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.