The Intern Experiment

The End

2007-01-10T15:31:00.000+11:00

As the automated doors swooshed open I walked out into the warm summer's night.

I looked down at my watch... it read 01:28am

I looked forwards... remembering words from a 'long time ago'*:

"Don't look back...before you go.
Eyes forward.
Choices to make...dreams to realise.
Don't look back...before you go.
Know the truth; learn to let go

It will be a hard life;
One without reward, without remorse, without regret.
A path will be placed before you, the choice is yours alone.
Do what you think you cannot do. It will be a hard life,
But you will find out, who you are.."

I slid the Litmann stethescope over my head and shoved it into my pocket, dangling out like a schoolboy's handerkerchief. I looked up at the dark summer sky and breathed it in.

It was over. Internship. And what a way to finish.

[1400 earlier that day]

It began like any other day. Rocking up to cubes to put in my time sheet (seeing as I was going to be on holidays when they were due next week) so I got paid. licking on the computer to check how many patients were queued up and which other doctors I'd be working with this shift.

Picked up my first one, a darling little old lady with "knee pain"... opened the door and started my usualy spiel, "Hi Mrs P, my name's J and I'm one of the doctors... do you want to tell me what's been happening?"

[1800 that same day]
There was no more room in the inn as we churned thru the patients and the day staff tried to hand over their remaining patients to those on night shift (ie me). I tired to discharge a patient with chronic cellulitis only to have my enthusiasitc registrar diagnose 'erythema multiforme' (she'd only seen it once in her entire life!) and thus relegating the patient to the medical registrar instead of home.
Mrs P sat in her room, with her faithful husband by her side, having just returned from the CT scanner... her bones were osteopenic and almost no bone density whatsoever. Her husband had been caring for her day after day since she lost her sight and I looked at their relationship feelign envious... their love apparent... not in displays of affection.. but in the daily sacrifices he made for me to care for her.

[2100 that evening]
A rather hungry intern named J started to sway from side to side from low blood sugar as the waiting room list exploded with patients who really shoudl know better. A young girl (20) hobbled in with her mother complaining of back pain after she had got a friend to 'crack' her back and [gasp] developed back pain shortly thereafter... like duh!

It was at this point all hell broke loose.

I walked out to the acute area to see a sea of stretchers with young men in hard collars being shoved into the ED. However as there were no beds free (due to a few infarcting oldies) they were just dumped in the walkway of the ED. I found out of my registrar that there had been a big MVA** and you could see the excitement in her eyes. Next minute she was gone, off to play 'trauma' and see some action and so I duly found myself abandoned with a department full of cubicle patients requiring registrar review. Truth be told their was an overseas doctor on as well, but he committed a cardinal sin and started sifting through the files to pick up simple finger fractures and lacerations... leaving me to pick up the miscarriages, the bizarre neurological symptoms and the meningitis patient.

It reminded me of an episdoe of ER I saw last year. All the senior doctors are out farwelling Dr Carter and the interns are left to run ED. A balcony collapses and the interns are forced to assume responsibility and it all makes for a very nice dramatic TV show. However in real life it just drove me nuts. I had cranky patients wanting to be seen in the waiting room. I had cranky patients in the rooms wanting to go home. I had cranky nurses wanting to know "what's happening" with each patient.

I just kept plodding along... reminding myself that if I lost it, I would be of no help to anyone.

"Just take one patient at a time J... one at a time" It was reminiscent of that firstovertime shift from hell in Whoop Whoop. And yet I was more confident.

And so I kept working them up, sending off bloods. Charting analgesia for people in the waiting room so as to at least "do no harm".

Eventually at 1am, the 2 registrars and consultant emerged from the chaos of the acute area dn came around to see how I was faring.

Exasperated I began my final handover "Mrs P is a 77 yr old female who was brought in by her husband after she sustained a twisting injury to her left knee. She had a CT of the left knee and was assessed by ortho as having no fracture and is for med reg review for analgesia and mobility seeing as she is blind and can't go home with her husband whilst she is immobile"

Why med reg? Why wont ortho accept? Why didn't you tell them about the ED's 'one referral policy'? How's she going to manage at home if we just keep her overnight?

Mrs P got admitted I think... the last patient I saw as an intern.

To be honest... I was over it. I made the last few phone calls, handed over the patient who needed a lumbar puncture and walked out the door for the last time as an intern. I had survived.

This week I'm on annual leave before starting back as a resident. Lats night i met up with almost all of my med school friends at our local Thai restaurant. The last time we had gathered there all together was after we finsihed med school. How fitting then that our reunion of sorts occured in the same place after our internships were finishing. Somehow we've all made it through (which given the high suicide rate of JMO's is a great feat to be thankful for) and none of us are drug addicts (or at least admitting to it).

To all of you readers out there who've read my blog/called me up and left messages of empathy, frustration, encouragement and urged me to persevere thru this... thankyou! No man is an island... and particularly fellow brother and sister interns... you guys rock! Congratulations!

It's time for "The Intern Experiment" to end. Don't worry I will now start writing the resident equivalent (http://theresidentexperiment.blogspot.com)... but as my internship has now come to a close... so must this blog. A closed chapter now to look back on and laugh, cry and smile at the biggest year of my life to date.

And so I want to finish this blog... with some quotes from ER... only because then encapture things that I cannot sum up any better:

When you do everything you can, sometimes more than you thought you could, you've got to walk away knowing you fought the good fight. You fought the good fight, Lucy. And tomorrow you'll fight another one.

You are wedges. The wedge is the most primitive tool known to man. That is you. You think you know what you're doing, believe me, you don't. Breakfast with your Senior Surgical Resident Dr. Benton will begin in 15 minutes. Dr. Benton is an intern's worst nightmare. He's smarter than you, he never eats, he never sleeps and he reads every medical journal no matter how obscure. He is the Antichrist. Beelzebub. Lucifer. A devourer of wedges. You will go to sleep at night wishing plague and pestilence on his unborn children and you will wake up every morning praying for his approval. You won't get it. Welcome to hell, ladies and gentlemen.

Patient: Are you married?
Doctor: No, I'm a doctor.

Patient: Oh, God, I see a light!
Doctor: You're not dying. It's just your ankle

Doctor 1: They can make your life easier or they can make it miserable. Whatever you did, I suggest you apologize immediately.
Doctor 2: I didn't do anything.
Doctor 1: Apologize anyway.

Most interns send their samples without knowing what happens once they're there. Let's pretend we're a urine sample and find out.

I'm beginning to think that "ER" stands for "everyone's retarded".

Rule #1, feed the nurses. It makes the job 50% easier

See, there's two kinds of doctors. The kind that gets rid of their feelings. And the kind that keeps them. If you're going to keep your feelings, you're going to get sick from time to time. That's just how it works. That's part of it. Helping people is more important than how we feel. Hell, I've been doing this eight years, and I still get sick

You set the tone, Carter!

* Star Wars Episode I The Phantom Menace Trailers ("One Love" and ""One Destiny")
** motor vehicle accident for my non-ER-watching friends

Full circle

2007-01-01T03:53:00.000+11:00

Happy New Year and happy birthday to my blog.

After 1 year and 127 posts, some of you crazy kids are still bothering to read my ramblings and so I guess I'll just keep on typing away.

It is now the dawn of a new year and the sun is shining brightly through my window.

"What a big year it has been... too much stuff has gone on to fit it all in this post... but let's just say I'm glad its over! Let's hope I'm not working ED next NYE!"

- The Intern Experiment Jan 1st 2006

Seems I was very keen to leave 2005 behind last year. If only I had known what 2006 would be like, perhaps I would have been less hasty to rush headlong into what this past year entailed. And so I'll repeat the same things I did last year... I'm glad 2006 is over. It's been a year of beginnings and endings... of intense joy and pain and a new depth to life that I didn't know existed.

I spent NYE this year at a friend's house. He graciously invited me over to join his dinner party where we ate good food, played some fun games and ushered in the new year watching fireworks from his rooftop and on television. It was just what I needed.

The fireworks pierced the black sky showering their light into the darkness. And I felt like the angst of the past was being washed away to make room for a New year. The cracking of the gunpowder... breaking the silence in my life.

It's time for a new beginning. Time to shed the skin of last year and walk boldly into the opportunities of 2007. So a Happy New Year (xing nian kwai lei) to all you blog readers out there. May your 2007 be full of joy and fond memories!

"Until next time, stay classy Sand Diego"

An unorthodox festivity

2006-12-25T23:55:00.000+11:00

The Silent Night was broken by the dawn on a cold and rainy morning. I dragged myself out of my warm bed and staggered to the bathroom to shower. Welcome to Christmas 2006.

A long distance phone call was made to the family to wish them festivities and say goodbye to my sister departing overseas yet again. The sound of the family enjoying themselves only made the distance seem further than it really was. I kinda wished that somehow they would show up on my doorstep to suprise me, but knew this would not happen.

The streets were devoid of the usual morning ebb and flow, as people spent treasured moments insdie with their families. I walked in eerily silence to the bustop and caught a ride into the city. Against the grey city outline I sought out the sandstone cathedral dwarfed by the surrounding skyscrapers.

With each song, the choir turned well loved meoldies into muscial poetry. The small gathering were reminded both in song and word of the hope that Christmas brings to all of us in Jesus. It was nice to just be alone for once and be anonymous. To sit and drink it all in. To thank my Lord for this day.

When I got home, I started to get ready to cook my traditional roast dinner when my phone rang. It was my intern buddies from other hospitals, fellow Christmas orphans in need of company on this Christmas day. And so my well planned out dinner was shelved and I found myself in the city eating Yum Cha and celebrating with good friends. It was a far cry from my desired turkey... but far more enjoyable than eating alone.

Finally the clock ticked over to 2pm and I found myself in the ED on Christmas. It was not too busy, the nurses were decked out in tacky $2 Santa hats and there was so much junk food we could have had an infarct ourselves. Some bored nurses started playing Christmas CDs over the ED intercom just to annoy everyone and one fo the specialists donated 2 bottles of champagne for us to crack open in celebration.

The atmosphere was jovial, the registrars were casual and it was great. We even had our own Rudolph the Red Nosed Drunk*

One lady came in with a head injury from a flying shoe (that her adult daughter had thrown at her) One girl came in with a black eye (that her drunk grandfather had inflicted on her) One guy came in vomitting blood (after he'd binged on alcohol for a month).

Amidst the celebrations, the awfulness of life sat side by side with the joys of life. Whilst some partied, others suffered. It was a far cry from my family based traditional Christmas. But it was a Christmas to remember.

* A rounded German man who was a Nazi sniper (apparently) and now spends his life getting drunk and wanting to commit suicide and frequently fronting up to ED.

The Importance of Christmas

2006-12-24T01:07:00.000+11:00

I must admit I'm a Christmas addict.

Being raised by a British mother, I was indoctrinated early into all things traditional about the festive season.

Our family would never dream of anything less than a roasted turkey for lunch on Christmas Day with all the trimmings and church in the morning.

Christmas Carols MUST be watched the evening before Christmas and lame jokes about leaving grass out for reindeer must be laughed at every time wihtout fail.

And I luv every bit of it!

But it's not the trimmings that make Christmas special.

I couldn't care much for the presents (although they are quite nice and I'm happy to have them)

And although I luv them dearly it's not about family either.

It's all about the 'reason for the season' (so they say)

Each Christmas I am so amazed and excited to think about how God limited himself and humbled himself enough to become a human.

To eat and breath with us. To share our pain and toil. To share our joys and passions. To wrench us from the power of death.

I cannot help but well up with pride and emotion as I hear the Christmas message sound forth each year in carols.

Their words so articulately enshrine the exciting news that happened 2000 years ago. That in a backwater town, out the back of a pub, was born the chosen one who woudl die in my place to break death itself and bring us into freedom.
"Born to raise the sons of earth,
Born to give them second birth.

Adam's likeness now efface,

Stamp thine image in it's place,

Second Adam from above,
Reinstate us in thy love"

This day is so important because it breaks the passage of time in two. The entire history of the world hinges on it. The dawn of a 'new and glorious morn' arrives. As I remember the plan of the ages fulfilled that lonely night, I look forward to the final chapter in which:
"Once again the scene was chang'd New earth there seem'd to be, I saw the Holy City Beside the tideless sea. The light of God was on its streets The gates were open wide And all who would might enter And no one was denied. No need of moon or stars by night, Or sun to shine by day, It was the new Jerusalem That would not pass away "Jerusalem! Jerusalem Sing for the night is o'er Hosanna in the highest Hosanna for evermore!"

Amen.

Christmas

2006-12-24T00:32:00.000+11:00

Last weekend I had an early Christmas.

Due to the fact I'm stuck in ED on Christmas Day, I decided to string together some days off and go home to spend Christmas with my family a week early.

As I flew home I gazed out into the distance over the dry dusty countryside. It amazed me just how barren and lifeless the land had become. Perhaps symbolic of what was to await me?

As the plane touched down I saw a familiar shape waving intently at the plane.

It was Dad.

As I got off the plane, I tilted my head down; half embaressed by the display he was putting on and half trying to avoid facing the reality of a man I once knew.

Finally I looked up... and as I looked up I saw a man that shocked me. A man devoid of the warm beard he once sported, the beard that had defined his care and yet his authority. The beard that had not been removed since before his marriage. It was now gone and the face I saw beneath looked too familar. Too much like mine.

The next few days showed just how much his degeneration had come. Familiar names meant nothing to him anymore. Phrases were less constructed and more bizarre. Days were spent picking up the leaves and sticks in the yard (purpose? we do not know but dare not ask).

The man who once controlled hundreds of millions of dollars of roadworks could no longer control his bladder. Days once spent in government meetings were now spent in front of a television waiting for the afternoon gameshows.

His new friends were now the strangers he met on the street. His old friends were now the ones he didn't know.

And yet as we exchanged gifts, it was as though time had forgotten the last year and he was the man I once knew. The familiar Christmas carols and rituals brought back memories of past festivities shared with this man. The out of tune singing, the warm summer nights, the home cooked roast.

Last Christmas I called this man "Dad", one year later he mistakenly called me his "Dad".

As I flew back to Sydney, I was confused. Was I leaving home? Or was I coming home?

As I hugged my mother and felt her tears, I knew that the dream I once remembered of home had gone. The warm past was gone and the cold future awaits.

Merry Christmas to all you blog readers... please treasure each Christmas day you have with your loved ones. You don't know how many you'll have.

The good, the bad and the ugly...

2006-12-20T23:42:00.000+11:00

The Good:
Getting a free Christmas lunch at work with hot chicken and salad followed by yummy mud cake. The bosses decided to splash out and suprise us all which was very nice of them and meant I actually got fed for once in ED.

The Bad:
Finding out I had a patient call up over the weekend and complain that I sent her home when she couldn't walk. To be honest, she was treated very quickly because we had a lot of other people waiting. And I DID make sure she had crutchs and asked the nurses to make sure she was ok befroe she left. Anyway, yeah in an ideal world I shoudl have done better but honestly, we had no registrar to cover us so we were pretty snowed under... just cranky that after trying to help these people they still complain... as my Mum would say... "If you're gonna die... go die quietly in the corner and don't make a mess on my nice clean floor"

The Ugly:

My face. Mum and Dad got me an electric razor for Christmas and so after years of using the cream and razor it's time to go electric. However according to some random site I Googled about tips for achieving a smooth shave it takes 1 month for the epithelial scar tissue to change (when you blade it you scar the underlying skin each time whereas with electric you dont) and during this time apparently one's face is supposed to undergo some weird skin remodelling. And so it's kinda uncomfortable and rough, but hopefull in a few weeks time my face will have evolved into a more electric-friendly protoplasm to deal with.

The future...

2006-12-12T15:04:00.000+11:00

Well the next 12 months of my life have now been set in stone and my social life will now have to accomodate the ordinances of the Zoo.

So what lies in store for Dr J next year? Fun filled medicine in the wards he once trod and loved?

Not really.

Term 1 - ED

That's right kids Dr J your favourite fun loving doc is back for round 2 in the ER. Usually people like to take a break from the banality of chest pain and PV bleeders but not J. He's overdosing on the excitement in the ED just becasue he can (well, actually is forced to). So whilst he graduates into being a 'resident', a flood of eager but paralysingly slow interns will be forging their way through the waiting room list and begging him for advice on stuff he himself has no idea about.

Term 2 - Relief

Contrary to the sound of the name, this term is NOT a relief...it is usually an excuse for JMO management to banish you back to ED under the excuse of "to help out the new overseas doctors" People generally take time off on terms they dont like.. and so you end up filling in for jobs that no one wants and do a whole lot of scut work.

Term 3 - Paediatrics

Time to do something I enjoy for once! Yes, that's right about 10 years ago (man I'm old) I decided I wanted to be a paediatrician and help sick kiddies. 10 years later it's still quite an appealing job. No grumpy old people and their non-English speaking families; just a whole lot of litigous over anxious parents with snotty kids. Thankfully the cafe in paediatric section makes up for the bad food elsewhere in the hospital.

Term 4 - Geriatric Rehab

They're incontinent of urine and faeces, they can't tell you what's wrong and no they're not babies.
Most people become suicidal when receiving a geriatric term. 10 weeks of crumbly old people who never get better. I was advised strongly by my GP trainers to do a geri's term to help me in the future. I despised working the geri overtimes though this year and so very cleverly (gold star to me) snuck into a geris rehab term where most of their acute medical problems are sorted out and they are just getting some 'body-building" (read: physiotherapy) prior to going home so they can have another fall and die within 12 months*

Term 5 - ICU

The one thing I have never done in med school (thanks to some clever wagging) was Intensive care. Thsoe people with bazillions of tubes stuck into every orifice just didn't appeal to me. No patient's awake to talk to, no happy discharges home and no happy relatives. And yet somehow I got lumped with a whole term of this with 12 hour/day 7 day/week work (on a rotating basis). I just dread the thought of advanced physiology/pharmacology. Thankfully I've got 2 weeks of annual leave then to break the suicidality I might be experiencing.

And so this is what 2007 will look like for me. Not much fun by the sounds of it.

But along with this comes a sad realisation. I have no more surgical terms. Due to intern requirements and SRMO's BST needs, I will never again don the scrubs. I will never scrub in to assist again. My last operation was my total colectomy at 3am in the morning. I'm kinda sad about that. I, who was once a hater of all things surgical am now lamenting the oppurtunity to wear those blues.

Soon it'll be time to end the "Intern Experiment" and start the "Resident Experiment"...

* statistically once you break that femoral neck you generally have less than 12 months to live.

Restless J syndrome

2006-12-12T14:00:00.000+11:00

Causes: Seeing off too many good friends at the airport, disruptive shift-work, lack of friends around during days off, family illness, lack of girlfriend, surmounting end of year bills, stupid hospital admin, propsect of 'another' term in ED.

History: Patient usually spends time at work wishing they were not and when not at work bored out of their brain and wishing they were anywhere else. Gets frustrated with life for no particular reason. Intolerance for minor issues and excessive somnolence. Poor dietary intake of take away.

Tests: Seretonin level, intolerance severity index, TFTs, EEG.

Treatment: Gold standard therapy is with multidrug therapy of holidayavir combined with peoplepril. Delays in initiating treatment can lead to the morbid complication of 'burnout' which can only be rectified by goinghomestatin.

Each week I hear of yet another friend taking off overseas/interstate on holidays and I just watch out the window of my house and watch the planes fly overhead wishing I was going too. Everyone else is getting exctied about the holiday season and I am stuck in ED on Christmas Day with no family or friends.

It's just hard to get excited about life when all it consists of is work and sleep. Work itself is actually not that bad at the moment. But somehow it's just not satisfying.

You know you're a doctor when...

2006-11-25T23:10:00.000+11:00

You believe that all bleeding stops ... eventually.
You find humor in other people's stupidity.
You believe that 90% of people are a poor excuse for protoplasm.
Discussing dismemberment over a gourmet meal seems perfectly normal to you.
Your idea of fine dining is anywhere you can sit down to eat.
You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants.
You plan your dinner break whilst lavaging an overdose patient.
Your diet consists of food that has gone through more processing than most computers.
You believe chocolate is a food group.
You refer to vegetables and are not talking about a food group.
You have the bladder capacity of five people.
Your idea of a good time is a cardiac arrest at shift change.
You believe in aerial spraying of Prozac.
You disbelieve 90% of what you are told and 75% of what you see.
You have your weekends off planned for a year in advance.
You encourage an obnoxious patient to sign a self discharge form so you don't have to deal with them any longer.
You believe that "shallow gene pool" should be a recognized diagnosis.
You believe that the government should require a permit to reproduce.
You believe that unspeakable evils will befall anyone who utters the phrase "Wow, it's really quiet isn't it".
You threaten to strangle anyone who even starts to say the "q" word when it is even remotely calm.
You say to yourself "great veins" when looking at complete strangers at the grocery store.
You have ever wanted to hold a seminar entitled "Suicide ... Doing It Right".
You feel that most suicide attempts should be given a free subscription to "Guns and Ammo" magazine.
You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there".
You have ever had to leave a patient's room before you begin to laugh uncontrollably.
Your favorite hallucinogen is exhaustion.
You think that caffeine should be available in IV form.
You believe the waiting room should be equipped with a Valium fountain.
You play poker by betting ectopics on ECGs.
You want the lab to perform a "dropkick" screen.
You have been exposed to so many X-rays that you consider radiation a form of birth control.
You believe that waiting room time should be proportional to length of time from symptom onset.
Your most common assessment question is "what changed tonight to make it an emergency after 6 hours / days / weeks / months / years)?".
You have ever had a patient control his seizures when offered some food.
Your idea of gambling is an blood alcohol level pool instead of a football pool.
You shock someone with an unrecognizable rhythm ... until you get one you DO recognize.
You believe a book entitled 'Suicide: Getting it Right the First Time' will be your next project.
You call subcutaneous emphysema "Rice Bubbles".
Your immune system is so well developed that it has been known to attack squirrels in the backyard.

(adapted form a source for nurses but I think it's more applicable to doctors in ED in Australia)

Introductions

2006-11-25T22:06:00.000+11:00

Well I feel a bit bad for not introducing you avid readers to the family of people who work in Emergency. They're an eclectic bunch with their own idiosyncrasies... but they're not too bad.

1. The triage nurse
Job description: to ask people what's wrong with them and make sure that the people with gunshot wounds or heart attacks get seen before the people with a sore toenail that's been there for 5 months.
Personality type: usually very task orientated and abrupt, knows the 'frequent flyers' to ED and warns you of them, often provide valuable advice about the patient's social situation before you see them (such as "the guy who dropped her off was carrying a great big knife" - always helpful to know!)

2. Ambulance officer
Job description: They are the delivery boys of our pizza shop. Except instead of getting rid of our products, they bring us more work. Thanks! Supposedly have some kind of training in first aid and some basic medical stuff, they love to run around with their sirens blazing and picking up the old ladies who 'had a bit of tummy pain'
Personality type: although they see a lot of action, they love to laze around after they've dropped off their customer and flirt with triage nurses or admin staff. Nige-phobes in that they often travel in packs and all arrive at the ED at once so they can hang out together, but having the undesired effect of making the doctors inside panic when they see 4 ambulances pulling up at once.

3. Comms clerk
Job description: To do all the dirty work of phoning up and getting a hold of extremely difficult people to contact. Whereas on the ward you would spend hours wasting time chasing down surgical registrars who refused to answer their page, these lovely people get them waiting on the line for you then announce over the intercom "Dr J to the bridge, surgical registrar on the line" thereby saving you the pain of having to find them.
Personality type: Anyone who can hunt down a surgical registrar must have a fair bit of tenacity and perseverance. They are generally very friendly for people who probably cop abuse all day from disgruntled doctors and are much more efficient than the switchboard.

4. The radiographers
Job description: To Xray anything that hurts in the Emergency Department because we are too precious to go across the hallway to the 'real' radiology departmant. They are a highly organised SWAT team of imaging and are veiled behind their magic lead-coated curtain.
Personality type: Reclusive. They rarely venutre out except to grab the next patient and then hide back in their little room devoid of sunlight or human touch. They make Quasimodo of Notre Dame look like a social butterfly.

5. The ED nurses
Job description: Never (I repeat NEVER) to be confused with their less evolved cousins the 'ward nurses', the ED nurses pride themselves on getting to wear blue scrubs like the doctors and being able to [gasp] insert IV cannulaes and take blood. Their job is to constantly hassle the doctors to find out what the management plan is so that they can enter their 'times' into the data collection system to make the State government look good for the upcoming election. They are also prone to the vice of the ward nurses known as the 'tea-break' which means that although you are not allowed to even relieve yourself, they may take all day to administer those medications if it even looks like interfering with their mandatory union-provided tea-break.
Personality type: generally less amoebic in intellect than the wards, they have let this confidence brew into disdain and can be more aggressive with interns who they don't trust* however provide a refreshing change because most of them 'want' to be in ED.

6. ED consultants/staff specialists
Job description: to run the department and direct medical care whilst keeping an eye on those dodgy young junior medical officers to prevent any mishaps and bad media coverage for the hospital.
Personality type: anyone who chooses to work shift work beyond the age of 35 is generally highly driven and does not want to 'settle' into the mundane life of general medicine. Often like to balance their career with extreme sports or vehicles and believe that every other department in the hospital revolves around them. Often willing to abuse ward registrars for not seeing the ED patients and will gloat about it afterwards.

7. ED registrars
Job descritption: To help run the ED whilst studying intensely every aspect of medicine so they can become like the above-mentioned consultants. Also run the entire ED on their own between the hours of 11pm and 8am when they have cortisol induced hypotension which they relieve by carrying around a large bottle of caffeine such as a 2L bottle of Coke Zero or the like.
Personality type: Not quite a boss and no longer a scut-monkey** they still have some humane aspects but enough cynicism to help them get through each day. Usually complaining non-stop about how overworked they are (which is true) they spend their spare time either doing extreme sports again or writing letters to our boss asking for more fellow registrars to be employed to share the load.

8. ED Interns and Residents
Job description: To see patients in the ED and then not really think too much about them because they have to present them to the boss anyway. Pretend to know something whilst really knowing they know less than they should. Try not to kill too many people*** and not pick up any gomers (old people) within the last hour before they leave. Have a glazed look after night shift which indicates their apathy and incompetence by the end.
Personality type: Over achievers who start to panic when they realise they may be out of their depth sometimes. Often seek outlets for their crazy wokring life, like drugs or chatting up allied health staff in early hours of the night shift.

And so here we have our wonderful world where we all run around in a noisy fast paced frenzy. This last week I have been doing night shift was has been a blast. Eating junk food with nice nurses (including a girl I used to know in high school) and having 'intern teaching' from a bleary eyed registrar at 5am. I've seen all sorts of diverse things such as a newly-diagnosed-brain tumour, a completely dislocated wrist with no sensation or pulse, a security guard who was beat up, chronic 'period pain', hyperventilation syndrome, someone with a lack-of-direction in his life (very urgent thing at 5am in the morning!) and am never ceasing to be amazed at what things people classify as an 'Emergency' in the wee hours of the night.

Can't you people read the sign? It says E-M-E-R-G-E-N-C-Y!

* one notable example was when I was told at handover round that a patient was to be admitted to the psychiatric ward once a bed was available. I was pestered non-stop by a senior ED nurse because it wasn't documented in the notes. I looked through the notes and found a clear entry from the ED consultant saying "Patient discussed with psychiatry registrar and for admission under the psychiatrists" Apparently that was not good enough and I was forced to 'reaffirm' this directive with a rather irate psych registrar at 5am in the morning.
** "Scut-monkey" is a term used to describe me and other junior med officers cos we end up doing all the crappy jobs that other doctors dont wanna do cos we are the bottom of the food chain.
***One shift started with a new registrar introducing himself to me and saying "I don't care how many of these patients you kill, as long as you don't link them to me in any way" - I hope he was kidding?

Mad Season

2006-11-20T18:50:00.000+11:00

I knew it was the beginning of silly season when the tacky Christmas trees appeared in the foyer of our Emergency Department.

And I don't mean silly seaosn cos of the festivities, but cos of the stupidities.

ED never fails to amaze me as I see bizarre presentations walking through those glass doors.

A young 27 year old male presented to ED in extreme pain. He was swearing profusely, looking very embaressed and had a worried wife with him. Turns out he had injured his male reproductive organ whilst procreating and had heard a 'snap' and immediately rushed to hospital.

Most of the females were trying not to snigger as all the males in the department winced in sympathy. He was urgently given lots of morphine by a nice male doctor as we all tried to work out how once fixes this 'broken' organ.

Eventually the surgical registrar gave him the all clear and we let him go with lots of ice packs and our sympathy.

I then picked up the next patient on the list who had 'high blood pressure'. Turns out this guy had measured his blood pressure at home and it was (*gasp*) 160/100! So he decided he needed to come into Emergency to get it sorted out on a Sunday night. Needless to say I wasn't overly impressed.

But I must say I am really getting into the suturing business. I end up suturing most shifts and enjoy sticking the anaesthetic in and then making nice little stitches in people's severed digits or lacerated heads.

And so after a week of wokring the evening shift, I get two days off before starting the graveyard night shift in ED. It's a token break before sacrificing my sleep-wake cycle on the altar of the public health system.

And so today I got up and had a lazy picnic lunch on the beach with some other doctors who were not working. We ate junk food, we basked in the sun, we argued over the attractiveness of girls passing by and we fought off the leering seagulls. And all of a sudden the weight of work lifted off my shoudlers and I realised that underneath it all, I'm still a person... and I can enjoy life in between the craziness of hospital.

And so tomorrow will be another such day of brunches and shopping and movies....

Ahh.. tis the season to be jolly!

ER

2006-11-16T00:47:00.000+11:00

Well finally I have come to the final term of my internship. And what a fitting end to an interesting year.

After honing my meal breaks to an art and de-skilling from medical school, I've been sent downstairs to the land know as the Emergency Department.

Now for those of you who don't know, there is an upcoming State election due next year which can mean only one thing. Time to crunch some numbers and show the public how wonderful and 'happy' the public hospital system is. And the best way to do that is to make the flagship of public health (the ED) reduce its waiting times. And so we are left with a bunch of junior doctors being told that their job is not to provide medical care (unless they're dying and even then that is debatable*) but to triage people and refer them to ANY admitting team. In fact it doesn't matter if you don't know the test results, if you know they need admission just admit them (much to the dislike of medical registrars).

And so we 'click-off' our patients and take thorough histories on people who are so vague/unable-to-speak-English/deaf/mentally-deficient and then procede to "buff and turf"** to the wards.

I must say at first I was a bit shell shocked cos I had no idea how the system worked but now I've grown to get used to the pace and it's actually a lot quieter in Emergency than on the gastro wards.

I was a bit scared the other day when I had to revise some obstetrics and thankfully avoided having to do a vaginal examination on the poor lady. I managed to diagnose a lung abscess on chest Xray and then got a pat on the back from the consultant.

But then today I found my new favourite activity...

Suturing!

That's right. I stand here today testifying to the fact hat one year ago I hated surgery. In fact I despised all surgical procedures and couldn't stand them. But I am now a changed man. I have learnt to appreciate the joy that can be derived from stick needles and sharp objects into people and fixing things with your hands and not with your head. You can just zone out and relax while you infiltrate with some local anaesthetic and then make nice wound closures and sew nice pretty surgical knots.

This evening I patched up a surfer who got on the wrong end of his surfboard fin and made a nice 10cm gash on his head. 20 minutes later he had a nice set of needlework on his scalp. Then a bit later I had another patient come in with a laceration to his eyebrow/eyelid. As I took his history he began to use medical phrases like "Um yeah, I saw the wound edges were nicely apposed" and asked if he was medically trained... turns out I was stitching up a psychiatrist! (no pressure there now!) But by the end I had a nice set of stitches that in 7 days time will come out and leave a very nice cosmetically-pleasing scar along his natural skin lines. Ahhh... I should have gone into plastics!

I have discovered that ED has it's own advantages too. Like being on shift work. I have realised that I am NOT a morning person and do not 'function' until after midday. And so wokring from 2pm till midnight all week is fantastic for me. It means I can sleep in, go for a swim and still have time for lunch with my 2 pharm girls*** before going to work being fully awake and ready. Add to that the fact you work 8 day fortnights and ED is not that bad after all. And so this week I've been getting outside and enjoying the beautiful sunshine on my shiny bald head.

Ahh... summer is almost here!

* Last week of my Gastro term, we had a patient almost exsanguinate in ED becasue they had been 'admitted' under us and as we weren't able to come and see him (due to our other 30 sick patients). ED just said "It's on your own head now, he's admitted under you" and so my Prof came down and cannulated and did bloods on this guy who was dying on BiPAP and gave him some much needed frusemide.

** See the book "House of God" by Samuel Shem. It refers to the process of making a patient look good and turfing them to someone else to sort out. It's soooo true!

*** Yes, my old pharm girls from the wards have been keeping in touch and we catch up for lunch. Gotta say, those chicken burgers are to DIE for.

Anecdotal Antidote

2006-11-05T17:53:00.000+11:00

In order to relieve the pressure of the last few weeks, I thought I'd include some of the nicer things in life.

Like teaching medical students.

I must say that I really do enjoy having these future doctors running around our wards.

Whether it's their unjaded enthusiasm or their quirky questions which display how much they do (or don't) know about the human body and life*, they remind us what it's like to be young and what ideal medicine is about.

And so this week I was pleased to receive a page from a 3rd year girl asking if she could watch me put in a cannulae** as he wanted to learn how to do them. And so despite the rest of the wards falling apart around me I agreed and walkeddown to the ward to take a break and do some teaching.

Found the med student and talked her through the procedure, explaining what equipment to gather and how to use it. Unfortunately the cannuale was needed on a sick dying man and so it wasn't really appropriate to let her do it, so I let her watch and then after that offered to let her put one in me.

And so after a year of putting them into patients, I finally had a cannuale put into me. It wasn't that bad actually. The girl missed and was nervous so didn't firmly push it in... but eventually she hit the vein and the look of excitement on her face was reward enough. The nurses passing by gave me strange looks but who cares... their fluid orders could wait.

She then turned around and asked "Can you put one in me so I can know what it feesl like?"

2 minutes later she was sporting one too.

It's little time outs like these that make work bearable.

* One such example given by a friend was "Um so what's a checkout chick?"
** the plastic tubes with needles that drips attach to to give you intravenous fluids

It is finished

2006-11-05T17:17:00.000+11:00

So Dr J hasn't posted for a while.

What happened? Had he forgotten about his loyal readers? Had he nothing exciting to write about?

No.

He was getting hammered by the ever-increasing list of inpatients on the Gastro ward. After ballooning to almost 30 inpatients, I had little time to relax, let alone put pen to paper (or whatever it is that bloggers do). And so I sincerely apologise and will give an update for life so far.

Gastro sucked. Words really cannot convey how awful the last few eeks of work have been. My workload almost doubled, my bosses halved (away on conferences or taking days off etc etc), my number of wards quadrupled (from 2 to 8) and my average leave work time was 7pm.

On more than one occasion I came very close to just walking out the door and throwing my pager under the wheels of the nearest bus. One particular day my registrar pushed me so far that I almost cracked but lucky for him he saw the look of anger in my eyes and quickly pulled back and offered to buy lunch so I wouldn't explode.

This last week I was getting paged so often that it was stopping me from getting ANY work done and so my registrar had to go down and tell the nurses off on my behalf for harassing me so much.

I wore my heart on my sleeve and this warned those who were wise to stay away and not disturb me unless it was urgent. A few naive nurses were not so lucky and copped an abrupt phone barrage.

One day after being pushed very hard all day, I needed to go to the bathroom. However I was not even allowed the luxury of relieving myself without my pager going off 3 times in 5 minutes.
And so I stormed out of the lavatory to the nearest phone and called the number that had interrupted me.

"What's so important that you had to page me 3 times? Is it an emergency?"

[It wasn't]

"So why did you need to page me 3 times in 5 minutes? Have I ever NOT answered my page? Does the fact that I didn't answer make you think maybe I was busy? Am I still allowed to go to the bathroom?"

[Nurse on high horse starts yelling at intern down phone]

So I charged down to the ward to sort it out only to find the head nurse comforting the nurse who I had argued with and telling him to relax.

"Look ... here's the doctor now. He's oming to fix up the problem... there's no need to get angry at him.. see.. he's writing that medication up now"

I gave the greasiest glare I've ever given to them and sulked off to the other ward to complain to my intern buddies. However I later found out that that nurse has a history of being inappropriately rude and had been warned prior and was now suspended because of his alteration with me. And just to top things off, apparently he has a psych history and is off his meds.. so now I'm expecting to bump into him one late night in the carpark as he seeks his revenge. Sigh.

The last few weeks I've barely been able to make it through each day. The stress and the suffering of going to work each day made me feel sick. I didn't eat lunch at work for a whole 2 weeks cos I was 'too busy'. I was burning out and crashing fast.

And so on Friday I walked onto my ard for the last time. With a smile.

The nurses said they had never seen me so happy before. I even laughed with them. They said that I had done a great job seeing as how crap my job was. I knew that in their own disturbed way they knew something of my pain.

I did the round with my registrar for the last time and spoke my lats words to my chronic alcholic/liver patients. I recharted med charts for the last time. I did my last ward discharge summaries. I said good bye to the allied health staff and shared some celebratory Maltesers with the pharm girls.

Prof filled in my term assessment and gave me a perfect score. He took me into the endoscopy suite and offered to let me do a gastroscopy (stick a snake like camera down someone's throat into their stomach) on one of our long term patients. Nervously I declined, knowing that if I touched that scope, I'd find it too easy to get hooked and maybe even start considering physician's training.

And then at 4:45pm, Prof and my reg and I went down to the hospital cafeteria to have our final goodbye. We sat around lamenting the hospital system (and it's lack of money) whilst we sipped our hot drinks and chatted.

The finally it came. After 10 weeks of living through hell, those words came out as life giving encouragement.

"Well J, I just wanted to say, that you've done a really good job! I know it's been very hard for you becasue we've had so many patients. In fact, you've had more patients this term than the other interns had earlier this year. And we're sorry that you didn't have more registrar supervision, but you've really been amazing"

And then my aggressive tough-guy registrar nodded his head and concurred "Yeah you've had it the worst so far this year but you've done well."

And in that instant all those weeks of angst and anguish dissolved into my hot chocolate and slid down my throat out of sight. It was finished. I had run the race and survived. And finally my master was saying "Well done good and faithful servant" .

And so I walked out of the hospital that night with my head held high knowing that although very few will understand what I went through, I can be proud. Internship IS like what you see on television in shows like Scrubs. It's a rollarcoaster of exhaustion and relaxation, of pain and joy and of maturation from students into doctors.

Now all that lies between being an intern and being a resident is this little thing called the Emergency Department. That's right. Dr J heads off to play "ER" for the rest of the year and prepare to emerge from the cocoon of internship next year.

Beginning of Jolin Tsai's Sydney Concert

2006-10-22T18:50:00.000+10:00

Good Weekend

2006-10-22T17:50:00.000+10:00

Work sucks right now so I wont dwell on it other than to say it's only 10 more working days till I leave Gastro and farewell my reg (who's renamed himself G-Astro Boy because a nurse commented on his gelled back Asian hair)

So on to more fun things. Like the weekend.

As I watch the medical students dissolving into frenzied sharks, I realise the beauty of working life. Time off.

Not to say that as medical students we didn't have time off. But there was always that lingering prospect of impending exams that necessitated study. Although we wasted many hours, they always fell under the shadow of those final exams.

But now how things have changed! The shackles of assessment have been loosened and although we are not as free with our time, it is time free of anything else. And so the weekend takes on a new meaning. It gives refreshment and an awful lot of enjoyment.

So this weekend began after a late afternoon ward round with the Professor which then evolved into a trip across the road to the local publican's house for refreshments with workmates (and even an invite to some random perosn's farewell party). It was good to just chill with the other doctors (all of whom had similarly awful weeks) and just relax.

Then it was off ot the city to join my mate A* for dinner with him and some of his Asian posse. I was ordered a whopping huge plate of ribs cooked to perfection and got to meet some really cool new people (I know some of you read this - haha) The it was off to score another 'sugarhit' at the Swissotel overlooking the streets from on high. It was sheer exhaustion that prevented us from kicking on to karaoke (probably to the benefit of those who DID go).

Saturday kicked off way too early with an early morning church breakfast of pancakes and prayer. I struggled home afterwards to rest for a short time before heading off to meet my sister for a late lunch and shopping trip. I had rashyl promised to buy her a birthday present for her 21st and so I was finally being held accountable to my promise and made to endure some 'quality' time with my sister as she talked and walked her way through 4 levels of shops to find what she wanted. Was good to hang out though and just spend time together amidst the busy-ness of life. Seems like only yesterday we were making cubby houses in our lounge room and fighting over the trampoline. Now we go on dinner dates and fight over who should pay. How I long for those old times when life was simpler.

Then it was off to eat some quality Japanese and catch up with some friends. The food was excellent as always and the conversation was so encouraging. Got back too late though after watching DVDs but this afforded me the oppurtunity to catch up with friends in Singapore and Taiwan who were still up (due to the 3 hour time lag).

Sunday was another early start due to a combined church service with our Asian sister congregation. But what really topped it was the Yum Cha with old college buds who turned Asian eating into a comedy routine**

It wasn't one thing that necessarily defined the weekend. But a whole lot of little enjoyable things that make you realise that life isn't that bad. That you will be able to keep persevering through the rubbish of your job in order to see the next weekend.

*of Jolin Tsai concert fame - I've been humming those diva's tunes all week.
** "English is the best language ever ... in Asia the word for pork is ju-ro but in English the word for pork is pork! How great is that!"

"Ladies and Gentleman... Welcome!"

2006-10-15T17:39:00.000+10:00

So began the first words of the best 2 hours of fun I've had in a while.

But first, one must set the scene.

It was a unusually scorching spring day where I didn't have to go to work. Got up late and put on a music DVD to get myself ready for the evening to follow. Had a casual lunch on the beach with a workmate and then went home to get ready.

Gave myself a haircut (yes it does need to be cut!) and picked out my fav pink polo tee and polished my head till it shone. Donned my redstripe Nikes and hopped on a bus into the city to meet my Malaysian mate A.

He was waiting with his SLR camera in the CBD and we highfived each other as we headed down the main drag to get some food. We exctiedly chattered about the upcoming night and planned ways to meet our object of affection in person. We travelled via Chinatown to peruse the CD stores and look at new DVDs.

We arrived at the Entertainement Centre with 30 minutes to spare. All I could see were short black haired fans of Asian extraction piling into the doors and chattering on their phones with excitement. We were definitely in the right place.

The security guards gave me a confused look as I passed through, triumphantly clutching my ticket. Upon entry, we were endowed with plastic fluro-cloured whistles and blow up 'banging sticks' (you blow them up and hit them together to make loud noises - go figure?)

We hurredly found our seats and realised we were in the main section 3rd row from the floor. We had a good view and were right in front of the stage. My mate A began to turn around and play the "Spot the white person game" (he counted a total of 3) and over the next 30 minutes the arena became packed with 6000 screaming Asians. As we waited nervously, big screens played advertisements for Taiwanese tourism, projecting images of places I'd long forgotten I'd visited.

And then it began.

The sounds turned down and the lights went out. A roar from the crowd heralded the imminent arrival of the Princess of Pop*. Suddenly a deafening minor chord blasted from the front and a lone female voice I knew all too well called out:

"Ladies and Gentleman... Welcome!"

A silhouette formed at the peak of the stage pyramid and next thing I knew the lights flooded the arena and there she was.

Jolin Tsai!

She launched straight into her latest album's first song and I began to shake with excitement. It was everything I had imagined and more. The dancers poured onto the stage and the spectacle began. It ws a nonstop action packed routine. Not only was she doing a full choregraphy routine, but she was singing live thru a headset microphone too (as evidenced by when it stopped half way thru the song cos she pulled it out accidently) Flamethrowers and fireworks routinely set themselves off from the stage and the crowd started going wild.

I found myself completely stunned. It was her! She sang fluently whilst dancing better than most of her support dancers and still managed to smile the whole time. In between sets she would chat with the crowd ending with a resounding "Hao, bu hao?"

Then the familiar chords of "Upup" started and I rose to my feet dragging A up yelling "This is it! This is the first song of hers I ever heard 2 years ago!" Yes that's right... 2 years ago I first heard her voice on Taiwan's MTV singing about an MP3 player and since then it's been sealed... I'm a fan!

In all there were 7 costume changes and enough warm smiles to reaffirm her title as the "teenage boy killer". Some random dude from 'F4' (Jerry) got up and sang as her support act, but thankfully only for 2 songs and then it was back to Miss Tsai.

And then it came, the penultimate song... her title track that took 10 months of dancing practice to master... the "Dancing Diva"... the Middle Eastern melody and harmonics came to life and next thing I knew there were moves that would put Olympic rhythmic gymnasts to shame.

And then to finish off, she welcomed the crowd down the front and what ensued could only be described as a massive Asian mosh pit as the Queen farewelled her Australian fans.

I rose to my feet with the crowds as we sang in Mandarin.

It was awesome!

And then she flashed us one last smile... took her final bow and said "Xie xie! Zai jian!"

And with that it was over. But the memories** will remain for years to come. Man it's good to act my age once in a while and be young!

"Jolin, wo ai ni!"

* well at least in Asia
** well not JUST memories. The disputes between A and I about who will marry Jolin will go on forever! As will the permanent hearing loss I now have from the excessive decibel usage. Haha!

Editorial

2006-10-15T17:08:00.000+10:00

Every once in a while it's good to have the opporutnity to respond to reader's comments and get some 'dialogue' happenin.

So after persuing through old posts indefinitely just wanna say the following:

# No I'm not chasing after girls of 'unequal' yoking. It was jus a comment that even if that person was, it prob wouldn't be a possibility anyway. However on that note, this week I had morning tea and lucnh with the pharm chick and another docotor and pharmacist. It's nice to have lunch with non-doctors once in a while. They're not as 'boring' as you might think! (haha - this is a joke, I don't want a tirade of "Stop being so up yourself Dr J" comments)

# Our callings in life are not static but dynamic. Just cos I have the ability to do something doesn not mean I should. I know this flies in the face of Western thinking which staets that if you have the ability, you should. But under that argument I should go and be a film director cos I'm ok at that too and enjoy that too and that helps people by conveying messages and helping them relax.
Please don't get me wrong. Medicine is a fantastic profession in what it achieves. It touches many lives and Jesus himself called himself the great Physician (I'd hate to see what his FRACP exam would look like). To want to alleviate suffering (either in palliation or cure) is a good and right thing, it shows that suffering in this world is not random meaningless chemical reaction, but a painful result of the curse we live under. However for me personally, I have decided that my time would be spent better elsewhere. I would encourage my fellow doctors to work hard in their jobs too and I will always hold a soft spot for med. But I have not made this decision lightly. It's taken me 6 years to decide and only after much talking with others.

# In terms of updates with my Dad, he's slowly pottering along. Part of his frontotemporal dementia is that he is disinhibited in his feelings and thoughts. And so where he once would keep his opinions on our lives to himself, he now becomes more open and tells us what's on his mind. And so it's become apparent over the last few motnhs that he is quite (well 'extremely' would be a better word) keen for me to get married. He keeps blatantly asking me EVERY phone call whether I've got a girlfirend and whether I'm talking to any nice girls (whereas he never used to ask) and telling me he's put away some money to help pay for my 'new family'. I feel kinda bad because this is what he really wants for me and yet it's kinda not something I can 'make' happen. My great grandfather died before my grandfather got married and my grandfather died before my father got married and it seems like now my father will die before I get married. I know it's not in my control, but if I 'could' give him his final wish... it'd mean so much to him. Sometimes this world sucks... big time!

Shuffling off this mortal coil

2006-10-09T23:31:00.000+10:00

Today I had the rather unpleasant expereince of telling a 40 yr old man's sisters that he was going to die.

It was needless to say unpleasant.

Put in this position by my registrar being too busy, I was left to exaplin to these ladies that their brother had an advanced cancer and had probably days to weeks left to live. As I tried to simply explain the details I could see one of them choking back the tears and holding back her disbelief. I saw the other just nod and let the news wash over her as a reassuring explanation of something she deep down already knew.

This poor guy is pretty sick. His wife died a few years ago and he will leave a young daughter behind to be cared for by his family. Within a few hours of my meeting with the sisters, crowds of relatives were piling out his door with women sobbing in the corridors as they paid their respects to this man on the other side of the grave whilst they could. I purposely walked to the other elevator so as not to bump into them, partly becasue I did not want to disturb them, but partly because I did not want to have to deal with it myself.

Death is not natural. No one 'dies with dignity'. Death is an unnatural thing that fractures our relationships and breaks down any meaning in our life. We toil and strive to get ahead in our careers and have a great lifestyle... but for what? In the end the fate of the poor man is the same as that of the rich man... they all die and take nothing with them. Death makes our lives now meaningless.

We sanitise death today. We use euphemisms like "passed away" or "loved ones" when in reality we all live in denial of our own mortality. I noticed this even amongst my own bosses who in their pursuit of prolonging life could not bring themselves to tell this patient's family the reality or to talk about a "Do Not Resuscitate" order.

And so over the coming days we will transfer this patient to the Palliative Care team and ship him off somewhere else, out of sight, where he can die... and we can all pretend like life goes on.

There's something seriously wrong with that.

The Results...

2006-10-09T23:03:00.000+10:00

Every experiment is designed to test out a hypothesis.

It contains an aim, methods and results followed by a conclusion.

An every experiment must have an end in mind.

Sometimes that end is brought about when the results clearly indicate the hypothesis being valid or invalid without requiring further validation.

This happens quite often in medical practice when a certain therapy is clearly better or worse than another and it is immeadiately stopped so as to be ethical.

And so it is with some relief/catharsis that I can reveal the preliminary results of "The Intern Experiment"

Aim: To determine what Dr J should do with the rest of his life.

Methods: Trial being a medical intern in order to ascertain whether or not Dr J should continue down the path of medical practice.

Results: 3/4 of the way through the experiment, the subject decided to terminate the trial at the end of 2007 and leave his current vocation citing 'other priorities'.

Conclusion: Dr J will cease in 14 months to be a doctor (at least temporarily) whilst he considers a new experiment trialling out full time Christian ministry for 2 years.

After much thinking and praying and talking with others over the past 5 years, I have decided to take a break (possibly temporarily, most likely permanent) from medicine and spend my days work telling people about Jesus and spending my time and energy 'working for the kingdom'.

Sounds kinda crazy doesn't it? Throwing away a medical education and the world at my feet? Maybe even a little immature? Living a poorer life in order to 'brainwash' people with the Bible?

Or maybe its not? Maybe there IS something more to life that medicine doesn't quite get. Maybe the priorities of this world are not going to last. And maybe... just maybe... it is time.

Time to stop sticking our fingers up at the one who made us. Time to stop blaming him for the way we stuff up the world and our relationships. Time to pull our head in and listen to him. Time to meet this man called Jesus and realise he is the Ruler and the Judge of this world.

I know some of you will say "About time Dr J!" and other of you will shake your heads and say "What a waste!" Ultimately though, I have to explain my life not to you readers/friends out there... but to Him. And can I urge you to at least listen to what he says before you dismiss him?

And so the next 14 months I will continue to experiment with medicine, but only as a way to earn some money and save up for the years ahead.

For the one who saved my life by his death.

Mando Pop

2006-10-09T22:38:00.000+10:00

Only 4 sleeps to go!

That's right, this Friday marks a special occasion in the life of every young doctor. A time of great celebration and joy.

One's very first Mandarin pop concert.

It began about 2 years ago in Taiwan. My tour companions and I would watch MTV Asia at night time whilst eating our dinner and we were captivated by a song "Up up"... we found it amusing and catchy and next thing I knew I had her album and it was all over.

On my second trip to taiwan I sought out the nearest music shop and looked for any more Cd's by the artist known as Jolin Tsai.

So imagine my suprise when 3 weeks ago my mate tells me she is coming to Sydney and playing at the Entertainment Centre. I almost fell off my chair.

And so this Friday I will make my pilgramage to Darling Harbour to see the Queen of Mando (or at least Taiwanese) pop. It promises to be "an original and inspiring mixture of fantastic choreopgraphy, stage design, lighting, music, and just plain entertainment brilliance."

So exicited! Hun hao!

At the movies... with Dr J

2006-09-29T21:03:00.000+10:00

Got roped into seeing "The Devil wears Prada" with some other doctors recently.

At first I was ready to snooze, thinking it would be a chick flick that would hardly sustain my attention span. However I actually found myself staying awake till the very end.

Why?

Cos for some strange reason I identified with it. It resonated with my experience.

No, not cos I'm somehow fashionlably endowed or into girls magazines, but because the hierarchical competite world it portrayed reminded me of medicine.

I wont spoil the story too much, but it portrays an ordinary girl working for a fashion mag who ends up changing her personality to survive and in the end wonders if it's all worth it. In the end she decides it's not and throws her phone into a fountain in Paris and frees herself from the suffocation of her identity by her job.

I watched her scurry in front of her boss to grab things and make deadlines and saw my own ward work on the big screen. What Prof wants... Prof gets!

Time after time the girl on the screen missed important parts of her friend's and family's lives because she was stuck to her work and couldn't leave. I felt my own guilt at the times I've stood friends up for dinner (even this week) because of work.

I feel like sometimes work is turning me into someone I don't like. Someone I don't want to be.

Maybe I should throw that pager into the nearest fountain? Maybe I should reclaim 'me'.

Memories

2006-09-29T20:54:00.000+10:00

Yesterday my mate M left on his medical school elective.

He's off to Kenya to go play jungle doctor and see the world.

As I took him (and his farewell entourage) to the airport, it brought back memories.

The airport holds do many memories for me.

Seeing my sister off with the family as she left for the US for 2 years.
Picking up my overseas uni friends when they return from holidays.
Nervously waving Sydney goodbye as I took my first trip overseas when I went on my elective to Taiwan.
Excitedly hugging MC this year when I saw her walk out of customs.
The shed tears at the departure gates when MC left with part of me going with her too.

It's been 2 years now since my elective and it still holds such fond memories in my heart (and always will). The wonder of seeing the 'novel'. The smell of Asia. The greenery of the tropics. The humidity and palpable vibrancy in the air. The buzz of speaking another language.

To be honest I learnt no medicine whatsoever during my 2 months in Taiwan. But I learnt an awful lot about life. I think going somewhere completely foreign and isolated was an awesome idea. You are forced to go out of your comfort zone and live life to the fullest.

As I saw M walk to catch his plane, I saw a flashback and knew that when he
returned, he would understand.

Good luck and safe travels M!

What is this thing called "Saturday"?

2006-09-26T20:07:00.000+10:00

After a month of working 6 day weeks it was pleasantly relaxing to enjoy the day known as Saturday.

Why?

Because:

a) you can leave work at 5pm Friday knowing you have 63 hours of freedom till you need to come back to the wards.

b) you can stay out really late on Friday night without feeling guilty about having to get up the next day for work. It also means you can go out karaoking with your Asian friends and then tie one of them up with duct tape and dump him outside the door of a girl he likes with a texta scrawled address label on his forehead.

c) you can sleep for long periods (enough said)

d) you can go to the shops whilst they are still open and buy things with all the money you've earnt from the past month of 6 day weeks. Things like exercise bikes (for that spring time health kick you've decided to embark on) or smoothie blenders (for the health kick too) or just random DVDs you have been eyeing for a while.

e) you can enjoy Sunday with less pressure knowing that it's not your only day off for the week.

f) you're not spending the day dealing with old people's medications whilst your friends are outside enjoying creation.

Can't wait for the long weekend! Bring it on!

Men are from Saturn, Women are from Liverpool

2006-09-19T21:46:00.000+10:00

Relationships.

They are so confusing in all their forms and yet they are fundamental for human existence.

We inflict so much pain through them, and yet become profoundly depressed in their absence.

Friday night I spent enjoying the relationships with friends from church at our annual ball. The theme was "Cluedo" and so guys and gals donned various coloured clothing and solved a murder mystery of epic proportions. However when the DJ's music remained techno for too long my mate and I rushed down to my car, pulled out a dusty CD from my glovebox and got him to crank on "Backstreet's Back". Worked a charm until my mates decided I should dance and I decided I shouldn't* What ensued next was a tangling of limbs and bar stools and helium ballons being sucked as I was dragged laughing non-stop onto the middle fo the floor and dropped.
It was great to just have some fun and muck around with my brothers and sisters without worrying about life.

Ended up staying out way too late but seeing as I had the 'easy' Saturday shift at work I figured I could always sleep a bit during my shift the next day. How wrong I was...
Rocked up to work bleary eyed only to find that one of the residents was sick and seeing as I had the cruisy shift I was dobbed in to do his job as well until they found someone else. So I ended up being overworked, running between theatre (open appendix and a trachie) the intern wards and the resident wards. By the end of the shift I felt so exhausted, both emotionally and physically. And all I wanted to do was come home to someone. To have someone in my life who would be there for me and tell me it was ok and someone to look forward to seeing.

But to be honest I find myself frustrated with the whole boy-girl relationship thing. Girls whinge about guys not being 'chivalrous enough' (whoops I forgot to open the door! Sorry J!) and never asking them out whilst guys shake their fists and lament how girls are fickle and looking for Mr Darcy who doesnt exist.

I think I've been scarred from past expereinces which have all been less than ideal and made me bitter/pessimistic about the whole process for the future. And yet why do I keep finding myself seeing nice girls as 'potentials'? If I'm so fed up then why am I so hungry?

"No man should marry until he has studied anatomy and dissected at least one woman." - Balzac

I realise that relationships are so vital to life. We are placed in many relationships. As a son, as a doctor, as a friend, as a flatmate, as a leader, as a learner.

I feel that work makes me value relationships more. Somehow the business and exhaustion of work needs people outside of work to fulfill it. One day I hope that'll be with some amazing woman** but it must not be exclusively there. Fulfillment of relationship is found in love. And that is found in God. But in this fallen world we just keep stuffing it up. And so I long for that perfect relationship. One that casts out all fear.

* I hate dancing. Not other people dancing. How they choose to express themselves is their own business but I personally refuse to dance because I am crap at it. Not in a 'aww-isn't-it-nice-that-the-guy-can't-dance-and-is-lamely-trying' way, but in a "get-this-moron-off-the-dance-floor' way.
** Latest OoA is Pharm girl #2 the new pharmicist on our ward who is of Asian extraction, extremely nice and all the other guys think she's good looking too. Finding myself wanting to 'review a patients medications' so much more often now. Hehe. (Don't worry .. definitely out of my league and prob not Christian)

The human side of medicine

2006-09-13T21:14:00.000+10:00

"A young intern confronts his own demons as he cares for a demented patient and is forced to face his own father's mortality."

Sounds like the TV blurb for ER or Greys Anatomy right?

Well it's my life!

Been havign way too many 'warm and fuzzy' moments in the last few days.

I think it all began on the weekend when I was working overtime and got called to a 'code blue' on my usual ward. As I looked at my pager I recognised the bed number as one of my little old ladies and a wave of dread fell over me.

When I arrived there were already 7 other doctors cracking her ribs, jumping up and down on her tiny heart and trying to stab for those ever important ABGs. Turns out she became hypothermic and dropped her temp to 32 degrees and became bradycardic... a sign of shutdown.

We called the son to come urgently and ICU came and rammed a tube down her throat... she went into Vtach and 20 seconds later got zapped with those paddles. She came back... but only for a few hours.

As we met with the son, I felt so awful listening as my reg explained to him what was happening and discusses the Not for Resus orders with him. Although she was sick and frail and elderly, I still feel like maybe I could have done something more... maybe I could have got a peripheral line in for some fluids? Maybe I could have been more aggressive in hounding the reg to see her? Either way, she's now gone and as my reg said to me:

"You're not a real intern until you kill someone"*

Then today I had one elderly patient ask me to sit on his bed and talk with him about 'life'. he onyl had a mild cases of gallstones but was convinced he was about to shuffle off this mortal coil tomorrow. I felt really sad as I listened to him and heard him talk abotu how great his life used to be and how he had bought his own house and raised 3 sons who were now living their dreams and he was living his life now through them. And yet there was a sadness there as he talked and he said he wished he could end it all rather than live a life of disability. It made me think just how truly awful it must be to see society devalue and ignore you as you age, just because you no longer have any capitalist value to them. I'm going to miss him when he goes tomorrow.

Straight after that I got called to see a lady with breast cancer who had liver mets and was dying but came under us cos she had biliary obstruction. As I stabbed her she began to pour out HER life story too (I must have had this sign on my head saying "please tell me ALL your problems"). As I sat there listening to her battle with breast cancer at a young age, it brought back horrific memories of my own grandmothers death. My grandmother was diagnosed at 45 with breast cancer and had a protracted 12 year battle with a slow but steady decline. In fact, it was her death that inspired me to become a doctor in the first place. And seeing this young 40-something woman dying there in front of me I couldn't bear it any longer and had to leave before I lost it.

But I only just made it to the ward when I was asked to talk to the wife of one of our demented patients about his return home. It was obvious this was gonna be a long one, so we went into a nearby room and she poured out her agony till she could say no more (and she was of Mediterranean descent.. there was a LOT to say). Sitting there listening to her talk about feelings towards her dementing husband made me feel like I was talking to my mother. All the pain and suffering I saw in her eyes resonated with the anguish I see in my own Mum each day. Hearing her reactions and grief to her husband made me break. I just sat there with her and gave her the one thing that doctors don't have... time.

Amidst the incessant paging and ward rounds, between the cannulas and med charts, we lose track of what it means to be a human and what it means to go through an illness. And so today I spent some time just sitting with my patients and listening to them. Not offering them textbook answers to their problems but just sharing their pain and being there for them.

To be honest, I dont like it. It makes me vulnerable and it makes me human. And doctors aren't supposed to be human. Cos if they were then they would not be able to cope with what they do each day. And to love others is truly... definitively... human.

* I didn't 'kill' her for those of you who are non-medical readers. It refers to that feeling though when you feel responisble for their deaths even though you did all you could.

What a difference a reg makes...

2006-09-13T21:05:00.000+10:00

Well the sun is shining and the light has fallen.

Came back to the wards this week to find that the gastro regs had swapped over and my old reg was now sticking cameras up bums whilst I had the smooth talking Indian reg who is renound for writing in large letters and signing his entry with only his first name (now THAT is cool!)

I wasn't sure if this would be a good thing at first. My few previous conversations with him had involved talks about whips and chains if the patient list was too large when he hit the wards. But these fears were soon allayed when he told me not to bring the notes to the patient's bedside to write in as HE would do this himself later.

That's right... I have a reg who insists on writing the progress notes himself.

I never thought such people existed but it's a welcome relief from spending hours postdating entries for the rest of the morning. And not only that, but he generates less consults, less CT scans, less crap for me to do and therefore instead of getting out at an average of 6:30pm... I'm now finishing my work by 3:30pm and looking for ways to kill time.

Also in the past few days I have only had 2 new patients whereas with the old reg I had an average of 4 per day.

Life at the moment is just a whole lot better.

Which is good because had I kept going at the current rate I was last week I would have ended up like this:
http://www.theage.com.au/articles/2006/09/12/1157826941987.html?from=top5

And as icing on the cake, we have a new ward pharmacist who is of Asian extraction and instantly turned me into a blubbering fool when she asked me about a patient's medications (one of the other interns is going to asses her single status for me... haha).

Enjoy the good times while they last!

The lighter side of life

2006-09-07T22:54:00.000+10:00

So what does an intern do when he has a few spare moments?
Read the latest edition of the New England Journal of Medicine?
Peruse eBay for a new Littman Cardiology III stethescope?

No.

I do the following:

a) decide which new free phone to get. That's right, customer loyalty in Gen Y is at an all time low and so my phone company is offering a new phone to stay with them. So now the only decision is whether to get the Motorola V3x or the Sony Ericsson K601i?

b) watch the latest movie trailers on Quicktime's website. Of notable interest is the new upcoming Teenage Mutant Ninja Turtle feature film. Long live my childhood! And there's even a sneak preview of Spiderman 3... is dark, is good!

c) roam YouTube for random video clips of long lost shows such as "Ren and Stimpy" with their classic song "The Royal Canadian Kilted Yaksmen" (to the tune of God Save the Queen)

Our country reeks of trees
Our yaks are really large
And they smell like rotting beef carcasses
And we have to clean up after them
We proudly wear women's clothing and searing sand blows up our skirts

And the buzzards they soar overhead
And poisonous snakes will devour us whole
Our bones will bleach in the sun
And we will probably go to hell
And that is our great reward
For being the-uh Ro-yal Canadian Kilted Yaksmen
And our saddle sores are the best.

d) order a whole bunch of Asian music and DVD dramas online to keep myself occupied.

A story of old...

2006-09-06T20:51:00.000+10:00

Amidst the craziness of the past few weeks, I have been looking after an elderly patient Mr A.

Mr A is a Swedish ex-navy officer who presented to ED with symptoms of chronic liver disease due to alcoholism. Your typical drunk old guy with liver problems... or so I thought.

Turns out Mr A has been hitting the grog hard for the last 5 years after his wife died. She was the love of his life.

They initially met in the United States when he was posted in the navy there. She was married at the time and he was a dashing young sailor. They hit it off well but since she was married they parted as friends.

It wasn't till 20 years later when he was in Australia that they met again by chance. In that time her husband had died from cancer. He had never forgotten her though and took the chance to find happiness with her. They were soon married and lived together in Sydney until she was taken from him by emphysema.

Since then he has lost his will to live. He doesn't care if he wakes up each day. He sees no point in living without her. It's so sad.

Whilst my ward rounds are pressing, I still find myself drawn to spend a little bit of time each day just talking to Mr A. Just to be there and listen to him talk about the love he once had and be there for him. I see a sadness in his eyes that haunts me. There's no sparkle there. Just a void of loneliness.

Tomorrow we are going to ship him off to a nursing home. His bed will be filled quickly with another patient with vague abdominal pain. And he will be lost to a world that has nothing of value for him.

Amidst the indifference I have towards most of my pateints, this guy has stood out as the one excpetion that shows somewhere underneath all the pounding of internship there is astill some shred of humanity left in me. Some piece of connectedness to the shared common experience that we all have that makes us relate to each other.

And so although he leaves our dreary ward, his memory will be a temporary reminder to me, that people are humans first... and patients second.

Re-Employment

2006-09-05T19:26:00.000+10:00

Last Friday had my first medcial job interview.

Basically had to reapply for my own job which was kinda weird seeing as all I'll be doing next year is the same as what I'm doing this year*

At first I wasn't that nervous as I expected that most people would get back in to The Zoo. However as the time drew closer for our date with destiny, people began to flip out. Interns began to gather in huddles to discuss rumours of selection criteria. Unofficial gossip from the JMO office began to strike fear in otherwise sane people. Panic set in and the fight or flight response cranked itself up.

When the day itself dawned, people started showing up for work dressed in suits and looking sharp. And one by one, interns started filing into the admin offices to face the firing squad.

The first few trickled back to the wards sounding mildly confident with the process, however this did little to allay the fears of those still to go. As the day progressed the tension eased slightly and at 2pm I put my suit jacket on, straightened my pink tie** and walke dup to the interview room. I bumped into the formerly fat/pregnant intern who was on maternity leave and we nervously made small talk about her baby whilst internally freaking out about our upcoming interrogation.

So finally they called my name and I walked up the long corridor to face my destiny.

"Welcome Dr J, please take a seat..."

Question 1 - Tell us 3 reasons why you believe you are the best candidate for the position.
I rattled off some rubbish about communication, organisational skills and clinical competence totally feeling self-conscious about 'selling myself'.

Question 2 - Clinical scenario about an unconscious guy on the ward.
Usual ABCs and as soon as I mentioned I'd do a blood sugar level they were happy to move on.

Question 3 - If you've had a really bad day at work, what do you do afterwards?
What the?? What a stupid question! "Well sir, I like to raid the nearest S8 cupbaord and steal some hard core drugs and then I go get high whilst on call" I mumbled something about having dinner with fellow colleagues to gather their input into how to deal with situations. Bah!

Overall I think I did well. Talking confidently in these kinda things and exams is something I've always had little trouble with. Only time will tell if this intern will be able to come back to the Zoo next year. Fingers crossed eh?

* With the minor exception that I will finally be able to write outside scripts and deal drugs to people who aren't in hospital.
** Pink ties are cool. Or at least the nurses keep telling me so. Hehe

Overwhelmed...

2006-09-05T19:07:00.000+10:00

I hate medical terms.... I really really hate them.

The last two weeks have been a non-stop rollercoaster ride known as "Gastroenterology" which have left me ever so tempted to just pick up my bag, walk out the door of the Zoo and never return again. To be honest, any enthusiasm or noble aspirations I ever held about helping people are well and truly gone. I hate my job and I hate in particular doing medical terms.

Started last week with a huge patient list and a Korean reg who is known for his abruptness and comments such as "I'm a liver man... only bother to call me if the ALP has gone up by 5!".

Within 5 days I had 5 patients dischanrge themsleves against medical advice. Now so far I had only ever had 1 do that ALL YEAR, but in one week either my sheer exhaustion/incompetence or the crap-ness of this term made 5 people leave hospital while they were still sick and needing treatment.

Patient A staetd that he needed to leave to go and buy a house in Adelaide, then when about to walk out the dorr demanded a taxi voucher to get himself a few hundred metres home and when we refused called us 'lacking in compassion and lacking in brains.

Patient B came in witha multi-drug resistant HIV strain and had a UTI and rectal stranding on CT. Didn't take Einstein to work out that this was "what happens when you put things in places they don't belong" (to quote the Urology registrar). However the patient didn't like the smell of poo on the ward (it's a gastro ward for crying out loud!) and so walked out the door to take his chances without antibiotics.

Patient C had acute pancreatitis and kept ripping out his drip on a 6 hourly basis requiring me to keep stabbing him. He wanted to go off to pay some bills and when I said we advised against this he self-discharged and said he was oging to admit himself to St Elsewhere's where they have more compassion (don't let that door hit you on the way out buddy!)

Patient D had chronic abdo pain and kept wanting more and more painkillers yet everytime we saw her on the ward she was running around and chatting on the phone to her friends then would double over in pain the instant she saw us... who you kidding girly?

Patient E came under gastro becasue she had mastitis. That's right. Apparently tummy doctors are now the ones to treat infected breasts. So we were about to start some good ole IV fluclox when the patient's 'natural therapist' objected and even though we got senior advice from the 'lactation advisors' that this was an ok anti-bug to use, she still refused. And so we had a patient in hospital refusing treatment but still wanting to be admitted to the private hospital... why bother coming to hospital if you don't want our treatment?

I've concluded that gastro is the medical term you dump patients in when you can't find any 'real' pathology that a surgeon could chop out. We send half our patients home with no real diagnosis and I've consulted the 'chronic pain team' more in 1 week than I have all year so far.

Combine that with the fact that my reg is constantly scoping/never around and I'm totally losing the plot. I have no morale and feel sick each morning as I get up to get ready for work. I even had to walk out of the ward the other day to stop myself from breaking down. I even had the social worker run after me to check I wasn't about to jump off the building (although very tempting).

The med students look at me with pity and horror. The senior ones have stopped asking me for patients when they see the anger in my eyes. The junior ones I try to be nice to and spare them the horror of what's to come.

There's no sparkle in life right now. It's just day after day or crap (and this is what life will be like for the next 9.5 weeks)

The only thing keeping me sane right now is Coca-Cola, grace, the onset of spring and the weekend food outings with old uni buddies.

Slicing and dicing

2006-08-25T14:44:00.000+10:00

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

2006-08-23T15:35:00.000+10:00

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!!!!!!!!

2006-08-21T10:48:00.001+10:00

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)

2006-08-21T10:32:00.000+10:00

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...

2006-08-07T02:08:00.000+10:00

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...

2006-08-06T01:37:00.000+10:00

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

2006-08-03T05:32:00.000+10:00

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

2006-08-01T00:47:00.000+10:00

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.

Lapping the main

2006-07-26T00:03:00.000+10:00

Yes that's right... I'm back rediscovering my 'roots' in good ole Bushville.

In order to:
a) escape the memories of last week and S
b) spend some time with my dad whilst I can
c) support mum
d) catch up with my gandparents

I decided to make the trek over the Blue Mountains to my home town out in the sticks. To be honest, it's not that exciting. All people do here is work, shoot things, drink beer and lap.

Now 'lapping the main' is a peculiar phenomenon to country towns. Devoid of such fun things as nightclubs or restaurants (other than the obligatory Chinese takeaway*) they have construed a novel pastime that entails them acquiring a standard white ute with bullbar and spotlight and gun rack and occasional live-dog-on-back and revving their aforementioned vehicle up and down the main street and leering at girls who are brave/stupid enough to be walking outside at that time of the evening (ie after 6pm)

* I use the term 'Chinese Takeaway' very loosely as I am aware of how the cuisine in such places is of no way related at all to true Chinese cuisine and is in fact a lame attempt to feed Westerners lots of MSG under the guise of being 'multicultural', but never let it be said that I don't actually enjoy the sweet-&-sour-insert-name-of-any-meat

However eventually the road comes to an end and faced with the prospect of having to turn off into another street, the local council so thoughtfully constructed two (that's right the only ones in town!) roundabouts, so that perplexed drivers may now turn around at the end of their journey and (you guessed it!) do it all again!

And people wonder why there's NO doctors in the bush. Ha!

But on a more serious note, it's kinda great to be home and also heartbreaking at the same time. Dad's already lost his 3 object recall ability (for those of you familiar with the MMSE) and his dementia seems to be progressing fairly steadily. I really wonder if it'll err on the shorter side than the longer.

Which raises a more uncomfortable question... is it better if it progresses quickly rather than drags on? Like on one hand, we love him heaps, wanna spend time with him and don't wanna let him go because he's so young. But at the same time, a long protracted illness will only mean suffering for everyone involved and be a long hard battle (esp for those who will be living with him daily).

Today he officially found out he's lost his job. We kinda knew it was coming, but he doesn't accept or understand it. It was really hard to watch him get hostile and angry about his termination, knowing that he has no insight into what's going on. Mum just looks on with a sorrow I've never seen before.

I see less and less of the man I once knew. I see disease taking him away from me, inch by inch. I see a man once full of life and love now reduced to a diagnosis.

The battle's only just begun.

Fallout

2006-07-25T23:21:00.000+10:00

So what happened?

Well to sum up, we spent the last few days enjoying the beautiful city of Sydney and eating some very exotic cuisine (never tried kangaroo till last week!) and then said a very emotional farewell at the airport on Sunday morning. As she left the country I felt a part of me had left with her...

But life goes on. Despite my desires for the world to stop and lament with me, the sun still rose, the drone of everyday activities kept humming and the daily mundane numbed the recent scars.

Thanks to all for the enouraging blog comments! And to those of you who have talked with me, I do appreciate it... talking through things helps get them out of my system.

So where to from here?

Well according to the SMH's well researched blog (http://blogs.smh.com.au/samandthecity/archives/2006/07/would_you_reloc.html), LDRs (long distance relationships) are the 'in' thing.

But yeah, S and I will keep in contact as friends... and who knows, one day I may end up in her homeland again? But I cannot give her the expectation that it will happen. Because it most likely will not.

And so I'll dedicate this last song to her...
http://www.youtube.com/watch?v=AJR7SJuT-OI&search=sun%20yanzi

Translation: "Tears turned into a Poem"

I've already turned my wounds into roses
My tears have already turned into rain and come again.
I've already stored up our conversations eternally
I can't remember if the sky is black or grey

When we break up, who gets hurt the most? Who makes it beautiful?
I've written my tears into a poem and now it's okay. Don't you remember?
The words don't make people drunk, they get drunk of their own accord;
Because the memories are so beautiful.

I've already turned insult into compliment
For you thought you were inferior; you thought you were not good enough so you said goodbye?
I've already turned the silence into sorry
I have no way to return, I can only face this with silence.

Zai jian MC...

Sometimes love just aint enough...

2006-07-20T21:07:00.000+10:00

18 months ago in country far from here...

"On Tuesday night we were taken out for dinner by one of the nurses S. S works with the mountain health teams and visits the mental health patients (especially schizophrenics) to deliver their medications. She really cares a lot about her patients and even bought all 70+ of them Christmas presents (out of her own pocket). She is also very blunt and frank with people (which is extremely rare in Taiwan because of people wanting to preserve 'face') which meant that we all get on really well with her... during the course of the evening, S told us about herself and her family and she has been through some very bad experiences and has had to face some awful things in her life. She told us that she is looking for 'answers' to the questions in life and so we were able to share with her what we believed about Jesus and she wants us to give her a Bible in English so she can read it. She even says she feels like becoming a nun in order to escape for a while and find some meaning/answers in life. As we talked she even told us about how she has had to forgive certain people in her life and the way she talked sounded like the way that Christian's talk. She is so close to the truth and it's really sad that we have to leave next week, because there is much more we could have said. We are going to invite her over for dinner next week before we leave and I would ask you to pray for her. I think God is working in her life and I pray that she will soon come to know Jesus."

It would be a year before we met each other face to face again. In between we emailed, we phoned and we used the ever-popular MSN to keep involved in each other's lives.

12 months later I went back to spend a week with her and to see the sights. Since then she had become a Christian, moved to another city and I had just finished my final med school exams.
We had some in depth discussions about love, life and God and parted sadly with a deeper friendship.

In the past 6 months since then, S and I have been regularly emailing each other about all matters pertaining to life. It so happened that her holidays fell at exactly the same time as mine and so with a bit of planning she arrived at Sydney International Airport last week with a beaming smile on her face and so begins this story.

When I first met S 18 months ago, her first words to me were:

"I hate doctors!"

And thus began a truly unique friendship.

You see, very rarely do a find someone who is willing to be 100% open and honest with me... we all like to hide behind our defence mechanisms and not allow the 'other' person into our lives. It's the way we learn to protect our fragile self-esteem from being trampled upon by the ruthless world.

But not S. She openly shared her life with me and told me what she thought on all sorts of topics. And I soon warmed to her and told her about my life and hopes and dreams. And so this week we finally sat down at my favourite bubble tea dining spot to talk about 'us'.

When I first met her, she wasn't a Christian and so not on my list of potential girls to consider asking out. However God works in mysterious ways and soon my only objection to this girl disappeared. It seemed to easy.

We talked about my plans/goals for the future and what hers were. We talked about our feelings for each other. We talked about the possiblities. We both said we would think about it.

So over the last few days I have been sleeping less and worrying/stressing/praying/ranting more than usual.

On the one hand I have this gorgeous girl who I like (and who likes me back!!). She's funny, honest, has similar goals in life and I think is quite attractive.

On the other hand, she lives in another country (although one I have been considering as a potential place to live in future years), speaks a different language and is 5 years older than me.

One part of me says "J, go for it! She'd be great for you and any differences can be worked through" whilst another part of me says "J what are you doing? Even if she does like you and vice versa, she speaks a different language. No matter how much you try, you'll never be able to communicate with her the way you want to."

What to do? What to do?

Well last night I told S that although I'm crazy about her and care very deeply for her (research girl and pharm chick are but trivial jokes at work to keep me from going insane), we cannot be together.

Today's society would tell you that if you're 'in love' then you should stuff the realities of life and make it work. But sometimes love just aint enough.

Sometimes despite the best of intentions, life's obstacles are too insurmountable. Just because I can, doesn't mean I should.

To be honest I feel so awful inside right now. I've deeply hurt a girl whose only crime was to actually care about me. I've thrown away a chance at getting to know a potentially amazing girlfriend.

Growing up I would despise men who did things like this to girls. I alwasy promised myself I'd try my hardest to not hurt a girl. And until now I've been content to cop my share of the pain and tried not to deal out any myself. But today I've failed my own standards.

Relationships in this world are frustrated and frustrating. We hurt people and get hurt in the process.

I need a 'physician' for this 'sickness'...

* Yes this is Dr J of KEC fame.
** Research girl alas is not Asian in extraction and therefore didn't really stand a chance because I have what my friends would like to call Yellow Fever or AF (Asian fetish) because I am an Egg (white on outside yellow on inside) and find oriental girls far more likeable than their caucasian counterparts.

Universal Consult Request Form

2006-07-04T17:47:00.000+10:00

Dear Registrar-on-call-for-consults-today,

You may not know who I am, but I unfortunately kow who you are. I am the intern for Dr A who has requested that your boss, Dr B come and 'offer their opinion' and 'assist with management'.

I know that as a registrar you get many stupid phone calls a day from interns such as myself asking you to drag your sorry bottom up one level (there are lifts if you're that unfit) to see our patients. I know that we have not investigated our patients as well as you would like us to have. That, my dear doctor, is why we are asking your assitance. If we KNEW what to do, we would have done it already.

I realise that having me page you is as annoying as when I get paged by stupid nurses asking me to chart a 'bottle of whiskey" on my overtime shifts. I realise that you probably have more important things to do with your life. However it's a two way street; just as you direct your intern to get us to see your patients, likewise you must come see ours.

Please try to remember as I fumble through my history that I am not psychcic and cannot remember every little detail of the patient's social situation. Please remember that it was my registrar or consultant who asked for the consult, not me. If I had my way, I'd never bother you and sort out all my patient's problems with a good old placebo, but unfortunately my bosses think otherwise at the moment and have not been convinced of this approach.

Please do not try to patronise me over the phone by implying (or just outright stating) that this consult is of questionable quality. I am quite aware of this and can think if a hundred more pleasant things to do than convince you that this reallyIS important (number 87 on that list would be "Sell ice to Eskimos"). In fact, don't try to educate me over the phone as if that will reduce the number of consults I give you. Unless you call my boss directly and educate him, the consults are gonna keep coming. Therefore when I call again next week with the same easily solved problem, please do not tell me off. I know it's a stupid request and have told my boss what to do, but they somehow feel a consult written will hold up better in court if something goes wrong than taking at face value the orations of their intern.

Then if you finally do see my pateint, please bear in mind I don't have all day to order another $1000 of tests in order to placate your fury at being asked to see more people. I know this trick too well for it to be of any use on me. I use the same tactic on nurses when the hassle me about 'falls' ("full neuro obs half hourly thanks!)" Please have mercy on us poor interns I beseech you! You were once in our shoes, you know what it is like. It's not like we are uneduacted nurses requesting things that are completely unreasonable now are we?

Thankyou for taking the time out to listen to the humble cries of us junior medical staff.

Yours sincerely,

Dr J

PS All the best with your exams!
PSS Will you take over care of this patient?

"Struggling to be human"

2006-06-27T19:23:00.000+10:00

Was wandering around the shops the other day when I stumbled across the first season of Grey's Anatomy on DVD. The blurb on the back caught my eye. It described the fresh aspiring interns as 'struggling to be human'.

Very insightful I thought.

Have been noticing that now having survived 6 months as a doctor I have definitely noticed some changes. The way I view the world has been modified to accomodate the all encompassing trade off known as 'internship'.

I find myself more 'blunted' in affect towards people's suffering. Maybe it's a coping mechanism to help one deal with the large volumes of sick and suffering. Maybe it's a laziness on my part to engage with the harsh realities of real human emotions. Maybe part of my humanity is being lost?

I also find myself more frustrated with the inefficiencies of people. Whereas last year I would have tolerated 'suboptimal' ways of doing things; now I cannot accept anything that slows me down. This isn't stemming from a desire to self-promote myself or put others down, but stems from a necessity to be continually striving for more ways to stream my workload in the face of ballooning patient loads. I find myself welling with rage at the nurses, gritting my teeth when slowed down by the black hole of radiology and tearing my hair out (metaphorically haha) when allied health staff put their 2 cents in.

I feel too tired to tolerate. Too exhausted to empathise. Too harassed to be humane.

Is this what medicine is all about? Replacing the human within with a machine that reacts to certain 'problems' and their solutions?

I feel like sometimes I personally cease to exist from Monday to Friday and only really resurrect myself on the weekends. The "Dr" part of Dr J consumes the "J" part of me and I really am just an employee.

What does it mean to be human?

The Intern Experiments?

2006-06-27T17:01:00.000+10:00

It's guinea pig time!

In an attempt to save money and generally just be stingy, The Zoo admin are conducting their very own intern experiment (I should charge them for copyright!) by stuffing around with our timetables. There's a conspiracy theory going around (based on the top secret 'leaked' email ploy) that this is part of a capitalist AWA ploy to eventually move all interns onto a shift based system of work (rather than our 'day job' system) in order to stop having to pay us overtime and thereby saving the government a few thousand dollars per year.

The RMO's are not happy. They are jumping up and down and brining in the consultants to back us up. The admin are citing their 'financial crisis' (which always seems to have enough money to pay for irrelevant departments/positions whilst not being able to pay their doctors).

And so I beomce one of the test subjects by doing an entire week of evening shifts. In reality I don't mind too much. It means I can sleep in and do stuff during the day before coming to work refreshed for the evening. Been shopping and swimming and watching late night soccer in an attempt to get some normality into an otherwise boring week. It's kinda nice to do a week of overtime too because you don't have to order any consults and justify yourself to registrars who should realise by now that it's your boss ordering them and not you and therefore they do not need to lecture you at length about the innappropriateness of your consult. It's nice to not have to battle daily with the radiology department about those 'urgent' tests (once again demanded by the boss) and wrestle with the dragon lady in the film department to get those scans onto the ward (oh why can't we have online radiology like every other civilised hospital?)

This week all I have to do is maintain the status quo. No need to solve the riddle, just keep the patient alive till the morning and "do no harm". Spending lots of time in front of the big TV screen is not necessarily a bad thing either.

Let's just hope no one gets too sick*!

*last night was quite awful with 3 'off' patients all going downhill at once... thankfully they are all alive tonight still which means I can't have done too bad a job?

Mourning

2006-06-27T16:11:00.000+10:00

Grief.

Sorrow.

The removal of pleasure.

Life is plagued with the onset of pain and troubles.

Sometimes they can come in the form of the ordinary. The little things like passive-aggressive nurses making one's day more difficult by demanding their will be done.

Sometimes it can come in the form of the personal tragedy. The bigger things like the father diagnosed with terminal degenerative illness and the changes that accompany a family coming to grips with such a diagnosis.

Sometimes it can come in the form of national surrender. The antithesis of the jingoism that characterises a colonial nation.

We lost the soccer. And it sucks.

To be honest I didn't highly rate our chances when we qualified late last year. I thought to get into the World Cup would be achievement enough for our fledgling patchwork team. But somehow they proved us wrong. Somehow they rallied together and pulled off some damn good soccer. And somehow they captured our hearts.

But last night we were heartbroken. A poor theatrical attempt by the despo Italians saw us packing our bags and switching off our TV sets. To be honest we played crap. We passed the ball too much and didn't have enough suprise in our attack. We gave them more than enough time to regather and form a wall in their box. But we didn't deserve to lose either. We held them at bay for 90 minutes only to have a crushing blow delivered on the siren.

Life just doesn't taste the same today. The gloss is a little less shiny and the mornings a little colder. The hopes have been curtailed and the wind taken out of our national sails.

Kinda like girls actually... you cautiously don't get too exicted because you don't like your chances anyway but then small little signs start to suprise you and your hope builds. You get sucked in to the 'match' and become a 'fan'. Only to have your dreams shattered by a decision that goes against you. And yet in another 4 years you'll get up, turn the TV on again and watch all over again. Hopefully the interval between nice girls wont be as sparse.

A good friend put it quite accuarately last week. "It'd be nice to have someone to wake up next to." Someone to be there when work is crap and you need to be remined of the good in life. Someone to lean on when your life starts falling apart. Someone to support during their times of difficulty. Just someone.

Another friend (who has been thru some suffering of their own) said to me that at times like these you really don't want people's sympathy. You get sick sometimes of repeated asking about how blah is going. You just want to be around your friends and enjoy the good things in life once more without being reminded of the bad.

Sometimes you need to be reminded to breathe.

Broken Hearts Part 1

2006-06-22T21:02:00.000+10:00

Thus begins the stories of Dr J, relief intern.

It was a cold winter's morning in the cardiology ward when the new surgically primed intern Dr J waltzed onto the ward. Exuding a new found confidence he strolled up to the computer and began to print out his team list expecting a maximum of 20 patients.

A sense of complete panic and fearwashed over him as he saw a 2 (TWO) page list of 35 cardiology sickies under his care.

Crap!

To make matters worse his team was to be on call for Emergency for the next 2 days which would mean even MORE patients would be arriving.

He had no idea who the patients were, no idea about the laws of the Empire (ie how to order tests in the 'level 6 cardiology unit') no idea what the Echo results actually meant and no idea how to interpret complex ECGs.

And so began the start of an awful week that would involve hours of unrostered overtime in order to stop patients from getting sicker and a vague sense of life spinning out of control.

You always hear the bad stories of dodgy doctors who don't follow standard practice and we all shake our heads and go "tsk tsk". But this week the sheer volume and complexity of our patient load led both my reg and I to overlook some basic stuff. We got phone calls from pharmacy querying certain discharge meds and asking us to review certain decisions we'd made. And most of the time they were right in questioning us.

Argh! I felt so overwhelmed I wanted to go into a quiet room and take a time out.. but I couldn't. I was hungry and tired but just had to keep psuhing on until it was all done... and this had happened everyday this week.

Sigh.

Cardiology is full of people with broken hearts. Full of people who have stuffed arteries from too much McDonalds. Full of people who have valves that dont work properly. Full of people with pump failure.

One pt came straight off a plane in VTach and got a direct ambulance escort form the plane to ED where he was shocked with the pads.

Another we zapped on the ward back into normal rhythm after a run of rapid AF.

So many people complaining of chest pain that even I began to feel some 'central rushing chest pain' as I tried to sort them all out.

But today was gold! Pure gold!

Stuck in another boring round when the med students come rushing in with a nervous look on their faces.

"Um J and A.... we think Mrs X is pretty sick... can you come see her?"

We ran (I've never seen people run to code blues) and from outside her room I could hear the 'gurgle of death'*.

The reg took command (like a good team leader) and the nurses bustled about grabbing stuff. The med students looked overwhelmed and as the adrenaline kicked in I grabbed the cannuals and started running thru my training.

A - airway patent
B - Pt put on high flow Hudson mask oxygen
C -time for cannulas!

Now I hate cannulas at the best of times. But when it's an emergency I hate them even more. My reg asked me as the next most senior to secure IV access and I grabbed the nearest cannula and got ready. Everyone around watched me as I went to puncture the skin.

Somehow I got it first go (in a 99-yr old lady that's pretty good!) only to hear my reg say "Great now lets get another one in the other arm"

10 minutes later I had secured another IV line with a large bore and given her 160mg of IV frusemide and a shot of digoxin and taken an arterial blood gas all on my first attempt.

"Quick get me a cannula bung and slaine flush stat!"

Afterwards the nurses congratulated me and the med students looked in awe. I was in control, I had secured venous access and taken an ABG in an almost textbook fashion. I was on FIRE! I began to orate my advice to the students "Well you see it's all about the LMNOP of Acute Pulmonary Oedema, we gave her Lasix, we gave her Morphine**, we gave her a Nitrate patch, we gave her Oxygen and we Positioned her upright."

Today I felt like I'd saved someone's life.

In 2 weeks that lady will get a telegram from her Royal Majesty as she celebrates her 100th birthday... and I had a part in keeping her here for that.

It's a small consolation for the crappiness of the rest of life.

*When in acute pulmoary oedema, pt's can sound very morbid as they try to breath.
** the reg gave this, it's a controversial topic as it may suppress resp rate so don't take it as gospel

Viva Viagra!

2006-06-22T19:48:00.000+10:00

After 11 weeks of strutting my stuff in the OT the time came to take off the blue clothes and don the stethescope once more.

It was an emotional farewell with my team as I filled the last discharge summaries and finally got my patient list down to 2 (thats right, I didnt get to enjoy the fruits of my labour!) and even got a peck on the cheek from a rather oldish nurse in the Urology department (Ewww!)

For our final team meeting we were graced with the presence of the Pfizer drug rep which can mean only 1 thing!

Free Viagra trinkets! Yay!

I had been waiting all term to score some cool Viagra stuff and they didn't disappoint. Got some of the high quality pens emblazoned with the big "V" symbol and they pulled out free 'erect' staplers. But the crowning jewel in their wares was the Viagra stamped dinner plates. Who needs fine china when one has a bright red dinner plate with a picture of a tiger in the middle and the drug name splashed all around the perimeter? I was ecstatic! I took two! Like seriously? Who is actually gonna own up to using a Viagra dinner plate? Haha

I had my end of term interview with the boss who wrote that I was "a pleasure to work with" (ie I didn't stuff up too badly) and managed to con my registrars into giving me references.

I sadly said farewell to the now-not-entirely-100%-evil and exited the Urology ward for the last time.

I'll miss the relative small patient load.

I'll miss the super-friendly surgical regs and their antics (I'm already finding myself becoming like one reg who was eternally frustrated with slow or annoying patients)

I'll miss the escapism of 'going to theatre' and avoiding my pages.

I'll miss having almost complete medical control over my surgical patients.

I wanna go back to Urology!!!! Argh!

The Grey Reality

2006-06-10T13:18:00.000+10:00

Being a surgical intern has been pretty cool I must admit. You get to live the lifestyle idolised by people on TV dramas like ER. You get to wear the scrubs and strut like you're important.

Recently, when people ask what I do for a living, I tell them I'm a surgical intern and that I'm basically living out "Grey's Anatomy" except without all the complicated love stories.

And to be honest, that's what it feels like.

Day after day I get to wear my scrubs and interact with other doctors with personalities that put the TV shows to shame. The little idiosyncracies of the surgeons, the backstabbing of other interns trying to get onto surgical training programs (well maybe just one in particular).

I feel like I'm living my dreams. We have interesting and bizarre surgical cases on Urology which always make for interesting stories. I get to assist with operating when my reg's aren't too busy. I have enough time off to enjoy and relax with my newfound financial freedom.

I know people who are like Izzy and care too much, I know people like George who are the nice-guys-always-left-out and I know surgical nuts like Christina who'd sell their firstborn child to get onto surgical training programs.

I feel like I'm on TV! And it's great!

However, I forgot that on TV, they are called 'dramas' for a reason. In order to make it interesting to watch, the writers need to add some kind of tension or problem in order to sustain viewers interest.

In the case of Grey's Anatomy, there is the estranged relationship with McDreamy, but on the side lurks another subplot regarding Meredith's mother who has recently been diagnosed with dementia.

And this is the Grey Reality of my life.

Last Thursday my father was diagnosed with Picks Disease (frontotemporal dementia) and for once the novelty of living out the reality of a TV show was not so great.

My ideal lifestyle has now come crashing down in a heap and my plans for the future are all in disarray.

Basically my dad has about 5 years to live (give or take a few) during which time he will progressively deteriorate and need more and more care. Whereas he once provided for the family for so many years, now it is our time to provide for him.

Somehow we gotta sort out what to do, but to be honest, I dont KNOW what to do.

There IS no treatment, no surgery, no pills, no intervention to slow or halt disease progression (unlike Alzheimers).

As a doctor I feel really powerless and useless.

Reality sucks!

"Saubawls"

2006-06-07T19:54:00.000+10:00

My registrar has a unique way of describing certain urological conditions.

One of his favourite 'diseases' is "Sore balls" (pronounced "SAU-Baw-LS") which is a syndrome mainly psychiatric in nature where young men present to EDs all around the city to whinge about their scotums.

Most are defiantly dismissed with oral Antibugs and referred back to the rock they crawled out from underneath.

But occasionally, just occasionally, we hit something more interesting.

Today got dragged down to the "Urology bed" in ED to see a young 30 yr old Saubawls Syndrome. Reg was gonna turf him out into the rain but realised this was the 2nd presentation in under a week for this condition.

I got the unenviable task of begging the ultrasound Nazi's to scan his scrote and chasing down the report.

Turned out it was not what we were expecting. Abnormal vascularity and random shape indicating a possible testicular tumour.

Now as bad as it sounds, something inside me got all excited when I heard the CT report.

Testicular tumours are rare but very curable. And to diagnose one as an intern (with registrar assistance) is very cool.

I hastily called my reg, blurted out the Ultrasound report and added on, "So can I send off a B-hCG and an AFP?"

My reg obviously impressed with my keeness to get stuck into tumour markers said "Of course! And lets do a CT too to look at lymph nodes"

Feeling very excited and telling any intern around I could find about my discovery, I then realised the poor dude with his busted balls had no idea what was going on.

You know on TV when the pt asks "Doctor, what's wrong with me?" and they give that vague non-specific answer that you know means bad news? Well today I know WHY they give that vague non-specific answer.

It's a fob off.

On the one hand you can't lie and say it's not more sinister when in reality theres a good chance it could be. But on the other hand, you don't want to get them worried and panicked when you haven't confirmed it yet.

So you fob it off. You say something like "Well we still aren't quite sure what it is so we need to do more tests to work out if it's an infection or something else".

You never specifiy what that something else is.

I kinda felt bad for being so excited about having 'interesting' pathology.

Maybe I really AM getting too into surgery... thankfully only 6 working days left!

Where's Wally? (stuck in ED!)

2006-06-07T19:35:00.000+10:00

I'm very sorry.

It's been a long time between drinks and I must sincerely apologise for not writing earlier.

To quote my registrar: "We've been raped!" (metaphorically, referring to our team list exploding, not literally)

The last two weeks have been hell... exacerbated by the fact that yesterday was 6/6/6 which can only really mean badnesss all round.

Came back form my ADO-weekend off to find that my boss had been 'turfed' all these patients from the general surgeon Dr T (who-I-have-now-decided-is-a-big-pilonidal-sinus-aka-pain-in-the-bum-because-he-turfs-everyone) and that due to their having been 3 theatres running at once my list had exploded from an average of 3 per day to 14 per day.

So I found myself on the "Urology" team managing:

a) a 87 yr old Jewish man with chronic proven cholecystitis who came to ED complaining of abdo pain... ED clumsily rammed a catheter into his willy and caused it to bleed and so Dr T 'turfed' us this obvoious gall stone pt because he thought the haematuria was not due to the IDC but to some rare cause of painful haematuria. (Pt is now sitting on ward for almost 2 weeks awaiting Nursing Home and hitting on all the nurses cos he's too well to be in hospital)

b) a 77 yr old morbidly obese (read:180kg) lady who came to ED with rapid atrial fibriallation and chest pain on a background of diabetes and chronic leg ulcers. An obvious cardiology/geri's admission? No way! Because this patient had a cystoscopy 4 days prior, the med reg insisted that this was a UTI exacerbated problem and needed Urology admission even thoguh the MSU was negative, the white cells were normal and the patient was afebrile. (pt is now awaiting geri's transfer and hallucinating about cats and ants running around her room)

c) a 83 yr old male came in with a simple urosepsis but deconditions in the 25 hours (literally) it took for him to become afebrile. Now he 'cannot' walk and needs long term physio rehab after only 24 hours of a UTI. However because he once had a superbug infection 4 (that's F-O-U-R) years ago he needs a seperate room a the rehab hospital and so we cannot transfer him until that bed becomes available. (Pt now hitting week 3 of 'waiting')

All these non-urological pt's are really annoying the crap out of me. I don't mind looking after a pt if we can DO something about them. But these ones are not our territory... we can't do anything more for them. And yet the med teams refuse to take them.

The ED is full. We get daily reminders telling us to discharge any patients who are well (as if we like keeping them for fun?) on our pagers. And yet the bedblock is due to the fact that stupid people keep dumping us with their patients. Grrr!

I have relabelled bed 3 in the ED cubicles the "Urology bed" because we consistently have a new pt in that bed waiting for a ward bed because there is no room in the inn. I even know the nurses down there pretty well now cos I'm asking them to manage the pt when I'm not there!

It all came apart yesterday when ED asked my reg to take care of a patient. She suggested it could be a joint admission but that we would NOT be turfed and would NOT take primary care of them. Later that day the patient was admitted under us.
Reg goes to ED.
Reg screams (I kid you not!) at ED reg and ED reg gets all sooky and stroppy with my red faced, red haired reg who is about to kill someone.
ED reg calls 'other' Uro reg and pt ends up admitted under different boss but Dr J the long suffering Uro intern still has to deal with the pt.

Fini

The Movie Show with Dr J

2006-05-27T16:33:00.000+10:00

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

2006-05-27T14:33:00.000+10:00

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

2006-05-27T14:19:00.000+10:00

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

2006-05-24T16:44:00.000+10:00

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

2006-05-24T16:29:00.000+10:00

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!

2006-05-23T21:24:00.000+10:00

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

2006-05-23T20:25:00.000+10:00

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"

2006-05-19T13:20:00.000+10:00

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

2006-05-16T17:44:00.000+10:00

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?)

2006-05-15T16:40:00.000+10:00

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"

2006-05-10T19:25:00.000+10:00

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

2006-05-09T17:21:00.000+10:00

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

2006-05-05T19:08:00.000+10:00

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"

2006-05-04T21:06:00.000+10:00

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!

2006-05-04T20:34:00.000+10:00

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

2006-05-02T21:05:00.000+10:00

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

2006-05-02T20:45:00.000+10:00

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!)

ADOitis

2006-04-30T17:58:00.000+10:00

Dragged myself out of bed on Friday morning cursing the admin stuffup that was seeing me work on my rostered day off and having to rearrange my errands to another time.

I felt particuarly seedy due to my persistant cold (which certain friends hate) and to make matters worse had to walk the half hour trek to work cos my car was being fixed.

My reg decided to rock up early and the other reg was in Dubbo doing a clinic so I had to cover her patients too. Then went straight to a Urology meeting before doing a professorial ard round with the big boss and then another consultant ward round.

By the time I finished all that it was 10:30 and I hadn't yet written in any of the notes (during the surgical rounds I prefer to wait till after the round to then go and write neatly in the notes so I can actually get time to write everything).

Now all I wanted after 31/2 hours of rounding was to just sit and quickly write in my patient's notes. But the nursing staff (and in particular the NUM) came flying at me demanding to know what was going on with each one of their patients.

1) If you WANT to know what's happening with your patients, why don't you show up when we do our round and find out for yourselves, rather than show up an hour late EVERY day and expcet me to tell you in a private one-on-one debrief.

2) If you aren't able to meet the above mentioned expectation, allow the poor intern time to compose his thoughts and sort his stuff out before harassing him and saying extremely dumb things like "Doctor, you seem a bit stressed today?" (to which I replied "Well it's my day off today, how do you THINK I feel?")

3) If you ask "Did Prof say Ms Blah can start self catheterising?" and I reply "Um I dont think he said anything about it today" plese don't stick in your little jab to insult me by saying "Well were you even ON the ward round?" cos this will only make me despise you even more.

I've realised that work can bring out the worst in me. I lose my patience very quickly and realise that I need to be gentle with the other staff even when they are extremely incompetent.

However, when suffering from ADOitis (as my reg so eloquently diagnosed me) I just lost the plot. Like not as in throwing hissy fits and running aorund waving my arms like a lunatic... but more like just skulking around the wards with a peeved look in my eye. Most of the nursing staff avoided me after they got the idea.

Thankfully ADOitis was cured with a 2/7 dose of Weekendamicin which resolved all symptoms and made the patient feel a lot better.

Weekendamicin was synergised by a steady infusion of Yum Cha today with my Asian buddies (followed by beers at the pub with the boys whilst the girls went shopping). Nothing like some unpronoucable food and chickens feet to lift one's mood (well maybe not the chicken feet).

New life

2006-04-27T20:11:00.000+10:00

Today was another day in the Zoo.

However it kinda sucked cos after they rostered us for a day off tomorrow, they informed us at 1pm today that we couldnt take the day off and all had to show up tomorrow even though we'd made plans for th eday off. Stupid admin! They can't even run a hospital!

Anyways, the day started with a quick ward round followed by some discharges and then off to theatre to play with sharp objects.

My boss let me help out with his theatre so there we all were, the boss, the reg and their intern (ie ME!) all with our hands inside someone's abdominal cavity, up to our elbows in blood. We were lopping off bits of kidneys (partial nephrectomies) and I learnt a very valuable lesson from this.

Now when boys are babies, most mothers will wanr you of the danger of standing directlyl in front of them when changing a nappy because inevitably you will get shot with urine.

Well when carving out chunks of cancerous renal tissue, one should really clamp the renal artery first and stand well back when actually chopping.

As the boss cut thru the purple-looking kidney I was hit with a jet of blood that looked like a little boy peeing at me. Here I was all scrubbed up intently gazing into the sterile field when I was suddenly soaked in fresh blood from a recently nicked artery. Thankfully I had my eye vizor on!

"We've got a bleeder" remarked the boss, ever so dryly. Thankyou Captain Obvious for that wonderful piece of insight!

But still, it was fun cos at the end I got to help the reg close up and she let me go nuts with the staple gun (whcih I'm sure most med students have used but seeing as I never showed up during med school to theatre it was a new toy for me)

Then I had to go and admit a lady who tomorrow is donating her kidney to her sick daughter (who is currently next door in the kiddies hospital). It's very touching to see a mother's love for her daughter when she is willing to give her own kidney to save her daughter from a life time of sickness. That kind of self sacrifice is all too rare in general these days.

For once I didn't mind staying back an extra hour to fix her up and get her ready for surgery.

Which brings me to my last point for today. As I was walking out of the hospital I got an SMS from my Aunty saying that my cousin had just given birth next door in the private hospital, so I promptly turned around and went to visit the mother and child.

My cousin and I aren't really close or anything, but it was nice to catch up with her and chat about life in general. The baby was really cute and only 30 hours old with a full head of hair. After a long day of operating it was really nice to go and see a brand new baby.

A new person untouched by the burden of chronic disease. A new life just about to begin.

All the Small Things

2006-04-26T16:26:00.000+10:00

It's the small things in life that make the 'shuffle on this mortal coil'* bearable.

Like when you have 2 days off during the week due to the public holiday and hospital wide ADO falling in the same week.

Like when you wake up on the public holiday to find that your flatamte has cooked you bacon, eggs, toast and sausages for breakfast for no reason in particular.

Like when you catch up with old friends playing Playstation and playign some random game where you have to crash cars in intersections to score points.

Like when you are looking forward to steak and chips at the university bar after work.

These small things lighten the load and inject some light into the otherwise dull monotony of life as a surgical intern.

Not every day is an episode of Grey's Anatomy (although Dr E and I were checking out hot chicks in the nearby Kid's hospital Cafe at lunch today)

Not everyday feels like you've made any difference.

But sometimes things just go well and your pager doesn't beep too much.

In these moments, one needs to breath and inhale the air before the smoke that permeates around chokes you.

On that random note, I'm gonna go home, eat steak, watch Mc Leod's Daughters on TV and then play Star Wars on my computer.

Zhinger, is this post too long for you?

* Some random Shakespearean way of describing our lives.

Eat...sleep... pancreas!

2006-04-21T15:24:00.000+10:00

Today was food day. After working on a surgical rotation for 3 weeks now I think I'm shedding weight at a rather fast rate. The constant walk between the ward and theatres/clinics is about 500m and so I make this trip about 10 times a day and am burning off all that adipose tissue I put on whilst doing psych in Whoop Whoop.

But today was time to put it all back on. We had the weekly meeting with the bosses where the drug companies feed us hot bagels with bacon and eggs and fruit and muffins and juice and theres always tonnes left over. After stuffing my face before the bosses arrived (always good to eat when they are not around so you don't get asked a question by them with a mouthful of food) we had one of those highly specialty-specific presentaions about some new urine test to detect bladder cancers (with a 4/5 false positive rate! it's as bad as PSA!)

We then had a professorial ward round with the head of the department and we bowed and scrapped and laid down palm branches for him and blew trumpets as he walked onto the ward (well not quite... but pretty close to how it went) He charmed all his patients with his refined genteel British accent and joked with them about fire hoses (referring to their bladder function).

Then he nicked off to go chair some meeting about incontinence and told us all (med student, intern and registrar alike) go home and read up about bladder physiology. During my time on the wards I have noticed we have these posters about incontinence which advertise a rather useful government service. Another shining example of the government's effective public health prevention campaigns. A truly ingenius initiative, tailor made to the web-savy patient.

It's www.toiletmap.gov.au

That's right! The Federal Govt went to the trouble of documenting the location of every public toilet in the nation. Never again do we have to get caught out looking for a loo. Therefore since we have such a map, let us draw near to the bowl with confidence... and let us not give up micturating together as some are in the habit of doing.

"Australians all let us rejoice for we are young and pee"

My registrar made good on his promise today and bought me lunch which was very nice for a surgical reg to do. It's kinda as close as they'll get to saying "well done!" so I took it as a compliment. As we were chatting he was telling me about his internship many eons ago and about some advice he was given by his surgical registrar all those years ago.

"Always eat when you can... always sleep when you can... and NEVER mess with the pancreas"

Such wisdom is never unappreciated... esp the pancreas bit!

I decided that since my reg had been nice to me, I would be nice to my med student to thank her for helping me with so much of my work. She's literally saved me hours of discharge summaries and preadmissions so it was the least I could do. So we actually left the hospital building and walked up the road to have coffee. I realised that there actually IS sunshine during the day. That life exists outside of the Zoo during the day.

Having eaten so much food and wasted most of the morning I decided to do some real work and went back to the ward. Got to remove a nephrostomy tube all by myself (registrar just said "cut it and pull really quickly!" - thanks for the great supervision there! haha) and afterwards the patient gave me the biggest reward of the day. She told me I was a great doctor and that she believed I was in the right profession. She knew my old 3rd year clinical tutor and said that if he taught me, I must be one of the best (ok, now I'm starting to blush). She said that she knew that doctors must get a lot of complaining patients but that she wanted me to know that she would always be thankful for us, for they way we help people and the way we treat people with respect. She told me that whenever I had a bad day I was to remeber her words and she hoped that in some way this woudl keep me balanced.

It was like a divine intervention or something. After dealing with my awful NESB patient all week (who is still acting like a pork chop and causing me grief and sleep loss due to nightmares), I was so humbled by this lady's kindness to me. All I had done was take time to listen to her and not pull her nephrostomy tube too painfully and she knew exactly what I was feeling.

I walked out of that room humbled. Somehow amidst all the rubbish I had to deal with, that simple honest gesture of thanks had made it all worthwhile.

It made things right again in this crazy world.

Nurses, Nutcases and Nocturnal-Surgery

2006-04-20T17:14:00.000+10:00

Today I was walking back form lunch when I bumped into an old highschool friend I hadn't seen in years. We were really good friends in high school and she even dated my best mate for a bit. Anyways, when we were in high school we used to talk about our dreams for the future and whilst I wanted to be a doctor, she wanted to be a nurse. We always joked that one day we would start up a clinic together and she could work for me. Well it seems 7 years later we've both achieved what we initially hoped for. She's now a nurse at The Zoo and I'm now a docotor at the Zoo. It's kinda cool to think that your high school 'aspirations' can actually come true. She hasn't changed a bit and definitely puts the pharmacy chick to shame (sorry Big D).

At the moment I am being stalked by one of my patient's families. He is a NESB* who keeps coming back to ED complaining of urinary retention even thoguh we've explained to him it's due to his straining from constipation. So everyday we have this huge discussion with him about why he's not peeing and what to do to and yet somehow he doesnt get it. His family (all 17 billion of them) keep asking the same questions and demanding to speak personally with the consultant (they're public patients! they dont GET to see him!) amd generally making my life hell.
Today his daughter in law grilled me nonstop and kept ranting and raving for 20 minutes whilst I got earbashed by her and then my reg finally caleld her back to 'keep her informed'. Then 20 minutes later I was accosted by a different daughter who was extremely passive aggressive and enquiring as to whether I had been to medical school at all (and yet she hersefl was an expert cos she was a 'natural remedy' practitioner - pff!)

I find myself slinking around my own ward tryign to avoid them as much as possible. They make my life hell and for no good reason. Argh!

Other than that, work has improved the last few days. Have managed to go to theatre a fair bit and fly around in my blue scrubs looking like a real doctor. Did an overtime last night and cruised through and even managed to assist with an appendicectomy (was on call for theatres) and make it out relatively on time. My reg said I'm doing okay and he's offering to shout me lunch tomorrow (which I think is a good sign?)

One of my mates from med school says I prob care too much... I think he's right. I just can't dissosciate myself and 'switch off'... I've tried to supress my altruism but somehow I DO feel responsible for them. It's one thing to not care, but it's another thing to get over invovled...

*Non-English Speaking Background - a particular breed of patient that are just horrible to deal with due to huge extended famillies and poor communication/'cultural' issues.

So Dark...

2006-04-18T21:53:00.000+10:00

Today I discharged 4 of my patients... and one of them was a 'terminal discharge'

What an awful way to say your patient died.

It makes it sound like they've gone to the train station or something.

Yes, Mr Blah didn't make it throough the weekend. Apparently his wound started oozing heaps of stuff (it wasn't his potassium!) and his poor health just couldn't cope with it all. This is the first patient with whom I've had ongoing care whose died on me. And although I shouldn't, I start playing the 'What If?" game...

What if I had checked his potassium earlier and given him supplements early?

What if he hadn't come out of ICU so quickly?

What if he hadn't had the operation at all?

In the end I know it's not my fault, but somehow I feel like we lost... we tried to beat death and this time death won.

And to make it worse, today we were finally dicharging one of our patients who has been in for a record 75 days. After multiple pulmonary emboli and bleeding diathesise he was ready to go home on light anticoagulation (INR 1.9) We had his meds ready, his transport booked and his bags packed. He was waiting for his ride to take him out of hospital when he started peeing blood everywhere.

Not a good sign!

Apparently even sub-therapeutic blood thinning didn't agree with this guy and so now he's bleeding away and we gotta keep him in whilst we try to work out how to get the right balance with his blood to prevent clots but ensure he doesnt bleed out on us.

He decided to do all this to us just as I was about to go home at 4:55pm. And then another patient decided to as lots of questions I couldn't answer about his condition (I'm an intern, not a specialist!) and before I knew it the nurses were asking me to sort out all these other problems.

Now I usually dont mind staying back a little bit... but it really annoys me when I work really hard all day so I can get out on time and then like clockwork all my patients crash late afternoon and make me stay back late... I really hate this job! At leats in a paperpushing job you can get your work done early and go home early... not so in the Zoo

Working tomorrow night which means a 17 hour day at the Zoo and then another 7am start the day after.

I think work is making me depressed. I wake up feeling sick just thinking about the day ahead. I find myself doing anything I can to get away as soon as possible.

Surely there's gotta be more to life than this? This is not the way things should be!

Sigh!

The Adventures of Super Scrubs

2006-04-17T21:45:00.000+10:00

Once upon a time, there lived a doctor named J who worked in a magical castle/Zoo and who had 2 older ugly step-sisters/registrars. Now unlike most fairy stories, these step-registrars were generally ok to their poor younger colleague but would make him do all the menial cleaning-type tasks such as ordering tests and consults whilst they got all the fun chopping people up in theatre.

Now usually in regular-type fairytales the downtrodden protagonist wished that they too could do whatever it was that the older oppressive-type people did (like go to the ball or do surgery) but Dr J had neither aspirations for either going to the ball or slicing and dicing with scalpels.

But one day the fairygodmother/consultant said "You should go to theatre young man! And wear these silly gumboots and blue pyjamas like the rest of us!"

So the fairygodsurgeon waved his magic scalpel around and voila! Dr J had a quiet day and made it into theatre to watch a magic camera get stuck into some old guys prostate. But his funwas not to end there. That very afternoon another surgeon type figure was performing an entire list of paediatric circumcisions in the adjoining Kiddies Hospital. So Dr J all dressed up (minus the gumboots cos he thought they just looked plain out ridiculous) spent his Thursday afternoon watching little boys get their hoodies snipped off. And as if this wasn't the tip of the iceberg, he was then allowed to scrub in and assist in an adult circumcision with the step-registrar.

Poor Dr J had never seen so much blood pouring from such a magical organ and began to feel quite nausetious and squirmish. He kept being told by the step-registrar (who was a female and prbably not aware of the social etiquette for such body parts) to "Squeeze it harder" whilst she slashed it open and fried it with her magic cautery wand.

Eventually he finished, however the step-registrar wanted him to stay scrubbed so he would assist with an orchidectomy (removal of the tesiticle) for someone with a 10cm tumour (to which a nursing unit manager replied "Isn't that the normal size?").

Having just semi-emasculated several males, he was in no mood to chop someone's source of testosterone off, and just at that moment his magical pager beeped loudly. It was the evil King of Pathology summoning him to the phone but alas he could not answer because he was in a sterile green dress so the nurse answered the phone for him and yelled to all in the theatre "Oh hey J, it's pathology apparently Mr Blah has a potasssium of 2.7!"

At that point the step-registrar relaesed her control over the intern and allowed him to go attend to his dying patients on the ward and herself summoned the other step-reg to assist her in her evil schemes.

So Dr J returned to the ward where he belonged and they all lived happily ever after (except for poor Mr Blah whose health was of questionable state and may not have survived the long weekend. Only tomorrow's team list will tell. Stay tuned!)

Dr J's Movie Reviews

2006-04-17T21:25:00.000+10:00

Match Point

Went to see this Woody Allen film with Dr D and Dr K the other night in the city and mistakenly thought this was gonna be a chick flick. Instead it turned out to be a rather ugly film about relationships and lies and deceit and lust. Not exactly light popcorn fare, but it was a very interesting movie.

You walked out of the movie feeling extremely uncomfortable and ugly. And yet that is what the director wanted you to feel. You were supposed to see the mess that lies and broken relationships caused. It was awful.. but artistically awful.

Made me realise just how awful we can be as poeple towards each other... we try to dress things up and pretend like we're nice people, but underneath all of our facades lies the potential for us to be truly horrible people.

Perhaps Love

On a much lighter note, durign my Friday overtime I managed to have enough time to squeeze in a DVD and watched the Asian hit movie-musical of the year in 2005 entitled "Perhaps Love". It was an awesome movie that intertwined the stories of 3 seperate love triangles involving the same people into one beautiful story. It also helped that the actress was really charming and had a real presence on the stage. Luved listening to the mainlander Mandarin in it (much more articulate than Taiwanese) and am def considering buying it once I find a store that sells it.

I must say that it wasn't as good as Sekia no Cushin de, Ai wo Sakebu, (my favourite Jap drama/movie about the sweet girl Aki who falls in love with Saku and then develops leukaemia and dies a slow sad death) but it was still very very good and the production quality was similar to Moulin Rouge.

Blood will have blood...

2006-04-17T20:49:00.000+10:00

"I am in blood stepped so far, that should I wade no more, returning were as tedious as go o'er"*

"Whoever sheds the blood of man, by man shall his blood be shed"**

Blood.

It's a interesting substance. Made up of clotting factors, platelets, white cells, antibodies and the ever famous red blood cell.

It's something I deal with every day and yet it's something pretty amazing.

On Good Friday I was working the geri's ward and happened to be in a rush and forgot to grab some allergy free latex gloves to perform a cannulation. Now if I was actually any good at cannulating this wouldn't have been a problem but cos I couldn't cannulate the aorta if it was opened up for me on the OT, I somehow managed to get some old lady's blood all over my hands.

I really doubt a 87yr old granny was at high risk of any blood borne viruses and I had no open wounds, so I declined starting antiviral therapy. But I walked out with my hands covered in blood.

It's a rare sight in medicine.

Normally we wear gloves to protect ourselves both physically and emotionally from the procedure we are performing. We seperate ourselves from the fact that we are spilling poeple's lifeblood all day long in small doses.

Blood is something personal. It's what keeps you alive and gives you your energy/life. And to take someone's blood is to take their life from them.

So I sat there on Good Friday, looking at my blood stained hands and remembering the significance of what I was doing.

Because 2000 years previously another person sat bleeding on that Good Friday. A man whose blood I also carried on my hands (in responsibility).

This man however wasn't getting a cannula put in, he had a spear put in. Roughly into his spleen and by that time his blood had coagulated into fluid and jelly-like substance. This man's blood was taken with consent, not for his own treatment; but for the treatment of my disease.

A disease that was much worse than anything I would face on that Friday shift. In fact, the one true disease that would be the cause of all other 'diseases' in the world. A pathology called sin.

Whilst Good Friday 2006 was spent by me trying to stop people from dying, Good Friday 33 was spent by Jesus actually breaking the power of death itself. Kinda makes my efforts look kinda futile.

You see blood is more than just haemoglobin. It's a symbol of our life itself. The blodo bank knows this when they ask for you to "give the gift of life". Blood is synonymous with life.

And one man's blood brought new life to the world. Not the kind of angstridden life we all trudge thru on this world... but real life... a restored relationship with the one who made life in the first place.

All the medicine in the world can't stop you from dying. It seems to have a 100% strike rate. But one man was seen to have come back after being clinically dead for 3 days... and if he says he knows the secret to beating death... well I reckon it's worth listening to him.

* What I can remember from Macbeth
** Genesis 9:6

A New Slave

2006-04-10T17:56:00.000+10:00

Today I finally received my very own med student!

She's a 6.02 model (6th year term 2) and seems to be a quality Asian version, not one of those cheap European brands.

She paged me around midday asking if she could come and help. I told her to join me in preadmissions and next minute there was a knock on the door.

And in walked my friend F!

Of all the med student to gain I got one I already knew quite well. So instead of all the trivial niceties, she was more than happy for me to shove her in another office and get her to do another preadmission for me!

I managed to con her into taking the blood... examining the patients and I just signed off at the end. How great is that?

Afterwards I took her to theatre to meet the reg and consultant and my reg was so nice to me cos he said "Well F, you're a 6th year and should be starting to act like an intern so on the wards you shoudl be helping Dr J with his work so you can get preparred for next year"

Yeah baby!

So now I have a personal slave! Someone to help me whe it's busy and do some crappy jobs for me when I don't want to do them.

With her assitance I did my preadmissions a lot faster and so I made it into the operating theatres today wearing scrubs for the first time this year.

Whenever I don the magic scrubs I feel like I'm someone special. It's like my Superman cape that gives me magic powers (even thoguh they are just shabby pyjama pants - but then again Superman wears his undies on the outside so that's quite the norm for superpowers).

Dressed to impress I stride around the wards like I'm some kinda hot shot surgeon. I even extend my neck and pull my shoulders back so I look the part. When I'm in those sexy blue scrubs I AM a surgical intern. I am one of the elite.. like the comedians on Scrubs or the love-lorn Meredith on Grey's.... I am part of their inner circle... I am one of the interns who the rest of the world wanna know about (evidenced by the numerous TV shows about us... but not garbage collectors)

I bumped into another med student I knew today when I was conducting my aforementioned fashion show and the level of respect I got was superb... I felt like I could hear the theme music of ER playing in the background.

Anyways, today was a lot better than last week. I felt more under control and knew the sytem a lot better. We're even discharging the few remaining patients we have left so tomorrow I should be able to spend a long time in theatre.

Ths is the life!

Dr J's back (alright!)

2006-04-09T16:07:00.000+10:00

I must first of all humbly offer my apologies for not having written in over a week.

Betwixt the trip back and the chaotic first week of being a surgical 'tern I have failed to keep my readers updated and neglected my blog.

So I aim to rectify this with one almighty big sum up of the past weeks events and perhaps it wont be too boring.

The trip back from Whoop Whoop was made in a good time landing me home before the stroke of midnight fell. I almost died however when a car travelling in the opposite direction doing 110kmph decided to veer into my lane at the last minute forcing me to swerve and only just missing a head on collision and a date with the orthopaedic surgeons.

The first weekend back in Sydney was a bit chaotic with housewarmings and 21sts and catching up with long lost friends (10 weeks can make you feel like you havent seen your friends in a year or so). I began to wonder whether I was just getting old... cos it really feels liek I'm no longer the 'young' uni student I once was. I'm somehow 'expected?' to be a more mature person... a more boring person? Who knows?

And so ended life as I knew it on that last Sunday night... as I kissed goodbye the vestiges of Whoop Whoop and adopted my new role as a surgical intern.

I woke early and got ready for my first day at 'big school'. I ironed my shirt with care and constructed my neck tie with a precise Windsor knot so as to make a good first impression. I arrived early and even got the updated team list ready for my reg's.

And then it began...

My first reg (who has the same name as my best friend from med school - but incidently is nothing like him) strode into the ward and conducted a Blitzkreig raid of his patients, pauing only briefly to fnd out where the next patient was.

It was fast, it was furious... it was over in 5 minutes!

I hadn't even written my name in the notes before we had moved onto the next patient and by the end of it I had no idea what was happening with any of the ward.

Then the female reg waltzed in and conducted a similar military style operation ward round before bolting to chop some people open.

So I slumped into the nearest chair and looked at my watch. It read 7:30am... and for the rest of the day I would be on myown to 'fix' the patients and organise everything from their Xrays to their trip overseas (I kid you not! I had to send one guy to Lord Howe Island!)

After the days in the Dungeon where I was gently led by my friendly registrars, it was a big shock being dumped on my own. Now it wasn't my new bosses faults. They are great doctors, but I'm just not used to doing 'real medicine' yet.

And so began a terrible week of 'teething' as I tried to figure out WHERE the Xrays were (no online radiology yet in the Zoo) and how to find the specialised Urology theatres. My pager beeped more in the first day than it had the entire 10 weeks in Whoop Whoop and by the end of the 2nd day I was becoming quickly sleep deprived.

Highlight of the week would have to be getting my first catheter into someone's bladder. The poor guy was so nervous so I didn't tell him it was my first time too and I grabbed his willy and threaded the tube into his bladder until out flowed the golden liquid into the pan. I must say I've never been more excited to see urine in my life (and by the sounds of it neither had he, cos he drained 950mLs)

One day I was asked by my reg to organise a medical consult for one of our delirious patients. The guy was pretty sick and we couldnt find anythign wrong with him so we asked cos we were pretty worried. SO I call up the reg on call and he tells me to call the other team. SO i call the other team and they ask me to call the original guy... I keep getting bounced between the two registrars so in the end I went to see my reg in theatre and ask him for help. He told me to document who I spoke to and when and then he calls their boss directly on his mobile phone to ask for a consult. Very soon after we had an angry reg calling back to give us the consult we were after... it's so unnecessary but sadly a way of life in the Zoo.

Then on Thursday at 5pm as I was about to leave I was called by peri-op to admit a patient who was having a rad cystectomy the next day. However this old guy had been worked up by the old intern and declared as 'fit for surgery' but when anaesthetics took one look at him they said "no way Jose!" But then I found out my boss had cleared his entire day to chop open this guy so if he wasn't going to go ahead my boss' entire day was ruined. So the poor tern (ie me) had to beg the anaesthetist to go ahead with the operation even though I agreed the guy prob shouldnt be operated on. The anaesthetist said "If I feel he's a bad candidate, I'll just cancel him.. I dont care!"

I left hospital at 7pm feeling like a failure for not having convinced the anaesthetist to put our patient under, and I was fearing the fury of my boss the next day.

I turned up early on Friday to make sure that I could beg for mercy form the reg before the boss found out. But as I preparred my final speech, I saw the anaesthetist sitting at the desk, looking very unhappy writing in the notes of my patient. Apparently my boss had called him and said, "I dont care, I wanna operate on this guy... just do it!" And instantly the waters parted, the heavens opened and my patient was on the table to be chopped open. (as an aside, the surgery went well and he's now in ICU recovering)

I feel like being back in the Zoo is:

a) very disorientating - I keep getting lost in the rabbit warren known as Radiology, I can't work out how to order certain tests or how to find my way to the RMO room in less than 10 minutes.

b) stressful - the nurses here are more stupid (everyone agrees), the profile of the patients is 'sicker', their relatives are more anal, the regs are more scary and you don't see the other RMOs as much

c) tiring - I'm working much longer hours and really don't think the surgical starts of 7am are suited to my body clock. Walking all aorund the Zoo is either gonna make me fit or give me premature arthritis.

d) depressing - not seeing the sun most days makes you fell like the days don't exist and you only ever see darkness when your outside. Not talking to your regs most of the day makes you feel isolated amongst the thousands of staff here.

However, on Friday afternoon, just as I was about to go home I rounded with my reg's one last time... and both of them, seperately commented on how they thought I was doing a really good job so far. It was a small compliment... but given how rough the week was, it meant more than they will ever realise. I went from hating my job to feeling worth something. I fel tlike I could face a whole other week of this based upon their small feedback. Is this normal? Or am I just losing the plot?

On another note, the love life of a intern is again, never smooth sailing. Met this really nice girl during the last few weeks and I started to think "Wow... she's pretty cool!"... we had a few long chats and she even laughed at my jokes (always a good sign!) however my shortlived liking came crashing down when I found out she had a boyfriend. Why are all the good ones not available? Sigh.

Again I reiterate the motto of my flatmates. "Girls are evil, throw rocks at them"

Fini.

Zai jian Whoop Whoop

2006-03-30T18:53:00.000+11:00

"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

2006-03-29T18:10:00.000+11:00

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

2006-03-28T17:25:00.004+11:00

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!)

2006-03-26T20:56:00.000+11:00

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?

2006-03-23T17:32:00.000+11:00

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

2006-03-21T13:45:00.000+11:00

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

2006-03-20T20:12:00.000+11:00

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!

2006-03-17T01:53:00.000+11:00

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!

2006-03-16T04:53:00.000+11:00

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

2006-03-15T07:36:00.000+11:00

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

2006-03-15T02:58:00.000+11:00

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!

2006-03-14T06:56:00.000+11:00

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

2006-03-12T23:26:00.000+11:00

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?

2006-03-11T23:08:00.000+11:00

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)

2006-03-11T02:48:00.000+11:00

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")

2006-03-10T00:40:00.000+11:00

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

2006-03-08T13:50:00.000+11:00

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

2006-03-05T23:16:00.000+11:00

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..."

2006-03-05T16:57:00.000+11:00

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...

2006-03-02T17:18:00.000+11:00

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

2006-03-01T14:00:00.000+11:00

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!