There's an article about your accident in the local paper. If you look online, you can see there all the dozens of comments from you friends, family and colleagues. They talk about your heroism and humour and what they loved about you. I didn't know about this before. I wasn't sure of your name until now.
The last time I saw you, you were on the operating table. I'd followed you from ED to the theatre. You know, you've gained some fame in the hospital, because of how the trauma guy made your heart start again in ED by clamping your aorta! That was a small miracle in itself. We were all full of hope then, and I can tell you that there was a frantic effort to save you. The surgeons worked with fierce attention, I could tell even from outside the window. When they left, the intensivists took over the business of trying to keep you alive. They tried everything in the book and few things beyond. And then, finally, they stopped.
We watched as the monitor slowed and slowed and finally came to a flat line. It's the first time I've ever seen it happen that clearly. The cause of death was exsanguination, we were told by the anaesthetist. Bleeding out, bleeding in...blood in your belly and blood on the floor. It was an ugly way to go. I remember thinking, I hope those movies are wrong, the ones where the spirit hovers over the body immediately after death. I hope you didn't have to see yourself exposed, bloated, blue and bloody.
But you're probably wondering why I'm writing. It's out of remorse. I'm sorry I was a voyeur, along with so many others. It was a circus. I'm sorry I was pumped with adrenaline from the drama of the moment, because it made me callous. I examined my feelings in those early stages and it scares me that I couldn't find much sympathy for you. There was only a competitive desire to see what was going on, looking for a good vantage point. You were anonymous to me. I'd met your partner and the boy in the ED as well, but it hadn't clicked that you were part of the same accident...and when it did, I still couldn't feel their loss. I'm sorry that even as you were dying, I was fascinated and even a little thrilled to see how it happened. I'm sorry that the other students and I stood not even two feet from your body and chatted and laughed as though you weren't there. I don't even know if dignity in death is absurd or what, but your body was you not so long ago, and we should have respected that. I felt the wrongness but didn't act. I'm sorry that I've told your story to so many, as though you were my first battle scar. Even this is an example of that. I'm sorry it's taken so long for the meaning to sink in for me.
I've read that you too saw violence and death in your line of work. Did you ever imagine someone would be looking upon you as you looked upon the broken bodies of others? I guess the watchers must all eventually become the watched, in the end. I still can't quite connect what I know about you now, the dad and mate and husband you were, to what I saw that day. It's funny, because compared to everything you did before that day, your death was the smallest, least important event of your life. But it's become significant in mine.
What is there left to say? I never knew you. I'll remember you. RIP.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
Saturday, April 25, 2009
Friday, February 13, 2009
Gastro updates
The score so far:
Despite the moaning and nervous breakdowns, I'm nostalgic for last year. Armidale was awesome, VN quite fun, and even academic semester was satisfying cos I was knowledgable for a whole three minutes there before it all drained out the other ear. This year hasn't been bad so far, but there's the vague undercurrent of DESPERATE PANIC from being in 4th year and expected to, er, know stuff. Somehow 4th year sounds so much more almost-doctor than 3rd year, just as being 23 is uncomfortably close to "mid 20's" and ensuing QUARTER LIFE CRISIS (part the umpteenth).
But all is well. I now know how to stop a nosebleed in a sheep. We had an ENT session with decapitated sheep heads (is that redundant?) at the morgue - this involved practising stuffing gauze up their noses. Should come in handy in rurality one day.
- Runaway patients: 1
- Birthday cakes eaten on ward: 1 (yay Woolies)
- Practice long cases done: 0 (arghhhh final week soon!! where did the month go?!)
- Ascitic taps done by me: about 3-4, lost count
- Traumatic ascitic taps done by me: 1 (so not my fault, patient was sat up....)
- Ascitic taps removed by the patient themselves: 1 (see: runaway)
- IV cannulas inserted: 1
- IV cannulas attempted: 3
- Patients presenting with alcoholic livers, GI haemorrhages, or combination of the above: ALL OF THEM, it feels like.
- Liver biopsies seen: 2
- Colonoscopies seen: 2
- Colonoscopies in which patient semi woke up: 1
- Emergency gastroscopies in which patient melaena'd on bed and had to be held down by three people: 1 (too many)
- Attempts taken to do a MMSE on a grumpy old lady: 2, with much cajoling.
- Patients successfully discharge-counselled: 1 (take your drugs, go to your appointments, stop that drinking, limit fluids)
- Longest stretch without seeing consultants: 1 week
- Pathology forms filled out: 127836987236874 (we are the intern's bitch)
- Items carried at one time: too many. OHCM, clipboard, notebook, steth, pen, mini handbag, charts
- Free food: less than expected. WTF, hospital?
Despite the moaning and nervous breakdowns, I'm nostalgic for last year. Armidale was awesome, VN quite fun, and even academic semester was satisfying cos I was knowledgable for a whole three minutes there before it all drained out the other ear. This year hasn't been bad so far, but there's the vague undercurrent of DESPERATE PANIC from being in 4th year and expected to, er, know stuff. Somehow 4th year sounds so much more almost-doctor than 3rd year, just as being 23 is uncomfortably close to "mid 20's" and ensuing QUARTER LIFE CRISIS (part the umpteenth).
But all is well. I now know how to stop a nosebleed in a sheep. We had an ENT session with decapitated sheep heads (is that redundant?) at the morgue - this involved practising stuffing gauze up their noses. Should come in handy in rurality one day.
Tuesday, January 27, 2009
First day of school
Sorry for the temporary break in programming! Ah, summer holidays, we hardly knew you. School started today already. TOO. SOON. It was a weird day. The morning was spent in (dis)orientation: fire safety, vaccination check, infection control. Then we were unceremoniously kicked off the branch and told to fly. No timetable, wrong contact details for supervisor, and instructions vaguely to "attach yourself to the team". Er. Even though I've done Armidale and Vietnam and have been at this hospital before during years 1-3, it still feels like I'm going to kindy for the first time and need mummy to hold my hand. Vietnam ED was different, there was only one place to go and what to do was pretty obvious. Armidale was tiny and everyone knew who we were. Here: big pond, small fish. Not even, more like a small anemone. How is one meant to fill the days?! It seems a bit "rock up to whatever you want to".
Anyhow. A bit too sleepy for full sentences, so here comes random listiness galore. What I Did On the Holidays:
Met a few interesting characters lately. My landlady is one of those people one can only call "decent" - you know, good in an uncomplicated way. She brought me juice and bus timetables with bits highlighted and a tin of cookies. Come to think of it, I should bake something for her, right? That's neighbourly. She's a 60something widow, formerly a nurse. Her sons, who came over to move the fridge in for me, are of that hardy, handy, decent stock of Real Aussie Bloke, tempered with a bit of 21st century snagginess - one of them is a yoga teacher. There's also a blond, angelic 2yo grandson who talked to me about the circus. How do these people exist in the world? A family where the sons come over to cut trees for their mum on the weekend?
Then one of the patients I met today was an incredibly sweet woman. Seriously, you only need look at her and she smiles this great big infectious grin at you that exudes genuine warmth. She's also an alcoholic with decompensating liver failure. Huh?
Too tired to make a point. Fingers crossed the net works.
Anyhow. A bit too sleepy for full sentences, so here comes random listiness galore. What I Did On the Holidays:
- Bought myself an iPod. And hence....
- ...listened to all 7 Harry Potter audiobooks. American version + British reader = things like "jello" and "sweater" read in a British accent. Just...no. Still, it was awesome and I'm having the same pangs I had when I was 4 and really really into Alice in Wonderland: dammit why can't it be real! I wanna fly on a broom.
- Listened to a crapload of podcasts. This American Life, Enough Rope, TED.
- Went to the Gold Coast. Tanned a lot. Beached some more in Sydney.
- Saw Cate Blanchett et al in an 8-hour Shakespeare play, War of the Roses. I heart her.
- Went to Jazz in the Domain (Gypsy Kings and Queens) and Festival First Night (Grace Jones) and camped out at Milson's Point for the fireworks. Sorry Melbourne, Sydney wins in summer.
- Stressed out from last-minute house-hunting. Currently in a literal granny flat (a granny's upstairs) near hospital. On the plus side, I have it all to myself. On the minus, I have it all to myself.
- Spent Chinese New Year / Australia Day alone, shopping at Aldi to stock up the new place. SAD.
- Quickly cycled through several phases: musical (guitar, ukulele), DVDs (The Office, Blackadder, some Sopranos, West Wing again)
- Shopped far too much. Not buying that much, just being dragged by mothership and stepdorkship. Talk about a consumerist rut.
- Did buy a haul of books. That new orange-covered Penguin modern classics series is so tempting. Only 10 dollar, lah! I'm partway through half a dozen books. Attention span of a....hmm?
- Avoided doing lots of things I should've. Like studying.
- Had a wisdom tooth out
Met a few interesting characters lately. My landlady is one of those people one can only call "decent" - you know, good in an uncomplicated way. She brought me juice and bus timetables with bits highlighted and a tin of cookies. Come to think of it, I should bake something for her, right? That's neighbourly. She's a 60something widow, formerly a nurse. Her sons, who came over to move the fridge in for me, are of that hardy, handy, decent stock of Real Aussie Bloke, tempered with a bit of 21st century snagginess - one of them is a yoga teacher. There's also a blond, angelic 2yo grandson who talked to me about the circus. How do these people exist in the world? A family where the sons come over to cut trees for their mum on the weekend?
Then one of the patients I met today was an incredibly sweet woman. Seriously, you only need look at her and she smiles this great big infectious grin at you that exudes genuine warmth. She's also an alcoholic with decompensating liver failure. Huh?
Too tired to make a point. Fingers crossed the net works.
Wednesday, November 12, 2008
It's a....squalling purple thing!
So I've been pretty crap at blogging Vietnam! I blame the shitbox wifi in my room. Sitting downstairs now glaring at my battery meter.
GUESS WHAT. Today I went to an obstetrics hospital. Borrowed scrubs and a student ID so I wouldn't look too conspicuous. What, that's totally legit!
It was awesome! And a little bit icky. But mostly awesome. I saw four births: one immediately afterwards (placenta still on the way), one C-section and two from start to finish. That is, we had a look of them before the "pushpushush!! HARDER! you can do better than that!!!" started. I even, ahem, assisted on one. That's to say, I felt the belly to see when it was taut, and was meant to yell at the mother to push and tap on the belly to help the contractions, except I was kinda shy and didn't fully understand the instructions.
The actual process of childbirth looks, um, kind of painful. When it's my turn, give me the frigging drugs already! And the cutting and sewing bit - only under lidocaine here - seems like torture. Eww. And the delivery suite wasn't very friendly. Women just lying there with their legs open, no one paying much attention to them. Is that the way to welcome a new life into the world? I entertained notions of having a hippie, birthing centre, water-birth, midwife type of thing, but then I can't be a doctor and forsake western medicine entirely hey. Maybe a hippie birthing centre next door to a major tertiary hospital. Also, yknow what? Newborns are so not cute. Maybe after they're cleaned up and oxygenated, not so much when cone-headed and purple and covered with dodgy slime and being held upside-down by the legs by a midwife who's suctioning said dodgy slime from its nose, mouth, and anus by the same apparatus (yes IN THAT ORDER, thank god).
My Viet student friend ultrasounded another woman's belly and after mucking around for a while trying to find it, we finally got the heartbeat. The mother's face lit up, as no doubt mothers' faces everywhere light up. My "omfg that rocks!!" grin was reflected in her face.
GUESS WHAT. Today I went to an obstetrics hospital. Borrowed scrubs and a student ID so I wouldn't look too conspicuous. What, that's totally legit!
It was awesome! And a little bit icky. But mostly awesome. I saw four births: one immediately afterwards (placenta still on the way), one C-section and two from start to finish. That is, we had a look of them before the "pushpushush!! HARDER! you can do better than that!!!" started. I even, ahem, assisted on one. That's to say, I felt the belly to see when it was taut, and was meant to yell at the mother to push and tap on the belly to help the contractions, except I was kinda shy and didn't fully understand the instructions.
The actual process of childbirth looks, um, kind of painful. When it's my turn, give me the frigging drugs already! And the cutting and sewing bit - only under lidocaine here - seems like torture. Eww. And the delivery suite wasn't very friendly. Women just lying there with their legs open, no one paying much attention to them. Is that the way to welcome a new life into the world? I entertained notions of having a hippie, birthing centre, water-birth, midwife type of thing, but then I can't be a doctor and forsake western medicine entirely hey. Maybe a hippie birthing centre next door to a major tertiary hospital. Also, yknow what? Newborns are so not cute. Maybe after they're cleaned up and oxygenated, not so much when cone-headed and purple and covered with dodgy slime and being held upside-down by the legs by a midwife who's suctioning said dodgy slime from its nose, mouth, and anus by the same apparatus (yes IN THAT ORDER, thank god).
My Viet student friend ultrasounded another woman's belly and after mucking around for a while trying to find it, we finally got the heartbeat. The mother's face lit up, as no doubt mothers' faces everywhere light up. My "omfg that rocks!!" grin was reflected in her face.
Monday, October 13, 2008
All in a day's work
Meals eaten in the last 48 hours: 2.
Sleep in the last 48 hours: 13. (3 + 10)
Self-medication (opiates! wheee!): lost count.
Dead people seen: lost count.
Open heart surgeries witnessed: 2.
I got up - note, not woke up - this morning. Showered. Put on my pants. Took off my pants because they had a dead woman's blood on them. Rummaged the laundry basket for my relatively cleaner white coat, the one that's not also contaminated by bodily fluids (at least not visibly). Swallowed codeine. Jumped on a taxi.
I was wrong, or unconsciously taking poetic license, because the floor and walls of ED are not white, but light grey, though they are indeed reflective. When I first came in the room was quite empty. God must've wanted to punish me for thinking so because before 9am there were already at least two brain-dead (I checked their pupils), a swathe of old people, five or so parties involved in a stabbing, an emaciated 30-something with massive cirrhosis, a maybe renal colic and more. One of the patients was about to be certified dead until he started breathing on his own! But I think he was still gone. All that before breakfast.
I haven't learned enough about death. I mean the clinical side of it. There was probably a learning target in first year that I pooh-pooh'd as fluff, but it's critical. When to stop CPR. When there's no hope of return. This is something that happens daily here. The first few days I just walked by the mini-ICU in ED a few times, not really knowing what was going on, but now I realise that the air pumping and chest thumping is most likely to be fruitless. My PBL training leads to determining causes, mechanisms and solutions, but leaves me high and dry when it comes to The End. As for the personal side....seeing the relatives grieving shook me up a bit, but the thing is, when someone's brought in barely alive, the transition to mostly dead isn't that obvious.
There wasn't a whole lot for me to do and I think Mr Intern wanted to give me a break from, yknow, death and destruction, so he took me upstairs to the cardiac surgery department. So, c'est vrai, surgery is just cutting stuff up then sewing it back together...but when the "stuff" is a LIVING BEATING HEART....dude, that is wicked rad. The heart guys are cooler than the ortho surgeons as well - the professor (God Himself) joked with me in excellent English and another one explained the repair of a Fallot's Tetralogy. When I started hacking up my lungs and swaying, I thought that was time to retreat.
My intern is becoming a friend. Imagine a small, deft, fine-fingered fellow with blinky myopic eyes behind thick glasses, square-cut hair, conscientious, finicky with hygiene at mealtimes and in surgery as befits an open heart surgeon to be. He spends his spare time studying (I KNOW!) and playing soccer and stuff with his friends, sometimes martial arts. He's so cute and gentlemanly - took me to the coughfakebookshopcough today and even offered to pay, and then drove me home. And he's a role model now too. He actually cares for his patients, in a setting where that's hard to do, and he is always seeking to learn more. Now I go around stage-whispering "he's a darling!". I sense he's got a little in reserve but I don't think this idol will turn out to have clay feet.
You know what I've been thinking about? Here doctors are really poorly remunerated, yet patients can still get an excellent standard of care. I have to give Mr Ortho props for the six gruelling hours he spent on that thumb...it only garnered him about 75 000 VND, which is about $7 AUD. The buying power isn't a lot either, given that a hospital lunch is about 30 000 VND. He could've just stitched the thumb on for aesthetic purposes, but instead took great care in connecting each tiny vessel and nerve. And Mr Intern probably gets paid even worse, but he stays overtime to make sure that his patients survive the handover and is meticulous in examining them. I've been taught (brainwashed) to think that a nation without rule of law must be corrupt and collapsing, each man for himself - and indeed there are horror stories about doctors giving sloppy care or sending patients for unnecessary operations because they have side deals with specialists. But there remains the integrity of individuals, the drive to excel at one's work and do good. It's heartening.
Sleep in the last 48 hours: 13. (3 + 10)
Self-medication (opiates! wheee!): lost count.
Dead people seen: lost count.
Open heart surgeries witnessed: 2.
I got up - note, not woke up - this morning. Showered. Put on my pants. Took off my pants because they had a dead woman's blood on them. Rummaged the laundry basket for my relatively cleaner white coat, the one that's not also contaminated by bodily fluids (at least not visibly). Swallowed codeine. Jumped on a taxi.
I was wrong, or unconsciously taking poetic license, because the floor and walls of ED are not white, but light grey, though they are indeed reflective. When I first came in the room was quite empty. God must've wanted to punish me for thinking so because before 9am there were already at least two brain-dead (I checked their pupils), a swathe of old people, five or so parties involved in a stabbing, an emaciated 30-something with massive cirrhosis, a maybe renal colic and more. One of the patients was about to be certified dead until he started breathing on his own! But I think he was still gone. All that before breakfast.
I haven't learned enough about death. I mean the clinical side of it. There was probably a learning target in first year that I pooh-pooh'd as fluff, but it's critical. When to stop CPR. When there's no hope of return. This is something that happens daily here. The first few days I just walked by the mini-ICU in ED a few times, not really knowing what was going on, but now I realise that the air pumping and chest thumping is most likely to be fruitless. My PBL training leads to determining causes, mechanisms and solutions, but leaves me high and dry when it comes to The End. As for the personal side....seeing the relatives grieving shook me up a bit, but the thing is, when someone's brought in barely alive, the transition to mostly dead isn't that obvious.
There wasn't a whole lot for me to do and I think Mr Intern wanted to give me a break from, yknow, death and destruction, so he took me upstairs to the cardiac surgery department. So, c'est vrai, surgery is just cutting stuff up then sewing it back together...but when the "stuff" is a LIVING BEATING HEART....dude, that is wicked rad. The heart guys are cooler than the ortho surgeons as well - the professor (God Himself) joked with me in excellent English and another one explained the repair of a Fallot's Tetralogy. When I started hacking up my lungs and swaying, I thought that was time to retreat.
My intern is becoming a friend. Imagine a small, deft, fine-fingered fellow with blinky myopic eyes behind thick glasses, square-cut hair, conscientious, finicky with hygiene at mealtimes and in surgery as befits an open heart surgeon to be. He spends his spare time studying (I KNOW!) and playing soccer and stuff with his friends, sometimes martial arts. He's so cute and gentlemanly - took me to the coughfakebookshopcough today and even offered to pay, and then drove me home. And he's a role model now too. He actually cares for his patients, in a setting where that's hard to do, and he is always seeking to learn more. Now I go around stage-whispering "he's a darling!". I sense he's got a little in reserve but I don't think this idol will turn out to have clay feet.
You know what I've been thinking about? Here doctors are really poorly remunerated, yet patients can still get an excellent standard of care. I have to give Mr Ortho props for the six gruelling hours he spent on that thumb...it only garnered him about 75 000 VND, which is about $7 AUD. The buying power isn't a lot either, given that a hospital lunch is about 30 000 VND. He could've just stitched the thumb on for aesthetic purposes, but instead took great care in connecting each tiny vessel and nerve. And Mr Intern probably gets paid even worse, but he stays overtime to make sure that his patients survive the handover and is meticulous in examining them. I've been taught (brainwashed) to think that a nation without rule of law must be corrupt and collapsing, each man for himself - and indeed there are horror stories about doctors giving sloppy care or sending patients for unnecessary operations because they have side deals with specialists. But there remains the integrity of individuals, the drive to excel at one's work and do good. It's heartening.
Unbearable whiteness of being
Home from my first ever graveyard shift in ED. It was a warzone last night. The combination of weekend drink-driving, rain and a motorbike nation is deadly. The room was full of head injuries, people vomiting and seizing and yelling and moaning and banging on their stretchers, many crudely restrained with their limbs tied to the the bed. Ears ripped off, partly severed fingers dangling, faces disfigured from swelling. Twice, power failures plunged us all into darkness. Patients and relatives kept clutching at me, "doctor, my arm is so sore, what can you do doctor", "doctor, help my son, please doctor", "doctor, the drip doesn't work". I don't know why they chose me out of the other students there - maybe because I look older, or because I'm not wearing the blue-striped coat that Viet students wear, or maybe because I haven't learnt the art of ignoring yet and still make eye contact. I felt helpless before such need, not having any answers, not knowing who to tell - just starting to get to recgonise the staff here. I didn't know whether to pass on their pleas or not? To my shame, in some cases I didn't do anything. But in the end I decided this was cowardice; it cost me nothing to ask. I napped a few fitful hours in the nurses' change room and wondered at how they could wake up immediately, get themselves impeccably neat, and head back into the fray at ungodly o'clock. It's practically heroic.
I did CPR for the first time on a real person. She was a middle-aged Jane Doe, with hair and skin tone revealing that she was probably a daughter of the war, half GI, half Vietnamese. Her feet were already blue. She had blood coming from her face; I couldn't tell if her upper lip was still there or not. The contents of her pockets were thrown on a tray: a wad of paper money, some silver jewellery, but no ID. I got some of her blood on my coat. When I returned from getting a scrub top from theatre as replacement, she was under a white sheet. Another first.
If this sounds emotionally flat, it is because I am. I'm washed out from the flu and from...I dunno, what's the noun for overwhelming? That. I'm curiously untraumatised. The glaring clinical whiteness of the ED - white-uniformed nurses, blinding white lights, reflective white floor, white walls, white doctors' coats - contrasts weirdly with the broken bodies lying there in pools of their own blood. It contributes to a sense of removal. Sure, I connected to a few people I interviewed and examined, but the innumberable semi-conscious head-injured started to blend in to each other, an undifferentiated mass of Them.
I'd like to say I feel that I've lost something, but I'm just tired.
I did CPR for the first time on a real person. She was a middle-aged Jane Doe, with hair and skin tone revealing that she was probably a daughter of the war, half GI, half Vietnamese. Her feet were already blue. She had blood coming from her face; I couldn't tell if her upper lip was still there or not. The contents of her pockets were thrown on a tray: a wad of paper money, some silver jewellery, but no ID. I got some of her blood on my coat. When I returned from getting a scrub top from theatre as replacement, she was under a white sheet. Another first.
If this sounds emotionally flat, it is because I am. I'm washed out from the flu and from...I dunno, what's the noun for overwhelming? That. I'm curiously untraumatised. The glaring clinical whiteness of the ED - white-uniformed nurses, blinding white lights, reflective white floor, white walls, white doctors' coats - contrasts weirdly with the broken bodies lying there in pools of their own blood. It contributes to a sense of removal. Sure, I connected to a few people I interviewed and examined, but the innumberable semi-conscious head-injured started to blend in to each other, an undifferentiated mass of Them.
I'd like to say I feel that I've lost something, but I'm just tired.
Saturday, October 11, 2008
Bones and groans
Well I had a long rant yesterday that is Saved As Draft, and there shall it remain. Long story short: morning spent wrangling with bureaucracy. Brief period of awesome when I finally got things sorted and was introduced to ED (English speaking! program for international students! assigned to people who are keen to teach!). Invited to "dinner" by a young gentleman - actually lunch at about 10.30 in the morning. Nerdy, nice, semi-weird (check check check) but alas, a foot shorter than me. Then I was hauled off by Mr Ortho to see hand surgery. Ok, so seeing a thumb COMPLETELY SEVERED cleanly like an anatomical diagram, with the loose bit covered in ants, was pretty cool/gross. And the patient semi waking up mid-surgery was...interesting. But most of the SIX HOURS was watching someone poke at something invisible with something invisible - microsurgery. And then the rest of the night was also spent in ortho feeling like a useless sack because I can't for the life of me understand mask-muffled franglovietnamese instructions. Didn't help that the flipside of Mr Ortho's Alpha qualities (decisiveness, vigour) is impatient assholicness that rears its fugly head in theatre. At the end - 11pm, because I was going to stay with him on 24 hour call but threw in the towel - he said "the best thing I've seen you do all day is holding legs". A job a block of wood can do! Could've been more useful with a five minute tutorial on what's expected of me and what the bits and pieces are called, but no, I'm sure letting people know they're tards is a better way of getting things done. Well screw you, Mr Ortho, and screw your specialty. It's a waste of intelligence - glorified carpentry. After something like twelve hours, I'd be happy never to see any ortho surgery again in my life. I came home pissed off and depressed.
Did I say short? Heh. Still had some rant left in me.
However, today was fantastico. Worked the 2.30-9pm shift in ED, which meant yay extra sleep! But really, I heart ED. Instead of cursing my lack of Viet abilities, for once I was glad of what little I have, as I was able to take pretty decent histories. Really don't know how international students cope here, when history is like 80% of diagnosis, and so much learning requires explanation. (Not to discourage anyone who's planning to come here! depends on the program, staff and department I guess). I got to do a few procedures like blood-taking, IV cannulation (1/2 tries - better than my 1/6 record in Armi) and suturing, which is always funzies. And saw stuff like a pneumothorax, CPR, CVP measuring, emergency intubation, acute glaucoma and paraquat poisoning. ED is where the medicine is: a bit of everything, fresh patients, mysteries to figure out. A thrillion times better than bones bones bones!
Did I say short? Heh. Still had some rant left in me.
However, today was fantastico. Worked the 2.30-9pm shift in ED, which meant yay extra sleep! But really, I heart ED. Instead of cursing my lack of Viet abilities, for once I was glad of what little I have, as I was able to take pretty decent histories. Really don't know how international students cope here, when history is like 80% of diagnosis, and so much learning requires explanation. (Not to discourage anyone who's planning to come here! depends on the program, staff and department I guess). I got to do a few procedures like blood-taking, IV cannulation (1/2 tries - better than my 1/6 record in Armi) and suturing, which is always funzies. And saw stuff like a pneumothorax, CPR, CVP measuring, emergency intubation, acute glaucoma and paraquat poisoning. ED is where the medicine is: a bit of everything, fresh patients, mysteries to figure out. A thrillion times better than bones bones bones!
Wednesday, October 8, 2008
Hog thoughts
This blog is going to be more of a pressure valve than ever, given that it's one of the only links to the English-speaking world I've got here. Translation: aquackening will be even more wanktastic than usual! I find when I'm isolated for too long I get all self-loathing and angsty. Will ask training dude about international students to befriend.
Musings from the back of a motorbike:
Musings from the back of a motorbike:
- From the Idiot's Guide to Idiocy: riding a motorbike just after you've come from a ward full of people with pins and contraptions on their limbs, and surgery where you saw hammers, chisels, screwdrivers, power drills, pliers and nails applied to a HUMAN BODY - most as a result of motorbike accidents. Own damn fault if anything happens. But taxis are hard to catch back from hospital and slow and you don't get to ZOOMZOOM with the wind in your face.
- Orthopaedics is just like mechanics except you're not allowed to scratch your nose. Ohmygod. The no-scratch thing should be used in Gitmo, it is serious torture. I'm going to invent a surgical itch stick.
- Finally I know why everyone always think my name is Thuy Tien instead of Thao - for some reason Thuy Tien is the preferred name for dozens and dozens of restaurants here. FYI people: I do not serve pho.
- Are you supposed to lean into bends or against them?! I reckon the former, but that's based on a half-remembered bit from The History Boys where the smarmy new teacher gets paralysed because he's unused to riding on the back of Mr History's bike (on which Mr History takes boys and feels them up). Um. I think. Alan Bennett: my life is in your hands.
- My Viet is sometimes taken for native, and yet at other times entire sections of conversation whizz over my head because I don't understand key words, or I misunderstand and answer some totally different question. In the Romance languages, even those I don't know well, at least educated guessing is possible, but in Viet the etymology is often from Chinese, so all that's possible is a dopey Huh?! face. Serious damper on personality.
Friday, September 19, 2008
Before and after
One thing I've been noticing lately is that I have to stop and concentrate hard to remember what it was like being a layperson. Did I know what a clavicle or myocardial infarction was? How lungs work? What viruses and bacteria are? A lady recently asked the doctor how you get oxygen into your blood, and a guy asked whether you can trace the source of bacteria from a swab. Certainly the fact that antibiotics are for bacteria only clicked in med school for me.
It goes further than just knowledge, though. It's being grossed out - or not - by certain things. I don't blink an eye at blood or guts or vaginas, but purulent wounds still make me go ick. Can't remember if I used to be affected by such things. It's how I feel about hospitals nowadays. For normals, they can be a place of fear and grief. The feelings of claustrophobia, displacement and unease from when my grandma was sick occasionally come back to me: all those depressing neon lights, haggard faces and barely masked smells. After Armidale though, I feel at home in hospitals - even theatre is now familiar and cool. They've become a place of learning, where we seek out interesting and fun experiences - and some of those interesting and fun things are other people's illnesses. Kinda twisted really. I've never been an inpatient before (except as a hairy-backed preemie), and I imagine it's got to be disorienting. I remember, in law we read some Foucault, about the parallels between hospital and prison. You're stripped of power, put in a uniform, your movement is restricted, you live by others' schedules, people do things to you which you mightn't fully understand or consent to, and you're surveyed day and night.
In politics one of my lecturers talked about how it's difficult for democracies to fight in asymmetrical wars because citizens generally aren't happy to send their sons off to commit the brutalities that are often unavoidable when you're fighting unconventional forces (NB: much is debatable there bien sur). Obviously, this theory was derived from Vietnam-type conflicts. The way around this is professional standing armies, as opposed to concripts. You separate citizens from civil society to a boot camp in the bush, teach them loyalty to each other and the institution, show them how to function in extreme circumstances.
I find this an apt analogy for med school, in particular clinical rotations. Besides the teaching of facts and skills, they help to transform us from wet-eared civvies into hard-assed troops. You learn the ethos, conventions, secret language, and see and perform things that would be considered horrors in other settings. Sticking a needle in someone's back or a finger in their bum. Cutting them open, exposing organs, then shoving everything back in again. Kinda absurd if you think about it. What's amazing is that this sort of initiation isn't uncommon. Nurses, undertakers, cops, firemen, carers, social workers, vets, soldiers, hell even dunny cleaners! Entire classes of otherwise normal people to whom weird-to-Joe-Average things are routine.
Some of the hardening is necessary of course. You can't have a doctor getting disgusted or freaked out every time they come across an anal abscess or something. But it's also a bit dehumanising, because dodging the discomfort of the situation also disconnects you from the patient's experience. I reckon it's a good thing to stand back once in a while and think, yeah, to normal people, this here is weird, embarassing, absurd, scary or gross. Like taking your own pulse, it tethers you back to your own humanity, the kid who lurks behind the professional.
It goes further than just knowledge, though. It's being grossed out - or not - by certain things. I don't blink an eye at blood or guts or vaginas, but purulent wounds still make me go ick. Can't remember if I used to be affected by such things. It's how I feel about hospitals nowadays. For normals, they can be a place of fear and grief. The feelings of claustrophobia, displacement and unease from when my grandma was sick occasionally come back to me: all those depressing neon lights, haggard faces and barely masked smells. After Armidale though, I feel at home in hospitals - even theatre is now familiar and cool. They've become a place of learning, where we seek out interesting and fun experiences - and some of those interesting and fun things are other people's illnesses. Kinda twisted really. I've never been an inpatient before (except as a hairy-backed preemie), and I imagine it's got to be disorienting. I remember, in law we read some Foucault, about the parallels between hospital and prison. You're stripped of power, put in a uniform, your movement is restricted, you live by others' schedules, people do things to you which you mightn't fully understand or consent to, and you're surveyed day and night.
In politics one of my lecturers talked about how it's difficult for democracies to fight in asymmetrical wars because citizens generally aren't happy to send their sons off to commit the brutalities that are often unavoidable when you're fighting unconventional forces (NB: much is debatable there bien sur). Obviously, this theory was derived from Vietnam-type conflicts. The way around this is professional standing armies, as opposed to concripts. You separate citizens from civil society to a boot camp in the bush, teach them loyalty to each other and the institution, show them how to function in extreme circumstances.
I find this an apt analogy for med school, in particular clinical rotations. Besides the teaching of facts and skills, they help to transform us from wet-eared civvies into hard-assed troops. You learn the ethos, conventions, secret language, and see and perform things that would be considered horrors in other settings. Sticking a needle in someone's back or a finger in their bum. Cutting them open, exposing organs, then shoving everything back in again. Kinda absurd if you think about it. What's amazing is that this sort of initiation isn't uncommon. Nurses, undertakers, cops, firemen, carers, social workers, vets, soldiers, hell even dunny cleaners! Entire classes of otherwise normal people to whom weird-to-Joe-Average things are routine.
Some of the hardening is necessary of course. You can't have a doctor getting disgusted or freaked out every time they come across an anal abscess or something. But it's also a bit dehumanising, because dodging the discomfort of the situation also disconnects you from the patient's experience. I reckon it's a good thing to stand back once in a while and think, yeah, to normal people, this here is weird, embarassing, absurd, scary or gross. Like taking your own pulse, it tethers you back to your own humanity, the kid who lurks behind the professional.
Monday, September 15, 2008
Teo and tangents
So I just finished watching the Enough Rope interview with Maverick Neurosurgeon Charlie Teo. Thought-provoking stuff. If you don't know his background, read on at Australian Story and Enough Rope.
The name Charlie Teo first crossed my consciousness this year, when I met one of his patients during my rural GP week. She'd had a tumour on her spinal cord and was handballed between various surgeons who told her it was impossible to remove. None of them mentioned Teo, the surgeon who was willing to operate on the inoperable. They were finally referred to him when the tumour was far advanced. They got to him just in time to save her life, but she was already a quadriplegic at that point. This lady and her husband were fair dinkum Aussie Battlers, and I say that without irony. Her husband had his own health problems - chronic severe back pain, multiple injuries from past car accidents, and was visiting the GP with pneumonia, requiring hospitalisation - but still managed to care for her full time. Despite their ordeals, they were philosophical, not at all self-pitying, and deeply committed to each other in an unsentimental, no-nonsense way.
To me, the Outcast Teo vs Medical Fraternity fracas highlights the contradictions in our noble profession. Questioning the validity of Teo's techniques is justifiable, but the visceral hatred he seems to evoke from the establishment goes far beyond the scientific. It comes from something baser, something like insecurity and jealousy and resentment.
See, on one hand there are the bright lights - doctors who inspire with their integrity, passion, intellectual precision, curiosity, compassion, humility, dedication and conscientiousness. I've seen these qualities in doctors at all levels, from humble residents, to GPs, to consultants (ie. Gods). I see the potential in many of my fellow students. The docs I had in Armidale were awesome. Being a small hospital, the structure was really flat - consultants actually deigned to talk to us lowly students and treated us as really really really junior colleagues. And they could teach, hallelujah!
On the other hand, I'm always wondering what patients would think if they really knew what doctors are like backstage. They are given so much trust, and abuse of that trust is so commonplace. Not so much the Dr Evil "mutilating genitals during surgery for kicks" kind of thing, but insidious, small betrayals. Using big words to take advantage of patients' ignorance. Never, ever saying "I don't know". Making referrals to specialists who've been nice to you, or not making referrals to specialists who've slighted you once. Putting on a façade of professional reassurance, only to talk crap about them behind their back. Using bias-based, not evidence-based medicine. Blaming patients for depression or addiction. Being careless with infection control. Doing tests or procedures that aren't strictly necessary to cover your own ass or make a bigger buck. Never admitting mistakes. Writing off some patients as basket cases, too hard, or not worth the bother. Aiming for "good enough not to be sued" rather than best care. I could go on and on. And the personalities, god, the personalities. Impenetrable vanity, arrogance, selfishness, apathy, laziness, bullying. I mean, I'm sure these things occur in all professions - petty rivalries and so forth. But people's LIVES aren't at stake in other professions, people's lives don't depend on whether Dr X's pride has been wounded or not.
I'm on Flynnie placement yet again, and in moments of particularly brain-numbing boredom I fantasise about the scathing portrait of my boss' foibles I'm going to write. A by-product of observing him for most of my waking hours. Let me try to capture some of his flavour. Our protagonist is a late-40's American ex-surgeon, a footballer who injured himself out of a career in college, dressed in all-American blue jeans and polo shirts. Adopts a folksy straight-shooting manner but bullshits his way around questions he can't answer ("What's idioventricular mean? It's something that's not working like it's supposed to. Like idiopathic, idiosyncrasy, one of those old Greek word things"). FoxNews devotee, son of a blue-collar worker, now multi-millionaire, casually racist ("Med school was so hard back in the day that two guys from my class killed themselves. Just couldn't hack the pace. They were both Arabs from Pakistan or something. Good thing too. Those people are all terrorists in the making"). He's threatened by and contemptuous of anyone who dares question his authority by showing any knowledge about their condition or using alternative therapies . Starts lots of sentences with "In medicine...", eg. "In medicine, this is called a puritic [sic] rash". Writes referral letters with really bad spelling and grammar. Asks "guess what I'm thinking!" kinds of questions to show off his knowledge or exert his power rather than actually discussing or teaching. Is impervious to student's eyes glazing over during his lengthy Pearls O' Homegrown Wisdom About Medicine - which he repeats. A lot.
A recent consultation went like this. A gentle, child-of-hippies type of woman comes in with diarrhoea and constipation.
Praps I have this impossible ideal of Perfect Doctor - one that others, and no doubt I myself, will constantly fall short of. But the standard's got to be at least: "how would I like to be treated? what if it was my grandma?".
The name Charlie Teo first crossed my consciousness this year, when I met one of his patients during my rural GP week. She'd had a tumour on her spinal cord and was handballed between various surgeons who told her it was impossible to remove. None of them mentioned Teo, the surgeon who was willing to operate on the inoperable. They were finally referred to him when the tumour was far advanced. They got to him just in time to save her life, but she was already a quadriplegic at that point. This lady and her husband were fair dinkum Aussie Battlers, and I say that without irony. Her husband had his own health problems - chronic severe back pain, multiple injuries from past car accidents, and was visiting the GP with pneumonia, requiring hospitalisation - but still managed to care for her full time. Despite their ordeals, they were philosophical, not at all self-pitying, and deeply committed to each other in an unsentimental, no-nonsense way.
To me, the Outcast Teo vs Medical Fraternity fracas highlights the contradictions in our noble profession. Questioning the validity of Teo's techniques is justifiable, but the visceral hatred he seems to evoke from the establishment goes far beyond the scientific. It comes from something baser, something like insecurity and jealousy and resentment.
See, on one hand there are the bright lights - doctors who inspire with their integrity, passion, intellectual precision, curiosity, compassion, humility, dedication and conscientiousness. I've seen these qualities in doctors at all levels, from humble residents, to GPs, to consultants (ie. Gods). I see the potential in many of my fellow students. The docs I had in Armidale were awesome. Being a small hospital, the structure was really flat - consultants actually deigned to talk to us lowly students and treated us as really really really junior colleagues. And they could teach, hallelujah!
On the other hand, I'm always wondering what patients would think if they really knew what doctors are like backstage. They are given so much trust, and abuse of that trust is so commonplace. Not so much the Dr Evil "mutilating genitals during surgery for kicks" kind of thing, but insidious, small betrayals. Using big words to take advantage of patients' ignorance. Never, ever saying "I don't know". Making referrals to specialists who've been nice to you, or not making referrals to specialists who've slighted you once. Putting on a façade of professional reassurance, only to talk crap about them behind their back. Using bias-based, not evidence-based medicine. Blaming patients for depression or addiction. Being careless with infection control. Doing tests or procedures that aren't strictly necessary to cover your own ass or make a bigger buck. Never admitting mistakes. Writing off some patients as basket cases, too hard, or not worth the bother. Aiming for "good enough not to be sued" rather than best care. I could go on and on. And the personalities, god, the personalities. Impenetrable vanity, arrogance, selfishness, apathy, laziness, bullying. I mean, I'm sure these things occur in all professions - petty rivalries and so forth. But people's LIVES aren't at stake in other professions, people's lives don't depend on whether Dr X's pride has been wounded or not.
I'm on Flynnie placement yet again, and in moments of particularly brain-numbing boredom I fantasise about the scathing portrait of my boss' foibles I'm going to write. A by-product of observing him for most of my waking hours. Let me try to capture some of his flavour. Our protagonist is a late-40's American ex-surgeon, a footballer who injured himself out of a career in college, dressed in all-American blue jeans and polo shirts. Adopts a folksy straight-shooting manner but bullshits his way around questions he can't answer ("What's idioventricular mean? It's something that's not working like it's supposed to. Like idiopathic, idiosyncrasy, one of those old Greek word things"). FoxNews devotee, son of a blue-collar worker, now multi-millionaire, casually racist ("Med school was so hard back in the day that two guys from my class killed themselves. Just couldn't hack the pace. They were both Arabs from Pakistan or something. Good thing too. Those people are all terrorists in the making"). He's threatened by and contemptuous of anyone who dares question his authority by showing any knowledge about their condition or using alternative therapies . Starts lots of sentences with "In medicine...", eg. "In medicine, this is called a puritic [sic] rash". Writes referral letters with really bad spelling and grammar. Asks "guess what I'm thinking!" kinds of questions to show off his knowledge or exert his power rather than actually discussing or teaching. Is impervious to student's eyes glazing over during his lengthy Pearls O' Homegrown Wisdom About Medicine - which he repeats. A lot.
A recent consultation went like this. A gentle, child-of-hippies type of woman comes in with diarrhoea and constipation.
Her: I had a look on the internet...and I know I shouldn't try to self-diagnose, but I was wondering if it could possibly be IBS?Doc instantly bristles, patronises her ("Cactus extract? What kind of cactus? There are many many kinds of cactus"), contradicts everything she says, and boots her out. After she leaves, he launches into lecture mode.
Doc: Impossible. Can't believe anything on the internet. Inflammatory Bowel Disease is a very serious condition and it is very unlikely you have it...(etc etc etc etc)
Me: Um. Didn't she mean Irritable Bowel Syndrome?
Her: Yes, that's it. So I tried some natural medicines they recommended at the shop over there...
That there was a good lesson for you. What they don't teach you nowadays in medical school, which they did back in the days when I was training, is that you should never, ever let the patient take control. You'll see. When you've had 30 years of experience like me, you find out all patients want to use and abuse you. They'll come in with some scrap they've found off the Google and try to sell you some bullshit. Like that girl just then, she just flung piles and piles of bullshit all over the room. I picked it up right away, as soon as she came in - I've got my observations honed to perfection, it'll take you 30 years to get that kind of skill. Cactus extract! You saw how she tried to get her agenda on, but no way, I don't stand for that shit. You gotta learn that you're the doctor and you're the boss. She's a massage therapist - probably flunked out of high school - and she wants to tell YOU what to do! (etc etc etc etc)Somewhere, an artsy-fartsy tie-died hippy-dippy anatomy-sucks ethics-roolz Newie lecturer is weeping. To be fair, I don't want to completely vilify him. He's got his charm and is great with babies. He works up his patients really thoroughly and goes the extra mile for them...at least the ones he likes. I can tolerate him...and occasionally learn a thing or two, though I now take whatever he says with a fistful of salt - he's quite capable of making up facts.
Praps I have this impossible ideal of Perfect Doctor - one that others, and no doubt I myself, will constantly fall short of. But the standard's got to be at least: "how would I like to be treated? what if it was my grandma?".
Tuesday, September 9, 2008
Ritual
First you have to get through the negotiations. You introduce yourself as a student and exchange pleasantries and nervous jokes. You put on your shiniest Bedside Manner, perky and polite. Almost invariably, they consent with self-deprecating good nature. Everyone's got to learn some time, right? I'm happy to help if I can. Yes, thank you so much - I really appreciate it. If you feel uncomfortable at any time, please let me know and I'll stop. Your group and tutor are standing around you, sometimes participating in this exchange, but often just silent spectators at the show.
It's a shifting of power. Once you have given them the semblance of control, you proceed to command them to perform all sorts of bizarre manoeuvres. Could you take off your shirt, please? And would you mind if I pulled your pants down a little further? Is it ok if I put my hand here in your groin? This is someone who could be your grandmother's age, or your father's. In everyday life, you would perhaps nod at each other on a sidewalk, or if you met, you would defer to them as your elder and better. Now, circumstances have contrived that you both meet here, in this place of delicately balanced vulnerabilities. You have to get past your own anxious voices. Am I doing it wrong? Do they all think I'm a tard? Am I making it up, or do I really feel this? Am I hurting them? This is embarassing.
But when you're in the zone, when you've passed all the awkwardness and anxiety and come to focus, finally the physical examination becomes an oasis. The laying on of hands, the strict order of the tests and the calm solemnity recall the rituals of the ancients. Feel a pulse - make sure it is not your own. Put your hand on a heart. Listen. The room is quiet, the clatter of the hospital fades into the background, and all you can hear is the heart beat and breathing. A steady rhythm, almost music. One-two, one-two. It is a moment of strange intimacy.
It's a shifting of power. Once you have given them the semblance of control, you proceed to command them to perform all sorts of bizarre manoeuvres. Could you take off your shirt, please? And would you mind if I pulled your pants down a little further? Is it ok if I put my hand here in your groin? This is someone who could be your grandmother's age, or your father's. In everyday life, you would perhaps nod at each other on a sidewalk, or if you met, you would defer to them as your elder and better. Now, circumstances have contrived that you both meet here, in this place of delicately balanced vulnerabilities. You have to get past your own anxious voices. Am I doing it wrong? Do they all think I'm a tard? Am I making it up, or do I really feel this? Am I hurting them? This is embarassing.
But when you're in the zone, when you've passed all the awkwardness and anxiety and come to focus, finally the physical examination becomes an oasis. The laying on of hands, the strict order of the tests and the calm solemnity recall the rituals of the ancients. Feel a pulse - make sure it is not your own. Put your hand on a heart. Listen. The room is quiet, the clatter of the hospital fades into the background, and all you can hear is the heart beat and breathing. A steady rhythm, almost music. One-two, one-two. It is a moment of strange intimacy.
Tuesday, June 17, 2008
66.66% done!
Today I...
Holyfuckingshit, if I pass these exams, I am HALF A DOCTOR. Or at least half an intern. Dr T-Dizzle. Snort.
- Had 3 hours sleep before my exam
- Sat one of my first OSCAs where I had to actually TALK to PEOPLE which I was scared about because a) I have not talked to humans for like a whole week and b) my sex counselling video was a total disaster and c) hello I'm an INTP! I hate people! hehe
- Was so nervous at some points I wanted to spew my Weetbix
- Counselled a fake patient about their herpes test results. I am in love with my tutor right now, because she STRONGLY HINTED that Breaking Bad News would be on the exam, so I actually looked up how to do it and had a framework for what to talk about and was practising "sorry, I'm afraid the HIV test is positive" last night in fact (aloud to myself). It went better than I thought it would. Was grinning all the way out, probably just the adrenaline. But it was like....maybe I'm not actually not as inept as I'd thought. I can do this stuff. I can do people. I listened reflectively! I empathised! And it didn't feel too fake!
- Completely blanked on how tiredness would relate to indigestion. Well actually the question was, "how would this change your thinking?" but I was too stuck on reflux to expand to cancer and systemic diseases and haemorrhage. STUPID!
- Had to scurry from the main exam room to the counselling rooms twice. Felt so sorry for the year manager because it's a huge logistics nightmare..they had to shuffle students up and down the corridoor like ten times, and sometimes people were too dumb to realise it was their turn, or went over time. There were walkie talkies involved and they had to co-ordinate timing and stuff.
- Took lollies from a stranger
- Took free tea
- Got into a car with an acquaintance on a whim, cos he asked if we wanted to go to lunch. The food was semi ok though we did have "what meat is this?" *taste* "I still can't tell" issues, but it was fun talking to people I don't know well.
- Told a guy he reminded me of my seedy uncle. hahahaaha he so does. He's our The Todd...a wannabe beefcake, real Alpha Macho "I like beer and cars and guys who don't are faggots" type. So closeted. Hilarious though. He smokes! We just did lung cancer, emphysema, ERECTILE DYSFUNCTION, diabetes and osteoporosis, and he smokes!
- Had to amuse myself on blank OSCA stations. I did half a sudoku and some word thing, but that somehow made me more stressed when I couldn't think of a three-letter colour ending in e, so gave up. Then I made a paper plane which I really wanted to fly, but that would probably be against the rules or something. So lots of the time I sat with my eyes closed and played air piano. That was calming. Also this breathing technique I learned from Mind Performance Hacks...you take deep tummy breaths in for 3 counts, hold for 3, out for 3. Stops the hyperventilation.
- Surprised myself at being slightly disappointed that this guy I know has a girlfriend. I never thought of him as potential! Not that he's that attractive, he's just the nerdy semi-weird but nice type I'll probably end up with.
- Wondered if the faculty made the questions less demanding this year because they don't want to fail anyone since they're changing the curriculum next year. They're dropping the Regional Rotation would you believe?! This is "We Need YOU to be a rural GP!" Newie we're talking about! And it's entirely for logistics not educational rationale. What a shame. The clinical stuff is, I hope, what will make us think of ourselves as Doctors to Be for the first time, and prepare us more for the real world than this "sit in a room for a week and cram" bit. Shame on you, Newie! This is partly a result of government policy I think. Making new places in med school sells well politically - "look, new doctors on the production line = totally the solution to the shortage!" - but there's the small matter of the hospital system accommodating for the extra training that we wide-eyed wet-behind-the-ears types need. And seriously? GP community placements won't cut it.
- Practically danced out of the exam. Such a weight off my chest. The written parts were ok, and regardless, having the two OSCAs out of the way means this hell is almost over.
- Asked someone how they coped with failing last year. I'm surprised at who fails. Some of them are obvious slacker "I accidentally got into medicine" types, but then there are also the really studious and serious Malaysians, as well as the outgoing and at least verbally impressive types who teach anatomy and stuff.
Holyfuckingshit, if I pass these exams, I am HALF A DOCTOR. Or at least half an intern. Dr T-Dizzle. Snort.
Tuesday, May 6, 2008
Candles and other obvious metaphors
So, radio silence.
What I haven't been saying here, or rather what I've been saying by not saying anything here (are we following?), is how I'm terrified that med is not my One True Vocation and that I'm going to turn out to be a incompetent doctor, bitter and resentful at how it's taken up my life.
I think it's partly because of our lack of clinical stuff this year so far, with hardly any patient contact. Buried beneath the books, the weekly grind of Working Problems, it's easy to lose sight of where it's all leading. I fear that I still don't own medicine; being a student doctor isn't part of my identity. Compare this with learning French- it is a part of me, it was my passion (at least for a while). Whereas with med, part of me is standing to the side, half amazed at what knowledge I have managed to pick up, half bemused and terrified at the thought of one day being Dr Tina. Who, me? What a ridiculous notion. With my heart not really in it, I was afraid that I would be a half-ass doctor, knowing just enough to get by, fooling the less critical of my patients. And that's just not what I want out of life; I want to be brilliant at what I do, passionate, absorbed. Sure there are doctors who can do other things at the same time, like my hero Oliver Sacks, the great neurologist who's written about things as diverse as music and botany. But I don't have that kind of protean genius; I know that just getting to grips with the mountains of med knowledge will take up most of my efforts, leaving my other interests by the wayside.
Also, med frustrates my desire for creativity and Making a Difference. You're at the coal face, applying other people's technologies and research, with your impact being limited to the patient in front of you, basically working as an algorithm-churning machine. Yes, it is a noble and important job and satisfying in its way, too. But it's constrained. The scientist who invents a new vaccine, the politician who brings in universal health care, the teacher who shapes a class-full of young minds...that's how you multiply your impact. Yeah I realise how grandiose and naive that sounds. I know my limitations, but I want to use what I've got for the greatest effect and satisfaction.
In short, I felt trapped. Trapped by the 5 years I've already spent at uni, the $100k debt, the expectations of family, the 5 years of Bonded practice and at least 7 years of advanced training awaiting me. So I've been idly surfing for alternative lives. An English-for-foreigners teaching diploma, a correspondence course for a Grad Dip Psychology.
These worries have been sloshing around for months now, and I never thought to speak them to anyone. It's taboo. Then yesterday had a chat with Chris. A light of hope! She told me that she too has doubts about clinical med being her life's work. I'm not alone. She's interested in business, finding a niche to fulfill future healthcare needs. Now that is exciting stuff, where new ideas are possible. She wants a non-profit branch to her biz too, and suggested that I be part of that, doing some kind of travelling medico-journalism kinda thing. What a pipe dream, what perfection! It's so obvious. One of my main objections to Being a Writer (ooh la la) is that I'm crap at making up stories. But lo, there are many stories in med. As I was reminded today- we had a palliative care placement, and oh how it was lovely talking to a patient. With 10 years of cancer but still seemingly well, he told us about his love for the bush and his career as a forrester, his worldwide travel, his passion for Schubert and art. In fact he's going to Sydney tomorrow to buy a Schubert CD of the most beautiful piece ever, he says. So among my notes about his medical history of hip replacements and diabetes is a citation for Piano Sonata in B flat, D960. Have a listen (I downloaded the Lipkin one). I dunno about "best evah", but it sure is beautiful, especially the second movement. For Friday I've volunteered to be the one quizzing him about the psychospiritual stuff (what a silly term for "what do you think about dying?").
Whether or not these are impossible dreams, suddenly the trap seems less deathly tight. The inevitable bitter end - haggard repressed half-assed GP - doesn't have to be that. There's something to work towards and hope for. I'm reminded how I convinced myself to get into med in the first place and it doesn't seem quite so self-delusional- that people and their stories are pretty damn awesome.
Now for the "study and pass" bit.
What I haven't been saying here, or rather what I've been saying by not saying anything here (are we following?), is how I'm terrified that med is not my One True Vocation and that I'm going to turn out to be a incompetent doctor, bitter and resentful at how it's taken up my life.
I think it's partly because of our lack of clinical stuff this year so far, with hardly any patient contact. Buried beneath the books, the weekly grind of Working Problems, it's easy to lose sight of where it's all leading. I fear that I still don't own medicine; being a student doctor isn't part of my identity. Compare this with learning French- it is a part of me, it was my passion (at least for a while). Whereas with med, part of me is standing to the side, half amazed at what knowledge I have managed to pick up, half bemused and terrified at the thought of one day being Dr Tina. Who, me? What a ridiculous notion. With my heart not really in it, I was afraid that I would be a half-ass doctor, knowing just enough to get by, fooling the less critical of my patients. And that's just not what I want out of life; I want to be brilliant at what I do, passionate, absorbed. Sure there are doctors who can do other things at the same time, like my hero Oliver Sacks, the great neurologist who's written about things as diverse as music and botany. But I don't have that kind of protean genius; I know that just getting to grips with the mountains of med knowledge will take up most of my efforts, leaving my other interests by the wayside.
Also, med frustrates my desire for creativity and Making a Difference. You're at the coal face, applying other people's technologies and research, with your impact being limited to the patient in front of you, basically working as an algorithm-churning machine. Yes, it is a noble and important job and satisfying in its way, too. But it's constrained. The scientist who invents a new vaccine, the politician who brings in universal health care, the teacher who shapes a class-full of young minds...that's how you multiply your impact. Yeah I realise how grandiose and naive that sounds. I know my limitations, but I want to use what I've got for the greatest effect and satisfaction.
In short, I felt trapped. Trapped by the 5 years I've already spent at uni, the $100k debt, the expectations of family, the 5 years of Bonded practice and at least 7 years of advanced training awaiting me. So I've been idly surfing for alternative lives. An English-for-foreigners teaching diploma, a correspondence course for a Grad Dip Psychology.
These worries have been sloshing around for months now, and I never thought to speak them to anyone. It's taboo. Then yesterday had a chat with Chris. A light of hope! She told me that she too has doubts about clinical med being her life's work. I'm not alone. She's interested in business, finding a niche to fulfill future healthcare needs. Now that is exciting stuff, where new ideas are possible. She wants a non-profit branch to her biz too, and suggested that I be part of that, doing some kind of travelling medico-journalism kinda thing. What a pipe dream, what perfection! It's so obvious. One of my main objections to Being a Writer (ooh la la) is that I'm crap at making up stories. But lo, there are many stories in med. As I was reminded today- we had a palliative care placement, and oh how it was lovely talking to a patient. With 10 years of cancer but still seemingly well, he told us about his love for the bush and his career as a forrester, his worldwide travel, his passion for Schubert and art. In fact he's going to Sydney tomorrow to buy a Schubert CD of the most beautiful piece ever, he says. So among my notes about his medical history of hip replacements and diabetes is a citation for Piano Sonata in B flat, D960. Have a listen (I downloaded the Lipkin one). I dunno about "best evah", but it sure is beautiful, especially the second movement. For Friday I've volunteered to be the one quizzing him about the psychospiritual stuff (what a silly term for "what do you think about dying?").
Whether or not these are impossible dreams, suddenly the trap seems less deathly tight. The inevitable bitter end - haggard repressed half-assed GP - doesn't have to be that. There's something to work towards and hope for. I'm reminded how I convinced myself to get into med in the first place and it doesn't seem quite so self-delusional- that people and their stories are pretty damn awesome.
Now for the "study and pass" bit.
Saturday, December 1, 2007
PayItForwardCrossing
Yet another 3am ramble. An hour when world-nudging delusions can actually get the edge over "omg this is SO OPRAH" cynicism.
The inspiration: zenhabits on bringing people closer.
The pitch: Pay it Forward concept breeds with BookCrossing technology.
PIF is a kindness pyramid scheme where A does a good deed for B, who pays the favour forward to 3 other people, who each pay it forward to 3 more, and so forth. BookCrossing is where people leave used books in public places, with a code and URL stuck in it. Whoever finds it can log in on the site and enter the code, then passes the book on, so you can track the progress of the book across the world.
So to merge these: a way of tracking good deeds. When you do something good for someone, give them a Post-It with "record your good deeds at payitforwardtracker.com" on it. The recipient of the favour registers what was done for them, and what they have done for others. They too give Post-Its to their recipients. Thus, theoretically, you get a map of the spread of good deeds and a community of altruists.
I can already see flaws in it actually, because the people most in need of good deeds, the disadvantaged, may not have internet access. Hmmmm. Maybe it could be entirely internet-based good deeds such as...I dunno, designing a graphic for free, or buying someone one of their Amazon wishlist items (nah, too consumerist) or mailing them stuff they can't buy from their own countries. Maybe it could be set up in an existing web community. Maybe the "act of kindness" needs to be a specific act - what is a universal good deed?
Come to think of it, the Jerry library is a pay-it-forward scheme and an idea with potential I reckons. Tis simple - each borrower mails the library set to the next. The key elements are:
Food for thought.
Oy, this blog was meant to be a place to forge (ha! double entendre) my identity as a student doctor, but it seems there aren't that many opportunities in med for these Giant Harebrained Ideas I seem to like. Or maybe I just haven't looked hard enough. We had CPR training this week and the guy showed us some horrible comparative stats on how many Aussies vs Seattle folk survive cardiac arrests. We suck. It was something like 7% vs 70% (don't quote me on that). The dude attributes that to the lack of CPR training and defibs here. If true, that is DUH. CPR is so easy. Here, go learn it. Hey, maybe the Thing That Is Passed Forward could be "teach someone" so it'd be a pyramid scheme of knowledge. It worked for Christianity, why not CPR! "Teach it forwards".
Yknow what this sounds like? Public Health. Is that where this is leading? P-values and policy-making?! eeep. Maybe should've stayed awake in Health Economics lectures this week. Reminder to self: write about breadth vs depth of impact, helping individuals vs groups.
Ok, pressing "Publish Post" now in anticipation of a "wtf is this crap I wrote?!" hangover tomorrow.
The inspiration: zenhabits on bringing people closer.
The pitch: Pay it Forward concept breeds with BookCrossing technology.
PIF is a kindness pyramid scheme where A does a good deed for B, who pays the favour forward to 3 other people, who each pay it forward to 3 more, and so forth. BookCrossing is where people leave used books in public places, with a code and URL stuck in it. Whoever finds it can log in on the site and enter the code, then passes the book on, so you can track the progress of the book across the world.
So to merge these: a way of tracking good deeds. When you do something good for someone, give them a Post-It with "record your good deeds at payitforwardtracker.com" on it. The recipient of the favour registers what was done for them, and what they have done for others. They too give Post-Its to their recipients. Thus, theoretically, you get a map of the spread of good deeds and a community of altruists.
I can already see flaws in it actually, because the people most in need of good deeds, the disadvantaged, may not have internet access. Hmmmm. Maybe it could be entirely internet-based good deeds such as...I dunno, designing a graphic for free, or buying someone one of their Amazon wishlist items (nah, too consumerist) or mailing them stuff they can't buy from their own countries. Maybe it could be set up in an existing web community. Maybe the "act of kindness" needs to be a specific act - what is a universal good deed?
Come to think of it, the Jerry library is a pay-it-forward scheme and an idea with potential I reckons. Tis simple - each borrower mails the library set to the next. The key elements are:
- A "good" that is scarce and valuable, but not priceless. Here the content of the library DVDs was rare, but the physical DVDs themselves don't cost much and are easily replaced.
- Decentralisation and self-sustaining. There are 3 sets of DVDs (two US, one Australasia), each with their own list. The admin only has to add new people to the list and borrowers contact each other for address details. The system relies on the next borrower harassing the previous person to hurry up and send the thing.
- A small "paying forward" burden. I've probably spent less than $50 setting up the entire thing, and each person probably spends less than $10.
Food for thought.
Oy, this blog was meant to be a place to forge (ha! double entendre) my identity as a student doctor, but it seems there aren't that many opportunities in med for these Giant Harebrained Ideas I seem to like. Or maybe I just haven't looked hard enough. We had CPR training this week and the guy showed us some horrible comparative stats on how many Aussies vs Seattle folk survive cardiac arrests. We suck. It was something like 7% vs 70% (don't quote me on that). The dude attributes that to the lack of CPR training and defibs here. If true, that is DUH. CPR is so easy. Here, go learn it. Hey, maybe the Thing That Is Passed Forward could be "teach someone" so it'd be a pyramid scheme of knowledge. It worked for Christianity, why not CPR! "Teach it forwards".
Yknow what this sounds like? Public Health. Is that where this is leading? P-values and policy-making?! eeep. Maybe should've stayed awake in Health Economics lectures this week. Reminder to self: write about breadth vs depth of impact, helping individuals vs groups.
Ok, pressing "Publish Post" now in anticipation of a "wtf is this crap I wrote?!" hangover tomorrow.
Tuesday, November 13, 2007
Quack hacks
So I've been surfing the productivity blogosphere while.....procrastinating on my work. Ferric, innit.
HAHA ferric, ironic, geddit? I will go kill myself now. We only children have to amuse ourselves.
Did you know there is a significant proportion of the human (hipster) population addicted to Moleskine notebooks? (googling "Moleskine porn" came up with this) I would be one of them, but I'm too stingy. My friend did give me this bright red silk one for my birthday once, which I used as my Vietnam travel journal. A little red book in one of the last bastions of Communism, oh the wittiness! They are sexy though. Not communists, Moleskines. Well I'm sure there are some sexy communists. Fidel does it for me.
I had a point somewhere...the productivity and the lifehacking blogosphere. Apparently there are shitload of blogs telling people how to improve their lives every day in every way. Came across a post by Scott H. Young about holistic learning, which involves interlinking ideas between subjects and understanding the concepts behind knowledge by visceralisation and metaphor. Food for thought indeed, cos I feel I've lost the knack of studying deeply and internalising concepts. I wondered if his ideas could be applied to the study of medicine, which has a lot of rote memorisation and arbitrary info (looking at you, anatomical pathology).
But the gist I took from it was that medicine shouldn't be as hard as it is. It's just that the teaching, both in books and lectures, is horrible. Just one effing thing after another. Often no overviews of the topic, no attempt to present narrative and links rather than bare facts. People don't think in lists! The only thing I've come across that is remotely sensible is the Made Ridiculously Simple series which has silly cartoons and visual mnemonics (eg. the spider of Willis).
So, an idea for a blog: Quack Hacks, or Medicine for Dummies. Med is the combination of a number of disciplines, each of which can be deconstructed and which have their own tricks. Pharmacology, for example- I wish I'd been told at the beginning that all you really have to know at first/second year level is name, mechanism, uses and side effects (inc contraindications and interactions). And for the blocks we're doing this semester, neuro/endo/psych, drugs can be grouped by neurotransmitter, mechanism or disease. I haven't figured things out in other areas yet, like biochemistry, which is a blur of cycles and loops. Wtf.
Yeah, no good ending here. Go back to drooling over Chairman Mao, that fox.
HAHA ferric, ironic, geddit? I will go kill myself now. We only children have to amuse ourselves.
Did you know there is a significant proportion of the human (hipster) population addicted to Moleskine notebooks? (googling "Moleskine porn" came up with this) I would be one of them, but I'm too stingy. My friend did give me this bright red silk one for my birthday once, which I used as my Vietnam travel journal. A little red book in one of the last bastions of Communism, oh the wittiness! They are sexy though. Not communists, Moleskines. Well I'm sure there are some sexy communists. Fidel does it for me.
I had a point somewhere...the productivity and the lifehacking blogosphere. Apparently there are shitload of blogs telling people how to improve their lives every day in every way. Came across a post by Scott H. Young about holistic learning, which involves interlinking ideas between subjects and understanding the concepts behind knowledge by visceralisation and metaphor. Food for thought indeed, cos I feel I've lost the knack of studying deeply and internalising concepts. I wondered if his ideas could be applied to the study of medicine, which has a lot of rote memorisation and arbitrary info (looking at you, anatomical pathology).
But the gist I took from it was that medicine shouldn't be as hard as it is. It's just that the teaching, both in books and lectures, is horrible. Just one effing thing after another. Often no overviews of the topic, no attempt to present narrative and links rather than bare facts. People don't think in lists! The only thing I've come across that is remotely sensible is the Made Ridiculously Simple series which has silly cartoons and visual mnemonics (eg. the spider of Willis).
So, an idea for a blog: Quack Hacks, or Medicine for Dummies. Med is the combination of a number of disciplines, each of which can be deconstructed and which have their own tricks. Pharmacology, for example- I wish I'd been told at the beginning that all you really have to know at first/second year level is name, mechanism, uses and side effects (inc contraindications and interactions). And for the blocks we're doing this semester, neuro/endo/psych, drugs can be grouped by neurotransmitter, mechanism or disease. I haven't figured things out in other areas yet, like biochemistry, which is a blur of cycles and loops. Wtf.
Yeah, no good ending here. Go back to drooling over Chairman Mao, that fox.
Wednesday, October 31, 2007
That is the question
1. Why must I rediscover the awesomeness of GarageBand in the middle of exam cramland? That's a Mac music editing program thingo, for you WinTel peoples. I could play with it for hours. You can compose songs with a ton of different tracks and there are built-in licks or whatever they're called. Plus you can record real instruments and then monkey with them- I got my humble acoustic to sound like Santana. Too bad it doesn't actually improve your playing.
2. Given GarageBand's awesomeness, why does the iBook not come with a microphone jack? Stupido.
3. How can tomatoes possibly be a fruit? I refuse to believe it. Biology be damned.
It's t-7 and I've still got like 3/4 of the course to slog through. My bargain with Allah is that if I pass this semester I will study hard over the summer. No really, I will. Not out of dedication or love of humanity, just to attenuate the soul-crushing humiliation that will inevitably come with clinical rotation pimpage.
Actually, haven't really been stomped on that badly so far, even with Mr "Nystagmus? I don't deal with that shit!" Neurosurgeon. He did torture a guy in my group, but I was spared. I wonder if it was because I bluffed my way through some obscureish questions (L'Hermitte's phenomenon was one of his pets) or rather because I'm quiet, Asian, female, and wear glasses. Probably the glasses.
PS. Tarisai is off! Muahahah yes! heh
2. Given GarageBand's awesomeness, why does the iBook not come with a microphone jack? Stupido.
3. How can tomatoes possibly be a fruit? I refuse to believe it. Biology be damned.
It's t-7 and I've still got like 3/4 of the course to slog through. My bargain with Allah is that if I pass this semester I will study hard over the summer. No really, I will. Not out of dedication or love of humanity, just to attenuate the soul-crushing humiliation that will inevitably come with clinical rotation pimpage.
Actually, haven't really been stomped on that badly so far, even with Mr "Nystagmus? I don't deal with that shit!" Neurosurgeon. He did torture a guy in my group, but I was spared. I wonder if it was because I bluffed my way through some obscureish questions (L'Hermitte's phenomenon was one of his pets) or rather because I'm quiet, Asian, female, and wear glasses. Probably the glasses.
PS. Tarisai is off! Muahahah yes! heh
Thursday, October 18, 2007
Heh
Alright, taking the video down now from paranoia. Sucks to be you if you missed this masterpiece!
Monday, October 15, 2007
Juggling mountains, real time
(This is from before the hols, forgot to post it)
So often you come across a list of symptoms and signs in a book, dot points to memorise for the exams. Receptive aphasia = Wernicke's area, expressive = Broca's, conductive = arcuate fasciculus. Easy enough. Wernickes are Wordy without making sense. Brocas have Broken speech. And then you find yourself at the bedside, running over the longwinded neuro exam in your head and launching into your well-rehearsed introductory "hi Mr X I'm a 2nd year med student and would it be ok if my friends and I asked you some questions everything you say is confidential and of course please let us know if you're uncomfortable at any time" speech....only to find that Mr X, though awake, isn't even looking at you or appearing to listen. Sudden panic. What about consent? how are you meant to proceed without a history? this isn't how it's meant to go! Then you collect your wits and think what this might mean. Is he deaf? Is he unable to understand? Does he have psychiatric problems? You try verbal and written questions, "could you close your eyes? what is your name?". Unblinking, he doesn't reply, despite several attempts. You notice his face is drooping on the right and lightbulbs start flashing. Mixed aphasia, facial paralysis...left hemisphere stroke. Lateral cortex, maybe middle cerebral artery? What next, coma scale score?
The registar comes with the answers, and shows you the physical exam tests you should be doing. Heaps of positive results. So, spasticity is when you bend his arm and it comes to a sudden stop. Hyperreflexia is when the lightest tap makes his arm jerk. Hemianopia is when he doesn't notice your fingers wiggling in one bit of his visual field. Inattention is why he didn't respond to you at all from the right side of the bed, but reacted a bit more from the left. The reg leaves. You're pretty proud you came up with a correctish diagnosis, plus seeing these signs in real life is frankly darned cool- things are starting to click. The panic has subsided, thanks to the comforting jargon and procedures.
Well, almost. You're still uneasy about what to make of this man. It doesn't seem right to speak about him as if he wasn't there. He's unable to understand you or say a word. Still, he's awake, can shift the blankets to warm himself, and seems to register your voice if not its meaning. How much does he understand? Is all communication lost to him, or just verbal language? If it is all language, can he even think? Is he trapped inside his mind, unable to express his indignation at being unceremoniously poked at by three young women? Can he be depressed? Does he retain his personality? Should you explain what you're doing, even though it seems to be useless? Some of these questions come much later when there is time for reflection, because on the spot you are preoccupied with figuring out what on earth is going on. Feeling a bit ridiculous, you look him in the eye to say "thank you Mr X" and pat his hand. Your friend snorts.
Outside, you look at his notes. He came to hospital for an elective operation, in decent shape albeit with some of the generic risk factors for stroke, cholesterol and blood pressure and all that. He didn't recover from the procedure as expected, and somehow - you're not sure if it's related or not - he ended up with this stroke, locked within himself. Among the pages and pages, a note from a social worker. It says how his wife was informed about how he will be severely disabled and would be best in professional care. She refused. He could be cared for at home in their back room. It is a few words embedded amongst measures of his vitals and physical exam results. Suddenly he's no longer a clinical puzzle, or a collection of cool signs, but a husband whose wife loves him enough to keep him by her though communications is impossible. Now you understand why there is a photo at the foot of his bed, a portrait of him with his dog, the man he was before he became a patient.
So often you come across a list of symptoms and signs in a book, dot points to memorise for the exams. Receptive aphasia = Wernicke's area, expressive = Broca's, conductive = arcuate fasciculus. Easy enough. Wernickes are Wordy without making sense. Brocas have Broken speech. And then you find yourself at the bedside, running over the longwinded neuro exam in your head and launching into your well-rehearsed introductory "hi Mr X I'm a 2nd year med student and would it be ok if my friends and I asked you some questions everything you say is confidential and of course please let us know if you're uncomfortable at any time" speech....only to find that Mr X, though awake, isn't even looking at you or appearing to listen. Sudden panic. What about consent? how are you meant to proceed without a history? this isn't how it's meant to go! Then you collect your wits and think what this might mean. Is he deaf? Is he unable to understand? Does he have psychiatric problems? You try verbal and written questions, "could you close your eyes? what is your name?". Unblinking, he doesn't reply, despite several attempts. You notice his face is drooping on the right and lightbulbs start flashing. Mixed aphasia, facial paralysis...left hemisphere stroke. Lateral cortex, maybe middle cerebral artery? What next, coma scale score?
The registar comes with the answers, and shows you the physical exam tests you should be doing. Heaps of positive results. So, spasticity is when you bend his arm and it comes to a sudden stop. Hyperreflexia is when the lightest tap makes his arm jerk. Hemianopia is when he doesn't notice your fingers wiggling in one bit of his visual field. Inattention is why he didn't respond to you at all from the right side of the bed, but reacted a bit more from the left. The reg leaves. You're pretty proud you came up with a correctish diagnosis, plus seeing these signs in real life is frankly darned cool- things are starting to click. The panic has subsided, thanks to the comforting jargon and procedures.
Well, almost. You're still uneasy about what to make of this man. It doesn't seem right to speak about him as if he wasn't there. He's unable to understand you or say a word. Still, he's awake, can shift the blankets to warm himself, and seems to register your voice if not its meaning. How much does he understand? Is all communication lost to him, or just verbal language? If it is all language, can he even think? Is he trapped inside his mind, unable to express his indignation at being unceremoniously poked at by three young women? Can he be depressed? Does he retain his personality? Should you explain what you're doing, even though it seems to be useless? Some of these questions come much later when there is time for reflection, because on the spot you are preoccupied with figuring out what on earth is going on. Feeling a bit ridiculous, you look him in the eye to say "thank you Mr X" and pat his hand. Your friend snorts.
Outside, you look at his notes. He came to hospital for an elective operation, in decent shape albeit with some of the generic risk factors for stroke, cholesterol and blood pressure and all that. He didn't recover from the procedure as expected, and somehow - you're not sure if it's related or not - he ended up with this stroke, locked within himself. Among the pages and pages, a note from a social worker. It says how his wife was informed about how he will be severely disabled and would be best in professional care. She refused. He could be cared for at home in their back room. It is a few words embedded amongst measures of his vitals and physical exam results. Suddenly he's no longer a clinical puzzle, or a collection of cool signs, but a husband whose wife loves him enough to keep him by her though communications is impossible. Now you understand why there is a photo at the foot of his bed, a portrait of him with his dog, the man he was before he became a patient.
Tuesday, September 25, 2007
Like an ACTUAL dumb blonde
Sometimes stereotypes are true! Quotes from our clinical tutor:
1) "There are only two people who can make the blind see and the lame walk. One's a neurosurgeon and the other you see on the Sabbath".
2) "Did you see that black car out the front? Anyone? The black turbo Merc bzzbzzbzzbzz 0-to-100kph-in-3.7-sec bzzbzzbzzboycartalkbzzz? Yep, that's mine."
3) "Oh, you guys are still in the caring phase. We neurosurgeons leave the caring to less qualified people."
!!
1) "There are only two people who can make the blind see and the lame walk. One's a neurosurgeon and the other you see on the Sabbath".
2) "Did you see that black car out the front? Anyone? The black turbo Merc bzzbzzbzzbzz 0-to-100kph-in-3.7-sec bzzbzzbzzboycartalkbzzz? Yep, that's mine."
3) "Oh, you guys are still in the caring phase. We neurosurgeons leave the caring to less qualified people."
!!
Thursday, September 20, 2007
Rural evangelism
So, I have been touched by inspiration. Dirty thing. No, I had this simple idea months ago at the Albury rural conference, but am finally getting my ass into action. Using pot-banging skills I acquired in rather different circumstances in fact- ta Jerry, ailing bushies will thank you one day (I bloody well hope)!
First I have to explain the plethora of acronyms about to be used. I hold a Bonded Medical Place (BMP), which means that for the privilege of plonking aforementioned ass in the hallowed halls of Newie Uni med school, the government owns my soul for 5 years. I still have to pay HECS fees like everyone else and there are no scholarship cookies. It used to be that I had to work 6 years in a District of Workforce Shortage (which can be anything from outer metro to beyond Whoop Whoop) after my fellowship, or else spit out $100 000 in repayment to the government. That meant I was bonded til about age 36. Yes, THIRTY-SIX YEARS OLD. Now the contract's changing so that the bond is only 5 years AND I can do half while training as long as it isn't inner metro, which means only 2.5 years of post-fellowship servitude (so make that 32.5 years old, still within baby-making range). Hallelujah! God only knows why the government decided to be nice to us. They also put in a new BMP Support Scheme run by the Australian College of Rural and Remote Medicine (ACRRM). It involves online education modules and e-mentorship and the true carrot, conference attendance: travel, accomodation and registration for FRRRRRREEEEE! I already took advantage of conference funding to go to Albury- mainly cos it was FRRRRRREEEEE! And along the way somehow got provisionally converted to the rural cause. Sort of.
The other thing is the John Flynn Scholarship Scheme (JFSS), also run by the ACRRM. You send in an application and from those, people are interviewed for a scholarship. You basically do work experience with a rural practitioner for 2 weeks per year for 4-5 years to get a feel for medicine out bush. And get paid $500 for each week, along with FRRRRRREEEEE travel and accomodation! (sense a theme here?) I got one of these scholarships, by secret fenimine wiles or something.
Who can put 2 and 2 together? My idea is this: they should allocate some extra JFSS places for BMP students. Simple. Same tough application process, but BMP's get a slight leg up from the unwashed masses. Pros: for BMPs, there's the FRREEEEE and the $$$$$ and the mentorship and the experience. For the government, they get potential rural recruits. It's not preaching to the converted because BMP students are not absolutely bound to go bush, we have a choice to go into outer metro areas as well. And even if later BMPs are pushed to rural areas by competition, then the JFSS will have prepared them. Instead of resentful BMP doctors flung blindly into the bush, you get people with some rural know-how. BMPs are ideal targets for the JFSS because many are from city backgrounds and don't know much about rurality, although they are likelier than normal HECS students to have to work out bush. In short, fun and profit for students (who otherwise get hardly any love in this BMP deal with the devil), for the government and the taxpayer, and for the poor sick rural folk.
And how is this all to be funded? Note how both the conference attendance and JFSS involve cost of travel and accomodation. The only difference is the cost of conference registration vs cost of paying mentors and communities, who get a stipend to support John Flynn scholars. THUS. The funding for extra JFSS places can come out of the BMP Support Scheme's conference wallet and redirected to this JFSS-4-BMP thing. Conferences are cool and all, but I would bet cold cash that students would be keener to get hands-on clinical experience than sit and be lectured at for a week, even if it's in glorious Albury-town. And it's better value for the government, since the JFSS plays into their rural conscription strategy unlike conferences which have nothing to do with recruitment at all. PLUS ACRRM runs both the JFSS and BMP support!
It's bloody win-win and cost-neutral and the infrastructure is already in place! How can anyone not see the perfection of this? I've written to the NRHN's BMP rep to try and get their support since they seem a natural ally, but he's a bit cool about the idea. I suspect that he's not even that pro-rural; he just sent me this long letter about the government's Grand Rural Conspiracy which isn't even exactly relevant to the proposal. You'd think the National Rural Health Network (peak body of university rural health clubs) would be all over this, n'est-ce pas. I mean I myself am not fully rah-rah-rah "gimme a R! gimme a U! etc" rural evangelist but I am all fired up about this because imho it is elegant and so freaking obvious. I've also contacted the ACRRM and Department of Health and AMSA peoples and plan to send word out to fellow BMPs to get support, via the BMP newsletter run by the department. I have a mind to bang the pot at the Health Minister Himself and his Labor counterpart; it is an election year after all. This had better work! I will lose faith in reason and democracy if it doesn't. I mean apart from the West Wing.
First I have to explain the plethora of acronyms about to be used. I hold a Bonded Medical Place (BMP), which means that for the privilege of plonking aforementioned ass in the hallowed halls of Newie Uni med school, the government owns my soul for 5 years. I still have to pay HECS fees like everyone else and there are no scholarship cookies. It used to be that I had to work 6 years in a District of Workforce Shortage (which can be anything from outer metro to beyond Whoop Whoop) after my fellowship, or else spit out $100 000 in repayment to the government. That meant I was bonded til about age 36. Yes, THIRTY-SIX YEARS OLD. Now the contract's changing so that the bond is only 5 years AND I can do half while training as long as it isn't inner metro, which means only 2.5 years of post-fellowship servitude (so make that 32.5 years old, still within baby-making range). Hallelujah! God only knows why the government decided to be nice to us. They also put in a new BMP Support Scheme run by the Australian College of Rural and Remote Medicine (ACRRM). It involves online education modules and e-mentorship and the true carrot, conference attendance: travel, accomodation and registration for FRRRRRREEEEE! I already took advantage of conference funding to go to Albury- mainly cos it was FRRRRRREEEEE! And along the way somehow got provisionally converted to the rural cause. Sort of.
The other thing is the John Flynn Scholarship Scheme (JFSS), also run by the ACRRM. You send in an application and from those, people are interviewed for a scholarship. You basically do work experience with a rural practitioner for 2 weeks per year for 4-5 years to get a feel for medicine out bush. And get paid $500 for each week, along with FRRRRRREEEEE travel and accomodation! (sense a theme here?) I got one of these scholarships, by secret fenimine wiles or something.
Who can put 2 and 2 together? My idea is this: they should allocate some extra JFSS places for BMP students. Simple. Same tough application process, but BMP's get a slight leg up from the unwashed masses. Pros: for BMPs, there's the FRREEEEE and the $$$$$ and the mentorship and the experience. For the government, they get potential rural recruits. It's not preaching to the converted because BMP students are not absolutely bound to go bush, we have a choice to go into outer metro areas as well. And even if later BMPs are pushed to rural areas by competition, then the JFSS will have prepared them. Instead of resentful BMP doctors flung blindly into the bush, you get people with some rural know-how. BMPs are ideal targets for the JFSS because many are from city backgrounds and don't know much about rurality, although they are likelier than normal HECS students to have to work out bush. In short, fun and profit for students (who otherwise get hardly any love in this BMP deal with the devil), for the government and the taxpayer, and for the poor sick rural folk.
And how is this all to be funded? Note how both the conference attendance and JFSS involve cost of travel and accomodation. The only difference is the cost of conference registration vs cost of paying mentors and communities, who get a stipend to support John Flynn scholars. THUS. The funding for extra JFSS places can come out of the BMP Support Scheme's conference wallet and redirected to this JFSS-4-BMP thing. Conferences are cool and all, but I would bet cold cash that students would be keener to get hands-on clinical experience than sit and be lectured at for a week, even if it's in glorious Albury-town. And it's better value for the government, since the JFSS plays into their rural conscription strategy unlike conferences which have nothing to do with recruitment at all. PLUS ACRRM runs both the JFSS and BMP support!
It's bloody win-win and cost-neutral and the infrastructure is already in place! How can anyone not see the perfection of this? I've written to the NRHN's BMP rep to try and get their support since they seem a natural ally, but he's a bit cool about the idea. I suspect that he's not even that pro-rural; he just sent me this long letter about the government's Grand Rural Conspiracy which isn't even exactly relevant to the proposal. You'd think the National Rural Health Network (peak body of university rural health clubs) would be all over this, n'est-ce pas. I mean I myself am not fully rah-rah-rah "gimme a R! gimme a U! etc" rural evangelist but I am all fired up about this because imho it is elegant and so freaking obvious. I've also contacted the ACRRM and Department of Health and AMSA peoples and plan to send word out to fellow BMPs to get support, via the BMP newsletter run by the department. I have a mind to bang the pot at the Health Minister Himself and his Labor counterpart; it is an election year after all. This had better work! I will lose faith in reason and democracy if it doesn't. I mean apart from the West Wing.
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