Slicing and dicing

0620- Alarm goes off. Hit snooze button and roll over.
0630 - Stagger out of bed and make the mad rush to shave/shower and grab a handful of jelly beans for breakfast as I run out the door.
0700 - Do the Colorectal Ward Round with Reg and Fellow whilst trying to sort out all paperwork during round so as to minimise work during day.
0800 - Enter theatre to start operating on Boss D's list. Hack, burn, chop, tie, flush anything that makes poo.
1600 - Emerge out of theatre completely exhausted to smell a rather distinct odour on ward. Walk into recently ICU-released patient's room to find black tarry smelly stuff in both stoma bag AND all over floor.
1601 - Panic.
1602 - Drag Reg and Fellow up whilst simultaneously doing a FBC/ABG/G+H and teeth-pulling radiology to get urgent X-rays.
1645 - ICU come and decide patient needs to be intubated and Boss N decides to 'wait and see' if patient needs any further management.
1730 - admit out of hours patient for surgery who is 'allergic' to injections and on a special diet of 'red delicious apples and snow peas'.
1800 - Start overtime shift 1 hour late.
1810 - Get called to theatre to assist with a LOL who needs a hip replacement.
2115 - Finish the carpentry job on afroementioned LOL.
2120 - Get called to assist with laparotomy for a ruptured appendix.
2130 - Ask permission to run out quickly and buy a hotdog before passing out from hypoglycaemia.
2300 - Finish 1st laparotomy to discover my sick patient from earlier that day is now passing black smelly maelena from every orrifice and needs an urgent laparotomy too.
0300 - Finish removing dead bowel and walk home with the stench of maelena up my nose.
0330 - Sleep
0730 - Wake up and rush to hospital to start another laparotomy... the saga continues.

So yeah operating almost non stop from 7am till 3am is NOT cool. Even if it IS for a guy whose abdo is full of dark tarry blood-poo requiring 8 litres of washout. Even if I do get paid lots of overtime money. Even if we did save some guys grandma* I was so tired that I was worried I'd slip with the knife/diathermy/stitches and hurt someone. I was day dreaming whilst retracting abdominal wall. it was only the offensive odour of maelena that stopped me from succumbing to my fatigue.

Fortunately the registrar on call was my day time reg so she generously granted me a 1 (one) hour sleep in before having to return to assist with another operation. As much as I luv being back in the scrubs, I'm kinda glad that in 90 minsutes I can hang up the scrubs for the rest of the year and go back to 8:30 starts and free breakfasts.

Adios sterile fields and ninja-like face masks!

*as I grabbed the late night hot dog for some sustanence I overheard the guy in front of me in the queue talking about how his grandma was about to have her appendix out. Turns out it was my 1st lap case for the night.

A Date with Mr Porcelain

I got home from work the other day and decided to stop eating out all the time and cook a meal for once. I needed some vegetables otherwise I would develop scurvy. And so I raided the freezer for some chicken, scoured the pantry for some vegetables and rice and cooked up a chicken stir-fry.

However about 1 hour later as I was sitting in my local bubble tea hang out with a friend, I began to feel rather unwell. It started with a headache and then my abdomen began to convulse and that swirling feeling of nausea overcame me. I politely excused myself and staggerred home and went to bed, thinking perhaps some sleep would solve the situation.

Oh how I was wrong!

I woke at 6am with a wrenching pain in my abdomen and had just enough time to run to the bathroom and stick my head into the toilet bowl before regurgitating the entire contents of the previous night's dinner including the tapioca balls from the aforementioned bubble tea.

I was unable to hold down and fluids and began to dehydrate. Regular pulse checking was enabled to ensure that I didn't decompensate and die all alone in my room. I called work to tell them I wouldn't be coming in whilst I couldn't sit upright.

The next 6 hours were a blur of crawling fro0m bed to bathroom as I manage to expel more fluid retrogradely then I though possible. My tummy was broke and I started rigoring and shaking in bed. As I lay there drowning in my hydrochloric acid, I was contemplating dragging my sorry self up to Emergency. What if it was appendicitis? What if I had a small bowel obstruction and was about to perforate my gut contents intraperitoneally? When WAS the last time I opend my bowels?

But my concerns about a possible ileus were soon allayed when at midday the upper GI symptoms ceased and the lower GI ones began. As regular as clockwork on every hour I was expelling those toxins and cursing the virus that caused such pain.

Thankfully such diseases are self limiting and upon waking the next day I had no trace of illness and resumed my normal activities. Unfortunately my friends weren't so lucky. Next day they were the ones actually going to Emergency. Whoops!

100th Post!!!!!!!!

Yes, that's right regular readers.

We've finally hit the 100th post mark.

Looking back at some of the stuff I wrote earlier this year, it seems like life has changed so much. And yet there is nothing new under the sun. The same problems and challenges represent themselves in different ways. The regularity of life is unstoppable.

But every so often it is interuppted by...

HOLIDAYS!

After sorting out my GP interview, I raced home, packed my bags and took off to the airport for a holiday. However the stupid bus driver couldn't quite understand that an airport bus is supposed to stop AT the airport and so I missed my plane (which I had just rebooked earlier thatday)... it was not looking good but I was determined to take this holiday so begged the lady at the desk to rebook me for the next flight (which she kindly did at a cheaper rate).

Whilst awaiting my departure I noticed a guy who looked like Sir Richard Branson walking around the airport. Then he started shaking the hands of all the flights attendants and I realised that it WAS Sir Richard Branson. 2 hours later I was at Surfers Paradise, ready to start my adventures.

I stayed at this cheap backpackers hostel overlooking the beach. During the course of the week I had South American, British, Japanese, Canadian, Korean and Mainland Chinese people living in my room which always ensured interesting conversations at night.

Each day I would wake around 10, wander down to the beach and eat bacon and eggs. However, I decided that onthis holiday I would eat at a different restaurant each meal and so I tried bacon and egss from 5 different places. Then I would go for a short swim and sun bake before finding another place to score some lunch. I'd then but the daily newspaper and sit on the beach and read books all afternoon until it was dusk. Then I would take a long walk up the beach and back (about 4km each way) and eat dinner before retiring.*

To be honest, I didn't do much... and I luved every minute of it.

I had time to sleep. Time to eat. Time to think. And time alone.

Sometimes you just need a break from everything in life. A break from relationships, responsibilities and to relax.

I felt like I was alive once more. I had drunk deeply from the wells of enjoyment and was refreshed.

And so when I returned, I bumped into a freind who commented, "You must have had a great holiday! Those bags that have been under your eyes all year have gone!"

With friends like these...

* This routine was only disrupted by my 'Movie Marathon Thursday where I watched 3 movies in a row just because I could.

You can call me Reg... (from next year)

Ok... must apologise for not writing in 2 weeks. My bad.

But to be fair, it's been very busy so I'll make up for it with a highlights package from the last fortnight.

So I finished my week of nights at 9am Monday morning and raced home to get ready for my trip. However in the mail that morning I received a letter from the GP training people asking me to come in for an interview sometime in the next 2 weeks.

I called them up to ask if I could arrange the interview for the following week (seeing as I was about to leave on my holiday) but they said the onyl time I could have my interview was THAT day at 1pm.

So in a mad scramble I rebooked my flight (costing me more $$) and had a haircut/shave/shower and tried to prepare myself for the interview in 2 hours time. I raced over to the interview and somehow stumbled through the questions (still having not slept since my night shift had finished) and apologisd to them for being so incoherent. Thankfully the sleep deprivation made me less nervous and made me ramble more (which is always good for a GP cos they are supposed to be big on communication etc etc)

Anyway, to cut a long story short, I got a letter last Friday saying that I've been accepted into GP training for the future which means if all goes well I only have 18 months left in the hospital system!

I dunno if I'll make a good GP or whatever, but I think it's definitely about the lifestyle for me. I just am not cut out for 7am starts (thereby ruling out surgery) and I cannot contemplate physicians training (cos I'd need to be admitted to a psych ward with acopia) and so I think GP is a great balance where I can work part time (or not at all) and pursue other (more meaningful) things in life.

On the topic of work, we had to reapply for our jobs last week which is such a pilonidal abscess (pain in the bum). Going around and begging people for references, writing CV's and cover letters and answering stupid 'job criteria' is such a waste of time. I feel so arrogant and conceited writing this rubbish about myself that I don't truly agree with. It's really uncomfortable trying to 'sell yourself' to employers. And it's futile too seeing as most public hospitals re-employ their own.

Oh well, 18 Months and counting...

Credit where it's due...

Ok I'll admit it... not all nurses are bad.

I know at times I can sound like an arrogant 1st year intern whinging about nurses cos that's just what doctors do.

But I want to be the first to admit that some (exact percentages are not yet available) nurses are really really great and make my job pleasant.

Such as the clinical support nurse on this evening... le Frenchman!

Le Frenchman's job is to go around helping wards out with stuff that they can't do but that don't always require the doctor. He will put in catheters, fix up APTTs that are too low and hit the veins first time in patients who even residents can't cannulate.

Often I will get called to do some procedural thing only to find that Le Frenchman has beaten me to the task and done it for me. Even better, sometimes he teaches other nurses how to do them so that they don't need to call the doctor next time.

Without him, my night shifts would be more like the hell-on-earth I experienced at Whoop Whoop where I ran around like a headless chook all evening chasing my tail to triage sick patients whilst stabbing people with needles.

Oh and the coolest thing is he is French. You don't meet too many frogs in this part of the world and he has a cool accent*.

And so I will end my nights here at this tertiary referral centre known as The Zoo knowing that I have survived these trials relatively unscathed and with only having to call 1 boss during his somnolence.

And so tomorrow as the dawn breaks over the Pacific Ocean and I enjoy the view from level 7, I will be content, having conquered all challenges bar ED (which will be the true test of mettle). And so what shall I do to reward myself?

I shall hop onto a plane this morning and fly to the Gold Coast for a week of nothing (all by myself)!

See you all in a week's time!

This is Dr J (signing off)

* Whilst French accents are cool, I must say the one that I find really attractive is a quality non-cockney British accent (Southern preferable to Northern or Midlanders). If I could find a Christian Asian girl with a British accent, I'd prob be engaged next week! Haha!

A 'fitting' end to nights...

Tonight I think I will have a generalised tonic clonic seizure because:

a) I have only had 3 hours sleep in 2 days - decided to work then get up and go to Katoomba to run a seminar for mission houseparty training then drove back (thank God I didn't crash) in time for my next overnight shift thereby ensuring sleep was a luxury I was not able to afford

b) been drinking way too much Coke and eating bad food thereby disturbing my electrolytes and so I'm probably hypo/hypernatraemic - discovered that night shift is great cos you only eat one meal a day and lose weight, but probably put it all back on with the amount of junk food one snacks on whilst prowling the wards at 4am and trying to stay lucid 'for the patient's sake'.

c) the stress of work is not good for me - see below mentioned gripe*

d) I've been seeing lots of pt's on the neuro ward who decide that my shift is the best time to start fitting having seizures - this young lass decided to have 5 absence seizures and 1 big ole tonic clonic whilst I was on duty and the nurses made me call the consultant at 3am (yeah, never a good idea) to 'let him know cos he likes to know when they have this many seizures'

It's been fairly good this week on nights. Compared to the anarchy of Whoop Whoop hospital, the Zoo is so much calmer and relaxed. If anything I get bored watching too much Foxtel every night (although have developed a liking for the trashy "Sunrise" show on Channel 7... it's so bad it's good)

Had the privelege of sleeping on my friend's floor during the day this week as she had the unfortunate luck to have her roof kicked in which meant I got to play 'guard dog' whilst I slept. Of noticeable concern though was the giant hunting knife left on the table for me to defend myself with if the thieves decided to come back for round 2. However I really doubt that had someone come back I would have been awake enough to make it to the tabele in time to arm myself with such a weapon and instead it most likely would have been used on me.

Thankfully they didn't come back and now I'm left to have my seizure!

* Pager: [Beep]
Dr J: Um hi, it's J here
Nurse: Oh hi Dr, we have patient with blood sugar 1.6 You come see now? (sic)
Dr J: Yeah I will, don't start that 2nd unit of blood until I get there ok?
Nurse: Ok
When the aforementioned doctor arrives on the ward he tells the nurses to give the patient 50mLs of 50% Dextrose. They tell the aforementioned doctor that they are not 'comfortable' with giving IV dextrose and tell him he has to do it. Fuming doctor gets dextrose ready and goes to inject patient, only to find that nurses have started that second unit of blood against his orders thereby rendering the cannula unable to be used and necessitating the insertion of another cannula in a large lady with poor venous access.
Moral of story? If you call the doctor for advise and he tells you to do something... LISTEN TO HIM!

Compliments, Confusion and Chocolate

Night shift is a bizarre thing.

Just you and half a hospital full of people trying to sleep (or get sick) under your careful watch.

Somehow patients who were otherwise ready for discharge turn into delirious geriatrics who think 'extreme bed falling' shoudl be made into a new sport. This phenomena is only exacerbated by the day team's instructions NOT to use any strong painkillers (despite a documented fracture) and of course the patient is well behaved during the day and so this never is a problem for them.

Last night I had one such 'darling old lady' swear at me and tell me I was in a gang of thieves who were trying to steal her money and that my parents should be ashamed of me. Then as I was taking her blood she struck me, knocking the needle straight into my hand. Thus ensued a trip down to Emergency to get blood taken just in case this 84 yr old lady was a drug user or hooker and had HIV or something similar.

Tonight the head nurse overnight was suprised to learn I was only an intern. "Oh, I thought you were a resident... you seem to have more sense in you than some of the others" I think that's a compliment right? Either that or the facial hair and bald patch are really making me look old.

To be honest it's pretty boring here as an intern on nights. They don't trust us to look after really sick people and so we get given the easy wards (geri's, neuro, rehab, psych, soft surgical pts, etc) whilst the poor resident is run off her feet with cardiology, acute surgical wards, renal and anything big. Maybe I shoudl be an intern again next year?

Speaking of which it's time to reapply for my job. In reality it shoudln't be too much of a problem to get my job next year, but it's more a hassle to chase down surgical bosses and ask them for references. I hate asking people for stuff and especially so when they are grumpy surgeons. Like they are really gonna be bothered to call them all up anyway!

Oh well 3 nights down, 4 to go!

The Smell

As I scurried into the main entrance of the Zoo, it hit me in full force. That olfactory sensation I had not noticed in many years.

That's right, the 'hospital smell'.

To be perfectly honest with you, I have not noticed the 'smell' of hospital for many years now. Perhaps due to the years of clinical placements or the dulling of my neurons; either way I've been semi-immune to what most lay people refer to as the 'hospital smell'.

That is... until tonight!

Having been on annual leave for 2 whole weeks has somehow turned me back into a semi-normal kind of person and not having set foot in hospital for an entire 17 days had allowed me to relax and even start growing a rather untidy crop of facial hair*. And so I have begun to experience the little joys in life once more, like the stench of industrial power anti-septic agents that characterise hospitals worldwide. Some people appreciate being able to stop and smell the roses... I like to be able to stop and smell the hospital.

And it's not just me! The other doctor on nights with me also commented that she too noticed the hospital smell this evening after she had been on holidays too.

I wonder if one could bottle this smell and put it into a Lynx fragrance? I'm sure it'd sell well! Hehe!

So anyways, I'm back on the wards again once more doing night shift but this time at a nice big hospital (instead of old Whoop Whoop) and I've noticed the following:

a) it's sooo much better when there's a resident around to keep you company and talk to.
b) it's really really cool to ALWAYS have a med reg on call and even better to actually have them soley on nights and on site rather than having to drag them out of bed.
c) having a common room with Foxtel, Xbox and coffee machine makes nights so much easier

I think this week will be fun!

* yeah I know it looks bad etc etc but cos I don't HAVE to shave for the next few weeks I wont. I hate having to cut my face every day... it requires me to wake up a whole 2 minutes earlier than normal.