Sunday, January 30, 2011

You're lucky I'm not a Jedi

People sometimes ask me, "PTR - how would my life be changed if some kind of super-villain stole all the liquid helium in the whole world?", to which I reply that I won't be drawn into speculating on hypothetical scenarios and that I would much prefer to talk about why people should keep their goddamn hands off my baby.

We were sitting having caffeinated beverages this morning in a nearby cafe when an adjacent table of oldies got up to leave.  Of course they have all been eyeing off the Hatchling the whole time so this is their opportunity to file past and ask us questions and give us unsolicited advice.  Which is, in general, fine.

Except this morning, one of the oldies thought she'd be funny and came and said, "What's in here, a baby?"  Sigh, yes, a baby.  Then she reached down and slapped the sleeping Hatching on the cheek with her big puffy ham-hock-esque mitt, looking frighteningly like Boris Yeltsin, and asked, "Is it a boy or a girl?"

Which is a question that I normally have no problem with.  In fact, I like it when people ask because it is, in a sense, acknowledgment of our refusal to sail with the prevailing winds and only dress the Hatchling in pink.  But this time I just wanted to fix the intruder with my best cold glare and say, "It's asleep."  Or perhaps just fire up my lightsabre and lop her whole arm off.

Did I?  No.  I'm too nice for my own good.  Plus I don't have a lightsabre.

Thursday, January 27, 2011

Wednesday, January 26, 2011

Catching earworms

In response to THIS COMMENT I simply wanted to say that the best treatment for an earworm is to use a juicy piece of bait to lure the earworm out.  This usually happens at night when you are sleeping, so the trick is to enlist the help of a close friend, jailmate, casual sexual acquaintance, or ideally someone who is all three at once, to catch the earworm when it pokes out its head and twist it around a short stick which can then be used to gently wind out the earworm over several days.  The best bait to use is a stinking piece of rotten meat such as Tubthumping by Chumbawumba.

Sunday, January 23, 2011

So far

I'm three weeks into my first clinical elective for fourth year.  Here's what I've learned so far:
  1. The reason you should duck when you're getting in or out of a helicopter with moving rotor blades, even though they are five feet above your head, is that at low speed a gust of wind can bend them considerably and they might just bisect your head.
  2. Wearing overalls in 35 degree heat is not fun, no matter how schmick they are.
  3. Some people get their kicks out of always telling you that you're wrong.  These people are extremely annoying but fortunately they are a tiny minority.
  4. People are, in general, surprisingly good at getting out of the way of speeding ambulances in a timely way.
  5. If someone tells you, "This will be your last chance to go to the toilet for a while", you should go to the toilet.  No matter what.
  6. If someone tell you, "This will be your last chance to eat anything for a while", you should eat something.  No matter what.
  7. A handy rule of thumb for ventilation is that you fiddle with minute volume to manage end-tidal CO2 and you fiddle with PEEP to manage oxygen saturation.
Personally, I think that fact number 5 is the most crucial.

Friday, January 21, 2011

Clinical stimulation

Yesterday I volunteered to be the subject of a brutal and inhumane experiment.  They made me pretend to be a doctor for half an hour and filmed me to see what I'd do.  And then when I tried to leave the ward to lounge around in the cafe they stopped me and said something crazy about having to look after the patients.  Huh!

Actually, it was really interesting and indeed fun (in retrospect).  I volunteered for it because every time I do a clinical simulation with these guys I learn something really useful that I didn't know before.  Plus the guy who runs them is, in my opinion, THE best teacher on campus.  If all our teachers were like him I wouldn't be as bitter and twisted as I am.

However, it was uncomfortable having to watch myself afterwards.  They'd filmed the whole thing with a veritable bevy of cameras and I had to watch the footage and assess my own performance before doing a review with them.  You know how when you hear a recording of your own voice it's always shockingly unlike what you expect?  Seeing yourself on camera is far, far worse.

It's not that I was expecting to see some manly, Clooney-esque figure striding purposefully from bed to bed, making quick decisions and saving lives with the ease of one born to it.  Oh perhaps I was, just a little.  But what I saw was just my balding, big-nosed, stooped, nerdy self, shuffling around indecisively with my left arm hanging limply by my side as if I'd had a stroke, while my right arm flailed in the air or clutched at my own buttocks or rubbed my face, saying things like, "oh!  err... um... I think the correct dosage is 50... 25... no... do you... I think just give the whole thing".

So I felt like a bit of a goose.  But the nurse in the simulation, who was a real nurse, was really lovely.  Afterwards she said that I'd done well and that she'd be happy to work with me in real life.  And that I should try not to clutch my own buttocks so much.

Wednesday, January 19, 2011

Summer of 2009

I got my first real stethoscope
Bought it at the five-and-dime
Listened til my ears bled
It was the summer of 2009

Me and some guys from school
Got into medicine, we tried real hard
Jimmy failed, Joey got deported
Shoulda known they'd never get far

Oh when I look back now
That summer seemed to last forever
And if I had the choice
Yeah - I'd never wanna be there
Those were the worst days of my life

Ain't no use in complainin'
When you got exams to do
Spent my evenin's watchin' shit on youtube
And my days stealin' notes from you yeah

Standin' at the ward clerk's desk
I told her that I'd wait forever
To get respect from her
She looked at me and said "whatever"
Those were the worst days of my life
Back in the summer of 2009

Man we were wastin' time
We were young and clueless
Can't be bothered thinking of a rhyme
Thank God nothin' lasts forever - oh, yay!

And now the times are changin'
Look at all the patient's who've come and gone
Sometimes when I use that ol' stethoscope
I think about them, wonder what went wrong

Standin' at the ward clerk's desk
I told her that I'd wait forever
To get respect from her
She looked at me and said "whatever"
Those were the worst days of my life, oh yeah
Back in the summer of 2009, uh-huh
It was the summer of 2009, oh yeah, I got a reaming in 2009
It was the summer, the summer, summer of 2009

Tuesday, January 18, 2011

The simple things in life are often the worst

Tense Doctor
Here PTR, take the phone while I do this.


Tense Doctor
Call the Operations Centre and tell them that the patient's O2 sats have dropped to 60% and we've initiated forceful ventilation and suction.  Tell them there's no indication of pneumothorax.  And tell them to inform the duty consultant what's going on.  And tell them...

Er, how do you unlock this phone?

Monday, January 17, 2011

Slow learner or slow teacher?

Deranged Old Lady
Ooh, what a gorgeous baby!  How old is she?

Almost 7 weeks.

Deranged Old Lady
She's beautiful!  I was a midwife for 27 years at the old hospital over there so I've seen plenty of little ones like this.  I'll give you some advice.

I love advice.

Deranged Old Lady
If you stuff some stockings and pop them under her legs, it'll stop her wriggling down under the blankets in her cot.

That's a good idea.

Deranged Old Lady
Yes, it stops them wriggling down under the blankets.

I see.

Deranged Old Lady
Yes, if you stuff some old stockings and pop it under their legs, it stops them wriggling down under the blankets.  I did it with my children and they've done it with theirs.  It stops them wriggling down under the blankets.  You just stuff some old stockings and pop it under their legs.

Yes, I think I understand.

Deranged Old Lady
If you stuff some old stockings and put it under their legs, it stops them wriggling down under the blankets.

Excuse me, I have to call the police.

Sunday, January 16, 2011

Papa Uniform India (ink)

Wow, it's been a whole week since I blobbed last.  Attempting to be a responsible adult is playing hell with my fun-time.

I can't remember if I mentioned that I got to go for a ride in a helicopter last week.  So excitement!  But I shouldn't call it a helicopter - that's not the lingo.  Nor are planes called planes.  It's "rotary wing" and "fixed wing".  I can't imagine why these terms are more useful or precise than "helicopter" or "plane", but there you go.  I suppose pilots are just like doctors in a way - why say "sweating" when you could talk about "diaphoresis"?

Unfortunately during the flight the cap came off a big thick black permanent marker which was in my pocket and it leaked all over me.  Fortunately I wasn't wearing my own clothes.  Unfortunately it was on day 2 of a six-week placement and I was wearing the uniform that I had been issued.  Fortunately it was a super-duper uniform that is resistant to water, fire, etc etc.  Unfortunately it was not resistant to ink.  Fortunately there are more of these uniforms around.  Unfortunately the uniform costs $500.  Fortunately I won't have to pay for it.  Unfortunately the taxpayers of Australia will.  Fortunately I don't currently pay any tax.

Ha ha!

Sunday, January 9, 2011

Two anti-pimping gambits

Pimping, in the medical context, is the act of asking a junior person deliberately challenging or obscure questions in public and then denigrating them for not knowing the answer, ostensibly in the service of education.  An excellent guide to pimping has already been published over there and I recommend it heartily. In response, I have recently developed a couple of useful gambits for diverting pimpage.

The Strawman Gambit: Make a purposefully inaccurate statement in response to the question, attributing the factoid to a previous instructor, and subtly indicate that you yourself don't quite think this is right.  Correctly executed, this gambit will divert the pimp into attacking your previous instructor rather than yourself.  True example:

What do you know about thiopentone?

I've gotten the impression that it's a bit outdated, kind of a World War 2 relic, which made me wonder why it's still being used.

Whoever told you that is a fucking dickhead.

The Polarizer Gambit: Most useful in response to a pimp that you know absolutely nothing about so you can't even bluff successfully, this gambit involves making a joke which candidly exposes your ignorance but seeks to distract the pimper with a humorous reference to a different topic which tends to produce strong feelings one way or the other and thus changes the direction of the conversation.  I find that this works best with Intelligent Design vs Evolution, as in this true example:

What's your take on the Strong Ion theory of acid-base homeostasis?

I think they should teach both sides of the controversy.

Ha ha, those fucking Americans have no idea do they?

Good luck using these gambits in your daily life.  If you have a notable success or if you come with other ideas, please let me know!


PTR used to be an engineer.

You're an overachiever, aren't you?

If you think that being an electrical engineer who knows nothing about electricity is an achievement, I suppose so.

Snappy comebacks aside, it really threw me that the nurse said that.  For a start, I wasn't entirely sure whether it was a compliment or a snarky insult..

The whole under/over-achiever label is a very strange one.  The under-achiever is the person with clear potential, obvious talents, who chooses deliberately to waste them, typically because he lacks the drive to pursue his gifts or because he is lazy and takes it all for granted and simply coasts through life.  Hmm, sound familiar?  So you'd think that perhaps an over-achiever would be a lumpen prole who somehow conquers all through his singular obsession and force of will.  And occasionally the label is used like that.  But more often, it's a not-too-subtle put-down aimed at a person perceived to have too many feathers in his cap and needing to be cut down to size, by implying that they are just doing this stuff in order to garner grudging admiration if not outright jealousy from the drab crowds left in their wake.  And every now and then the over-achiever tag is used as a short-hand simply for someone who is outstandingly successful.

I don't feel like any of those sorts of over-achievers.  Not because I can't see shadows of myself in at least one of those descriptors, but because I don't feel like I have actually achieved anything.  I have one of those tissue-paper C.V.'s that looks nice and full but if you hold it up to the light you can see straight through it.

When I was young - that is, at school - I used to feel like a high achiever.  I would take home shiny new report cards every few months which had nice things written on them and I felt like I was succeeding.  Hmm, actually that's not true.  I felt like I was a high achiever because I got good marks in tests.  I always flunked my assignments because I left them to the last minute.  So my report cards tended to have varying grades on them depending on how much assignment work was part of that subject, and the comments from my teachers looked superficially like praise but were packed full of dogwhistled alarms that indicated that I was goofing off and annoying the hell out of them.  So on a day-to-day basis I felt like an over-achiever of the third kind, but when my report card arrived I'd feel like an under-achiever.

That continues to this day.  My colleagues tend to view me as some kind of Smart Guy while my supervisors tend to view me as some kind of Smart Arse.  As a result, people seem to never quite know whether I'm under-achieving or over-achieving.  And it seems to drive them nuts.

In my most recent exams I was paranoid about running out of time, so I had a schedule for how many questions to do every fifteen minutes.  I'd glance up at the clock and think, "Okay, good, got those done in 12 minutes, it'll be okay", and I just seemed to get faster and faster.  During the reading time I knocked off a bunch of questions too, with the end result being that two hours into the three hour exam, I was finished.  And since I have a policy of never changing my answers, I picked up Yoda and walked out.

The reason I tell you this story is because a couple of weeks later, I was talking to one of my Esteemed Colleagues who said to me, "Someone told me you left the exam really early so you must have either smashed it or just crashed and burned".  It made me think of the under/over-achiever tightrope that I seem to spend my life walking.  I explained my exam strategy to my Esteemed Colleague and admitted to her that I had neither excelled nor failed, I simply did okay really fast. 

Which is pretty much me in a nutshell: top-speed adequacy.  No wonder it gives people the shits.

Thursday, January 6, 2011

Boundlessly optimistic

I found out today about a "Fatigue Score" that the ambulance service uses to try to make sure that they don't wrap themselves around stobie poles when they are supposed to be unwrapping you from them.  It's a simple three-step process:
  1. You get a certain number of points for how many hours of sleep you got in the last 24 hours.
  2. You get more points again for how many hours of sleep you got in the 24 hours before that.
  3. You get a final chunk of points for the difference between the points you got in the first two steps and how many hours you will have been awake by the time your current shift finishes.
  4. You get more points again if you have to keep going back to the start because you're so tired you can't remember how many points you have.
  5. You lose points if you notice that this is no longer a three-step process.
  6. If you understand the process you automatically score zero.
If you score higher than a certain cutoff you must ring the shift coordinator who will tell you to go home.  Preferably in a taxi.

I was excited about this concept, so I approached one of wise old doctors:
Can I have a copy of the fatigue score algorithm?

Wise Old Doctor
Sure, here you go.  Why do you want it?

I reckon I can use this to get out of the 4 a.m. nappy change at home.  I'll just show my score to my wife and go straight back to sleep.

Wise Old Doctor
That's a great idea!  Except no matter how high your fatigue score is, I can guarantee you your wife's will be higher.

Wednesday, January 5, 2011

The beginning of the end

Yesterday was my first day of fourth (and final!) year medicine.  The most surprising thing I learned yesterday was how to extract myself from an upside-down underwater helicopter.  Hopefully this will be something that remains in the arena of theoretical knowledge for me rather than something gained through practical experience.

Apart from a few strange things like that, the day was pretty quiet.  I had a chat with one of the paramedics after lunch:
What have you been up to so far today?

Not much, I've spent the past couple of hours taking it easy watching the cricket in the tea room.

It's not "taking it easy" - it's "fatigue management".  Very important skill to perfect if you want to be operationally effective.

Monday, January 3, 2011

Ich bin Kevin Bacon

A couple of years back I found out that, in one of those strange coincidences that probably happen all the time but you rarely actually find out about, the mother of the fiance of one my Esteemed Colleagues is also the daughter of my Aged Mother's bridge partner.  Although there is a word in Cantonese to describe such a relationship, there is not in English, so I have taken the liberty of illustrating it with this simple diagram so that we can all be "on the same page", if you will forgive me a brief pun.

This is all well and good, and has served to provide my Esteemed Colleague and I with many minutes of interesting conversation.  But now my Aged Mother is putting pressure on me and my Smaller Half to invite my friend's fiance's mother around for afternoon tea.  I mentioned this to the Esteemed Colleague concerned and he speculated that perhaps my Aged Mother wanted to meet his future in-laws to discuss her bridge partner (a.k.a. his mother-in-law's forbears).  I had to clarify to him that my Aged Mother is 1600 km away - she merely wants me and my Smaller Half to invite them around to show off the Hatchling, under the assumption that the Hatchling is a creature of ineffable beauty and is to be much wondered at by all who encounter her.

When I told my Aged Mother that I thought her plan was strange and eccentric, she was most put out and asked me to explain myself.  I said that I had never met my friend's future in-laws, in fact I didn't even know their names, and to suddenly invite them around for afternoon tea purely on the grounds of a doubly tangential association thrice removed seems both precipitous and presumptive.  She said that my behaviour was most unnatural, that she was unaware that she had raised such a prodigious misanthrope for a son, and that forthwith she would not venture to assail me with suggestions purely intended to relieve me of the solitary burdens of child rearing despite her best instincts to the contrary.

So I casually mentioned to her the over-ripe plum that I habitually carry in the pocket of my jerkin, muttered "whatever", and hung up the phone.  She won't mess with me again!

Sunday, January 2, 2011

I rock, apparently

The threshold for paternal competence seems criminally low.  In the last month, since the Hatchling arrived, plenty of people have complimented me either straight to my face or via my Smaller Half, saying what a great dad I am.

I do not understand why, because what I am doing at the time is simply holding my own child.  So I'm standing there just holding a sleeping baby and some complete stranger comes up to me and says, "You're a great dad!"

It just doesn't make any sense.  Perhaps if the baby was screaming and I was holding it in one arm while ironing a shirt with the other and making pancakes with my feet I would understand that people would be impressed.  And as for how impressed people are when I change a dirty nappy.  Good Lord.  You'd think I'd transplanted my own liver into the kid, the way it causes people to fall all over the places in rapturous praise.

Elderly women are the worst culprits.  I've had them grab me by the arm as I walk past, demanding to inspect the Hatchling, then praise me for my parenting skills.  Incredible, that I can walk in a straight line and yet, somehow, contrive to not drop the Hatchling or accidentally feed her peanuts.

Meanwhile, my poor Smaller Half, who busted a gut (literally) to produce the Hatchling and is in a permanent daze from the shock of being tethered to her 16 hours a day, looks on in wonder as she is elbowed to one side by hordes of women singing my praises and ignoring her contribution completely.  The upside of it all though is that it's very rapidly rebuilt my self-esteem after it was destroyed last year by my jerk supervisor.  Right now, I'm pretty sure that I'm some kind of superhuman.

And if you'll excuse me, I have to go.  I've been recklessly holding the Hatching in my arms while I type this and her neck seems to have developed more joints in it than mine does.  Gotta straighten her back out again.  All in a day's work for Super-Dad!

Saturday, January 1, 2011


Happy New Year!  And now for a purely hypothetical situation that I'd like your input on.

Just say, hypothetically speaking, that you and your dear wife had had a trying day with your darling newborn baby.  And just say, hypothetically speaking, that after cooking a delicious meal you prepare a plate of cherries, apricots, and seasonal stonefruit varieties to be enjoyed by you and your dear wife.

And imagine, if you will, in this hypothetical situation, that one of the red plums on that plate was the very same red plum that languished alone in the refrigerator for a week while you and your dearest went home to celebrate Christmas in the lunatic asylum that passes for your family home and as such this hypothetical red plum is past its prime.  To put it bluntly, the red plum is too soft.

And, hypothetically speaking, imagine how you would feel if your dear wife was to say, "I don't like the look of that plum", and you, in this hypothetical scenario that bears no relation whatsover to any events that may have occurred right here in my own house this very evening, were to bravely offer to try the super-soft plum and then were to pronounce it fit for consumption only to have your dear wife decide that "fit for consumption" was perhaps setting the bar too low in terms of the suitability of after-dinner treats and thus decide that the entirety of the super-soft red plum was yours to eat.

So hypothetically speaking, which do you think is true:
  1. You are entitled to some of your dear wife's cherries to compensate you for having done the manly thing by eating the possibly suspect fruit on her behalf?  Or,
  2. Your dear wife is entitled to some of your cherries to compensate her for having missed out on the red plum?
I really want to know how you think on this weighty issue.