Twice in the last four days I've gone into hospital out of rostered hours to check up on patients of mine that were a little sicker than most. My reg and my fellow intern would probably roll their eyes if I told them that. We have this on-going joke that if it's my afternoon off, they know they can still hand me work to do at 4:45pm. I'm weird about taking afternoons off. My reg assures me that that is a passing phase.
One of these patients had been under our care for about a week. When she first came in she was a little wary of us, and we thought she was a little weird too. I think we had all pegged her as someone who might retreat into the sick role and give us some trouble in terms of refusing tests, procedures and just generally be someone we couldn't get along with.
We found that she was, in fact, a real trooper. It probably helped that she was getting opiate analgesia four times a day, but she was a good sport about our repeated failed attempts at getting intra-venous access and the multiple blood tests and radiology tests we needed to essentially tell her we weren't sure what was going on.
Yesterday, after a week of tests, fate pushed the agenda, and her bowel perforated. We rushed her to surgery yesterday afternoon. My fellow intern and I assured her that she was in good hands and that we'd see her after the Anzac day holiday.
Today I called the hospital just to see how the surgery went. The ward told me, "She's not here, she's just in recovery after her procedure and she's going to ICU soon." I didn't like the sound of that. What procedure? She couldn't have gone til today without having her surgery, which meant this 'procedure' must've been something else entirely.
I padded into the hospital, feeling somewhat naked without a tie or stethoscope, and far too comfortable in sneakers.
I found her in the recovery ward. She lay there with multiple arterial and venous access lines, and her breathing was assisted by a large ungainly BiPAP mask. Being a public holiday the rest of recovery was entirely empty, and the mechanical Darth Vader like hissing from the mask created a surreal mood.
I quickly flipped to the last entry in her notes.
CT Pulmonary angiogram: multiple pulmonary emboli. 1st and 3rd segment of some artery in some lobe or somesuch. Even if had known what they meant I had stopped registering the words after "multiple pulmonary emboli." They are, for the non-medical, blood clots in the lung, the same entity that drove the media wild back when they bayed about "economy class syndrome."
They are a complication in surgical patients we try to aggressively prevent.
I explained what was going on to our patient. She could hear me, despite the fairly heavy analgesia that was running in her veins. She seemed to take it well, the trooper that she was. I stood by her bedside for another 20mins while the nurses got things ready to move her to ICU. Before they moved her she looked up at me and I gave her a crooked smile. I was wondering whether I had done all the right things to prevent this, whether we could have picked it up earlier, whether she'd be okay.
She reached up for my hand and I gave it a little squeeze. It might as well have been the other way around.
Tuesday, April 25, 2006
Thursday, April 20, 2006
Boy's club
Things you don't expect to hear a man say while fondling/manipulating another man's genitalia, even if it for a vasectomy:
Surgical registrar (losing traction on the vas deferens): "Prick!"
(coaxing it back): "Come here, you..."
(grimacing): "It's a little tight in there."
Surgical registrar (losing traction on the vas deferens): "Prick!"
(coaxing it back): "Come here, you..."
(grimacing): "It's a little tight in there."
Wednesday, April 19, 2006
Matlock'd
People exert and display their power in different ways. My consultant has several tricks up his sleeve to let people know that He is the Boss.
He is, firstly, an imposing figure - by towering over most medical staff at at least 6'3" he can simulatenously give you an inferiority complex and create a vertical illusion that diminishes his middle-aged pot-belly. His voice is deep, controlled and also distinctly Australian. He is, I'm told, a incredible surgeon with tens of thousands of operations under his belt.
He is also a wily fox.
Yesterday he asked myself and my registrar to look up the results of a patient's test for him. The results weren't back, so we said we'd chase them up. Today he asked me, "Did you see the results yet?"
I said, "No, I haven't had a chance, I'll look it up as soon as possible sir." (I had actually forgotten).
I managed to check the results and hours later when I was passing him in the hall I decided to try to prove that I was a hard-working intern. "Sir, those results..."
"I already know. I already saw them. I just wanted to see if you had."
A few weeks ago my colleague attended his theatre list as our registrar suggested it would make this consultant happy. The registrar helpfully briefed my colleague on the sorts of questions to expect from this operation - it was an excision of a pleomorphic adenoma, so the anatomy of the facial nerve was the key information. My colleague studiously memorized the branches of the nerve and their relations. When she arrived at the theatre, she was met with,
"Which number cranial nerve is the facial nerve?"
She knew the right answer, "The seventh."
"....are you sure?"
(For the non-medics, imagine the previous exchange like so: After you've prepared for a high-level maths exam including imaginary numbers - "What is 2 plus 2?" "Four." "...are you sure?")
It reminds me of an episode of one of those legal shows back in the early 80s - I think it was Matlock. Tha Lock had some poor schmuck on the stand for brutally assaulting some other poor schmuck. Matlock didn't have quite enough evidence for a conviction, so he says,
"What if I told you that your victim has just died in hospital?"
The schmuck on the stand breaks down and confesses, sobbing, to the whole crime.
The victim then turns up, making a grand entrance into the courtroom. The schmuck on the stand, shocked, turns to Matlock and yells, "You lied to me! You said he was dead!"
Tha Lock quips back, "I only said 'What if I told you he was dead?'"
Wily. I'm still not sure what to think of my consultant. He seems to have sent a clear message: "I am two steps ahead of you - because I am one step in front and you one step behind."
He is, firstly, an imposing figure - by towering over most medical staff at at least 6'3" he can simulatenously give you an inferiority complex and create a vertical illusion that diminishes his middle-aged pot-belly. His voice is deep, controlled and also distinctly Australian. He is, I'm told, a incredible surgeon with tens of thousands of operations under his belt.
He is also a wily fox.
Yesterday he asked myself and my registrar to look up the results of a patient's test for him. The results weren't back, so we said we'd chase them up. Today he asked me, "Did you see the results yet?"
I said, "No, I haven't had a chance, I'll look it up as soon as possible sir." (I had actually forgotten).
I managed to check the results and hours later when I was passing him in the hall I decided to try to prove that I was a hard-working intern. "Sir, those results..."
"I already know. I already saw them. I just wanted to see if you had."
A few weeks ago my colleague attended his theatre list as our registrar suggested it would make this consultant happy. The registrar helpfully briefed my colleague on the sorts of questions to expect from this operation - it was an excision of a pleomorphic adenoma, so the anatomy of the facial nerve was the key information. My colleague studiously memorized the branches of the nerve and their relations. When she arrived at the theatre, she was met with,
"Which number cranial nerve is the facial nerve?"
She knew the right answer, "The seventh."
"....are you sure?"
(For the non-medics, imagine the previous exchange like so: After you've prepared for a high-level maths exam including imaginary numbers - "What is 2 plus 2?" "Four." "...are you sure?")
It reminds me of an episode of one of those legal shows back in the early 80s - I think it was Matlock. Tha Lock had some poor schmuck on the stand for brutally assaulting some other poor schmuck. Matlock didn't have quite enough evidence for a conviction, so he says,
"What if I told you that your victim has just died in hospital?"
The schmuck on the stand breaks down and confesses, sobbing, to the whole crime.
The victim then turns up, making a grand entrance into the courtroom. The schmuck on the stand, shocked, turns to Matlock and yells, "You lied to me! You said he was dead!"
Tha Lock quips back, "I only said 'What if I told you he was dead?'"
Wily. I'm still not sure what to think of my consultant. He seems to have sent a clear message: "I am two steps ahead of you - because I am one step in front and you one step behind."
Tuesday, April 18, 2006
The circle
I was invited to sit at the table in the nurses rec room today. I was only looking for a working tap to quench my parching tongue but it was nice to be included. The nurses rec room is a private sanctum, and interns don't intrude on tea breaks unless something Truly Bad is Going Down. I sat there quietly sipping lukewarm water and listening to amusing stories about wrangling maternity leave and having babies. This is the second time in a couple of days that something similar has happened. I appreciate that maybe this means I'm not messing up too much on the ward. The first time it happened, one of the NUMs had just made me a nice hot cross bun and said, after I thanked her, that it was because she "looked after those who looked after ours."
There are small things in everyday that keep you going and this was one of them. A small word from one person to another takes seconds but it's enough to give things meaning. I'm starting to feel at home on my ward and I feel ready to give that extra mile if needed. Granted, I'm not on a busy team so I have quite a few extra miles to give. I'll look after those who look after mine.
There are small things in everyday that keep you going and this was one of them. A small word from one person to another takes seconds but it's enough to give things meaning. I'm starting to feel at home on my ward and I feel ready to give that extra mile if needed. Granted, I'm not on a busy team so I have quite a few extra miles to give. I'll look after those who look after mine.
Monday, April 17, 2006
Make with the clicky
I've been heavily censured all round for the delays in posts. My "friend" Marcus likes to call me "Milo", because I'm not "Quik" har har har (not in regards to blogs, just in regards to life). And my other "friend" Carmen loves that joke so much that between them I can never again drink flavoured milk.
So I thought I'd give a shout out to some other noteworthy blogs from terrific people that you might like to read (all medical interns, btw) in lieu of my tiresome tardiness.
Chronic Vertigo - esme's blog is (much like the author) true grit and no nonsense
The Intern Experiment - Another well-written blog from the always amusing Dr J
my aimless ramblings - from the bubbly Themis
Peekaben - from the equally bubbly Ben Lee
So make with the clicky. In the company of such esteemed writers I have no choice but to lift my game. Or send their sites trojan horses.
So I thought I'd give a shout out to some other noteworthy blogs from terrific people that you might like to read (all medical interns, btw) in lieu of my tiresome tardiness.
Chronic Vertigo - esme's blog is (much like the author) true grit and no nonsense
The Intern Experiment - Another well-written blog from the always amusing Dr J
my aimless ramblings - from the bubbly Themis
Peekaben - from the equally bubbly Ben Lee
So make with the clicky. In the company of such esteemed writers I have no choice but to lift my game. Or send their sites trojan horses.
Tuesday, April 11, 2006
Back in the game...but still losing
Humour me for a few minutes and let channel a bit of Bridget Jones. Somewhere in the last three months I had bought into the myth that as a fresh new male doctor I suddenly represented security, benevolence and good grooming to the opposite sex - the next best thing to George Clooney. My mojo, despite being battered through some abortive campaigns during uni, had been instantly rejuvenated! Bouyed by an inflated sense of self-worth and amnesia over past failures I headed back into the trenches of the dating battlefield.
Day 1; 2000hrs, Dizzy's Jazz club 6/4/06
I roll up to Dizzy's alone to see Axle Whitehead, the VJ on Video Hits and a former Idol contestant. It's an extremely crisp night in Melbourne. Dizzy's is a cute little club where the people standing at the bar are literally within spitting distance of the performer. It used to be an old post office, so what it loses in floor area it makes up for in history. It is so small though, that the poor girl selling tickets at the door is sitting outside the club in an equally tiny vestibule warming her hands to an element heater that might just be warm enough to heat her left pinky.
I pay for the cover charge, and she says to me, "I really like your jacket." This in itself is unfamiliar enough to make me bluster and bluntly change the topic to the weather. I excuse myself and head indoors. Indoors it's warm enough for the mojo to thaw out, which somehow gives me the chutzpah to head back out.
"Do you, um, want something to drink?"
She seems surprised by this for a moment, but goes with it and smiles,
"Um, a peppermint tea would be great."
"Uh, one or two sugars?"
"A dollop of honey, thanks a lot."
We exchange names. She speaks with confidence and ease and it doesn't surprise me when she says she's a politics/english major hoping to become a journalist. Her nature is easy-going and inquisitive which I find initally very comfortable until she stumbles on the fact that I'm a doctor which she finds fascinating.
I'm not particularly ready for this - she has a myriad of interesting questions to which I have boring answers (dropping the gory details of the latest failed faecal disimpaction is fun with friends but simply kamikaze with a stranger), and as anyone who's seen the 40 Year Old Virgin knows, you really ought to be talking about her, not you. I find myself trying every conversational tact but each somehow leads back to doctoring - parents: her father is a doctor, what's uni like: must be nothing like working as a doctor. It's like trying to play chicken, only you're driving a tram.
After the show I try to find her to say goodbye but she's gone. As I drive off I spot someone that looks suspiciously like her making out with a bald dude at a tram stop.
Scoreboard: Dave 0; Axis of women 1
Day 2; 2400hrs, Lavish nightclub 7/4/06
I go out for after work drinks to try and get to know some of my colleagues and end up trawling with two hotshots who dress big and talk bigger. When I talk about buying into the myth that young male doctors are the shit, I've only got options. These guys are majority shareholders.
Lavish on Fridays is an Asian club. I've been wary of trying to meet women at Asian nights, not just for fear of rejection, but for fear of getting stabbed, trolley-pole'd or otherwise violently beaten down for looking at someone's woman the wrong way. Tonight I swallow these fears with a few potent Jager bombs. For those of you not familiar with the Jager bomb - it's a shot of Jagermeister thrown down in half a can of Red Bull. It is essentially a drink that mangles your common sense by over-caffeinating your senses to the point where you gleefully allow the Jagermeister to sneak up on your inhibitions and stomp on them.
I'm wobbling somewhat, and decide that the previous night's trial of the "I'm a doctor" card was not rugged enough. Shamelessly I go up to a girl who caught my eye earlier in the night. She's got good game - well dressed in a slinky strapless, and stylish looking despite rocking the 80s hairstyle that's in fashion these days. I can't complain, because it means her hair is up off her shoulders, and she scores points for elegance.
Amateurishly, the words that come out do not reflect the situation. I hear myself say,
"Hi, I like your style. Let me introduce you to someone, this is my friend, he's a doctor."
I'm such a n00b. Now, granted, my opening gambit wasn't particularly clever, but my friend should have prepped me a little better - as it turns out this girl I tried to introduce him to was friends with a girl that he has this on/off thing with. She came back to me later,
"Your friend? He's a player. He's a doctor? You're a doctor? You know, I don't trust doctors. You and lawyers, you're all full of shit."
So much for elegance. And please, don't ask me why I tried to introduce this girl to my friend, when I had my own eye on her. I blame the Jager.
Scoreboard: Dave 0; Axis of Women 2
Day 3; 2300hrs Unk cafe, 8/4/06
I'm at a 25th birthday party of a friend of a friend. I'm telling my good friend what I have just told you, and he's talking out of his ass, the sort of talk you can talk when you are fortunate enough to be in a stable relationship. He's goading me into chatting up the waitress. There's no alcohol on board, but he's talking just enough to make me do this so I can shut him up.
His girl offers me a way in - this waitress has an accent. Why not ask her where she's from?
Some of you might know that I've not had a great record at chatting up foreign waitresses. The most famous knock-back I've received was, "I'm sorry, I don't speak English" followed by an immediate exit.
Still, let the fact that I continued impress on you my immense desire to shut my boy up. The cute waitress turns up with some appetizers, and I take my chance,
"I notice you have an accent..." (again, no points for an elegant opening) "...where are you from?"
She's from Germany, on a working Visa. In a couple of weeks time she's heading off to New Zealand. I recommend the South Island, having *never* been there, and desperately try to dig some high school German out of the dusty crate I call the hippocampus. Banishing the long repressed memory of Frau Graham's tobacco stained teeth and oddly masculine voice I sheepishly utter,
"Um...wie heissen Sie?"
She laughs at the stilted formal grammar and answers,
"Katie"
and walks off.
Scoreboard: Dave 0; Axis of Women 3
Day 1; 2000hrs, Dizzy's Jazz club 6/4/06
I roll up to Dizzy's alone to see Axle Whitehead, the VJ on Video Hits and a former Idol contestant. It's an extremely crisp night in Melbourne. Dizzy's is a cute little club where the people standing at the bar are literally within spitting distance of the performer. It used to be an old post office, so what it loses in floor area it makes up for in history. It is so small though, that the poor girl selling tickets at the door is sitting outside the club in an equally tiny vestibule warming her hands to an element heater that might just be warm enough to heat her left pinky.
I pay for the cover charge, and she says to me, "I really like your jacket." This in itself is unfamiliar enough to make me bluster and bluntly change the topic to the weather. I excuse myself and head indoors. Indoors it's warm enough for the mojo to thaw out, which somehow gives me the chutzpah to head back out.
"Do you, um, want something to drink?"
She seems surprised by this for a moment, but goes with it and smiles,
"Um, a peppermint tea would be great."
"Uh, one or two sugars?"
"A dollop of honey, thanks a lot."
We exchange names. She speaks with confidence and ease and it doesn't surprise me when she says she's a politics/english major hoping to become a journalist. Her nature is easy-going and inquisitive which I find initally very comfortable until she stumbles on the fact that I'm a doctor which she finds fascinating.
I'm not particularly ready for this - she has a myriad of interesting questions to which I have boring answers (dropping the gory details of the latest failed faecal disimpaction is fun with friends but simply kamikaze with a stranger), and as anyone who's seen the 40 Year Old Virgin knows, you really ought to be talking about her, not you. I find myself trying every conversational tact but each somehow leads back to doctoring - parents: her father is a doctor, what's uni like: must be nothing like working as a doctor. It's like trying to play chicken, only you're driving a tram.
After the show I try to find her to say goodbye but she's gone. As I drive off I spot someone that looks suspiciously like her making out with a bald dude at a tram stop.
Scoreboard: Dave 0; Axis of women 1
Day 2; 2400hrs, Lavish nightclub 7/4/06
I go out for after work drinks to try and get to know some of my colleagues and end up trawling with two hotshots who dress big and talk bigger. When I talk about buying into the myth that young male doctors are the shit, I've only got options. These guys are majority shareholders.
Lavish on Fridays is an Asian club. I've been wary of trying to meet women at Asian nights, not just for fear of rejection, but for fear of getting stabbed, trolley-pole'd or otherwise violently beaten down for looking at someone's woman the wrong way. Tonight I swallow these fears with a few potent Jager bombs. For those of you not familiar with the Jager bomb - it's a shot of Jagermeister thrown down in half a can of Red Bull. It is essentially a drink that mangles your common sense by over-caffeinating your senses to the point where you gleefully allow the Jagermeister to sneak up on your inhibitions and stomp on them.
I'm wobbling somewhat, and decide that the previous night's trial of the "I'm a doctor" card was not rugged enough. Shamelessly I go up to a girl who caught my eye earlier in the night. She's got good game - well dressed in a slinky strapless, and stylish looking despite rocking the 80s hairstyle that's in fashion these days. I can't complain, because it means her hair is up off her shoulders, and she scores points for elegance.
Amateurishly, the words that come out do not reflect the situation. I hear myself say,
"Hi, I like your style. Let me introduce you to someone, this is my friend, he's a doctor."
I'm such a n00b. Now, granted, my opening gambit wasn't particularly clever, but my friend should have prepped me a little better - as it turns out this girl I tried to introduce him to was friends with a girl that he has this on/off thing with. She came back to me later,
"Your friend? He's a player. He's a doctor? You're a doctor? You know, I don't trust doctors. You and lawyers, you're all full of shit."
So much for elegance. And please, don't ask me why I tried to introduce this girl to my friend, when I had my own eye on her. I blame the Jager.
Scoreboard: Dave 0; Axis of Women 2
Day 3; 2300hrs Unk cafe, 8/4/06
I'm at a 25th birthday party of a friend of a friend. I'm telling my good friend what I have just told you, and he's talking out of his ass, the sort of talk you can talk when you are fortunate enough to be in a stable relationship. He's goading me into chatting up the waitress. There's no alcohol on board, but he's talking just enough to make me do this so I can shut him up.
His girl offers me a way in - this waitress has an accent. Why not ask her where she's from?
Some of you might know that I've not had a great record at chatting up foreign waitresses. The most famous knock-back I've received was, "I'm sorry, I don't speak English" followed by an immediate exit.
Still, let the fact that I continued impress on you my immense desire to shut my boy up. The cute waitress turns up with some appetizers, and I take my chance,
"I notice you have an accent..." (again, no points for an elegant opening) "...where are you from?"
She's from Germany, on a working Visa. In a couple of weeks time she's heading off to New Zealand. I recommend the South Island, having *never* been there, and desperately try to dig some high school German out of the dusty crate I call the hippocampus. Banishing the long repressed memory of Frau Graham's tobacco stained teeth and oddly masculine voice I sheepishly utter,
"Um...wie heissen Sie?"
She laughs at the stilted formal grammar and answers,
"Katie"
and walks off.
Scoreboard: Dave 0; Axis of Women 3
Sunday, April 02, 2006
Circadian again
24 hours after I left my final night shift I stepped back into hospital and it was, once again, a strange place. I joined my new surgical team at 7am and by 8am I could feel the physical pressure of having people around me again, palpable and almost measurable with a barometer. In amongst the throng, I am once again a lowly intern - answering a page with simply "Hi it's Dave" is no longer enough, but I have to include my full branding "Hi, it's Dave, General Breast Endo Surg Intern number six-one-five."
The compensation to anonymity is the relative abundance of pretty young things wandering about. In one day I almost managed to walk into two IV trolleys after my retinas re-registered what a cute woman looked like. Go Pharmacy! Go Physio! Go hot older NUMs! Go! Go! Go!
Big ups (or downs) too, to cute medical students too, who wear totally impractical clothes to hospital! Girls, you look cute enough to make my brain temporarily dump the definition of heart sound S3, but if you brought handbags big enough to fit a Talley O'Connor in there you wouldn't have to ask me, would you?
I decided to send them to see my favourite patient, who wasn't surgical in any way. He was initially seeing our surgeon for a lump and they found he was anaemic. I was the one who admitted him to hospital and it turned out his anaemia was haemolytic, a condition where the immune system breaks down red blood cells. We turned him over to the haematologists and a few days later I spoke to his wife who told me that he was disappointed that I wouldn't be looking after him personally, which warmed my heart and made my day.
There's a general feeling that surgeons just like to cut things, and don't really care about their patients. I think it's more a product of an overloaded public health system. If you've only got five patients on your list (like I have), then you can afford to take a few more seconds with a patient and make them feel unique. If I've got a light list, then it's not just a privilege, but a responsibility to take those few extra seconds.
I have to thank Caz and Paul, friends of mine who were holidaying and staying with me this week. It made the transition to surgical internship much more enjoyable knowing I had something to come home to in the evening.
Two small plugs:
1) Masala Magic in Flemington - great, affordable Indian food.
2) Hyde bar on Russell St - managed by my fellow intern Marty, who was nice enough to hook me up on the guest list for the grand re-opening on Thursday. The decor was eclectic - plush couches sat next to thumping RnB, while Terracotta warriors sat at the bar either reading the random books about the place, or checking out the gorgeous bartenders. Caz, Paul and I turn up to see Marty sitting in the back corner with his posse looking like he's this town's Jay-Z and I think to myself that sometimes a little bling ain't a bad thing.
The compensation to anonymity is the relative abundance of pretty young things wandering about. In one day I almost managed to walk into two IV trolleys after my retinas re-registered what a cute woman looked like. Go Pharmacy! Go Physio! Go hot older NUMs! Go! Go! Go!
Big ups (or downs) too, to cute medical students too, who wear totally impractical clothes to hospital! Girls, you look cute enough to make my brain temporarily dump the definition of heart sound S3, but if you brought handbags big enough to fit a Talley O'Connor in there you wouldn't have to ask me, would you?
I decided to send them to see my favourite patient, who wasn't surgical in any way. He was initially seeing our surgeon for a lump and they found he was anaemic. I was the one who admitted him to hospital and it turned out his anaemia was haemolytic, a condition where the immune system breaks down red blood cells. We turned him over to the haematologists and a few days later I spoke to his wife who told me that he was disappointed that I wouldn't be looking after him personally, which warmed my heart and made my day.
There's a general feeling that surgeons just like to cut things, and don't really care about their patients. I think it's more a product of an overloaded public health system. If you've only got five patients on your list (like I have), then you can afford to take a few more seconds with a patient and make them feel unique. If I've got a light list, then it's not just a privilege, but a responsibility to take those few extra seconds.
I have to thank Caz and Paul, friends of mine who were holidaying and staying with me this week. It made the transition to surgical internship much more enjoyable knowing I had something to come home to in the evening.
Two small plugs:
1) Masala Magic in Flemington - great, affordable Indian food.
2) Hyde bar on Russell St - managed by my fellow intern Marty, who was nice enough to hook me up on the guest list for the grand re-opening on Thursday. The decor was eclectic - plush couches sat next to thumping RnB, while Terracotta warriors sat at the bar either reading the random books about the place, or checking out the gorgeous bartenders. Caz, Paul and I turn up to see Marty sitting in the back corner with his posse looking like he's this town's Jay-Z and I think to myself that sometimes a little bling ain't a bad thing.
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