2013 Recap

A recap all seems so meaningless now.

2013 was the year that I moved to the country and studied medicine in preparation for passing my barrier exams. Ultimately I passed, and passed well. I made a great group of friends, who all passed and did well too.

It seems strange, given that many of the blogs I have written this year were gripes about various things. But I've had a great 2013. Maybe I wouldn't want to do all the exam prep again, but on the whole? Everything else was fantastic.

Uni goes back in a few days. I have achieved my goal of becoming relaxed, in preperation for the new academic year. All the hallmarks of stress that usually befall me have lifted and I'm so very happy with how life is going. Amen!

I do have some resolutions for this coming year. I've never made any before - so why not do them in bulk? Lots are cliche, involving exercise and becoming a man mountain. But the rest are unique and truly me. I shall keep them close to my chest ;)

So I wish you all a pleasant 2014. Keep safe - as I'm starting the year in the emergency department and wouldn't want to inflict myself upon you.

Blessings!

Raging.

I can tell the year is over, because I have been to the dentist. My classical post-exam tooth examination. I always feel compelled to get the damage from the pre-exam bruxism and Jaw-clenching checked out. Once I know it's all okay I can quit somatising my pain there, and focus on other locations. Haha! The trip was a raging success though.

I intend to write an entry sooner or later describing the journey that was third year, but right now I'm enjoying having a holiday.

It's funny though, I got a glimpse in to what next year will be like. I was ducking back to the hospital to shred many pages of confidential material, when I joined in and saw a few patients for kicks. Not having the weight of impending exams just made the interaction that much more enjoyable. I am really looking forward to next year, in what will hopefully be an excellent year of learning through application.

I realise that sounds super nerdy - but my goal for next year is: Don't be a horrible intern.

Oh the places you'll go!

Exams - over.

Farewells - said.

House - nearly empty.

Proper update - coming.

" I meant what I said – you have been a great group because you have been “a group” and helped each other along the way – that’s important and will be so throughout your careers – I hope you can all relax for a bit over the next month and look forward to next year and beyond – remember take care of yourselves and your families , take care of your colleagues and take care of your patients . I hope you will all look back on the year with positive thoughts and am sure  your experiences will make you “great”  Doctors " 

Possibly the nicest thing anyone has ever said about a group I've been in. I can't believe it's all over. More on that soon. But for now, thanks for listening to my gripes throughout the course of the year.

I hear drunken teenagers

There's a delightful irony about this. Here I am sitting my final exam of medical school, ten years to the day from when I sat my final exam in high school.

And tomorrow, if only for a few minutes. I will be partying it up in the very same location that i was a decade a go(then quickly leaving so not to be accused of being a toolie.)

Party on Wayne! One of the Adelaide Uni fifth years, do hang in till the two minute mark at least.

E*X*A*M 4077

 Some days I wish i had become a helicopter pilot. How can you not have fun as a helicopter pilot?

With one day till the hands on exam, and three days till the written. I've hit the limit. Nothing more will go in. I am at the 'listen to loud music and band my head' stage of revision.

I hope that will be enough to pass! Here's an insight in to something i don't know very well.

pre exam stress would be okay if it didn't make me feel quite so wretched. just snuck up to the hospital to see a couple patients and pick my supervisors mind. I think I'm handing it all okay. I just want to pass and move on.

ECG, trops and iStat... stat?

Starting to realise I won't be able to defer responsibility with 'I don't know, I'm just the medical student' for all that much longer.

Scary prospect.

Better make the most of it while I can.

One day more...

Every time I use the carton of milk, I see the date reminding me. Reminding me of the upcoming exams. And every time I buy new milk the anxiety gets worse as the date draws closer.

Quit judging me milk!

I have got to stop drinking so many cups of tea :/

Generally surgery.

After a long discussion about how much he loves his job:
Esteemed surgeon, "Oh man, I've been operating so much I've given myself two carpel tunnels, it's agony at night."
Medical student easily impressed by massive incomes: "Wow, that must be a lot of operating."
Esteemed surgeon "Yeah, I'm thinking I might get them both done at once so I only have to have miss out on a months worth of income instead of two."
Easily impressed student. "Wow, both hands operated on at once. That's rather drastic... Have you thought about the implications..."
Esteemed surgeon "Yeah I think I could take a bowel prep the day before the operation and the load up on codeine after."

I couldn't help but laugh.

And then the gloves came out

"So what did the test show?"
"Well, let me see. *Scrolls through computer files* Your PSA has gone up since last time, it has doubled."
"Ah... What does that mean. Does that mean I have cancer?"

If ever there was one test in medicine that was designed for long and confusing conversations, PSA is one. It's not diagnostic, it's neither sensitive or specific, and patients want you to do it expecting answers.

 "Most people die with prostate cancer rather than from prostate cancer."

Drip.

Six weeks out from exams. Thinks are starting to get sketchy. While many of my fearless colleagues have a resolute demeanor. The facade is starting to come down on some others. Everywhere. Cracks. And that's okay. Med students are like water molecules. Sometimes hard as ice, put often quite prone to melting under pressure. Most of all, we're held together by a constant surface tension. Why do I keep waking up spontaneously before seven!? This is a new thing.

There's always time to change

We had practice exams yesterday, the hands on kind. It went okay for me. They gave us our marks today. The only station I really sucked on was the psychiatry station, it reflected my obvious lack of psychiatry exposure this year. I hope to fake it till I make it come exam day though.

*bell rings* I was happy in the X ray station , they decided to give us 5 sets of x rays and all you had to do was say what the defect was and what your management would be. Whenever I'm bored in the hospital I just flick through the x rays and test my interpreting skills, so I was happy to get this station. Smashed out all the scans and then ended up talking about exotic holiday locations for a minute. A wonderful little destress in an otherwise stressful ordeal. *Bells rings*

Claret production record

Attracted by the flashing lights I went up tot he hospital to see what the ambos had brought in. They were quickly unloading the patient from the bus just as I turned up. The first thing I saw was the same set of sneakers and jeans that my own dad likes to tote emerging from the back of the ambulance on a bed. Freaky. Fortunately for me it was someone elses father.

And then the blood. I have never seen so much blood. There's an old axiom that says 'head wounds like to bleed.' And this was a huge head wound. A paramedic volunteer trying to squeeze bits of scalp together trailing the stretcher as it was wheeled in.

The quick thinking doctor acting fast. Blood and now vomit coating the floor. "Get me this, give me that. Draw that up, put one of those in. Start one of those. Pressure! Pressure! Good." And then miraculously, the bleeding was halted. At least... halted sufficiently to send to a surgeon in town.

Those adrenaline filled minutes are few and far between, but when they happen. Wow.

Pilgrims progress & conscious incompetence

Parents often describe children as having 'wonder weeks,' Where all of a sudden a marked progression or change in the child is noted. Sometimes I feel like a child in amongst a rather adult medical system. Every now and again though I feel like I show signs of progression. Even if its something as silly as getting five cannulas in a row (a new record.)

I think there have been a few cases over the last few weeks where I've managed to assess, diagnose, present the case to a doctor, chip in what I think needs to be done next and then actually do some of those things without making a mess of it. I hope that marks some progression, because some of the cases haven't exactly been easy. I've had a run of interesting acute neuro presentations which have been diagnostically challenging.

The other day we had a patient who had walked in to a fence pole and cut their leg. it didn't hurt too much and it hadn't bled too badly. Or at least that was the history that was conveyed to us. So the nurse and I decided we should have a look at the "wound" that was being hidden beneath a rather large towel and maybe give it a clean up. Usually in these situations it ends up being a disappointingly small cut or skin tear that may or may not need stitches. The towel sure wasn't dripping with blood today, and I was eagerly hoping to put in a few sutures if it was going to be big enough. Needless to say we were both quite surprised when we unwrapped the leg and found a 20+cm complex laceration going down to vessels and tendons. Suffice to say a plastic surgeon had to be found and I didn't get to do any stitching. Oh well! It's always amusing when people understate their injuries.

And that's my life.

And he will direct thy flight paths

So... It looks like I'm going to Zambia to work in a mission hospital next year. You'll be hearing a lot more about it in the future, but suffice to say I'm going to be out of my depth and open to some new things! Do pray that I come back! Really excited though.

Before that t I have to spend three months in Darwin. More on that in the future also, but a good opportunity to get some tropical/infectious disease exposure before I depart.

Hey, I know not a lot of you come directly to my blog home page. But if you haven't done so in a while, do check out my 'Some Better Bloggers' section over here >>>>>

I've been updating it recently with some great new blogs. You should check it out.

Lay off the creeping.

A lot of medicine is about pretending. Usually I just pretend to be a doctor.

Today though I had to pretend to be competent at putting casts on and sewing up pig trotters. Luckily the first year medical students enjoyed it.

Then the firies and ambos got together and put on a show, extracting a couple patients from a car wreck for our entertainment. It was actually pretty good to see a live demo of a cut up and extracation, as some times the on call doc is called out to an accident scene and has to jump on in.

I was genuinely impressed by the volunteers. All of them giving up their own time and being exposed to some pretty horrific situations on occassion. It's strange the way people volunteer for those sorts of jobs.

Just before I came here as a student here, there was a pretty significant single vehicle accident. It sounds as though the experience was pretty traumatic for everyone, as all the GPs seem to reflect on it occasionally. It involved a young man who had been in a crash. One of the docs and the intern went out to meet the ambos and retrieved him. The patient was chatty and fairly well until they were rolling him in to the hospital. The patent deteriorated rapidly and died despite best efforts. The experience was hard on a lot of the staff. Veterans of seeing the elderly move-on, but the young are always hard. Why would you choose to watch and get involved in that?

I'm not sure what my point is. Other than trauma being traumatic and coping mechanisms being of variable efficacy. I guess some people just want to make a difference.

Drive safe everyone.

It took me half an hour to write this, and half a minute for you to read it. I wonder if you're really paying attention to the world longest title.

I've been pretty lucky this year. By virtue of circumstance and geography I've managed to see more sunsets, sunrises and the clearest night skies (as well as shooting stars and satellites) I've ever seen. I'm constantly impressed, amazed and left to ponder how and why we all came to be. It's a real blessing.

The other day I went to visit a friend in one of the other remote locations. It was a couple hours drive through the boonies to get there, but oh so pretty. I really enjoyed getting to see some of the riverland towns and surroundings. They felt so busy and alive compared to my tiny town!

I found myself driving back at night, perhaps a slightly silly thing to do, but still very pleasant. The sky was moonless, one section of the road virtually straight for over 90 kilometres. That some road had been entrancing during the day, but the dark star lit sky had become majestic with the headlights cutting a swathe through the trees. I only saw four other cars in two hours. It was a pleasant way to to travel.

I kept my eyes out for kangaroos hoping not to plow in to one at 110ish km per hour. Fortunately I didn't see any. Two-thirds of the way home I got to drive on to a ferry in the dark, in order to get across the river. Pretty much the middle of nowhere. The diesel engine of the ferry fired up as I approached from the steep bank, rumbling in to the still warm sky. I was the only person on board apart from the driver on a quiet weeknight in the sticks. As I drove off he reminded me to look out for roos. The significant amount of roadkill I'd already driven by had been warning enough though. I thanked him and resumed my drive.

What he should have been telling me though was to look out for wombats. As I was taking off from the ferry a wombat appeared in my high beams, only just distinguishable from the dark road surface. A rapid deceleration later... And luckily we didn't come together. It was pretty nice to see a wombat unexpectedly though.

I came out to the sticks to make sure I'd be happy spending the rest of my life in a big hospital. I feel more and more challenged by that notion every day.

One more assignment, and then its nothing but exams till the end of the year. And then just one more year and a few more assignments until I'll finally stop being a dead weight on society!

Heck yeah!

It's somewhat like Christmas

I've velt a lot of pregnant womens bellies this year. And I've got to be honest, I'm still useless at it. I can pick a head and that's about it. This disturbs me greatly as I'm usually pretty good with spatial orientation in other aspects of my life.

Oh well. Practice practice practice.

A toyotas a toyota

Had a good week medically this week. In fact the last few weeks have been pretty good, although nothing overly dramatic. I still enjoy the on call / emergency stuff the most as it lets one exercise the diagnostic and management side of medicine. Why is that good? Because in order to pick a management option you have to actually make a decision - something many med students and junior doctors tend to shy away from. Fortunately everything I do gets run by a doc. So it's nice to have that safety net :)

Anyway, my on-call day this week was quite busy. I really enjoyed it. Started with a dog bite, then conscious collapse, a ?pancreatitis, an atypical cardiac presentation, another chest pain, a ?cholecystitis, a classic URTI and then a non-specific abdo to finish.

I think that's why I like ED/ rural GP stuff. Good history, good examination, some procedural work and sufficient variety to keep the mind stimulated.

I'm starting to wonder whether I'm developing inclinations to certain areas of medicine!

Heya. Heyaaa

I'm still alive! Fear not.

A day in the life.

"What's that?" Says the Orthopod pointing somewhere near the thumb.
"Errr, is that the abductor pollicis?" I stumble, struggling vainly to remember my hand anatomy from 9 months ago... And why have I been unable to remember any of that cramming I did last night?
"What? No."
"Hmm, is it the palmar aponeurosis?" I'm not sure what she's pointing at any more. Time to guess wildly.
"Stop answering in the form of a question! I ask the questions! See it's white, now what is it?"
"Is it" I pause as a groan emerges from the surgeon. "It's a tendon..." I say with a slight upward inflection.
"It's palmaris Brevis" she says, looking up from the half-finshed carpal tunnel. I nod, having only ever heard of the palmaris longus.
"Oh... right. I've never even heard of that muscle. I don't think it's in my textbook. What does it do?"
"I ask the questions!" She yelped before laughing and letting me guess at its function... Apparently it has no function.

Actually that was a fun day. After another five carpal tunnels I finally had it figured out! We stopped halfway through the list to have ham and pea soup which one of the nurses had brought in declaring "It's very farty!" Fortunately the topic turned from me getting drilled to chatting about horses and the best way to keep bugs out of strawberries.

Country medicine!

On the topic of leaders

I enjoy politics. Well not really. But I enjoy watching it. All I can say from this leadership challenge, and all I've seen on TV.

I want to see more Annabel Crabb.

Because of the gift

An excerpt from someone who writes and sings much better than I.

I have lost my appetite!
And a flood is welling up behind my eyes
So I eat the tears I cry...

And if that were not enough !
They know just the words to cut! And tear and prod,
When they ask me “Whereʼs your God?”

Why are you downcast, oh my soul?
Why so disturbed within me?
I can remember when you showed your face to me

As a deer pants for water, so my soul thirsts for you
And when I survey Your splendor, You so faithfully renew.
Like a bed of rest for my fainting flesh!

When Iʼm looking at the ground...
Itʼs an inbred feedback loop that drags me down
So itʼs time to lift my brow
And remember better days

There's something pleasingly angsty about this reinterpretation of Psalm 42. I've listened to it a few times now. I'm thinking about heading to Africa next year. I remember once listening to a song in church, sung by the youth pastor of all people. It's about a guy who lives a comfortable life, but can't quite shake something.

 It was entitled 'Please don't send me to Africa.' Strangely I think that's where my curiosity may have been sparked.

Oh Lord I am your willing servant
You know that I have been for years
I'm here in this pew every Sunday and Wednesday
I've stained it with many a tear
I've given You years of my service
I've always given my best
And I've never asked you for anything much
So, Lord I deserve this request

Please don't send me to Africa
I don't think I've got what it takes
I'm just a man, I'm not a Tarzan
Don't like lions, gorillas or snakes
I'll serve you here in suburbia
In my comfortable middle class life
But please don't send me out into the bush
Where the natives are restless at night


I'll see that the money is gathered
I'll see that the money is sent
I'll wash and stack the communion cups
I'll tithe eleven percent
I'll volunteer for the nursery
I'll go on the youth group retreat
I'll usher, I'll deacon , I'll go door to door
Just let me keep warming this seat

So much to think about.

The land of sore throats

For the first time this year, I think I'm fighting off some sort of throat infection. I had naturally assumed I'd be sick all the time in GP land. Ironically I think I caught it by sitting next to another medical student.

Having said that, I still recoil whenever I have to see a patient with gastro. I haaaaate gastro.

easy hiyo

Just took part in a paediatric resus. A very floppy child. After 5 shots at IV access they ended up using interosseous... I.e they jam the needle in to your shin bone and squeeze fluid in. Its actually pretty effective. Except you have to use a small power drill to drill the needle in.

Fascinating. Very emotionally charged for all too.

Reflexes

I've had a few awkward moments this year. Here's another one:

I'm what you might call hyper-reflexic. Very easy to trigger reflexes that are quite substantial in their magnitude. Unfortunately I happened to have my legs crossed when I slapped my hand on top of my knee. My remotely triggered patella-jerk kicked in, sending my leg flying forward. I kicked my patient right in the bony part of the shin. We both exchanged awkward laughs as I apologised profusely.

Maybe this is why doctors sat behind desks all those years.

Reflections

I had my twenty-seventh birthdy this week. It's probably the first time in a while where I have embraced getting older. I think despite many around me losing theirs, my head is entering a good place at the minute! Time to embrace it while it lasts!

I've been really fortunate over the last few weeks to enter an awesomely reflective mood. I think being on holiday has allowed me to jump out of 'being in the moment.' A bit of cognitive re-framing!

I can't help but be thankful for my wonderful parentals. Sure I may accuse them of being weird sometimes, but they surely have been great life and spiritual role models. As I professed to a friend recently, to get to our age with a still functional family is truly a rarity and a blessing!

There are my two fantastic sisters. The unacknowledged role models with whom I shan't compare except in hilarity in which I am superior (true fact). The good eggs with whom I have thrown myself in to the carton. Thanks team! I realise you didn't have a choice but you humour me so well!

And then, the relatively recent acquisitions! The brother-in-law and the niece and nephew! The icing to an already rich family cake. A very fortunate member of this elite establishment am I.

I have outstanding friends, outstanding colleagues, amazing mentors and the opportunity to study with some of the finest and brightest students that I truthfully respect and admire.

I am blessed and certainly don't want to not realise that till twenty years from now when I only have hindsight to clarify these thoughts!

Ironically I think I've been somewhat spurred in to writing these things down by the finality of life. I've seen lots of patients die in recent weeks. For the majority old age won out, but for some a premature cause beat old age to it. I guess this is the blessing and the curse of the continuity of care in the country. The patients you meet will all eventually have their names transitioned to the whiteboard in the tearoom in the sky.

But then I reflect on these people and realise that so many have had such a great shot at life, even if they didn't crack a century. I hear tales from other students and doctors of children dying from preventable diseases in far off countries and can't help but feel my heart ache. Yet my cognitive dissonance is still so great.

What a privilege. What a curse. To be so blessed. To have our cups run so far over that we complain about the mess on the table.

So here it is, my prayer for the 28th year and beyond. To acknowledge that God has provided me with far more than I deserve, and the hope that he'll find a way for me to use the bounty he has given me. In the way of his choosing. Because up until now, trying to do my own thing hasn't really panned out as best as I'd planned!

 Trust in the Lord with all thine heart; and lean not unto thine own understanding. In all thy ways acknowledge him, and he shall direct thy paths.

30 km, 3cm

So I'm waiting. Waiting for the call. Somewhere a baby is contemplating being spewed forth from their mothers loins. And I get to watch. Cool.

Could be a while yet. Since I've never had to work a night shift before, I'm hoping I wont fall asleep. Fortunately I'm taking a tip from the GP and hoping to walk in right at the moment of impact, with none of that long and painful contraction business to wait for.

Onward march!

Inspired by the mandatory health and well-being session

Holiday time!
Those of you who have suffered along with my blags might recall I used to liken life to jamming a pentagon in to a box. The pentagon being you (and the five key aspects of your life) and the box being your ability to keep things under control. No matter how much you try to rotate the jolly pentagon there's always a corner sticking out - something always needs to be addressed. Or at least that's how I've felt in the past.

Right now I feel as though I need a bigger box! Either that or my capacity to keep things under control has been subdivided in to a triangle.

Suffice to say, I did pretty mediocrely in the practice osces on wednesday. My lack of exposure to some areas caught me out.

Oh well.

No sir, no dancing today.

I've written the last couple blags on the phone. Hence the jitteryness. But it's nice to do some writing before falling asleep. I must have had helicopters on mind though, because I was pretty sure I woke to the sound of a helicopter landing at about three AM. Another retrieval. Nah, two in one day is pretty rare.

Turned out in an awkward twist of fate that the on-call doctor had become quite unwell and had to be choppered out (albeit doing okay after some emergency surgery.) But everyone was very concerned at work today. And it threw the whole day in to chaos for the patients of course. Such is life!

Pretty crazy stuff though, I know how much doctors hate being patients. I certainly never want to take on the patient role ever again. Being sick blows.

I like this little town

I like this little town. Had a retrieval today. But we don't have a helipad on site. So the CFS unit gets called out to clear a spot on the school oval. If it's night they shine their headlights for the chopper. If it's a Saturday they scare away the footy teams, meaning the game the whole town seems to go watch comes to a halt.

The volunteer ambos shuffle the medics and patient back and forth. It's very quaint. Very community. I'm quite fond of it.

Highlight of the day was when a patient nearly weed on the intern as they were about to catheterise. It would have been laugh out loud funny if it was anywhere else.

no enter key. weird.

I'm not sure why I'm feeling angsty right now. long study day on women's health. I know more than I want to know on the issue now. But it all went well. Every body presented interesting cases. And did a good job.  But now I'm home and feeling restless. What does it all mean?I think the weight of assessment is starting to weigh on me. I think I need this holiday... 1 week!

 I think watching "girl with a dragon tattoo" to chill out was a bad idea.

The picture is the clue

You'll never guess what I saw today! Also, arterial spurting! Wicked!

Interesting factoid, the episode of the simpsons where Moe rescues Homer from a boxing match is actually based on a real life event!

Read about it here!

Catch me im fooling

There's nothing so unfulfilling as the heart-sink patient. It's forty minutes of tears and sympathetic nods. It's obviously important to listen, but ultimately there's nothing you can prescribe to fix their situation even though you desperately want to help.

And no, Mr.s Wisenheimer. The tears were not mine.

Dub-trub

"Ahhh, there's flies in my sterile field." Said the super-doctor as she finished inserting the central line. Rural medicine!

Medicine in the country never ceases to be amazing. Actually that's not true. Myself and my colleague were lamenting how few exciting things had happened over the past few days.

Let me rephrase then. Medicine in the country never ceases, amazing!

The hospital I reside in is pretty small, you can count the number of inpatients on yours or hand most of the time. So when the infrequent occurrence of a proper emergency happens, it gets interesting.

Today we had a full blown resus. The kind where the already dodgy patient is going downhill fast and the ambos radio ahead for you to get your dancing shoes on. It was intense, though as usual I didn't contribute much, not that I was required. The team managed to get the guy back and stable enough.

Of course the unthinkable would happen and the ambos brought in another priority case. Fortunately medstar had arrived and was already working on the first guy, which freed up some of the other doctors. Both patients ultimately got choppered to town, still alive. As well as a third patient from the next town over. A very busy day.

This all happened in the middle of the afternoon. And as I've said previously. There aren't emergency doctors, the people who answer the door are the local GPs. They are all pretty competent though and brilliant general practitioners. Unfortunately if you happen to pull four doctors out of the consulting rooms in order to keep someone alive, the regular GP patients tend to get a little angsty. It's almost as if some people are devoid of empathy.

So that was my afternoon. I did get to see some educational stuff, including a rapid sequence induction, arterial and central line insertion and external pacing. Although I feel bad for learning from other peoples misery, best to be prepared in case I ever end up calling the shots and its one of your lives on the table.

I hope not to suck.

What happened to yesterday!?

I'm not even sure how to describe the day in a single word. So here's tale and maybe you can summarise it for me

Well the day started off fine, assisting in lumps and bumps and getting first dibs on ED patients. And then quite unexpectedly I was off with the veteran doctor and in to the suburbs. One of the frequent fliers, indeed a gentleman I was talking to just yesterday had been found dead. I was off to see my first certification.

I'm not sure why I'd thought this person would have just died in bed asleep. It came as a bit of a surprise to find that it wasn't the case. It was very weird to see the person come cadaver still awkwardly in situ at the site of transformation.

Outside I joined in on a quiet joke with the ambos, the policeman and the undertaker. Asked how I found the scene I gave an unguarded 'disgusting.' Instantly regretting my choice of word. The friendly ambo and undertaker were kind enough to put 'disgusting' in to perspective for me by comparing other scenes. I guess it wasn't that bad then.

I jumped back in the docs car feeling ever so mildly nauseated. Fortunately we got in to a good discussion about how you survive in a small country town as the heroic doctor and how you avoid getting involved and ultimately emotionally destroyed.

I think I learned a lot. Not about medicine though. It was another one of those 'learning things about life' days.

After a few moments of pondering it was back to clinic work. I was left to make contact with the orthopods at the kids hospital to transfer a broken distal humerus to them.  I got absolutely drilled by the ED consultant I spoke to about my apparent lack of anatomy knowledge and inability to describe the fracture. Arrrr! All I wanted to do was send the pictures. I mean, how do you describe a chunk of bone that is pushed in two directions and rotated.

Well I found a way: Badly.

After my botched explanation of the two x rays, and because this doctor obviously thought he was hilarious, he finished with a 'what year medical student are you? Ah I see, well 'posteriorly' means backward.' Then started laughing at himself. He did give me some tips though, which was very nice of him.

Luckily he put me through to the orthopod and I got a real doctor to do the speaking. *rubs hands*

Better touch up on the old anatomy. But there is a difference between inexperience and idiocy.

I think I learned a lot. It was another one of those 'learning things about medicine' evenings.

A door to the face? But a window opens.

Got to sew up a mans face last night. Was very exciting. Luckily there was a real doctor working further down the face on the ugly looking lac, while I got the little straightforward one. Still, was nice to get some facial suturing in. Luckily the patient couldnt see the fine trembling of my nervous hands as the blue sheet was draped over his face. I actually thought I did a good job in the end. Good apposition with nice eversion of the edges. And all my knots on the same side...

Then today my streak of discovering murmurs continued. Found a mitral regurge today, my first! I've really only been able to find systolic aortic ejection murmurs before. So maybe my ears are finally dialing in. Was good too, as it happened to be a patient that I'd decided to get assessed on.

Suffice to say, I'm having an 'up' day today.

Polyp ahoy!

Spent the whole day in surgery today. A scope list in the morning, where I got to see lots of polyps, proctitis, haemarrhoids, skin tags, stomach ulcers and hiatus hernias getting explored. Interesting in parts, but didn't get to do anything. Which kinda sucked if I'm honest. But the surgeon seemed to think that all of the stuff I was seeing was novel and that the scope list was usually a lot more boring. Thankfully he was realistic enough to say that one session was enough and to try avoid ever having to see another scope list as you won't learn anything new. Good bloke.

Then it was more hernias and gallbladders in the afternoon. It's the kind of stuff that would be really interesting if you were involved. But watching it from beyond the blue zone is kinda boring. The videos on youtube are often just as good.

I have a suspicion surgery might not be for me. It's all so confusing!

Parasympathetic overshot

Have had a spate of the doctors and nurses becoming patients lately. Quite amusing.

I'll make an honest evaluation here. Doctors are much better doctors than patients. Which once again reassures me that its perfectly normal to vasovagal after having a cannula put in yourself and yet be able to happily put them in to others.

"Knowledge brings fear."

Yesterdays Jam.

Bit of an emotionally trying/draining few weeks. Very up and downy. Forunately was warned to expect this. Having no boundaries is certainly proving a formidable challenge. I might elaborate on that at a later date. But not today.

A little while ago, I was reasonably fortunate to be standing on the other side of a curtain, whilst a patient misinterpreted their benign diagnosis to be much more severe than it was. As funny as it sounds, it's not often that you actually see people appreciate their lives. It's a very real emotion and a great chance to hold a mirror to your own life.

As the introvert that I am, I'm often stuck in my head wrestling with things. I guess that's why I enjoy when things are brought back to basics. All that's left is the clean cut, where things are or aren't and reality is at its most appreciable.

I guess its ironic that I'm about to segue from reality to religion, because for many they're quite contrary. And yet...

Here is a song. I originally liked it for its punchy kick drum and mellow toms, but I've grown to love the lyrics. Mostly though, it's what I needed to hear today.

Fairest Lord Jesus, Lord of all creation
Jesus, of God and Man
You will I cherish, you will I honour
You are my soul’s delight and crown

Fair are the meadows, fair are the woods
Robed in the blooms of spring
Jesus is fairer, Jesus is purer
He makes the saddest heart to sing

Fair are the flowers, fair are the children
Beautiful in all their youth
Yet is their beauty, fading and fleeting
Lord Jesus yours will never fade

Fair is the moonlight, fairer still the sunshine
Fair is the starry sky
My Jesus shines brighter, Jesus shines clearer
Than all the heavenly host on high

All fairest beauty, heavenly and earthly
Jesus, in you is found
None can be nearer, fairer or dearer
Than you my Saviour to me bound

Words by German Jesuits, English translation by Joseph A. Seiss, 1873;
Music by Alanna Rodgers, Richard Fenton, Greg Cooper, Andrew Judd & Garage Hymnal.

Sorry about that!

A quick blah from the phone.

One of the things I find interesting is about how people judge they are sick.  Most people seem to have a fairly good idea when they are sick and to what extent.  But some times there are people at the ends of the spectrum who are either desperately anxious or seriously sick. Often the history comes across initially similar. Its only when you look at them that the patchy story resolves as an exaggeration or an understatement.

I managed to diagnose an infective endocarditis the other day.  I was pretty happy to be able to deduce it from the history and have it ultimately be shown to be correct by the egg heads in town.

Some times I think I could do this doctor business.  And then I go stick a sharp thing in to someone and blood goes everywhere in an uncontrolled fashion and it looks nothing like how the real doctors do it.

Practice makes mess.

A dream within a dream. but its not a dream.

"I know you can be overwhelmed, and you can be underwhelmed, but can you ever just be whelmed?"

Poo, wee, blood, tears, various mucous and lots of liquor (pronounced lie-core you idiot). Yes that's right, I saw my first  delivery. Extremely fascinating stuff. But after several hours of waiting for something to happen my over-riding emotions were definitely hunger and boredom/anticipation. Fortunately the delivery was text-book stuff. There's nothing like watching a babies head spin through 90 degrees on its own volition whilst hanging out of someones nether-regions to make you sit up straight.

I really have no idea why people harp on about the magic of birth. It's totally grody, even if it is essential to life. Totally learned a lot though. Was very much surprised to see pethidine is still in vogue in obstetrics. Crazy!

Oh yeah, I forgot about the vomiting. So much vomiting. I dont know how I forgot about that. Apparently vomiting is normal and a good sign. It means 'things are happening.'

After that though I felt rapidly spent. Far too much driving for my liking last week. By the weekend I was feeling quite average. Came home and lay on the couch all Sunday afternoon after a shocking sleep in bed saturday. Nothing worse than feeling mediocre and then not sleeping. Bleah.

And now the week begins again!

The lone 'pine

Had my first epic psychiatric patient encounter. The raised voices, police-involved, blood everywhere type of event. I don't really have much to say on the issue, apart from reflecting on the high social price of drugs and alcohol. I mostly got to stand around and take it all in and keep the scissors out of reach.

A lot of what I do here is 'taking it all in.' Medicine in general I guess. But this time seeing how the mental health act works in the real world, and how country hospitals straddle the fine lines of wanting to help but being woefully equipped to deal with serious acute mental health problems.

It's a tough job and in a small country town there seems to be potential for a high emotional toll, especially in that inevitable circumstance where the patient is your friend or at least well known to you. This rural GP thing has certainly proved quite insightful. There are a lot of super-nice doctors and nurses out here though. It's not the intellectual backwater you fear it might be.

Personally, I still have no idea if I'm learning anything or not. Or whether I'm just accumulating things that fall in to the life experience basket. But at least at the end of the year I'll have a lot of interesting tales to tell. Like this one:

Driving at 110 in the dark, I squashed my first rabbit the other night. Now my air-conditioner has this weird organic smell to it. Luckily the cool change is here. I'm just happy it wasn't a roo that darted out from the bushes.

Red gold

Had a fun day yesterday. Spent it studying for the large part. But it meant I could sit in the ED and see what comes in. Lately it seems there has been a rather aggressive tummy bug going around. There's lots of people looking the worse for wear.

For the second time this week I was able to check out a patient who was looking a bit parched and then sink a cannula in to the back of their hand. Totally felt like a medical rock star because my streak of successful cannulations has blown out to two (an all time high!). Now I just need to figure out how to cannulate places other than the hand!

As others have said though, it's all in the mind. Believe you can do it, and it will work some of the time! But don't die wondering at least.

"Sharp scratch"

To be honest though, the thing I hate most about sticking the plastic tubes in to people is the bit at the end where you have to tape it down. The sticky stuff drives me nuts...

It means I was drunk yesterday

Interesting man: "You know it's easier to get a root in this town than it is a park in the main street."
Me: "Really? I've never had any trouble getting a park in the main street." Awkward pause... "I wouldnt know about the former."
Luckily he gave me some sagely advice about how to make my parking situation look comparatively bad.

After yesterdays feel-good binge, today I was brought back to reality in the clinic. Had a terrible run of answers to rather broad conceptual questions. Whilst they weren't incorrect, they weren't the all encompassing answer my supervisor was hoping for. Compounding this, I had to then ask for my mandatory sheet of paper evaluating my performance to be filled out.

In all honesty, it was a very accurate evaluation. I'm not sure why I was hoping for more. Not that it even counts for anything!

I just don't want to be a mediocre doctor.

Spread your wings

Part of pretending to be a Doctor is dealing with the spectrum of patients that encompass the human condition. Most patients are happy enough. Sometimes patients are just generally unpleasant. Sometimes they are too focused on a problem that they can't see all the functional bits that are left over!

Every now and again though, you find the proverbial diamond in the rough. The sort of patients that justify the existence of the human race. I saw a patient today, elderly but sharp as a tack. A former bomber pilot.

Part of my learning experience is something called 'parallel consulting.' Whereby I see a patient for 30 minutes, then the GP comes in and looks over what I've done and cleans up my mess in half the time.

I really enjoyed talking to the chap today. It was possibly the first time I've wanted the doctor to run late because once my medical is over we usually make chit chat. So we got to talk about the war, flying and life in general. I told him about my love of that era and how I've always wanted to learn to fly. It was great! He sized me up pretty well too

"I like that you're speaking loudly for me, you're at the right volume. But your enunciation is terrible." It may be true, but I'm going to blame the poor acoustic insulation in those cockpits...

I really warmed to the guy. He commended my personality and told me I'd make a good GP. I don't think anyone has ever cast me as a GP before, normally my nerdy and anti-social side shines too bright.

As I passed him over in to the care of one of the practice nurses, he shook my hand and gave me some sagely advice.

"If you want to learn how to fly, get in to a glider. It's only when you can't power out of trouble that you really learn how to fly."

Part of me feels that coming to the sticks for the year has put me in to the pilot seat of a glider. It is as scary as it is exhilarating. Despite my enormous lack of knowledge, I'm really keen to see how we land this thing.

In conclusion, I know those words make for a great metaphor but I fully intend to one day take them literally.

Lanced Armstrong

All I know is this: I wish I was the one wielding the scalpel, because watching the pus explode out of that abscess... and then keep flowing and flowing and then oozing half coagulated blood. It looked like so much fun!

Ohhh the satisfying feeling the doctor must have had! Me wanty!

In surgery this week

Whilst removing a saphenous vein:
Surgeon: "Pass me the stripper please... So [student] are you married?"
Me: "Are you making a connection between strippers and marriage?"

Needless to say, I got torn apart for my lack of knowledge about the vascular system. But in the kind words of the surgeon

"It's not your fault your uni doesn't teach you enough anatomy." The perils of a four year course I guess.

It was actually a really good session. I learned a lot. Got to pull some veins out and work on my needle work. Then came back to my home hospital and sunk a cannula with nobody but me and the patient watching.

I'm still very hesitant to ask to do things though. I just hang around with puppy-dog eyes until stuff falls to me. Hopefully that will change though.

Bypass

I like hanging out with doctors. It means I can have my phone as obnoxiously loud as I want, and nobody cares because you fit right in.

They do know that my 'extremely important messages' are just facebook updating though, right?

I drove 800km this week :/

Rule number 666

Note to self: Don't ever get an embarrassing tattoo in an embarrassing area. Actually, just don't ever get a tattoo. Best to be on the safe side with these things. You never know when a room full of people will be staring at it.

Actually this ones pretty good...

Learnings of the week

1. ACE inhibitors can cause hyperkalemia. So always do repeat bloods.
2. Surgeons don't retire, they just hide in part time private practice.
3. Going home and snorting cocaine won't cure intractable bleeding.
4. If in doubt, the answers are staphylococcus, cephalexin or flucloxacillin. 
5. There are more than two types (small and big) of potato.

Chefs special: Seniors.

Pop goes the ...

Had a shot at relocating my first shoulder yesterday. No love, couldn't quite manipulate it properly. Luckily the veteran doctor swept in and effortlessly put it back with what can only be described as a visually spectacular relocation. So weird watching the bulge of the humerus recede back under the deltoid and in to the armpit. I want to do the next one!

You don't have to be a doctor to know that something doesn't look quite right here. The question is what?

The patient (another victim of the aquatic activities that occur so frequently around here) managed to get her heart rate above 200, she was that nervous before the relocation. I was suitably impressed at the bodies ability to dump adrenalin, even when lying down in bed. She was understandably shaking like a leaf. Not that she remembers that anymore.

Magic magic drugs. Fascinating!

The chefs special this week seems to have been ulcerated and or infected feet.

Long weekend

A lot of the med students gathered back in Radelaide this long weekend. It was good to see all the people who had gone rural, as well as the city slickers. It was a good opportunity to exchange war stories from out first week on the job.

I thought I had had an interesting first week. What with spending a day in surgery and then having a sink hole open up in my garden and try and swallow me. But apparently my week was medically boring.

One of my friends was asked to relocate a shoulder (because the intern was too scared to try) on his first morning in the clinic. He also got to perform a mental block unsupervised.

But the best story I heard was from another of the rural girls. Her first night on call yielded a person who had had their ear completely bitten off in a fight. Literally the whole ear, back to the bone of the skull. It was disgusting... yet cool. And there were photos to prove it.

I can't wait to start on call this week!

Beeeep. Sizzle.

Got to assist in surgery today, it was an interesting time. May not have learned that much, but I've always wanted to get involved in the theater.

I hope I get used to the waking up at 5:30 though.

Health watch

Well I moved. I don't have internet yet, so don't expect any updates. I've run the twenty metres up the hill from my hospital shack to steal the free hospital internet.

It's quite pleasant here. There is a pleasing afterglow as the sun goes down. The lights of the hospital emergency department are glowing behind me. A pleasing view of the river is on my left.

All in all, the fundamentals are here for a good year :)

Excited? Much.

mo' problems?

I sold the Jeep yesterday. It all happened very quickly. Within 24 hours my first automotive love had transformed in to an envelope of cash. It was all a bit sad, but I was greatly relieved to sell it to a guy who obviously had the same passion I had.

He and his parents turned up to my house, sporting a brand new Jeep T shirt and two mix CDs he had hand crafted for his first drive. The opening song featured the lines 'cruising in my jeep.' It was all very cute, considering the guy was in his late 30s. But some things you quite simply have to do before you die!

As I heard the deep rumble of the engine rev, the sounds of gangster rap were cranked up and a tortured mother in the passenger seat smiled merrily. And then it was gone...

Call DR! ABC stat!

It's pretty much how I always imagined the scenario would happen. I'd be standing there shirtless, bikini clad women would be standing around me and someone would be down on the ground in need of help. And that's exactly what happened on Friday night to me and a couple of my medical colleagues.

After a late night swim we were on the hunt for food at Brighton. Just as me and a colleague were crossing the road someone riding along the footpath at a rather sedate speed slammed down on to the ground. Ominously there wasn't any noise from the fallen rider. So we wandered over to the young girl who had come off her bike. Her riding partner had pulled up just in front and was standing idly waiting for her to wake up from her awkward face down position.

And that's when my heart started racing. Unable to rouse the girl, my colleague began calling an ambulance. I put my hand in front of her mouth, but couldn't feel her breathing. 'Crap!' (or similar) I thought to myself. I rolled her on to her back and slipped off her helmet. Checking again, I still couldn't feel her breathing on my face. So I did a jaw thrust and much to my relief she inhaled and started softly blowing moist warm air on to my cheek. My third colleague rocked up, and a surf-life saver who had sprinted off during the previous moments arrived with a bag of resus goodies and oxygen. So we put her on some oxygen and sized her up for an OPA (as I was still holding her airway open) but she fortunately went to a higher level of consciousness (or something) because she took control of her own breathing.

Although I know it was extremely unlikely that their heart would have stopped, I was just so happy not to have to move on to the next letters in the basic life support algorithm. I've never actually done compression on a real person, and I still live morbidly in fear of breaking my first ribs.

As she was now more stable we put her in the recovery position and a few minutes later the ambos rocked up. Much like the scenarios they put you in at uni, you hand over the case and things very quickly are no longer your responsibility. Except this time there were throngs of people standing around watching, attracted by the flashing lights.

Like all things in life, once you've done it a few times it will be less exciting. If this happened to me as a veteran doctor I wouldnt be fussed. But this was the first time I've ever been called on to help a fellow human in a real emergency situation. It was a super adrenaline rush and it was a fascinating insight in to my mind and panic response. It took me a few seconds to become composed enough to act at the start, but amazingly, I think the deep-end scenarios they throw you in at uni had paid off. I hardly wasted any time in getting to the airway checking and didn't umm and arr about whether an ambulance should be called. Finally! I'm decisive under pressure!

Just as they were rolling her in to the ambulance she started coming to, so I'm chalking that up as a win to the posse. I'm glad I didn't have to do that one on my own!

2013

I have a feeling, this is going to be a great year. I'm excited!