A yearning within

 

Still here, still going. Content with my lot in life.

Whilst anaesthetising for a colonoscopy list the other day, that had many varied characters on it. I said to the medical student, "You see colonoscopies are like a box of chocolates, you never know what you're going to get."

And then he just looked at me like I was some sort of sage and nodded. There was no understanding of the reference. I think I'm done with young people!

Anyway, I think I'll have to vent some more of the horrors I've seen at work here another time. 

Again

 Blogs may have gone out of fashion, but it's such a good way to mark time passing and reflect on periods of growth. Given that nobody reads blogs any more I feel much better about throwing my life out to the void.

Anyway.

We had another baby, Abigail. Two under two has been... challenging. It's not that it's always hard. It's just that when one thinks you have mastered a challenge, a new one arises.

The latest challenge has been getting our eldest to sleep in a bed. It's been a lot of being woken up by a curious two year old, buoyed by her ability to get out of the bed on her own volition.

The pandemic seems functionally over. Ironically I finally caught COVID and gave it to my family. It was fairly uneventful save a few myalgias. At work normality is resuming and face masks are mostly vanishing from faces, except when facing a patient. Not that im complaining. THe other day I had someones bleeding trache blast blood all over me. The mask and goggles I put on spared me the full damage at least.

Finally, I finished my anaesthetic training. I'm a consultant now working in a public hospital. I start private practice in a few weeks. That will be terrifying albeit lucrative.

Everything is coming up Milhouse. 

My loves

Times have changed

 Well. Two years since I last updated. 

Where we left off in 2020, isolated in Darwin where Corona didn't exist.

To set the scene:

1. The global pandemic rages on. I still haven't caught covid.

2. We moved back from Darwin. I spent six months at the women's doing countless sections and epidurals.

3. On the home front we had a baby of our own, little Victoria. She has been a source of endless delight. 

4. Worked in the paediatric hospital for four months. It turns out I don't mind kids. 

5. Went back to my favourite hospital, sat and passed my final exam with the help of some good friends I have made along the way. 

6. 2022 has rolled around and I am finishing my anaesthetic fellowship in vascular surgery and neurosurgery. Though to be honest as the fellow you are just used as a general dogs body, and left to supervise junior trainees at night.

Sometimes on night shift I even get to crawl in to this crappy bed in a dank suicide box room in the bowels of the hospital.

This year has been pretty wild. I've seen some stuff.

Just in the last few months I've had to help jam a breathing tube through the front of someone's neck following a trauma. 

I had my first person try to bleed to death during a C section a couple nights ago after an artery got accidentally severed and I had to pump in a loooot of blood. 

And now I find myself increasingly left alone to manage brain haemorrhages, ruptured AAA and septic people with perforated bowels.

The devil's anaesthetic

I don't think I've been so terrified and had so much fun at the same time ever. Some times it feels like a game - make the numbers look pretty and put the tubes in the other tubes. And then every now and again you look back and think, 'wow, I just said the last words someone will ever hear and I didn't even realise it at the time.'

Anyway, life is good.

All quiet on the Northern Front

Perhaps its a bit crazy, but its one of those thoughts. In fact its the kind of thing that comes back and haunts you after you die as people ironically mention your internet commentary.

But I'm missing the war.

The first iteration of intubation PPE

It's probbaly not a bad thing though. It reminds me of a soldier keen to get into the fight, unable to appreciate the horrors of a war yet to come.

And yet, here I am.

We've trained, we've run scenarios, we've put on our armour and taken it off so many times it has begun to lose meaning. We've stopped all but the emergency operations, and reoriented ourselves to the intensive care unit. Hallways have been cleared, and tape lines marked out to designate clean from dirty.

But by some fortuitous chance I find myself in the Northern Territory, where only one case has been sick enough to come to ICU, and now two weeks down the line there are no new cases and everyone has all but recovered. I spend my time putting in epidurals, doing C sections and giving gentle GA's to the mildly sick.

Hell, I shaved all the hairs off my face for this battle.

Have I missed the war?

I've seen the photos, I've heard the first hand accounts. My overseas colleagues tell me about their now non clinical friends dragged back to the front lines to touch patients for the first time in years.

I was particularly moved by this junior doctors account in the NHS of what the front lines are like. And the relief she felt when finally her number was up and she caught the virus herself.

But here I am. A guy who can intubate and run a ventilator, without a hole to put a tube in or a bag to squeeze.

The waiting has been hard, and this is only the opening salvo in a long war. But if I've somehow missed the war - I'll be okay with it. But I'm happy to do my part when the time comes.

Well done Australia. You stayed the thrashing sword of COVID, and bought our army time for our tactical advances over the next year or two.

Perhaps I'll see some action after all...

Matt, Kat and Pajero. RDH staff accommodation.

2 years and 2 months

I'm still alive. But found this from 2003, while clearing some stuff out of my folks place.

Humble blogging

I am studying for exams again - which means I'm procrastablogging. That's right, I've put on my fingerless gloves and hunched over my keyboard to quickly write an update. It turns out I forgot to blog for over a year.

Things that have happened since the last blag:
Coupled up
Spent another six months in ED, spent six months in AMU
Got in to anaesthetic training, and am now working as an Anaesthetics registrar at a new hospital.
Purchased my first house.
Celebrated the new house by exploding the water heater and nearly losing my eyebrows while attempting to relight the pilot light.

Perhaps a couple pictures then, as I'm too lazy to insert words. This is my backyard. It started out filled with old Italian lady pots, concrete and olive trees. Plus a stupid amount of bricks and cement. As you can see, I've managed to make it look a lot worse over the last three months.

More to come once the skip comes  and the bobcat has leveled the back. Looking forward to giving my avocados a proper home finally.

That's it for now.

A Tidal volume

 "But then a doc from theatre came out and grabbed me again, offering me the opportunity to drop a tube down the next guys airway. It was sooo cool. I've seen it done on ER lots of times, but to actually jam the tongue down with the metal dealy, see the cords and then pass a tube through them - so cool! Best of all, it went in first shot, in the right spot. "

-Lumpage - 2011, as a first year medical student

I'm on anaesthetics for a couple months. I am absolutely loving it. I haven't had the opportunity to try intubation again since that one and only time I did it in my first year of medical school. It has been great to get some more experience with airways, and already in the two weeks I've been there I can definitely say I have progressed. I wouldn't want the job to fall to me if someones life depended on it - but I can now get the tube in some of the time under optimal conditions!

Just call me the tooth fairy (credit to another web site for their photo)

It turns out it's actually technically more difficult than I thought putting what is essentially a gaint metal spoon in to someones limp and lifeless mouth in order to see down their throat. The sensation of accidentally touching what acts as a giant lever on a patients teeth, is disturbing. But practice makes perfect - or at least improves rapidly.

Onward!

A quiet breath

Oh, right. Hey, how's it going?

I'll blog again soon.

Under the sun

How can you tell if a meth user is lying? 

They open their mouth.

-Emergency medicine consultant

I've cone to the end of my first three months in emergency. I only have 4 more months in ED for the year after this. Perhaps it's not really something to celebrate then. But I'll tell you why I am.

When I was preparing to go do my mission trip / medical placement in Africa, I had to undertake some preparation. As a casual "Missionary" I was informed that a short trip would be interesting and a great way to learn from and be involved in a new culture. Of course, when you first arrive it can be quite shocking. Wait a few weeks and it becomes a comfortable contrast. Wait a few years and you'll find you feel at home. 

But in the middle ground there, there is a danger period. You're no longer at home, but you're in a place that feels foreign. Things that were peculiar at first become frustrating. And those that give up at that point, and go back from where they came, often leave bitter and resentful. So time is important. Either stay a short while, or dig in.

As a general medico my life is portioned out to me in three months blocks. Three months of emergency, or three months of general medicine, three months of ortho and so on. So every quarter I uproot and find a new home. My experience so far when one is posted in a demanding rotation is one of perpetually leaving just as things are about to get really frustrating, and being happy to move on.

This time though I'm doing back to back rotations in the same place. Six months! But when the alternative was worse I'm totally okay with it. 

I leave that preamble floating in the milieu because I've actually found the last few weeks of work quite tiring. Part of it is the shift work - the perpetual poor sleep and disruption to a normal social life. But the major grind is the patients. Specifically the patients who are only patients because of their own stupidity and often neglect. Most recently though, my bugbear has been the meth heads.

The other week I had a patient, who having lost everything in his life because of his drug abuse went off to detox, for the fourth time. He presented to ED, noting that after 4 days in the community he was having panic attacks and didn't feel safe at home. He remarked that he was being watched by his now ex partner. Healthy paranoia right? That's fine. You're off the drugs, which is a great life choice. You're not suicidal, go see your GP tomorrow yada yada. Send him home. He returns home, has a panic attack and calls an ambulance. I have the misfortune of seeing him again, only this time he reports that actually he started using meth again and is just tripping badly. Very paranoid and wondering if he should kill himself and was too embarrassed to tell me the first time around. 

At this point all I want to do is scream and declare that I don't care. You're only suicidal and paranoid because you're on meth. You're only alone because of meth. You've only lost everything because of the meth. There is a very strong cause and affect between your issues and meth. Not to mention that  you've had four presentations exactly like this over the last three months! Why now is this my problem!? At some point you have to take responsibility for yourself don't you? 

But instead I gave a few stiff words, make him cry and then let the mental health person say he can stay for the night. I accept this, because I feel I'm too early in my career to let someone go home and kill themselves on my account and I don't want to get sued. But I guess on some level it's also the right thing to do.

Morning handover - I come to work for the pajama clothing and sneakers

So I cite that example about things that have been grinding me down in emerg of late. I've had a few people lie to me about their drug use, and annoyingly at times I've believed them. Like the other day when I had a twenty year old who for all intents and purposes was having a heart attack neglected to tell me about his methamphetamine use, until he was at the next hospital and mum was out of the room. Found that out from my housemate...

So what does it all mean? Who knows. Opportunely though We've been working through Ecclesiastes at church. It's the book of the Bible that was written on a Monday morning, so to speak. Fascinating book and something to wrestle with. But I've found the words oddly appropriate at times. I'm thinking of replacing my old mantra of 'people are idiots' with "meaningless, meaningless."

Here's an exerpt for your perusal:

² “Meaningless! Meaningless!”
    says the Teacher.
“Utterly meaningless!
    Everything is meaningless.”

³ What do people gain from all their labors
    at which they toil under the sun?
⁴ Generations come and generations go,
    but the earth remains forever.
⁵ The sun rises and the sun sets,
    and hurries back to where it rises.
⁶ The wind blows to the south
    and turns to the north;
round and round it goes,
    ever returning on its course.
⁷ All streams flow into the sea,
    yet the sea is never full.
To the place the streams come from,
    there they return again.
⁸ All things are wearisome,
    more than one can say.
The eye never has enough of seeing,
    nor the ear its fill of hearing.
⁹ What has been will be again,
    what has been done will be done again;
    there is nothing new under the sun.
¹⁰ Is there anything of which one can say,
    “Look! This is something new”?
It was here already, long ago;
    it was here before our time.
¹¹ No one remembers the former generations,
    and even those yet to come
will not be remembered
    by those who follow them.

So what does that all mean? Well... I'll let you know when I'm done wrestling with it. But I'm optimistic that by the end of six months in ED, it will feel like home and all of these issues will continue to float right on.

Horizontal Mattress

Set a new personal record. 25 sutures in to the one patient. And the lesson I learned, is that if you are going to trip over in your garage. Don't land on an axe.

I do this all the time

So I'm back to working in emergency again. I finished my internship at the start of this year and was fortunate to gain employment as a general trainee. The medical equivalent of the dogs body. And that means time in emergency. But I'm not complaining. I actually really like being in emergency... most days anyway.

I'm working at one of the smaller hospital. It has the distinct advantage of feeling slightly like a country hospital, but that anything overly complex gets sent to one of the big hospitals, or never even makes it to the door because they are too sick. But there are a few gems that turn up under their own power.

The thing that I like about working in emergency is that it's so varied, and there is the opportunity just to give things a go. Now obviously there's a difference between recklessness and well supervised learning, so I don't perceive that I'm doing anything overly nuts. But at times I get to go out of my comfort zone.

One of the hardest things I've had to start doing is putting IV drips in to children. It sounds odd I guess, but children are a protected species in tertiary hospitals. Certainly you don't get to stick needles in to them as a medical student, and rarely if ever as an intern. But then the time comes at three in the morning, on your third consecutive night shift, when you have a two year old child who is sick, hot and sweaty, hasn't drunk anything for a day, heart racing and looking feeble. Their worried mother has dutifully brought them to ED because Nurofen and Panadol isn't working - and it falls to you to do your first ever cannulation of a toddler.

And then bam, the nurses pin the child in a bed sheet, one arm held out tight, and you take out a tiny needle that you have never used before, walk up to the kid and deftly slide it in to the tiny vein that you can just feel somewhere in the nook of their elbow. Bam (again). You're everybody's hero. Except, you know you were fortunate that time and hope all the next times will be that easy.

So yeah. That's why I like the adventure of emergency. But also hate it. But mostly like it.

Earning my knighthood

I've been working nights the last few weeks. It's been a pleasant change from working in the days (though I really had a lot of fun in my Infectious diseases rotation). For better or worse most of my conversations have now been reduced to:

"Hi I'm Lumpage one of the night doctors. Sorry to wake you, you looked quite comfortable. The nursing staff have told me something interesting about you. How are you feeling in this regard? Oh, I see. Let me have a look at your whatsits... Well let's try this and this. No I don't know what your usual doctors are planning for you, I just look after everybody at night. Now lie still while I stick a needle in you. Okay see you later, try get some sleep!"

If all goes well we get a nice 3;30 am lunch. Alas this seems to be a rare affair.

Well it's not always like that, but that would be 90% of my patient interaction. Another 5% would be turning up to find the patient that complained of being in pain or not being able to sleep is funnily enough asleep. The other 5% the patient can't speak.

Lots of people really hate nights, but for me the experience has been good so far. Perhaps the most distressing part is when you get called to see the same patient every night. Not because the day team is doing a bad job of managing the patient, but because the same patient is just dreadfully unwell. In this regard I've found working with the haematology and oncology patients the most confronting, but also the most satisfying in terms of developing rapport and clinical acumen.

I really wish I could tell more stories, as some of them are genuinely uplifting, but I'm more conscious these days of the ehtico-legal complications of blagging.

Anyway, I have finished the medical sub-specialties rotation and now become the surgical night doctor until January. I'm excited, but also intimidated. it's been several months since I've dangled my toes near a surgical patient. Should be fine though.

Incidentally - I seem to be earning the reputation as the most chillaxed intern. I'm not sure if that's good or bad... Eh.

Oh yeah, it's one week one; one week off. Which allows me to get some quality nothing-time in. Hooray!

Maybe we're just too close to see the big picture

I find it hard to believe that this time last year I was getting to experience the life of a medical missionary doctor. I find myself constantly reflecting on the experience. The joy that it was to make a difference in peoples lves, and the incredible pleasure in getting to meet and work with some of the missionary doctors and nurses who are there with a great dedication and servant heart.

One consultant surgeon who I really admired was a great example of this. A young woman with real passion and a phenominal talent. But mostly an inspiring love of God. I was incredibly saddened last night to receive the e mail that she had returned to the States because she had become unwell the last few weeks. And now she has been  diagnosed with breast cancer. And I just can't understand it. Where is the sense in it?

Here is a young woman, actually helping people and make a tangible difference in the world, and doing it in God's name, only to be pulled from the field with metastatic cancer. I have no words, and I feel crushed.

If you're the kind of prayer warrior this world needs, perhaps have a read of her latest update: An excerpt:

"As a surgeon, I have spoken the word “cancer” countless times. To my patients, to their loved ones, in academic discussions with my colleagues, and in hearing the sad news of others. I have learned to speak about cancer without emotion and without fear because, after all, like a broken arm or a bean in the ear, it is a clinical problem that I am working to solve. Even when it involves sharing difficult news with a patient or hearing of the tragic diagnosis of a friend, it does not consume me, and rarely does it change me. This week, however, I have heard and spoken the word “cancer” more times than I can recall. And all of them in regard to me."

And so I'll leave you with this. A sneaky little recording I made of one of the church services I attended. This is a language that only two million or fewer people speak - so I can guarantee you've never heard anything like this before. Except you have.

Visions of Zanzibar

I recently put a new hard drive in to my aging 2010 era macbook. Now when I say recently I mean February. Of course, the fresh computer smell eking out from under the aluminium underbody wasn't the only benefit. It freed my computer of five years worth of files (and those things are heavy!)

Unfortunately I lost all my firefox tabs, because I was too impulsive to back those things up. So a lot of sites I used to frequently visit when I procrastinate just kind of ceased to be visited. Long story short I've not really blagged. Nor read your blags. Crazy I know.

Quick update then. I survived my 11 weeks in ED. And just as importantly I survived my surgical term in vascular surgery - and even managed to enjoy it at times. Now I find myself in gen med - where dreams go to... maybe not die. But my dreams are being palliated aggressively. The part I'm finding the most intimidating at the minute is the cover shifts though. Surgical cover shifts were easy.

Person has no blood? But more blood in! But medical cover shifts are more complex. Everyone has loads of co-morbidites. Mmm. It's okay though on the whole.

So that's it really. Haven't had anything terrible happen to me yet. Nobody has died on me and for some reason I get paid to turn up each day.

How things have changed!

And now for something completely different: Tomorrow is the shortest day of the year. So get ready to say goodbye to your seasonal affective disorder. Summer is coming! *Yeah!*

ABCDE

Well. Medical school finished and tomorrow I start work as a doctor. I'm feeling slightly angsty at present, but I'm sure once I say hello to that first patient it will all be... okayish.

On a serious note, please don't hurt yourself or become ill over the next little while...

Zambia part 1 - holidays bits

Helsinki, Cambridge, Manchester, London

Salmon soup and coffee. It was -2 after all.

"Modern art" = Pink urinating man

This Tea joint was owned by Mr Scruff!*