Smile

I got a call from my lovely friend Jaz tonight as she was concerned with the trend my posts were taking lately. I conceded that despite the blogs, life was all in all good - and in fact I could do a lot worse than to be catching up over the phone with an old friend. So, if I may return to my numbered list format for another time (and David Letterman be damned)

TOP TEN THINGS THAT MADE ME SMILE IN THE LAST TWO WEEKS

1. Jaz's phone call
   
2. More new pop music than you can throw a pre-fab Girlband (TM) at: Justin Timberlake's "FutureSex/LoveSounds" is, particularly in the middle section spiralling through "My Love", "LoveStoned/I think she knows" and "What Goes Around/Comes Around" a deliriously ambitious and entertaining opus; Beyonce's new "B'Day" is an efficient and slightly forgettable effort excepting the dirty blues of "Suga Mama"; Xtina's double CD "Back to Basics" is a bloated mess with so much "whoa-ooh-ooh" that you forget she actually got a nice voice (see "Save Me From Myself"); John Mayer's "Continuum" has, in "Heart of Life" and "Stop This Train" a beautiful return to "acoustic John", but the other tracks, while polished, lack the live, bluesy urgency that made "John Mayer Trio: Try! Live" such a revelation.
3. Visiting my friends Mr and Mrs Nickless who are expecting their first child in February - I'm glad there are some grown-ups in our group down herealthough I almost lost continence when said Mr Nickless decided that the layman's definition of "anal tag" would be what you swipe pass the barcode reader for the price of an old person (thank God for people who've worked retail)
4. When my med students looked at me like I was nuts but still cannulated me successfully on the first pass - so well that I had to forgive her for forgetting to take the torniquet off and letting me bleed over the table
   
5. Being approached at the hippy festival "Earthdance for Peace" by a girl selling No Sweat shoes made to protest sweatshop labour and having to shamefully admit to wearing a Converse T-shirt at the time
   
6. Elana Stone live at Bennett's Lane - if you're in Sydney you should try to catch her shows -see www.elanastone.com
7. Elixir live at Bennett's Lane - Katie Noonan's voice is so pure and so fluid that even when she's bending and contorting the words of a random poet into a folk tune it's a beautiful mess
8. Me and my brother laughing our heads off at the ridiculously brutal sound effects in the XBox boxing game Fight Night: Round 3
9. Australian Idol contestant Ricky Muscat's unbelievably HELTER SKELTER SERIAL KILLER EYES
   
10. Wondering each day whether the cute Eurasian Aged Care reg thinks me and the other intern on my unit are idiots, and wondering whether this might have proportional repercussions on any attempt to ask her to coffee (I know this is slightly sad, but I find I laugh at ridiculously sad things much more often than I should)

Oh, and the other thing. The things I posted about in the last blog are not unique to me. Many people are grinding away at it a lot harder than me. I've resolved to write to a newspaper, not just for me, but for all of us, and not for any special recognition, but just for a little bit of peace so we can get on with a job that is busy enough as it is. I'll keep you posted.

Thanks to everyone who has commented on this blog so far, particularly in the last few weeks. It's appreciated. And Jaz, stay wonderful.

Good luck to final year med students sitting exams soon, and I hope the interns got their jobs back.

Smiling, even though I've got to work tomorrow. :)

Worn

I am wearing thin.

It has continued to be hectic at work with much of the same old routine. We've had a roster change meaning that we work slightly less, and get paid less, so that we have enough money to pay for an extra registrar which on the whole is a Good Thing.

So I've not been worn down because of the usual scut, but by a rather malign reversal of the dictum that doctors need to empathize with patients and their families and "walk in their shoes."

The last couple of weeks have been characterized by demanding families belittling, insulting and otherwise degrading medical and nursing staff.

Amongst other things, events came to a head a few days ago when I had to try to obtain a Not For Resuscitation (NFR) order for one of our patients. A NFR order is a decision by medical staff to not use aggressive measures like CPR or ventilation machines on a patient in the event that their heart or lungs stop, with the reasoning that the potential benefits are miniscule and that the quality of life after such a resuscitation is extremely poor. We make this decision in consultation with the patient or the family of the patient.

It is NOT a decision by the staff that we do nothing. Non-invasive and conservative measures are all still applied as appropriate.

I had been warned by my registrar that this particular family would be difficult to convince of the validity of our position. I sat down on the phone with them, and over the course of an hour I tried to explain that our position on NFR for their relative came out of a desire to preserve quality of life and to avoid doing harm. I did my best to assure them that we were still committed to using all other measures at hand. I asked them to think about it and discuss it with me when they came in later.

When they came, I asked them if they understood our position. The grand-daugther replied to me,

"Basically, you're saying my grand-father's an old piece of shit and no-one wants to do anything."

She went on to complain at me about the nursing staff, who had just been trying to salvage a intra-venous cannula but who had unfortunately caused the patient some discomfort.

"Basically, everyone's the same, so many sick people you just don't care and it's just a job to you people."

I stood there with the nurse unit manager and we were both speechless. There are just so many things you want to say when somebody accuses you of not giving two shits, but when you're the representative of a hospital you kind of have to sit there and take it in the face. Or, more realistically, in the ass.

"I think it's really unnecessary that you just inflict pain. It's unnecessary that you just use him as a pin cushion and stick needles into him."

My mouth ground shut. It boggled my mind how this person could reason that we would be failing in our duty if we didn't jump on her grand-father's chest (and in the process of CPR probably break all his ribs) or shove a large tube into his windpipe in the event of an arrest, and then turn around and complain about us trying to put needles into him that deliver vital fluids and antibiotics.

No, it's not unnecessary that we stick needles into him. What would be unnecessary would be me, sticking a needle into myself.

So that's what I did. The next day I got my medical students to cannulate one of my veins to remind myself of what it feels like. The med students looked at me like I was nuts, but they did it anyway, because for a med student, a chance to cannulate is a Good Day. For the record, they got it, first pass, too.

And yeah, sure, it hurts a bit. But life hurts. In the recent push to make doctors drop their God complex people forget that doctors were never god in the first place:

A hospital is not a magical place where the laws of physics and reality stop. A hospital is not a magical place where the laws of economics and taxes stop.

When I say that I'm sorry that I couldn't get there sooner or that a nurse couldn't get there sooner it's not because I left my Sonic Hedgehog Running Shoes in my other pants and I'm lying to your face.

When you ask me "Why aren't there more nurses and doctors?" you forget two vital things. For one (If I may paraphrase Dr Bones McCoy from Star Trek) I'm a doctor, not a politician, nor a font of unending financial resources or the silver bullet to a flagging health system. If you've got problems with our health system, use your DEMOCRATIC RIGHT and tell your member of parliament. Don't tell me things I already know.

The other thing: The end of a 14 hour shift is ALWAYS the best time to tell a doctor that they don't care about their patients, it really is.

Swallowed

Gen Med is still running me like a bitch. I hesitate to really scream because it sounds like it was much, MUCH, worse the rotation prior to mine, and also because I just read esme and Dr J's blogs and the poor bastards are going through worse. But, like last post, a quick summary, in numbers:

1. 5 registrars in 2 weeks sucks hard. Less continuity and more dead-air time than a David "Mullholland Drive" Lynch movie. HOWEVER,the only thing that sucks harder than 5 registrars in 2 weeks is...
2. 0 (ZERO) registrars in the last 2 days.
3. 2 cute registrars (on other units), 1 cute physio and 2 cute nurses; however given the sleep-deprivation and general time-stress I've taken to smiling nervously and bowing my head like a pleb to their goddess each time I pass them in the corridor.
4. 2 young and very pretty female consultants, 1 of whom I confused for a medical student on the first day of the rotation (luckily I didn't say anything out loud). Seriously: this petite, slim Asian girl/woman strolled into the handover room wearing this woollen grey bob one piece skirt/dress, grey matching nylons, huge puffy handbag (I mean huge by "cutesy Asian" standards) and white heels. What else was I supposed to think?
5. 5 other cool interns (1 colleague on my team, 4 on other medical units)

It's not too bad, but when you get back home at 2200hrs and you find your similarly-aged neighbour is breakdancing in the car lot in the full moonlight just for the hell of it, you start to wonder where the fun is going in your life. Then, when he tells you he's already bought a house on a hill in New Zealand and he's going to move back there when he has a family, you wonder how some people managed to get smart. Not book smart. Just real smart.