professor and hence the random topic

"Waiting to be killed... waiting to be killed"

Today's post title is brought to you today by the indie film "Thumbwars" in which an anthropomorphified thumb imitating a rebel starship commander looks around and waits for the Darth Vader figure to come and kill him.

It's a cry of bordeom from a digitially enhanced film character and yet it has nothign really to do with life other than I am bored.

Bored in a good way!

Last 2 days have been very different.

Day 1 - (ie Yesterday) having 2 patients on the ward meant I had nothing to do. It also meant that because Boss A was operating with the reg, that Boss B needed a theatre assistant for a nephrectomy. And so the lucky intern who had nothing to do got to scrub in and take the reg's spot in the far more interesting surgery.

However, somehow anaesthetics took a long time to get a central line in so Boss B and I sat by ourselves for 2 hours waiting for them to get the patient on the table. Boss B also happens to be my term supervisor so everything I say to him must be said with utmost caution so as to not detract on my assessments. So there we were trying to make small talk (which is difficult enough at the best of times) whilst he is getting visibly impatient at the delay in surgery.

"So are you into sport at all?" I asked, going for the safe topic option.

"No not really" ("Damn" I thought!)

We ended up chatting about travel options in Queensland (as one does) and the political situation between Taiwan and China.

Eventually we got into theatre and I got to use the vacuum cleaner (sucker) and help stitch the wound closed. There was lots of pus in the abdomen which kinda looked like chicken soup as it all came pouring out when we made the incision... not very nice!

Then before I had a chance to get lunch I was called to the other set of theatres to admit a GP's father (who of course gets 'special' treatment cos he's a GP's father and only had 1 partially functioning kindey in acute renal failure) but we were awaiting the blood results to make sure he wasn't hyperkalaemic, when we got a phone call from the lab saying the specimen was haemolysed.

No problem I thought. I'll quickly take 2 more EUC tubes and send them thru the chute immeadiately with "Super-Urgent" marked on the form.

1 hour later still nothing. I called and they made some excuse about not knowing where the tubes were. 1.5 hours later the understandably cranky anaesthetist calls up the lab and abuses them only to find out they have 'lost' BOTH of the specimens I sent them. Needless to say there was an IIMS ( Incident Managment Something-or-other) report involved.

Day 2 - today

Reg A was away today doing some rural clinic in Inbredsville and Boss A had flown off to Hong Kong to talk to the Asians about incontinence.

Therefore Reg B was the only one on and Bosses B to D had had all their theatre lists cancelled (thru some admin stuff up)

Reg B presented a talk on vasectomies (always fun to hear about early in the morning) and quoted a journal discussing the 'taste' of post-op pt's 'products'.

After the morning meeting, I was invited to go and "see some scrotums" with Reg B and then had the rest of the day to myself.

Was about to leave hospital when Boss D paged me urgently. I was a bit worried. Would he spoil my day? Did he need an operating assistant? Was I about to get into trouble for not ordering some CT?

"Dr J, I just wanted to ask you a question. Did Reg B REALLY say that it tastes the same post-op?"

"Um apparently that's what the journals say?"

"Thanks bye!"

[dial tone - call ended]

D-day: The Tides have Turned

From the above title, one could be forgiven for thinking this will be a post about war and the reclaiming of ground lost. The storming of the French coastline in order to liberate the European continent from it's oppressors which turned the tide of the war and eventually led to the Allied victory.

Well it's not a post about that. Although there are many similarities.

For the past few weeks I have been fighting a war. And it has notbeen going in my favour.

I started this term with a fairly big inpatient list for surgery (anything over 10 qualifies as a 'huge' surgical inpatient list) and have never been able to shrink it. In fact if anything it has gotten worse with last Friday's AMO count reaching 15 inpatients.

It was looking bad. All the wide old RMOs were telling me how Urology was renowned for 'not' having many patients and how I must be doing something wrong.

Well today was the day that Dr J struck back. It was the day he regained that lost ground and the tides turned on his bad fortune in the inpatient stakes.

I managed to discharge all of the 15 from last week except for 3 so that now I am left with a trio of stable easy to manage patients.

Contributing to my agnst over the past weeks was a 102-day-stayer who had PE's and haemorrhages requiring ICU (x2). It seemed no one could budge him. The old Uro intern tried and failed. I tried once, only to have him pee blood everywere and go into ICU the very day he had his bags packed to leave hospital. So finally, after extensive hours of discharge plannning I personally escorted him to his vehicle and carried his bags for him, lest he trip and end up with a # NOF or something.

We estimate he cost close to $100,000 in taxpayers money over the last few months (at a conservative estimate) and now to celebrate his departure the reg's are shouting me and the old intern dinner next week to say thankyou.

For the first time in 6 weeks things are looking quiet. Tomorrow I look forward to taking a nice long lunchbreak and a few 'coffee-breaks' too. This is making things bearable. I no longer feel like jumping off the helipad each day. I can look forward to some uncomplicated theatre time without the incessant paging from the wards. Ahhh!

Speaking of which, I had my interview with the Director of Clinical Training yesterday. These informal chats are supposed to see if we are coping ok and whether or not we need help. So our DCT (who looks uncannily like John Candy) sat me down and began:

"So how are you finding The Zoo?" (monotone)

"Um yeah its ok, I..."

"So what do you wanna specialise in?"

"Well I was thinking either GP or Paeds, although..."

"So do you wanna come back next year?"

"I'd like to."

"Thanks for coming, Bye!"

He really should have been a surgeon and not an ED consultant.

I am the boss (well sorta?)

Sometimes it's really frustrating to deal with people who are below you inrank but think they know more than you.

Like even if they DO know more than you, in the end it's your job on the line, not theirs.

So I got pretty peeved on Saturday when on my overtime I kept getting bugged by this nurse who was convinced she knew better than everyone else.

There was a patient who had a fall and had been a bit off since then. No signs of visual disturbance or headache and her GCS was 15/15 throughout. We discussed the patient with both the night and day med registrar and both of them agreed that CT was not needed.

However when I went to see the patient the nurse was like "Why isn't this patient getting a CT?" I nicely explained that we had discussed the patient with 2 senior doctors who also both agreed no CT was indicated.

But this wasn't good enough. Of course the nurse knew much more than 4 doctors with medical degrees and began to rant and rave about how the patient was unsteady on her feet. I explained gently that this patient had been like that for the past week as documented in her notes due to her hepatic encephalopathy.

But that just made her more ticked off. So I started to attend to the other patients and try to ignore her.

But she came to ask me to review a pt's CT scan. I looked up the system and found the patient had never HAD a CT Scan so didn't review something that didnt exist. I was promptyl called back to say she had changed her mind and now wanted an EEG reviewed for this patient. Now EEG's are never really that urgent and interns on call are NOT expected to review EEG's as part of their on call work.

But this nurse wouldn't give up. And I wasn't gonna budge. I told her "If you want this EEG so much, you go find it for me!"

30 minutes later I got paged again. "We got that EEG urgentyl faxed over for you to review"

Grrr!!!

So I reviewed the report which was essentially normal. "There.. you happy?" I thought to myself.

Obviosuly not happy enough for the nurse. She then pointed to the notes written in haste during the week that said that if the patient's EEG was normal he could be discharged. Now this was a note for the regular team to be reminded... not for the oncall intern to be sorting out.

However, 30 minutes later I found myself filling in a discharge summary for this man and doing something just to please the nurse (never good practice)...

Sometimes I wish they woudl just let us be the leader in patient management and stop bullying us into doing things they think are best... I'm happy for them to express a disagreement, but after I've listened if I still say "no" then that means "no!"

To quote the immortal words of O-Ren Ishi:

"As your leader, I encourage you from time to time, and always in a respectful manner, to question my logic.
If you're unconvinced that a particular plan of action I've decided is the wisest, tell me so, but allow me to convince you and I promise you right here and now, no subject will ever be taboo.

Except, of course, the subject that was just under discussion.
The price you pay for bringing up either my Chinese or American heritage as a negative is... I collect your f!#$ing head.
Just like this f!#$er here.
Now, if any of you sons of b!#$%es got anything else to say, now's the f!#$ing time!

[pause]
I didn't think so.
[calmly, in Japanese]
Gentlemen, this meeting is adjourned."

"There's no such thing as a fat intern"

As an intern we alwasy get worried when patients lose weight for no good reason or without trying. It's usually a sign of something bad eating away a person's insides or the 'systemic' manifestation of a bad ass tumour.

So when an intern starts losing weight unexpectedly what are they to do?

During my psych term in Whoop Whoop I managed to keep my weight stable by taking extended trips to the local mall and super long lunch breaks. But since working in the Zoo I am shedding weight like it's going out of fashion.

Unfortunately I haven't quantified it (so won't be able to get a consult until I do as all good terns will know) but the clothes are definitely getting looser and my curved abdominal adipose tissue is flattening out.

My reg once aptly told me that fat interns are an anomaly and I am starting to believe him.

My other reg gave me a drug company pedometer as a gift/token-of-appreciation/instrument-of-torture. So now I am subject to daily questioning by her about how far I've been walking. Today I clocked 9km around the hospital which I reckon is pretty impressive for a tern on a surgical term. Most old people feel happy with 1-2km per day and boast like their hearts are so much better for it. So if that's the case my heart should be extremely healthy (I wish!)

No wonder we surgical interns are so tired and apathetic!

But quote of the day goes to the fictiuos Dr Yang from Grey's Anatomy who referring to a close friend going thru a crisis said:

"Are his problems surgical?"
"Well no..."
"Then technically he doesn't need our help!"

Assertiveness

As interns, we don't really get much feedback to let us know how we're going.

Most of the time we are flying blind hoping that we are performing ok (or above average) and I don't know about other 'terns but it makes me feel a tad insecure.

What if I'm really bad and no one is willing to say so? What if I just have no idea and by luck I haven't killed anyone yet?

It would be nice occasionally to be let known just how well (or not well) we are going so we can improve/celebrate/whatever.

Thankfully the nice people who register us as doctors during this year, make us go through the student-like process of getting assessment forms filled in every 5 weeks or so.

These forms are mandatory red pieces of paper designed to make sure we are not gonna end up being a new generation of "Dr Death's". Last term in psychiatry I did pretty well in these assessments (mainly cos if you showed up to work you were doing better than most other psych interns) but I had apprehensions about getting my assessment for my first 'real' term as an intern (especially cos it was a surgical term and surgeons are never known for being nice)

So today I was pulled aside by one of the bosses and set down in a consulting room to 'have a chat' about life/surgery/the-meaning-of-PSAs. I was feeling nervous because out of all my 4 bosses, I knew this one the least and his quiet/reserved demeanour made him a harder surgeon to woo over.

His first question to me was straight to the point. "What career are you interested in J?" Argh! That loaded question! If I say the truth "I wanna be a GP!" then he'll think I'm an idiot and give me a bad assessment cos I don't want to emulate his surgical career and if I lie and say "I too wish to play with pee for the rest of my life!" then he'll start expecting me to show up more to theatre.

I decided that truth is good and lying is not good (esp for Christians) so I told him I was considering GP-land. I braced myself for fire and brimstone and a rogue scalpel aimed at my head but none arrived.

He somehow tried to convince me that GP's need to know lots of Urology and so I should still come to theatre. Phew! Crisis averted!

So we chatted about PR's (sticking fingers up people's buttholes to feel if they have cancer) and whether I was being 'supported' enough by the bosses.

Eventually it came time to fill in the dreaded red form. He ticked straight down the midline ("Consistent/Average for level of experience") and told me that this was as good as he ever gave interns and that often he failed them so I should be very pleased with this. So I was.

He said that my registrar was more than happy with me so far (wish they would say that themselves rather than through the bosses) and that the only thing I need to work on is "being more assertive"

Being more assertive? Apparently I am not kicking enough surgical butt on the ward and this is my downfall. Maybe I really AM caring too much about my patients and keeping good relations with the nursing staff that I am compromising the staunch tradition of abrupt gruff surgical practice.

My boss told me that I am now in the rat race (thanks for pointing that out)... for the first time since high school I am actually competing against other people to get where I want to be. I need to "show how good" I am to impress bosses and "suck up" to them (Seriously... my boss said this!) I gotta sell my wares to those in high places and fight tooth and nail to stab those other 'terns in the back to beat them and get into training places.

I'm so not up for that.

To be honest I'm not a 'career' person. To me, this is a job, not a careeer. I show up, you pay me. I'm not doin it to be a high flying specialist who tops the exams. I'm doin it to make an honest living whilst I help people.

So I find it hard to sit there and be encouraged by my boss (as good-willing as he was about it) to join the petty fights to get to the top when I don't wanna 'go' to the top.

But yeah, I'll have to work on that assertiveness... watch out nurses! Here comes Surgical Dr J!

Confessions of an OT junkie

I must use my words carefully. Whether by coincidence or via a mole, my boss has started referring to me as "Dr J" (ie using just this title and not my real name) which means he may be reading these blogs. If you are sir, please leave a reply and say hi, otherwise I shall proceed with caution.

Anyway, the above mentioned consultant told me today that I HAD to see this certain operation he was about to perform today. So I quickly flew through the daily ward stuff and wrote in big red letters on the white board "In operating theatres, only page if urgent!"

So I ran down stairs as fast as I could, donned my magical blue scrubs and powered up for a scrub in with the boss and reg. Turned out we were doing a laprascopic nephrectomy and lithotomy using a new innovation called a "gel-port". Basically we were pulling a huge 15cm stone out of someone's ureter but insetad of using the rather cool standard fibreoptic camera cuts we were using this new technology called a 'gel-port' where a glowing green circle is placed into a cut in the patient's abdomen and you then shove your hand thru the port into the patient's abdomen and watch your hand on the TV screen. It kinda looks like the TV show Stargate where this people have alien-snake creatures in their abdomen called Goa'uld which exited from their hosts via a similar star-shaped port in their tummies. In the end we needed to convert to an open approach which meant the poor guy had the gel-port for nothing... but as an aside, my boss informed me that the port is made form the same rubber as "blow-up dolls" (you know those one's nerdy guys who can't get dates have stored in their cupboards?) That information will come in handy on trivia nights I'm sure!

As I was about to pass out from low blood sugar standing still in the operating theatre for over 4 hours straight, the kind scout nurse appeared with a packet of Allens snakes and offered to insert them between our face and our surgical masks. So there we stood with our hands coveed in blood in this guy's abdomen whilst a nurse hand fed us sugar snakes to keep us going. A bizarre sight indeed!

It was so nice today to be scrubbed up and have my hands inside someone's belly. Not becasue I'm some weird fetish psych patient, but becasue it afforded me the oppurtunity to NOT answer my pager. That blasted beeping contraption gives me nightmares everytime it goes off. It has one of those crescendoing bleeps that means if you catch it early enough it's not too loud, but when you're in theatre and the nurse has to answer it for you, it gets to be quite loud and the boss kinda looks around as if to say "Whose beeper is disturbing my performance here?" SO today I just let the darn thing bleep all it wanted and everytime the scout nurse answered it for me, I would tell her to tell whoever it was on the other end to call the other registrar if it was urgent cos I was scrubbed.

Everytime I hear that thing go off, I feel my heartbeat quicken and my blood pressure slowly rise. Is it the ward calling about some sick person? Is it pharmacy asking about the dose of a medication? Is it the lab calling about a hyperkalaemia?

My reg told me an amussing anecdote about how her pager as an intern sounded like a bomb going off with a progressively frequent beeping noise. Apparently one anaesthetist banned it from their OT because the stress of impending explosions was too much for their sensitive soul. But now I've come to the point where I 'hear' my pager going off whenever I am in crowded places and there's any sort of electronic beeping noise.

I think I need help!

"Dum Vivo Disco"

This quaint Latin phrase was the motto of my senior high school.

Apparently it means "Whilst I live, I learn"... lifelong learning... something every doctor is a fan of. In the ever-expanding universe of medical knowledge, we must continually strive to grow in our understanding of the latest updates in our field of expertise. From new investigations to the latest pharmacotherapy, we are all students in this life, never ceasing to gain new information till the day we quit practice.

Each week at hospital, we are subjected to 'RMO Teaching" sessions where we get refed information on the latest management of anything from actue respiratory emergencies to "Understanding diversity health using storyboards"

Part of the Hippocratic oath staets that what we have learned from our teachers as doctors we will pass on for free to the next 'generation' of medical professionals. And so with much awkwardness I have begun this cycle of perpetual learning/teaching.

That's right, I got me my very own set of 4th year med students to teach.

A small troup of fresh little 'keen beans' popped up from behind the nurses station to greet me with their "Hi-we're-your-med-students-please-spoon-feed-us" routine. They we're all looking at me like I was a doctor or something. (oh that's right... I AM a doctor now! I'm 'supposed' to know stuff?)

So I arranged to meet them in the afternoon to 'go see patients'. I scabbed some cardio patients off my fellow terns and got ready to critique the youngling's examinations. However they turned the tables on me by asking "Can you please show us how YOU do a cardio examination so we can learn properly?"

A rush of adrenaline shot over me... I was suddenyl the one being cross examined.. and by a bunch of 4th years!

I had to think quickly and remember my cardio examination which I haven't done in over 6 months. I fumbled through it and diverted their questions to "Go home and read Talley (the textbook)"

So off we went and I let them have a go and then thoroughly grilled them to remind them that I am the one with the medical degree and not them (so that they didn't realise how dumb I really am... haha!) It was so weird cos 4th years know a lot of theory and so in reality probably know more academic medicine than I do... but my virtue of having done way more clinical exams than them I can pretend like I have something to teach them.

I felt by the end of it that they might be getting bored... but then they asked for another tute next week! Yikes!

I think I'm going to have to read up beforehand! So much for not studying at all this year!

Dum Vivo Disco!

PFO!

No this does not stand for "p!#$ed and fell over" as some ED 'terns have asked.

Instead it is the extremely rare patent foramen ovale which our urology team diagnosed yesterday.

Boy comes in with abdo pain. Boy gets CT scan. Boy's CT-scan shows dead kidney. ED calls Urology. Urology do CT angiogram on boy and find isolated embolus in renal artery. Urology then get suspicious and get carido, resp, renal, ID and haematology to consult. They all dance around not wanting to take over care so we start ordering Echo's and V/Q scans and CTPA's and what do you know we find a V/Q mismatch highly indicative of a PE, and on Echo we find that there's a giant hole in this poor boy's heart.

Cardiology/Resp/ID/Haem doctors -0 ...... Urology surgeons - 1

It took up most of my day and the poor boy was being wheeled from test to test and although it's extremely rareand interesting medically... this poor boy is facing some serious medical issues and his parents have been worried sick. I feel so sad for him... his whole life ahead of him and he has all these issues to deal with.


Thankfully after all that running around yesterday I finally negotiated that long awaited day off which was spent today doing absolutely nothing! In retrospect I didn't HAVE to take itoff, but it was the principle of making sure I get my days off so that the evil hospital sytem doesn't steal them from me.

Interestingly, I was talking to some other interns last night who were complaining about having to do ED later this year because they wont get paid as much (cos they will work less hours)... I was quite taken aback cos to be honest I'd rather have less time at work and less pay than the opposite scenario.

Each to their own I guess?

Having a day all to myself though was just what the doctor (ie me!) ordered. It was nice to just be by myself with no commitments to take my attention, no friends to call up and invite me out... just time to sleep, eat, relax and blow up Imperial Stormtroopers (playing "StarWars: Empire at War" on my computer)

Back to the hustle and bustle of the Zoo tomorrow however... if only for one day... and then the weekend.

Come oh weekend.... come. The intern and the registrars say "Amen"!

Mixers

Intersting to read in the SMH today about mixed relationships.

http://blogs.smh.com.au/samandthecity/archives/2006/05/intercultural_d.html

Apparently in Australia today I have a 52% chance of having a mixed marriage.

Some of my friends would say my chance is a lot higher.

It's not that I'm against "guilo" (Causasian) girls. I just seem to find more Asian girls attractive.

At least I'll have good looking kids though. 95% of those mixed babies are amazing in the looks department and a small minority are on the other end of the beauty scale.

One of my Asian mates was trying to set me up with his girlfriend's friend the other day. We'll see what comes of that! Haha!

I feel this year that I am a lot more settled in regards to girls. I don't feel the need to hunt down a girl, club her and drag her back to my cave (this is a joke female readers... don't get indignant).

Even if I DID find a nice girl, right now I feel I am too busy to even think about a relationship. If I was dating me at the moment I would dump me cos I had no time for me (that makes no sense whatsoever!)

Whatever the case, there's always the pharm chicks at the Zoo to give all us single men out there hope!

Chaos Theory

Today I am seriously considering a career change.

I think it's time to get me a job flipping burgers at McDonalds.

I remember my glory days working in Pizza Hut. When I was on the 'make' table nothing could get in my way. I had each pizza's toppings memorised and I could literally make any pizza with my eyes shut in 20 seconds.

When my mate "Ratboy" ( seriously, that was his name... we even had a secret society of "dodgy brothers" and would make tapes of "pizza-making-music" to listen to) and I were on shift, we had the store under control.

Things would admittedly get busy, but we always knew how to handle it. We could get thru the busy rush periods knowing how to keep things from escalating into chaos.

Not so with medicine.

Somewhere today on the ward I lost the plot completely.

It looked to be another ordinary day until at midday 4 patients simultaneously all got really sick at once.

Now if it's just one or two sick patients and everyone else behaves themselves I can deal with it.

But when I have 4 of them all crashing at once I cannot deal with it*. I tried to focus on them one at a time but the nurses kept hassling me about the other ones each time I sat down to sort out one of them properly.

It really messes with your mind as you are trying to go through your med school teaching on APO as a nurse badgers you about hypovolaemia and it starts to confuse your thinking.

"Does this patient have too much fluid or not enough?"

"WHICH patient's notes am I even writing in?"

At this point I received a page from one of my reg's... and I did the only thing I knew how to... I asked for help.

I dunno if it's a sign of 'weakness' in the tough surgical world to admit defeat, but I was stuffed.

I thought it more important to get these patients better than to worry about looking 'competent' in front of the regs.

So Dr C came down and brought her calming influence to the ward. Patient's had tests promptly ordered and management was swift in its arrival.

Why can't I be like that? Why is it so hard for me amidst the chaos to stand back and be objective about the whole situation?

On overtime I seem to manage much better at assessing theings detachedly. But somehow on the chaos fo the ward I cannot segregate these things.

Someone suggested it was cos I was being too nice to the nurses and so they will keep paging me for stupid things and wont leave me alone... I'm sure there's some truth in that!

But eventually I escaped the ward and made it into the peacefull bliss of overtime. Where my pager does not go off and my wards are all calm. I am back in my vibe once more and exert my 'pax romana' across my empire.

Or at least until tomorrow...

*Especially when one of them is a patient refusing to talk (stupid psych issues I think!) about his shortness of breath, one is my renal donor whose daughter just rejected her donated kindey (very sad!) and the other is a 16 yr old boy with a renal infarct of 'unknown origin' who is septic and being seen by 4 different medical teams (I don't even know why we surgeons are seeing him!)