Cold cold feet

Sooo, Canada's East coast is without power due to an ice storm. The family medicine program in Ontario only includes one (optional) week of ICU time. Ontario has a strict Return-of-Service contract. In summer, they have West Nile Virus. I've fled the province once before. I have good friends who live there. I miss Canada. I miss my family.

Christchurch is surrounded by mountains. Christchurch hospital would love me to do a mixed surgical/medical year next year that includes Emergency, ICU and anaesthetics. It is currently 26 degrees and sunny there. In winter, you can buy a season's pass to amazing snow for roughly 300 bucks. The population is only slightly larger than Guelph's.

I have a meeting with the St V's heads of ED training tomorrow. They would like me to train at St V's, and even if I'm only around for half of next year, they'd like to offer me a job. It was sunny, 27 degrees and breezy today. I spent yesterday at a local beach. I eat sandwiches with beetroot. I love my friends and family here.

No specific points here. Just musings. Just sayin'...

I'm dreaming of a white Christmas...

I have returned from the wards where we assaulted very sick people with a relentless cacophony of off-key carols. I have made Eggs Benedict with Dave and we're preparing fruit salad to take to Gran & Pa's. It's a beautiful day. I am only slightly home-sick.

I think Tim Minchin says it best.

We'll be drinking white wine in the sun.

Merry Christmas.

Bliss!

I have peaked. My life will never get better than it did this morning.

I was putting the final stitch in a half-meter long leg wound (saphenous vein graft site, if you're interested) when two spotlights suddenly hit the needle. My senior boss and registrar had both turned to look at my work.

(They wear headlamps for surgery, hence the lighting. It's a lot like I'm a rabbit in the headlights, frozen and waiting for imminent death. But I digress.)

"Sam, that looks beautiful", my Senior Boss said.

"Sam, I never thought this day would come, but you're not embarrassing me", Registrar said.

I realise that this may be an indication of my low expectations, but this might be the best day of my year. Definitely the best day of my surgical rotation. My Reg let me close the chest alone, and as we were applying the dressings, we were both singing along with Elvis, "Dreaming of a White Christmas". A rare moment of harmony.

Combine that with a sunny half-day (I'm not wearing pants!) and buying flights (MEL-YVR-YOL-YVZ-DCA-YVR-MEL, phew...) I am flying high. And I get to go meet my lovely girls for burgers and gossip.

Happiness, thy name is Sam.

Sloth & God

I don't want to get up. I'm blogging from the softness of my crisp cotton sheets. I've just had nine and a half hours of unbroken sleep and I feel re-born.

Gone is the pain of hearing my boss say, "No matter how you do your hair, you're still the same shitty intern". Gone is the tension from seeing my supreme boss roll his eyes during my ward audit. Fatigue and ennui? Washed away. Hunger and rage? Melted into happiness.

Sleep has knitted my ravelled sleeve of care, and just in time; I have to go Christmas shopping today.

The thing about being in Australia for Christmas is that it doesn't feel right. Sure, the shops have decorations up and people are singing carols, but it's bright. Sunny. The days are long and hot. According to my internal clock, Christmas is a time of dark, cold and wearing soft sweaters. Hence, it's not Christmas.

Yesterday, as I was bent over a patient trying to coax a drip into his arm, I heard a choir singing carols. St V's being a Catholic hospital, they go all out; our ward is decorated, our website says "Merry Christmas" and all the Jews are working Christmas day. My patient, who has air bubbles collecting under his skin from a previous lung rupture, started singing along to "Silent Night" as I finally got blood. That was the moment I thought, "Oh it's Christmas."

And then immediately thought, "Shit, I have to go shopping".

Anyways, I suppose there are two points to this:

1. I have to readjust my perception of what Christmas is.

2. I really really love my sleep.

From the land down under, where presents are delivered by Skippy the Bush Kangaroo, Happy Christmas.

lurgy

Cardiothoracics is a plague-ridden speciality, probably due to the long hours we work.

This is especially apparent on Wednesday mornings, when we attend the "Heart Meeting", a collaboration between the cardiologists (who try and fix the heart with pills) and us (who try to fix the heart with knives). The meeting starts at 7, which is a sleep-in for us. We arrive early, dark circles under our eyes, wild-haired and untucked. At least one of us will be audibly sniffing/coughing/sneezing/bleeding from the ears. We slump into our seats and wait for the cardiologists to arrive.

Around 7:10 they start bouncing through the door. Well dressed, well ironed, bright eyed and bushy tailed. They make small talk about their tennis games, new cars and lives.

This week, one of the Cardio registrars sat down next to me. At the front of the room, my Reg sneezed. Then I sneezed. Cardio Reg looked at both of us and slowy, subtly, moved to another seat. I heard him whispering to a colleague, "The surgeons are sick again..."

I don't blame him. We are sick.

My tonsils are so swollen it feels like something must have laid eggs in them. Every time I swallow, I expect a torrent of spiders/maggots/plague monkeys to erupt from the tonsils and spill down my throat, mercifully ending the pain.

Of course, my GP just laughed at me. "Sam, you don't need antibiotics, you have a mild viral URTI. Get some rest, drink lots of fluids and take it easy."

I'm pretty sure my GP just told me to quit my job. Right? Right.

Out of Context

"Get in and suck that, Sam!"

Ahem.

The testosterone level in Theatre One runs fairly high. Alpha males at alpha work create an environment where every second sentence is met with a snigger. Seriously, if someone uses the word "size" they giggle into their masks like school-boys. It would be adorable if I wasn't on the receiving end of so much mockery.

"It's big. And size matters."

"Really pull on that thing..."

"Give it a good shake"

Etc, etc.

The most senior surgeon looks like a cross between Santa Claus and an Ewok, and comes out with the best lines of the bunch.

"Just cos a man's dick swells up when he puts a condom on doesn't mean he has a latex allergy."

"Hey Sam, look at that new valve. It's a walrus' delight!"

"Sorry, sir?"

" A walrus' delight; a nice tight seal..."

I get annoyed, but I have some perspective after today. Our patient died on-table. These men worked for 5 hours to try and save him despite all the odds. When they finally conceded defeat and let him go, they had to get up and get on with the rest of their work.

So I have respect for them. Disturbing, grudging, confused respect.

Acopia

Sometimes people come to hospital who aren't, strictly speaking, sick. These people are often old, crumbly, living alone, not eating very much or very well. They're often a bit whiffy, wearing bizarre clothing and rambling or confused.

They get admitted to Gen Med with a very special St Vincent's diagnosis: Acopia.

As in, not coping.

I had an acopic moment this afternoon.

I'd arrived at work AT 6:30 this morning, toured the ICU so I could update our patient statuses, presented a ward audit in front of the entire team of Cardiothoracic surgeons (to quiet derision and open scorn), done the ward round, gone to clinic, come back to find that every other doctor (in a team of 6) was in theatre and run the ward alone for 5 hours.

Halfway through our evening round I cracked it. My co-resident had just turned up and said, "Aw, you can go if you like Sam." I think he meant once the ward round was done. Oh well.

I thrust my patient list into his hands, turned on my heel and left. Walked straight past the senior boss and, picking up my bag, straight into the lift.

I am at home and it's still light out. I've eaten. I'm wearing soft pants. Acopia is not so bad.

Look, my job is still awesome (I got to put in a chest tube yesterday, which involved inserting my finger into a patient's ribcage and wiggling it till I felt a lung) but it's also exhausting. When a girl gets a bit whiffy, confused and starts rambling, it's time to go home.

As a side note, our acopic patients often do really well. With a good feed, some clean clothes and a bit of TLC, they perk up nicely. Then we send them to nursing homes to live out their days. Something to look forward to.

anecdote

More proof that I will never be admitted to the exclusive boys club that is surgery:

We wear masks in theatre. These masks are made of special filtration paper, and often slide around one's face during an operation. This can obscure one's vision.

Bossman, being an experienced surgeon, uses a strip of medical tape to attach the mask under his eyes, thus ensuring a good fit (and preventing his visor from steaming up). After weeks of a steamy visor and working semi blind, I copied him.

The operation went well. I had the best view I've ever had while stitching. After I scrubbed out, I went to peel my mask off. It hurt. A lot. Tears sprang to my eyes, but it all came off in one piece and I thought, "Great! I'll be able to use this in the future."

Then I went to the mirror. The skin under my eyes was still stinging, and when I looked up close I saw tiny pin-pricks of blood across my face. The damn tape had peeled off a layer of my skin. For the last two days, I've walked around with two scabby raccoony bruises under my eyes. And my face hurts every time I put the mask on, even without tape.

My skin is too soft for surgery.

Bossman bursts out laughing every time he sees me.

triumph!

I GOT TO CLOSE THE CHEST!!!!

On my first day in theatre, Bossman said "Sam, patients judge a surgeon by how good the chest wound looks. They don't care about anything else. So you will never get to close the chest, because your stitches look like shit."

Tonight, around 8:45 pm, I finished my row of deep (non-skin) sutures and stepped away from the body to allow Bossman room to work. He gave me a look and I quickly stepped back, thinking I had made a mistake. He slammed the needle-holder into my hand and walked away without saying anything. So I closed.

The endorphins got me home, elated and singing out loud (JEW Praise Chorus, FYI), despite lack of sleep/food/personal life. Now i know why the surgeons do it. It feels so good when you get it right...

Uh oh. Have I drunk the kool aid?

hot

There is something magical about walking home on a hot late night. The streets reek of garbage and bats skitter overhead, but my veins are still fizzing with the last MET call and it feels good to be moving. The greasy yellow moon lights my way past the Smith Street bums and Monday night alcoholics and I nod at them. I just put a drip into one of their friends.

This city has its moments.

I'm pretty sure 98% of my current goodwill is being generated by my air conditioning.

2% love, 98% air-con.

Life Skills

While I rant, rave and moan about it, my surgical rotation is giving me useful life skills that I have employed this weekend. Before this rotation, I was soft. Weak even; I ate regular meals, got regular sleep, rarely experienced physical pain and spent so much time doing things I enjoyed that I became spoiled; I didn't appreciate what I had.

No longer. My time out of the hospital feels like a release from prison. Everything I do is tinged with a sensation of rose-tinted wonder; "O my god. I'm not unhappy right now!" And while I'm sure it gives me an air of thinly veiled desperation (Must.Have.Fun.) it is also paying off in pleasure.

Examples:

1. Hot Date Friday met me at a rooftop bar in Melbourne, which was packed. We stood and talked, sipping beer in the sun. Later, as we sat at a tiny table in a filthy Chinatown dumpling house, he exhaled; "It's good to sit down; we were standing for 2 hours!" I hadn't noticed.

Surgical skill: standing motionless for hours, ignoring physical pain.

2. Harry Potter movie, Saturday. We'd been out for lunch at Glen Waverly's premiere Japanese restaurant where I had consumed litres of diuretic liquids to accompany perfectly seared beef tataki & thinly sliced tuna. Harry Potter is a long (amazing!) movie; almost 3 hours with the previews. I didn't leave the movie once.

Surgical skill: See above. You can't leave theatre to pee, so ignore the pain.

3. Back from HP; due to meet friends at Spanish Fest in 20 minutes. The weather is hot, we're going to be dancing. I change from comfy summer dress to sultry Latin swishiness in ten minutes, out the door and arrive on time.

Surgical skill: Quick change. "Sam, we need you in theatre to close the chest! Stat!"

Other things come up daily; not taking criticism personally, learning to compartmentalise (she died, we need to focus on him), diplomacy, selective hearing (Sam, you're eating again? Aren't you worried about getting fat?) and physical and mental endurance.

Mostly, I feel this INTENSE appreciation for everything I do that is not surgery (And I seem to pack a lot more into every weekend). It makes life seem just a little bit sweeter, so maybe this job is good for something.

kidnapped!

I think I have Stockholm Syndrome.

I'm starting to stay later than is required of me. I actually came back to work this evening, after leaving, to make sure that all my jobs were done perfectly. And I voluntarily stayed until 8pm yesterday to cover for another intern who was sick.

Why? I want my Registrar(s) to like me.

Yep, the same guys who delight in tormenting me.

There's also a little voice in my head that says, "Screw them. I'm tough. I can totally keep up with them and work just as hard and laugh off the deaths and handle the blood and..."

In a way, it means work is going well. When you push yourself to do more, and realise that more is getting done, you've achieved success. Right? Right.

Now off to sleep, I'm going in early to prepare for 6:45am rounds.

Seriously, Stockholm Syndrome.

Addendum

I just skimmed the blog and realised that I've mentioned crying in my last four posts. There are good things happening in my life, I swear.

Like Nurse Bear bringing over home-made spinach cannelloni in meal-sized portions so I can have something real for dinner this week.

And having brunch with my favourite girls at my favourite spot where the Saturday special was "Canadian breakfast - pancakes with maple syrup & bacon".

And having my friends tell me again and again that they hope I don't get a job in Canada.

So, yes, work is hard. But life, overall, is good.

lengthy, emotional rant ahoy!

The roller coaster continues.

I handed in my fortnightly timesheet yesterday. I worked 168 hours. I will be paid for roughly 100 of these. The other hours are apparently my donation to the hospital; the gift of my sanity, health and life.

My bosses laugh about it. "Cardiac surgeons work the worst hours," they say with a note of pride. They equate their work hours with masculinity and identity as surgeons. These are men who don't see their kids and don't mind.

The women (nurses, of course) of cardiac surgery are not much better.

The snapshot is a woman in her mid-thirties, wearing excessive mascara (when you wear a scrub-mask, you've only got your eyes to work with) and tanned within an inch of her life. She talks loudly about her gym sessions, flatters the surgeons and ruthlessly undermines any new female on her turf. Say, the new intern.

I get a continual barrage of snide remarks ("God, you look tired", "Your sniffing sounds disgusting", "We got you the extra large gown", "Don't think you can do what the guys do in here") and daily subtle gestures to let me know that I'm not wanted.

The worst was Tuesday night. An emergency case; a woman with a dissecting aortic aneurysm. I scrubbed at 2:30 and was still standing at 8:45pm. We were all exhausted and hadn't eaten since breakfast. One of the nurses brought some lollies in and, being careful to keep sterile, tucked a snake or jelly-baby behind each surgeon's mask. First the boss, then the registrar. Then the anaesthetists. Then the other nurses. She looked at me pointedly, smiled and took the rest outside.

Alas, I can't just hate women. My boss, Matt, is equally kind. "Sam, your stitches yesterday looked like shit", "Sam, you're embarrassing me with those hand-ties", "Sam, don't be so weak". And maybe I am weak.

But yesterday, our patient arrested on the table and blood fountained across my head and mask as we re-opened the chest. Matt turned to me and said, "It's the intern's fault" and laughed like a drain. I had been scrubbed for 8 hours at that point, had not spoken a word, eaten, drunk or peed for those 8 hours and now there was blood all over me.

I stood there and took it. And I didn't cry till I got home.

So I'm not as weak as they think.

Fuck this job. 9 weeks to go.

choke

Well, it's happened. I've cried in front of the nursing staff.

Today was the first of two back-to-back 15 hour shifts, otherwise known as "weekend cover", a euphemism implying that I flit about the hospital smiling at the nurses, casting an eye on patients and generally, not treating anything too serious.

In reality, my patient's airway obstructed.

He's a guy waiting for an emergency stent of his bronchi (breathing tubes) cos a cancer is compressing them. His surgery was supposed to be this morning. It was bumped. It was supposed to happen at noon. It was bumped. Each time it got bumped, I reassured his wife and him that they shouldn't worry, he would be fine until the theatre became available.

Then he started making gagging noises. "Stridor" is the medical term for the sucking, wet snore that comes from obstructed airways. He was so loud I could hear him from the hallway. I called my boss who said, "Look, he's sounded bad before, don't worry too much." I took another look at the patient. Sweat was pouring from him, his rib cage taut with strain and he looked terrified. I called a MET.

In a way, its a good thing. You get lots of help, senior doctors come and tell you it's ok, the patient is whisked away to theatre.

The downside is that you're left on the ward with 110% adrenaline in your veins, and get a little bit teary. And then a nurse sees you and her face crumples with sympathy and she says, "Oh, don't worry sweetie..."

Suddenly you've lost the respect of the entire nursing staff. For the rest of day they give you pats on the shoulder, ask you how you're doing with "poor poppet" faces and try to feed you everywhere you go. (Ok, it's not all bad.)

Sheesh.

2.5 hours to go tonight. 15 tomorrow. Then back to the 12 hour days Monday.

I don't want to do this anymore, thank you.

Everyone loves a good medical drama. During medical school we watched House, Grey's Anatomy, ER and All Saints obsessively, thinking that we were looking into the future.

Sadly, it turns out that Scrubs is the most realistic show on TV.

Unfortunately I'm not the "Turk" in my show; that's my Buddy. She's got the love life, sporty balance and career pathway all mapped out. She makes it look easy.

I'm JD. I spend my days trying desperately to win the approval of an emotionally shut-down megalomaniac, skiving off with my friends/co-interns and failing to have a personal life. Overly invested in getting people to like me, good at the family/empathy/heart to heart stuff, not so good at the medicine.

Adge is the cool talented one. I'm definitely nerd.

I told K, the cool pharmacist, about my halloween look (for the record, Sexy Grapes was a sweet outfit) and she laughed. "Oh Sam, that's such a Doctor's costume." Not a compliment.

Anyways, see if you can match the action to the episode:

- hiding in the changing rooms/storage closets/doctor's office

- being condescended to for being female, then mocked for not wearing makeup

- stealing patient's food off the trolley, getting caught by the boss

- wondering if I've lost my earring IN someone

- getting hit on in clinic by patient's nephew (there to translate, uncle was not impressed)

- singing out loud on the wards (seriously, I'm that tired)

That said, I'm ok with being JD. I know who I am (Nerdcore!) and I'm making it work for me. Plus, wouldn't you rather live in a comedy? House is waaay to intense. I need the comic relief.

PS: It's all the more surreal cos my co-intern sounds a lot like Uter from the Simpsons. Recently arrived from Germany, she laughs like she's wearing lederhosen. And she's always eating chocolate.

Man up, bitch.

I think I have PTSD.

Every night, as I lie in bed trying to fall asleep, I get flashes of rended flesh, bone saws, needles, wires and blood. I had dreams about suturing last night. Cardiothoracics is quite confronting, and since I don't have time to process it at work (12-16 hour days this week) my brain has decided to process it at night.

My interactions with the team may also be having an effect. All week I've been stoic, laconic and taken everything on board without whimper or complaint. I've been the perfect dude.

Sure, I can laugh at your jokes about mistresses vs wives.

Yeah, it's weak to admit uncertainty or fear.

Totally, you should dismiss nurses/clerks/women if you don't find them physically attractive.

It's wearing. I feel depleted.

I had my afternoon off yesterday and ended up sniffling in Myer's shoe department. I was looking at all the pretty girls in pretty dresses and realising that they don't feel the need to justify or hide their femininity. They don't over-compensate for their perceived female weakness with an ice-queen demeanour. They're allowed to enjoy being girly without fear of mockery.

I'm going to overcompensate for my current asexual, repressed, verbally-abused state by choosing a slutty Halloween costume. Because that's empowerment?

I can't win.

1 week down, 11 to go.

wrong again

Cardiothoracics is amazing.

I sewed up a half meter of leg. (Then I had to take the stitches out and sew it up again, but my bosses were really nice about it.) I helped twist sternotomy wires into place. I poked a lung out of the way to get at the aorta. I touched a beating human heart.

My life has never been more like Grey's Anatomy.

Despite my pessimistic predictions, the day was somewhat balanced. Sure, I started at 6:45 this morning, but I was home by 6:30 tonight. AND I got lunch. Yes, it was my half day. I essentially worked 5 hours of unpaid overtime, but Dude! I touched a heart!

The team is definitely not used to having a girl around. The conversation centered on the Registrar's lack of sexual prowess as correlated to his manual dexterity. Due the gown/glove/mask combo, I'm pretty sure the Boss thought I was dude. "Sam, pull like a man, not like a little girl..." But they were patient, they taught me ridiculously cool things, and they were very charitable about my fear of surgery.

Actually, maybe they were so nice BECAUSE I'm a girl?

Boss: "You want to do Emergency? It's not as good as cardiothoracics. But it's a good choice for women, cos you can take time off to have babies."

More notables:

- getting told off for being gentle while putting catheters in. "They can't feel it, so if you take more than 2 minutes, you're being soft." Ouch.

- the heart "restart"; not a gentle lub dub, but taking a metal rod and jabbing the exposed myocardium violently, like killing a bug.

- watching litres and litres of blood pour out into tubs, then get sucked back into the body, clean and oxygenated

- getting 6/10 on my (repeat) suture line. Triumph!

- realising I hadn't peed, drunk water or breathed clean air for 5 hours, and still feeling pysched to take on the afternoon operation.

1 day down, 89 to go.

Lifestyle

I'm fresh off the Inter-Hospital soccer tournament, beet red and happy.

Hilariousness ensues when a bunch of deconditioned, unathletic people push themselves as hard as they physically can. As Adge says, "When doctors are off work, they just want to prove how good they are at other things". We are not that good at other things.

Highlight: Adam in goal. Alone. Opposition breakaway. He started screaming, "Seriously? Seriously??? Seriously??" Opponent freaked out, tripped and gave up the ball.

Also, seeing our mild-mannered Endo registrar do a full sliding save. He's my boss, but I was screaming "Pick it up! You're the wall, dude, you're the wall!"

In contrast to this awesomeness, my last shift in Rehab was Saturday morning. I'd been to the End of Rotation drinks the night before, where I had abstained from food & common sense. As a result, I found myself telling a family, "I'm so sorry for your loss" and certifying a still-warm body while hungover. I can't recommend it.

I guess it's the Aussie commitment to leisure. The work hard/play hard thing gets taken to extremes in medicine, but dammit, we're having fun.

But now I need a nap.

reflection

Regular readers (hello VPL! Edmonton! Dan!) will remember the debacle of last week; the patient who bled from his gut, code blued, was intubated and topped up with blood. And my egregious error of not PR-ing (bum-poking) him for a suspected bleed. And the ensuing thanks to various religious figures for his continued survival.

Anyways, he's back.

This poor gentleman has returned to Rehab for some more physio, some more therapy and a little more medical negligence.

He actually looks much better. His colour has improved (the result of keeping blood INSIDE his body) and his breathing has slowed (ditto). I am afraid to go near him.

Why do I bring this up? Cos I had a small mental breakdown this afternoon when reading his medical notes. My entry goes "Pt's breathing resolved, BP improved. Impression: panic attack, for review in am". The next entry goes "MET call".

Every single panic attack I see from now on will get a PR.

Every last one.

(I talked to my consultant about it and she said, "Sam, everyone has near misses. And everyone makes mistakes. And people get lost. You've got to push on, and don't worry too much about it.")

Now I'm drinking a beer on my sunny deck.

My job is messed up.

Moving on up...

I haven't moved in almost 4 years.

For the last 4 years, I've been sleeping on the same side of the bed, in the same room, with the same windows, doors and night sounds.

Tonight, I am going to sleep on the right.

Packing 4 years worth of debris was both dusty and illuminating. I found all the "bad" (career-girl-rescued-from-miserable-existence-by-dashing-artist) books I'd stashed under my yoga mat. I found the ear plugs I thought I'd lost two years ago. I found the love letters from a guy I haven't spoken to in years. I found the source of that smell. There was a lot of sorting. A lot. Some laughter, some tears, some screaming. The hardest part was sorting my books. Every "give-away" feels like losing a friend.

It's true, I haven't moved far; just up a flight of stairs. But it feels like a major transition. I have my own bathroom, a walk-in closet and a balcony. My own balcony! (I can almost see greenery from my window!) I am starting to feel like, maybe, I'm a grown up. Successful even.

So, while my next three months may be a living hell (see previous post), I will have my own grown-up room to come home to.

I will have the memory of this first night of feeling like a success.

Especially with the Top Gun theme song on the stereo.

"No, Iceman. You can be MY wingman..."

Uh Oh

Adge and I had a rough day. Post-work, we needed a drink. We went to our hospital bar ("Where's the bar?" "Mom, it's a hospital, there's no bar." "No wonder people hate hospitals!") and ran into the Cardiothoracics team.

The 6 dudes I'm going to be working with for the next 12 weeks. Luckily, I was drinking, or else i'd be panicking right now.

"Ha, we make fun of Ken cos he's Asian..."

"I just don't get Jewish humor"

"O no! Two women interns? What will we do? TWO WOMEN?"

On and on, until one of them got a text message and said, "Dudes, we have to go. The hot nurses will be leaving soon and I want to hit that..."

This is the team I will be spending (roughly) 60 hours a week with, for the next 3 months.

They were friendly at the pub, but one of them already told me "I don't have a good side, so don't bother."

The other one looked sheepish at that, then told me, "I'm the moderate". And the third (married, devout Muslim, father of 5) told me, "I'm the nice one..."

But then they all laughed.

There is no nice one.

It's not that I think I can't handle myself; I worked at SSG for 6 years.

They duct-taped my head to a phone WHILE I WAS TALKING TO A CUSTOMER. They verbally and physically abused me. They were the most sexist, racist, homophobic pack of bitches on the planet. They were (in short) private school boys.

So why am I worried? Cos that was 9 to 5.

This is 6:15 to 7:15.

Am to Pm.

Expect either:

1) Total mental breakdown

or

2) Sam integrates. Adopts the behaviour. Starts hitting on nurses. Threatening to show you her balls. Etc etc.

And all I wanted was a quiet drink before moving day.

Comeuppance

I thanked Jesus at work today.

The old "no atheists in foxholes" thingo turns out to be right.

Last night I left work after seeing a patient who, though sick, I declared stable.

This morning, he wasn't on the ward.

He had crashed around midnight, bleeding from an unknown source. His blood pressure dropped. His heart rate skyrocketed. He had to be taken to emergency, intubated and topped up with 4 units of blood. Then they did an emergency gastroscopy. He had perforated an ulcer.

Seriously, at 6pm, I had pronounced him well.

My registrar (the aforementioned SpiderReg) said, "Look..." (and you know nothing good ever starts with "Look"). "You were probably right. But, if this sort of thing comes up again, do the following..." and listed the appropriate management of a suspected bleed.

Which I've learned before. Which I KNOW. Which I have employed hundreds of times on hundreds of patients before this, but decided not to do this time...

My complacency has been flayed off me.

I'm going to start paying more attention at work.

PS: He lived. He is not dead. And it is for that, and my soul, that I offered fervent thanks to Jesus. Christopher Hitchens can suck it.

O Canada. Thank you for your stunning vistas, your majestic trees, your placid seas and most of all, your endless bureaucracy.

I just paid 235 US dollars to write a TOEFL exam. An exam testing, through writing, speech and multiple choice questions, my ability to speak English. Despite having English as a first (and only; Klingon doesn't count) language. Despite attending high school, university and medical school in countries that have English as their primary spoken language. Despite flying colours in the MCCEE which is administered in, natch, English.

This Canadian application process can't be good for me. I alternate between white-hot bubbling rage, utter despair and cheerful denial. My skin is peeling, my hair is falling out and I'm eating everything that's not nailed down. (And no, we can't attribute that to the sunburn, hair-dye or last-night's-baking frenzy).

To add insult to injury, I have to do my TOEFL in time for results to be sent to Canada. Which means this Saturday. At 9am. In Werribee, a pox on the land between Melbourne and Geelong. I will have to get up at 6:30 to train to bogan-central in order to speak into a microphone and have my English skills criticized by a panel of faceless robots.

I am supposed to be moving, picking up a Turkey and basking in the new spring sunshine.

Instead, I will be using hand sanitizer to remove the waxy germs from the communal test headphones.

Do you see where the rage comes from?

Falling in love...

On Thursday night, I was all set to write a dour description of "The Talk", the conversation you have with your patients when they are going to die.

I was going to compare it to "The Talk", the conversation you have with your partner after they tell you proudly that they don't read books. And "The Talk" you have with your family when you realize your life choices are going to disappoint them, yet again.

Luckily, Thursday night I was too full of Xiao Long Bao to breathe, let alone type.

Friday brought new thoughts. We have a new Registrar, a smart, sarcastic funny woman who is 19 weeks pregnant and loves medicine.

We saw every patient, and she actually solved problems. Not "patient has itchy foot, apply calamine lotion" problems. More "patient has been confused and disoriented for weeks, let's check his growth hormone level, realise he has pan-hypopituitarism and replace his pituitary hormones" problems! Giving families of brain-injured patients new hope! Getting chemo for our cancer patients!

We call her "SpiderReg" and Adge and I hum as we whip through the work. "SpiderReg, SpiderReg, does whatever a SpiderReg can..." That's right. She has super-powers.

She sat us down in the afternoon and taught us things.

I can now name the 5 components of a haemolysis screen. The 5 DIC markers. The effects of hypoadrenalism on the body (Conn's Syndrome to you). This is the first time I've formally learned anything THIS YEAR. I could feel my brain yawning and stretching, saying "Ooh, this feels good, why haven't we done this more?"

So, Friday I'm in love. With my job, with medicine, with my Registrar. I'm on the ball with my Canadian applications (reference letters are such a great confidence booster). My team is set up to win the Grand Final this weekend. I no longer have to listen to Lawyer Talk at home. There are home-made sausage rolls cooling on the counter.

Life is sweet.

Rowr...

Lions have massive paws. An adult lion will use it's paw to kill prey - no teeth, no claws, just a powerful swipe that kills an impala in a single blow.

Why do I mention this?

Buddy has been making "paw strike" motions every time the nurses ask us dumb questions.

The nurse unit manager ("Hulk" or "Eggplant" depending on her attire) is a particularly egregious offender.

EG: Our patient has a pulmonary embolus, a blood clot in his lung, that has the potential to kill him. Not like, "one day we all must die", but "chest pain, O2 sats drop, heart stops, RIP". We asked if the nursing staff could take the patient's stats four times a day, in order to keep an eye on him.

"Does we have to?" Hulk asked. "Cos that's a lot of extra work..."

Before my eyeballs exploded with indignation, Adge made a quick paw strike gesture behind Hulk's back. I snorted, and my rage dissipated.

Problem solved. The foolish Impala is left to bleed on the Serengeti, leaving the herd stronger and me less annoyed.

Other paw strike moments?
"The patient just opened his bowels after 6 days of constipation. Would you like to inspect the motion?"

"I know you ordered the blood test for 6am, but I had my tea break then, so is it ok if we do it now (10am)?"

"We've given the patient a double dose of his heart-slowing medication for the last three days; can you change the documentation so we don't get in trouble?"

The rehab plains will soon be strewn with fallen prey, but I bet the patients (and I) will have longer, happier lives as a result.

Refresher...

Things that are awesome:

We get to play with botox. Not, like, celebrity botox, but using botox to paralyze muscles that have become overactive. You attach a syringe full of toxin to an electric needle. Stick the needle into the calf and turn on the juice. If the leg twitches, you're in the right spot. Push the plunger, the botox hits and you get three to four months of placid, untroubled limbs.

We get to go to jail. St V's (being of Catholic persuasion) has a strong focus on helping marginalized populations and so, has a prison ward.

Our patient beat his head against the floor so hard that he chipped his spine. I opened his file to do the paperwork and read, "Patient murdered his wife last week". We went to see him. Metal detectors, tattooed nurses and airlock doors, but once you're in it's the nicest place in the hospital. Quiet, only 2 patients at a time, free TV and lots of food...I'd beat my head against the wall too.

We get teaching. My boss in Rehab is a tall, powerful woman who is passionate about getting patients the best Rehab in the world. She also has a terrible stutter when she's nervous. She was teaching us about cardiac rehab (post-heart attack, etc) and told us that, "Patients want to get back to their previous lives. Working, playing with their kids and ma..ma..making lo..lo..having sex."

Apparently, if you're fit enough to walk up a flight of stairs, you're good to go.
I'll never look at the Stairmaster the same way.

cracked

Ok, MCC, I get it. I am not good enough.

My transcripts aren't shiny, my medical degree speaks with a funny accent and I can't even get electives right - BC Children's? Where's that?

I'm having flashbacks to my last set of Canadian applications. No joke, I'm actually starting to have the same dream I had back then.

What dream?

The one where my then-boyfriend would present me with a rejection letter and laugh and say, "Obviously, you're not good enough for me. Now I'm free to spend my time with someone shorter, cuter, with bigger boobs and clearer skin, who does everything you do, but better AND understands my career. Thank GOD."

I know, I know. It's late. I just worked a 14 hour shift. I slid needles into HIV positive people and grannies and young women with post-partum psychosis. I'm greasy and grumpy and have eaten a kilogram of chocolate in the last 5 hours. I can't be taken seriously.

But seriously, why don't I ever pick the easy way?

the fear

I don't want to alarm you, but something could go horribly wrong any minute now.

Rehab is the source of my boredom AND my anxiety now - we have three young patients (well, 40-50) who have had spontaneous brain bleeds of varying types.

It chills me to write up their admission paperwork.

Previous medical history: None/migraines/broken wrist
Drug & Alcohol: Non-smoker, social drinker, smoked pot once in '83
Family history: Nil
Lifestyle: architect/marathoner/stay at home dad (2 kids under 5)
Presents with: Acute onset headache, nausea, vomiting, coma.

They are being taught how to use a spoon again.

The stuff that comes up with these patients is completely different from the issues oldies face. For example, high-level care facilities (nursing homes) do not take patients under 60. These people have young kids who don't understand why Daddy doesn't recognize them. As opposed to the gentle-stroke-compounding-previous-senile-degeneration, these people are going from black to white in a day.

Some people would approach this information with optimism. They would say, "There but for the grace of God", "I am thankful for my blessings", "I must live life to the fullest".

Obviously, I take another tack.

I am insuring myself against EVERY possible outcome. Income protection, health insurance, life insurance, upping my insane vitamin intake, exercise twice a day, social time, quiet time, more greens, less meat, goji berries, blah di blah di blah.

According to Strictly Ballroom, a life lived in fear is a life half-lived. According to Rehab, it doesn't matter what you do, so you might as well prepare for the worst.

Thank goodness it's Spring here - sunshine and pretty dresses help ease the fear.

Don't eat the marshmallow!

Delayed gratification has been a way of life for me for almost 6 years now. I have been well trained in putting off my immediate desires (beer! travel! study-free nights!) in exchange for long-term goals (beer! travel! study-free nights! employment!).

Watching all the young, previously healthy patients in Rehab has been something of a kick in the pants; if you fall off your bike tomorrow, you could spend the next 40 years eating through a nasogastric tube. Life is too short not to try for happiness.

Life is too short to not eat the marshmallow.


With this in mind, I am having more instantaneous fun, but I am also trying to stop living my life with the big picture in mind. Now that I have a (satisfying) job, who cares how quickly I advance in my career? Not me.

Canada is my marshmallow. If it happens, great. If not, I've got some serious chocolate lined up as a substitute.

What spurred this outburst? Old flames popping up with life advice. I listen carefully to the suggestion, then do the opposite. And then I get this song in my head and...ding a ding a ding dinga ding ding...

Vive la difference

When I got my first paycheck, the first thing I bought was a proper bed. It felt fabulous to spend so much money on something that was JUST FOR ME (high hopes for my romantic future) but since then, I've pretty much been living my usual student life.

There have been other extravagances. I no longer get my hair done at the teaching salon. I no longer have a "black and gold" pantry; there are some brand-name foods in there. I eat out more often and get a second glass of wine with dinner. But deep down, I'm a frugal girl.

Until this weekend. I have seen how the other half lives, and I want it.

Beautiful B has moved into a one-bedroom. She has, all to herself, a bathroom, hardwood floors, floor to ceiling windows, and a balcony. She can have naked dance parties. She has room in her fridge for condiments. I want room for condiments!

I also want to live in Port Melbourne, home of the Liberal(s). It's the "blonde, skinny and posh" area of town. I've seen what my life would be life if I spent my money. I could buy imported Canadian candy (Reeses! Coffee Crisp!). Run around in yoga pants and not be sneered at by hipsters. Drink overpriced organic juice. I could buy a little dog and a little jacket for my little dog!

I know, it's a momentary infatuation. I'm sure I'd get sick of it the same way I get sick of Kitsilano; two weeks and I want to claw my eyes out. But for those two weeks, I'm happy to eat the fancy cheese, sleep on the 800-thread count sheets and wake up to the absence of pub noise.

Two weeks. Then I'm back to no-name tuna surprise. Sigh.

shallow end of the gene pool...

I am a drama queen.

I assume the worst, catastrophize, mad-crush, fetishize and over-indulge. Apparently this is a genetic advantage.

An article in the Age this weekend extolled the virtues of people like me; the idea is that those who fear the worst are better prepared for negative situations. I fear, therefore I hide, therefore I am.

I was reminded of this today, when I turned to my long-suffering buddy and said, "I think I have tonsillitis". She (sensibly) ignored me.

"No really!" I insisted, sniffing heavily. "I have a sore throat and I feel really tired. I'll probably have to go to Emergency for IV fluids and Prednisolone."

...silence...

Why does she ignore me?

2 weeks ago I was convinced I had HIV. Symptoms: Fatigue & muscle aches. Post-gym.
A month ago, I was sure I had Hanta virus. Due to the large population of South American deer-mice in the 'Bool.
Yesterday, my rumbling stomach was a clear sign of Crohn's Disease. Or cafeteria tacos.

This drama is a plus in my work-life: all my patients are seconds from death, even if they're just a little gassy.
It's less useful in my personal life: I seriously considered turfing my Liberal cos I got a cold this week. As far as my hysterical brain is concerned, this man is the Ebola Monkey.

Luckily, Buddy tuned in at this point.

"Sam, you work in a hospital, surrounded by sick people. It's much more likely you got your cold from them."
"But I haven't been sick all year, and now I'm on the cusp of death due to Liberal's Auswegian germs!"
"Sam, you can't blame him. And you cannot spritz people with antibacterial wash, no matter how much you like them..."

So, while I recognize the genius in the Marriage family motto (Cowardly at all Costs!) I think my melodramatic genes need to be paired with phlegmatic Kiwi DNA if I'm to have any chance of reproducing.

That's if the prostate cancer doesn't get me first.

Retraction

I take back everything I said about Rehab; now that I've experienced "life outside medicine" (a theoretical concept described by employers who's contracts you haven't signed yet) I may never go back.

I've been exercising.
Eating 3 balanced meals a day.
Interacting with both non-bleeding AND non-vomiting people.
We had an election party. More importantly, we had time to plan, shop for, dance through, clean up and rehash-over-brunch. I think people call this "living"?

As you are probably aware, the election has not had a clean result; this meant that our original plan of "wait for Labour victory, celebrate Green victory in Melbourne, drink, dance, repeat" was scuppered.

Instead, we had one half of the room focused on the results as they ticked in and the other half determinedly ignoring them. We had three heated arguments and two storm-outs (though one was related to brotherly ire re: sisterly pashing). And we still don't have a result.

Not everyone was so vehemently partisan though; Greens and Liberals were able to wake up and have a civilized breakfast before resorting to snide remarks and name calling. NB: A re-usable cup does not make me a dirty hippie.

Life in rehab is PROPER LIFE! This means less medicine, more scandal and SO much more bacon. Bliss.

False Modesty

I know what all the normal people feel like now.

I got up this morning, made my lunch, walked to work. Bantered with my co-workers. Sat through a meeting. Did useless paperwork. Had a lunch break. Came home. Ate dinner.

Nobody died. Nobody bled. I'm sure someone vomited somewhere, but I didn't have to smell it (or worse, examine it). And nothing I did today could have resulted in someone's accidental death. Accidental unnecessary x-ray, maybe. But NO DEATH!

Anyways, I hate it.

Rehab is touted as the perfect rotation for mid year. By now, we're all pretty burned out and tired, and rehab is mellow. Sedate. Coma-inducing. When we planned our year, buddy and I thought it would be ideal.

I am not enjoying it at all. It has all the drawbacks of gen med (interminable ward rounds, malingering patients, daily drug-charts) but lacks the glamour. You heard me. It lacks the glamour of GENERAL MEDICINE. Sigh.

Anyways, it's been good for my post-nights delirium, but please expect a rapid descent into madness. Rehab ward isn't even in the hospital proper, and every time I cross the chilly divide between acute and...brrr....subacute medicine, I feel a pang for emergency. 5 months to go.

Bacon Muffin Day

Game on, bitches.

One hundred dollars of my hard earned cash (it takes skill to tweet while hiding from the nurses) has been sent in to the Medical Council of Canada. They assure me that this money will be used for important things, like verifying my exam scores. The exams that they provide. That cost me 2000 bucks last year. But I digress...

Hitting "send" left me giddy! Even if I don't make it, even if they spit on my application and tell me I'm more suited to Koala therapy, even if they ban my descendants from applying based on my scores...Even if, I'm excited.

My worst case scenario is that I don't get a job which means:
- Morocco in January with Dan & co (no interviews = holiday time)
- A year of exorbitantly overpaid freelance work (including Warrnambool ED, where my boss forgives my use of the terms "retard", "strap-on" and "motherfucker")
- 2 months in Canada IN SUMMER, with a planned trip from BC, through Calgary (gotta meet Little Sammy) and on to TO for dancing with Ian, Rachel & Corey.
- the satisfaction that I tried something, even though it had an uncertain outcome.

See? Win win. Which is not something I could have seen 3-4 years ago. I am so glad I'm not 25 anymore. Which reminds me...

Happy Birthday Dan! Don't be afraid, it only gets better.

Eleventh Hour

I met a Kiwi doctor who working as the Orthopaedic resident in Warrnambool. I asked her if she was interested in pursuing surgery as a career (the only people who take these jobs voluntarily tend to be folks ready to sacrifice 6 years of life/happiness at the alter of SET training) and she said, "Oh, I don't know. I'm very laid back. I'll just see what happens."

I was immediately suspicious.

Anyone who says, "I'm really laid back" isn't. It's like someone telling you, "I have a great sense of humor", "I don't care what people think about me", or "I won't get emotionally attached if we hook up". Lies. All lies.

Cynical? Not even.

Part of it comes from observing patients who tell you earnestly that they're dieting/quitting/taking their meds. The desire to make it true translates into a wide-eyed avowal of honesty that is integral to their sense of self. (Challenge at your peril...)

I also recognize the tone of voice/innocent expression/defiant head tilt from years of protesting too much. In the years applying to Canadian medical school, I kept saying, "I don't care if I get in, if its meant to be it will happen..." And then I'd scream at my boyfriend for agreeing with me (sorry J).

So, with tomorrow being the kickoff for Canadian job applications I would like to get the following out in the open:
- I am freaking out that I will spend all of next year homeless and unemployed
- I care waaaay too much that my Canadian training wont live up to Aussie standards
- I am worried that I'm doing this cos I'm bored in Melbourne and will be bored in other cities too

There. It's out. Friends and relatives can breathe easy.

Anyways, the Kiwi doctor and I chatted on about job applications and prospects for the future. I ventured that it was quite stressful making decisions about the next year when the outcomes were so unknown. She looked at me and said, "Well Sam, it might be for you. But I'm very laid back..."

Then she told me a story about how her boss called her beautiful, which ended, "But I really don't care what he thinks about me..."

Amazing.
Maybe psychiatry does have some appeal.

Political

I had always considered my friends in Australia to be relatively apolitical. We don't generally gossip about politician's gaffes (Scores-gate! Budgie smugglers! Julia's roots!) and we're not likely to wake each other for breaking news in Government.

I didn't know we had a new Prime Minister until I got the the gym (house in Warrnambool had no TV, internet or radio) and she'd been in power for 7 hours already!

But. We are having a house party on August 21. Election day.

This party is bringing out the inner passion for Government. People want to come, "But only if you'll..."
a) NOT show the election
b) show the election results with the sound off
c) show the election with the sound on and provide candles for a mourning vigil
d) play the "moving forward" drinking game

And everyone has opinions on who will win, who should win and whether we should do a shot every time Mr Abbott gives Julia a "do me" look.

Australian politics are so much fun. In the last month we've had the usual baby-kissing shenanigans, but we've also had a "bloodless coup" that deposed a PM with 60% approval ratings, Kylie Minogue being hit on by leader of the opposition (who also hugged a puppet) and the local comedy troop offering Julia Gillard $2000 bucks for her Mining Tax. As part of her "Cash for Clunkers" plan.

The PM responded with, "Oh, thanks love, but you work for the public broadcaster; you need to keep every penny you have."

She's an unmarried atheist who's childless by choice and pro-work choices. I'm still voting Green, but I'm giving my preferences to her.

Also, Clarke and Dawe are back. On a frighteningly familiar topic.

Tie me up, tie me down

As medical students, we had infinite discussions about dignity, the right to autonomy, respect and minimal interventions for our patients.

Nurse Bear (cousin extraordinaire) often mocked my naive perspective; "When you've got a patient trying to punch you, see how you feel about chemical restraints..."

Night shift has brought this all to a head. Obviously, nights are when patients "arc up" - delerium kicks in, less staff is available, doctors are hiding in the residents room watching "Dr 90210" (ahem).

We were taught that agitated and aggressive patients should be managed with minimal intervention.

Then came Thursday night. The patient kept getting out of bed, taking off his clothes and pulling out his lines. I suggested small interventions - leave the light on, lower the bed so he doesn't fall, give him a gown, wrap up his drip points. He began wandering the wards, trying to get into other patient's rooms. Close his door, keep an eye on him. He began shitting and pissing on the floor, fingerpainting with his own faeces.

Haloperidol. Stat.

He tried to pull the lines out of a patient in the next bed. More haloperidol.
He got up, shat, slipped in his faeces and had a fall.

I had him shackled. Top and bottom.

The next night I had a patient who is delusional. He believes that he's in a prison camp back in Italy, posssibly under the fascists. Mindful of this, I was sticking to chemical restraint, as I didn't want to traumatize him further.

He kicked me in the head. A crafty gentleman, he would wait until I tried to examine him, then lash out with a very bony knee. (He was also kicking at the "people" at the end of the bed. I was the only one there.)

Shackled.

Lord, I don't even blink any more. Goodbye theoretical medicine. Hello night shift.

I want your disease...

Things that happened on my birthday (or within 2 hours of it):
- cupcakes at midnight
- first on scene at code blue that required intubation and CPR
- projectile vomiting
- pericardial effusion that was causing minor tamponade
*(on TV, this is solved with giant needle to heart)
- housemate party: jelly-slice cake, homemade butter chicken, eating in pj's
- finding out the UBC has changed their requirements for application again and I NO LONGER QUALIFY
- hearing "Bad Romance" as the sun came up and I struggled to get a drip in
*(hello theme song for 29!)

Last year, the birthday didn't happen due to interplanetary time differences. This year, cos of the night shifts, it lasted for about 48 hours. My work life is so strange; I have never had more texts/messages/emails of love on a birthday, but I spent the majority of the day with very sick strangers. Medicine is weird.

Today is pseudo birthday; I've had fancy breakfast at a local cafe, napped for 4 hours and am about to punish my hair with another round of "colour me random". Followed by dinner with my beloved(s) and perhaps a glass of champagne.

Behold; my birthday tune (no embedding, damn you YouTube)

Taking off the cowboy hat...

Alas, last night was my final night in Warrnambool. We decided to stay in town on Friday night in order to experience a "proper" country night out. It was the first time we didn't have to get up early to work so we thought, "Hey! We'll let our hair down, country-style".

After a semi-wholesome afternoon off (whale-watching, surfer-changing-in-the-parking-lot-watching, slutty-shirt-shopping, milkshake drinking) we met at my house to drink any leftover alcohol we could find in our fridges. Champagne, Canadian Club and low-carb beer, all served with a side of stale Doritos? The beginning of a very classy night.

Dinner and drinks, then we hit "The Pub".

I was dancing up a storm when I noticed a familiar face over Dan-the-physio's shoulder; a patient who had come to ED a few weeks ago. I started to smile at him in recognition when I remembered what he had come in for; he was a drug-seeker, and I had denied him drugs. He had been quite angry, needless to say.

I ducked and covered (thank you tall Dan), but I don't think he recognized me, cos he later tried to hit on me after grabbing my ass. Or maybe that was a sign he DID recognize me?

God bless the small country town. And thank GOD I'm back in the big city.

the rise and fall of Dr G, in one short hour

I am drunk with power! (And not, alas, just drunk)
Why? I have no bosses today!

For those unfamiliar with Australian country hospital daily operations; Every morning all the doctors meet in the ICU for a ward round. Then we split into our medical teams; A senior boss (consultant), a junior boss (registrar) and me (pig-spit). The bosses review the patients, create their care plans and alter their medications. I follow them around, frantically writing down whatever they say and trying to deflect nursing questions until the round is done.

This is often unsuccessful, and I have actually written down "Can patient have tea?" into the middle of a care plan.

Today, my registrar has a day off. My boss is away at another hospital. I did the ward round all by myself. I was excited - I could take as much time as I wanted, make sure all my questions were addressed, look up drug doses instead of guessing randomly...

But, since I have no power, knowledge or expertise, it went like this:

Sam: Hello patient! How are you feeling today?
Pt: Stone the crows! Crook-as, love.
Sam:...uh, right...
Pt: Crikey! I spewed this morning, but I'm feeling a bit better now.
Sam: Oh, good?
Pt: So, what's the plan?
Sam: (backing from room slowly)

Sadly, I have no idea what the plan is. Or indeed, whether this patient can go home, should stay, needs stronger medication for his heart rate. So I smile, duck out of the room and hide in the library. Where I write my blog.

The pinnacle of my career, yes? Maybe not.

Go!

Do you know why I hate the medical wards?

Because there is too much downtime. I've been back on the wards for 6 hours now, and I've already worked myself into a state of such grotesque self-loathing and anxiety that I could eat a cafeteria meal. This, it should be pointed out, is akin to an act of self-harm.

Do you know why I love Emergency?

The last three weeks, I have been working in the Emergency Department. In Warrnambool, this means babies, truckies, man vs farm animal, drunk guy vs plate-glass window, drunk girls, kids on motorcycles and STDs.

It also means that from the time you arrive at work until the time you leave (usually two hours late) you are ON. Running. Panicking. Chasing a pantless toddler who is determined to poop on the floor. Trying to stop your drug addicted patient from stealing your stethoscope. Trying to explain to an 18 year old girl that, "No matter how much you like him, you have to use a condom when you can see blisters".

In short, bliss! No time for self-reflection! No time for soul searching! No time to pee!

Workaholism is still better than alcoholism. Similar amounts of vomit, but at least it's not mine.

the cons

These are the reasons I should not go back to Canada:
- the salary
(I'll be taking a pay cut of approximately 15 thousand annually)
- the hours
(In Canada, you get paid a flat rate, so hospitals have no incentive to keep you to your maximum hours. A friend of mine says they essentially work the doctors "until they keel over", and then they work some more.)
- the training
(everyone I've spoken to insists that Aussie training is better. Not just Australians are saying this; we get more general education, so are better overall doctors, instead of just niche specialists)
- the choices
(in Australia, I'm an excellent candidate for just about any program. In Canada, I am told to be grateful for the positions that other Canadians don't want.)

So. What now? Essentially, I can pick career suicide, longer hours, less compensation and less recognition OR I can stay in Australia.

Obvious choice?

Then why is there a little voice in my head saying "I don't care! I want to go home!"? Blerg. All this and peppermint hedgehog slice. I may be sick.

the big decisions...

I am going to move back to Canada next year.
There, I said it.

This weekend, the "Junior Doctors Jobs List" came out in the paper. My lovely friends were actually on the cover, and their smiling faces shone out at me as I sat in my Warrnambool brunch joint, eating hotcakes.

I thought, "I can't leave Australia! I have so many great friends here! I have a fantastic working environment! I like my co-workers and my lifestyle! Plus everyone's so good-looking!"

Anxiety began to gnaw at my stomach, detracting from the cinnamon-infused marscapone and toasted walnuts. My wonderful friends were, at that exact moment, driving 3 hours to come and visit me in my blissful sea-side town. How could I walk away from such a beautiful happy life?

Answer: ...um...

I think it's time. That's all I can say. I love my life here, which is why I can leave with a clear conscience. I'm not leaving cos I never settled in, I'm not leaving cos I'm fleeing an unhappy relationship or bad job. I can honestly say that I am 94% happy with my life here, so it's time to go.

"It all boils down to one portable phrase; if you love something, give it away."

Next up: 12 months of unemployment, anxiety and Canadian Medical Council Examinations. Gun-to-temple stuff. Bear with.

HTFU

Everybody dies.

More specifically, everyone I look after seems to die.

This weekend had a combined death toll of 3, which doesn't sound that high, but... When you think that on Friday you were chatting to all these people, holding their hands and taking their blood and telling them, "We'll try and make you better", it becomes chilling.

Emergency was busy this weekend; at one point we had 4 young men in cervical collars - motorcycles are a bad idea. I dealt with TWO kids under 14 who had been riding motorcyles and crashed.

We also had an acute trauma where a Dad & daughter combo (on another motorcycle, natch) collided with a kangaroo. Guess who won?

And finally, a gentleman who said his biggest issue was that he couldn't pee. He looked a little blue in the lips, but I took him at his word and put a catheter in. Then he crashed. We revived him. He crashed. We revived him. We got him well enough to go to the ward. He crashed again today. "CPR, done right, should break a few ribs". Indeed. I broke ribs. He still died.

Luckily, there's no time for introspection on the job. We washed our hands and walked back out to wards; I got a little teary, but finished the ward round. As they say down in ED: "HTFU Sam."

Harden the F**K up. In the meantime, coffee, head down and power through.

Faux pas

I get flashes where I realise I am completely out of touch with reality.

Today there was a MET call (medical emergency) on my ward. I skulked over to the appropriate room to find the full contingent of Warrnambool's finest all inserting drips, taking notes, getting drugs...in short, running the MET call perfectly. I took a look at the patient, who had copious red blood pouring from his anus, along with large chunky clots. I asked the senior doctor, "Do you need me for this?" and when he said "No" (they had it under control), I went back upstairs and finished my lunch.

Other similar moments of unreality?
- telling a patient, "Oh, good news! You just have to have your carotids stripped and then you'll be better!" Patient looked at me and said, "Sorry, did you just tell me I need to have major surgery on the blood vessels to my brain? Cos it sounded like you said "Good News"."
- telling the same patient, "We got you a slot in today's vascular surgery lineup!" and attempting to high-five him. He was not impressed.
- walking into a woman's room and saying, "Now, I've just got to put my finger in your bum, but don't worry, it'll only take two seconds and then you can get back to your afternoon tea".

Seriously. What the hell has happened to me? I've become one of those doctors you read about in "Why I hate hospitals" columns. But I'm also getting a lot better at my job. That's a scary inverse relationship.

ouchie

Sunday morning in Warrnambool is a beautiful thing. I wake late and wander over to my local cafe for a latte & muffin. I am perched at the bar, powering through the Sunday papers when my yoga instructor waltzes in. She looks completely different out of class; gone is the severe bun, replaced with blonde bouffant and face full of slap (makeup). Next time she chastizes me for my impure life, I will not be afraid.

I'm working in the ED this weekend and it's reconfirmed how much I LOVE this job. It's not a big city hospital; you can't get xray after 5, you beg for ultrasound (probably wont get it unless your patient is spewing blood), and there is a distinct lack of senior staff. But the patients are great; yesterday being Saturday, I saw 5 footy players and 4 netball players, all with various fractures, bruises, sprains and bumps. They say today will be all Mother's Day related injuries- kids eating peanuts at the local restaurant and grannies collapsing after an exciting morning with the grandkids.

All in all, I'm looking forward to it. Plus, ten hour shifts FLY by. I couldn't believe it when they told me I was done last night. It felt like I'd just arrived.

It's also fun to work here cos everyone thinks I'm the local celebrity. "Canada! Wow! I love Canada, I've always wanted to go! Aren't you brave to come all this way..."

And I think, yes. Yes I am.

porn for women?

http://hotguysreadingbooks.tumblr.com/

Yes. Hot guys reading books. "Hot" is subjective, but who doesn't enjoy the literary type?

15 hours yesterday. 1 death, 2 getting shouted at, 3 psych committals. Just about to start 10 hours in ED. It's gonna be a bumpy weekend.

just a small town girl...

I think Vancouver might be a small town. I've been really happy in Warrnambool, feeling really at home and comfortable in this environment, and the reasons are as follows:
- I can see the ocean from most windows on the second floor or higher
- I can get to a sea-side running track within ten minutes
- the whole city is green; grass, trees and flowers are everywhere
- people are, on the whole, friendly and pleasant
- the yoga here is as close to torture as is legally allowed
- I can wear sweats to the grocery store
- I don't feel guilty if I come home from work and chill out; (in Melbourne, I always feel like I should be going to hip bars, trying new restaurants, taking pole dancing classes, etc etc)

All these things are the things I love about Vancouver too; big city, small town feel. Of course, Vancouver has the drawbacks of a small town. I can't go for a manicure without running into the French teacher who hated me in grade eleven (Damn you Bourbonnais!). I would hang out primarily with people I've known since high school. I would eat nothing but sushi for the rest of my life...

Lots of things to consider. Lots on my mind - job applications will be due soon and one must ask herself, "What do I want from the next three years?"

spewing...

I get off the train at a one-platform station and walk 15 minutes to the hospital. Not a single car passes me. I can't sleep at night because the silence freaks me out. From my bathroom, I can hear cows going nuts. I have gone Country.

This happened to me once before, during my first degree. 2 years at an agricultural school ("Guelph - the sound one makes when vomiting!") left me in overalls, two-stepping like a champ.

The hospital is pretty quiet at night (and yes, I'm still at work, 13 hours on) and I have caught myself singing as I walk from floor to floor.

On long shifts, we get a meal ticket to take to the cafeteria. I have enjoyed such delicacies as meat n'potato, lamb stew & frozen veg and hot chips. I sit in the empty cafeteria and listen to the kitchen staff talk about the footy.

"Crikey! Did you see Geelong? Rooted!"
"I know, I was spewing...Where was the heart?"
"Awww, and the kicking! Useless pack of mongrels, the lot of them..."

Then I get paged and go see who needs some more warfarin. Nice work if you can get it...

PS: I've started watching Friday Night Lights and the comparisons between small town Texas & small town Oz are eerie. No cowboy hats, but lots of smokes, fights and people who talk reeeeeal slow. Plus baking for every occasion.

yeehaw.

I am officially a country girl. I moved into my flat last night; they put the interns into Pleasantville-style mini-houses across from the hospital. I made a home-cooked meal from scratch (bacon/chicken/mushroom/pumpkin risotto) and slept, without earplugs, for the first time since I moved to Australia. Bliss.

The patients are starting to know my face. I put a drip in a poor old lady and left a bruise the size of a pineapple on her forearm. Now, every time I walk by her room, she waves the black welt at me and says "Not so clever now, are we?"

My 14 hour shift included drips, catheters, drug charts and a code blue just as I was about to leave for home. When I finally arrived at Ward 9 (I got lost AND got locked into a safety corridor in the psych wing) I found the team chatting to a young girl who had just hung herself on her bedhead. The usual.

Today, I had all my real work finished by about 10am and am now free to wander the hospital looking for tea, cakes and free internet. As I said, I am now pro-country.

4 days down, 61 to go.

Keitha.

The head nurse of my new country ward is named Keitha.

I saw her nametag during orientation and began giggling uncontrollably, but alas, no one else got the joke. We're a long way from Kansas, Toto.

4 hours from the Melbourne, Warrnambool is situated on a lovely vantagepoint, stunning beaches...fabulous local culture...blah blah blah.

They don't have enough accomodation for all the doctors they've employed, so I'm living in a motel (old school;my milk was delivered in a porcelain jug). The hospital was described by our director of education as "a falling down piece of crap". My patient today accused me of pretending to be smart cos I talk funny. They served us tea and scones this morning, because civilized people have morning tea.

Mixed bag, really.

I'm off to scout out the pub (for dinner, I swear. Just dinner.) and then prepare for tomorrow's 14 hour shift. God bless rural Australia.

A whole new world...

Alas, I have returned. Melbourne is lovely tonight, cold and crisp and moonlit, but I am moping. I am struggling with having to wear close-toed shoes, sensible shirts and most of all, pants. Down with pants!

That said, my current job is keeping me on my toes. I am the "relieving" intern, meaning I cover shifts that other people can't do (eg: if they call in sick). When there is no shift to cover, I get to help the anaesthetists in theatre. Monday morning, I was supposed to start at 11:30am in anaesthetics. However, as it was my first day back, I thought I'd check in with the hospital to make sure. At 8am, I rolled over in bed and rang the co-ordinator.

"Hi, this is Sam, I'm relieving today at..."
"O, great! Are you in the hospital now? Cos we need you to cover gen med."
"...um...no...I'm not at the hospital..."
"How soon can you be here?"

Which is how I ended up eating cold pizza on the tram at 8:09, un-showered and still wearing my pajama top under my sensible blouse. Worked from 8:23 (boo-ya!) till 6:20 that night and then went home to crash. Day one of relieving...

Day two has been more civilized. Anaesthetists like to talk and I'm a good listener, so I was regaled with footy tips, tales of bad doctors past and helpful hints on how to get a tube into someone's windpipe.

Awesome, right? Plus, wearing scrubs is the closest you can get to not wearing pants in a professional arena. I just need everyone to stay healthy this week. Vitamin C all around!

heal thyself?

Blerg. Last day in Thailand. I am supposed to be reclining under the firm yet tender hands of a Thai masseuse, having my pending-work-anxiety beaten out of me. Instead, my stomach rolls with every change in posture. I am pale, sweating, pained...AND I DON'T KNOW WHY!

This is possibly the most annoying day of my life. If I could say confidently, "Oh, it's a traveller's sickness", I would be ok with that. Food poisoning. Malarial infestation. Hell, I'd even take syphilis as long as I presented with a clear and obvious pattern of symptoms. But this? Malaise? Non-specific nausea? No other real symptoms? How does one treat such vagueness?

Prescription: water, french fries (o! western food!) and lying under a ceiling fan while watching made for TV movies from 1998.
Blerg indeed.

PS: Ok, I REALLY don't mean it about the syphilis.

take it with you...

I am on holiday. Blissful, blissful holiday, with snorkelling, sharks, rock climbing, cold beer, hot nights and so much delicious Thai food...

I am still at work. Every night, i close my eyes to see the screen of the Emergency Map; what patients are due to be seen, who are still waiting for test results, what needs to be done now. And while we walk on the beach, I am thinking about how I will stitch our wounds when we cut our feet on broken glass. I am listing the antibiotic regimen for travellers diarrhea (and the red flags associated). I am watching the beautiful people kiss on the dance floor and thinking about the recent increase in syphilis infections worldwide.

It's a weird bliss, but it's mine. Can't change who you are, so I've decided to embrace it; use my knowledge for good. As opposed to my usual "torture my friends with descriptions of their predicted future deaths". Happy times.

I'm going to lie face down now and NOT think about scabies infections.

Geni's on the Block

In the video, the ABC team review the Australian Censorship Board's approach to female external genitalia and look at how that is affecting the population's perception of what a normal vulva looks like.

Please be warned, the video was broadcast on ABC television, but does contain graphic images of female genitalia and surgical operations.



I think it is an important video to watch. I was appalled to hear the Doctor's description of "improving" genitals. As a Western nation, we condemn cultures that practice genital mutilation; we think it is abhorrent to cut away the outer genitals to make the vagina more "attractive". Yet we also seem to be condoning the practices of this (very shady) plastic surgeon.

Now, I realise that not everyone in Plastics is evil. Some people are out there reconstructing burns and replacing mastectomies and cleaning horrible wounds that ED docs are too scared to touch (thank you Plastics Reg!). This guy just leaves me with the same sinking feeling I get when I hear small breasts described as "malformed".

At what point do we say, "Enough!" If there must be soft porn, let that soft porn show real genitals, not the neat & tidy clefts that the Government deems acceptable.

Friday Night Lights...

Alas. While I still love my job, I am getting less committed to doing it well.

For example, in the first month of my employment, I refused all social engagements that would take place on a "school night". I wouldn't even have a glass of wine at home if I was working the next day. I wanted to keep my edge, to be sharp and ready to shine!

This Thursday I did a day shift (7:30-5:30). My next shift was for Friday, but didn't start till 4pm. What did this responsible, caring member of society do? She went for margaritas. (Admittedly, the best margaritas since Uncle Norman taught me about cointreau.)

Instead of rigorously focusing on the job to come, I went to yoga this morning! I ate brunch! I watched crappy TV for so long that I was almost late for work!

I saw lots of interesting patients tonight (OMG! coca-cola coloured urine!), but I kept letting little things slide. This is ok if you're working at Summer at Saints (worst outcome: lower score in Bejewelled) but less ok if you have a 95 year old woman waiting for blood tests.

Sigh. As I said, I still love my job, but if I want to keep doing it, I've got to learn to stay focused. Stay driven. Stay...oooh! Shiny!

will to live

We have a frequent flier at St V's; someone who comes in again and again with the same problem. This girl calls the ambulance every few weeks.

When they arrive, she shows them the massive cuts on her arms. She then takes them to the fridge, where she has stored all her blood in jars. In this way, she can tell the paramedics exactly how much blood she has lost.

For a while, everytime she came to ED, they would fill her up with donor blood and send her for psychiatric counselling. Unfortunately, when she has enough blood in her, she feels "too full" and wants to bleed herself again. The hospital was going through all it's O-negative blood on a single patient. There is now a hospital order that we just give her fluids and stitch her up as best we can.

Did I ever say I wanted to do psychiatry? I retract that statement, officially, here.

Emergency is still good. I still enjoy my work, even during crappy, frustrating, sad days like today. This is a good sign.

bitch tits

My patient weighs almost 150 kilograms. KILOGRAMS. (2.2 pounds per kilo, people). Because of his extreme BMI, he has developed lymphedema; essentially, a backlog of the fluid that bathes our cells. Trapped fluid gets infected. Infections mean he has to come to hospital, where we try to calculate the dose of an antibiotic for a person who is 1.875 standard people.

Anyways, his wife came in with their darling baby daughter and I had an utter WTF moment. Who marries this man? How did they get pregnant? How does their daughter look at him? Does she see him as a mountain of flesh or just her Dad? He's had 2 previous lap band surgeries and still weighs more than twice me.

If I'm honest, this is not about my patient. There was an article in the paper for Valentines Day that said women who are still single past 25 are probably too picky and are doomed to a life alone. I look at people like my patient and I wonder if I'm too superficial.

Maybe there's a wonderful 100kg man out there who will be the father of my children, my best friend and apple of my eye.

Or maybe I'd rather be alone than share a bed with someone who suffocates in his sleep under the weight of his neck rolls.

Bah. Forgive me. Canada's hockey loss has put me in a foul mood. Well, that and the fatty.

eeew...

The world gets smaller while I'm at work; the patient, the blood test, the xray, the fever, the pain...The ED is super busy, but if i'm not speaking to someone about a case, "Hey" is the most conversation we'll exchange.

Sometimes there's a lull, and you get a chance to go "phew" and tell your colleagues about the interesting pubic grooming your young Crohn's patient had (who knew teenage guys were into sculpting?)...

Anyways, I go back into the world, watch the Olympics, read the web. Then I find this article about genital lipstick, and feel glad that I get to back to work in an hour.

Back into the bubble.

Valentines Edition

I only know one man who wears Old Spice, but it smelled good when we were 16 and it smells good now.

I am so ridiculously homesick after watching the Olympic opener that I plan to go back to bed and listen to Leonard Cohen and Sarah McLachlan while reading Michael Ondaatje and drinking maple syrup. Peace out.

a stern talking-to

Last night was the first ACDC concert of the Black Ice Tour. 80,000 people attended. At least 10 of those people ended up in St V's ED; fighting, drinking, falling down and biting each other(!).

Another concert attendee lost her toenail when she smashed into the stage. However, she was not seeing ACDC. She saw Taylor Swift.

I have finished my first round of nightshifts! It is 9:46 am, I have been at work for the last 10 hours and awake for...well. Too long.

I was incredibly lucky in that my Reg (senior doc) was a straight-talking, uninhibited, blue-haired Goddess of Emergency Medicine. I think she should write a book of her teaching catch-phrases. My favourite:

"Don't negotiate with terrorists..."

- patients who are refusing to comply with treatment, taking off their C-spine collars, spitting at the nurses, not taking their meds...

These patients get the patented Reg talking-to. "You are a grown-up. You don't have to be here in the hospital. You are free to leave. If you want medical attention, however, you have to let us do our jobs to the best of our abilities, which means YOU DO AS YOU ARE TOLD."

I had a patient who got drunk and hit her head. She kept taking off her C-spine collar and when I explained the risks to her (spinal cord damage, paralysis, death) she looked me dead in the eye and said, "I'm an alcoholic, I don't care if I die, you're not giving me the (pain medication) treatment I want, so I'm leaving".

I need to work on my stern voice.

so far...

I left the hospital at 8am this morning and walked into the harsh sunlight. So far, the best thing about night shift is being first to the bakery; my walk home included a still-warm pain chocolat and Ryan Adams on the iPod, which made everything better.

Last night included stitches for every young man in Melbourne (they bite each other, stab each other, knock each other over, hit each other with bottles), drunk kids, kids on too much ecstasy, kids on too much tylenol aaaaand...a post-coital penis bleed.

I am going to invest in some safety goggles.

living the dream...

I spent a large portion of Wednesday night praying for the sweet release of death. It was 35 degrees in my bedroom and the fan only served to push waves of hot air over my dry, swollen skin. I knew I had to sleep, knew I couldn't and kept having flashbacks about the gory scenes from True Blood. Death seemed like a merciful option.

Of course, today I am glad that Jebus doesn't hear my prayers.

An epic day. ALS training (Vincent the mannequin vs Sam the mannequin-killer) followed by a long shift in the ED. I was supposed to leave at 11pm. I got home at 1:00. It was totally worth it; I got to learn lumbar punctures with K, the blue-eyed Irish resident. If it weren't for the trembling, terrified patient, it would have been just like a Harlequin.

His hands shook slightly as he guided my fingers to the spinous processes. With a thrilling combination of strength and tenderness, he found the intervertebral space and reached for the chlorhexidine swab.

"Sam..." he breathed. "Can you pass me the local?"

As I handed him the needle, primed with anaesthetic, our eyes met. His blue gaze seared into mine and I felt my heart flutter. I knew I would never jam a needle into someone's spine again without trembling.

....sigh...

A girl can dream. On to nights! Expect loopiness!

heatwave

Night shift starts tomorrow. I've had five days off to "prepare" (read: go to the beach, book holidays, sleep in the sun) and I'm still not ready. I am still having nightmares about my last days at work.

It's about 34 degrees outside, which means 31 in my bedroom. This weekend is the anniversary of the Black Saturday fires and the weather has given us a heatwave.

I've been reading first-person accounts of what it was like last year. I didn't know much about bush-fire preparedness before this, but now there's a special in the paper every weekend. Heavy clothing, wet blankets, don't try to flee at the last minute. It has encouraged me to read up on my burn treatments. I've seen a couple of bad burns (paediatric ED was particularly grim) but nothing like what these people have survived.

The heatwaves also mean old people and babies overheating in their homes, which means a busy ED.

I'm hoping for 6 nights of small cuts, non-cardiac chest pain and alcohol intoxication. Wish me luck.

upstairs hollywood medical school...

A middle-aged chronic ethanol-abuser (alcoholic, for you folks at home) came in after a nasty fall. He was wheeled in as he couldn't stand, and his knee, elbow and ankle were swollen beyond belief. He got x-rays of all three joints, which I took to my consultant (boss).

"Boss, I can see a definite fracture in the ankle, maybe a fracture in the elbow and the knee is intact..."

"Yes, the knee is intact, there IS a fracture in the elbow, but... I don't know about the ankle. I think what you're seeing is an old fracture."

O, but I was sure. I argued my point, demonstrating the interrupted cortical bone, the exquisite tenderness of the medial malleolus, the massive swelling of the ankle.
Finally, my boss agreed, and I put the man in a plaster from knee to toe.

He also needed a sling, which meant he couldn't use crutches, and so we had to admit him so we could keep him safe. (Alcoholics are not very well people, and definitely not good using one crutch with two broken limbs). Admitting him meant I had to I call the Orthopaedic surgeon to let him know about the broken boned patient.

Let's call him Bruce.

"G'day, Bruce here, I've had a squiz at the X-ray and there's no new fracture. It's an old fracture."
"But, we're admitting him to hospital..."
"Nah, he's fine. He can go with a walking boot."
"But...I already put him in a plaster!"

...silence....

"Are you one of the new interns?"
"Er. Yessir."

Hysterical laughter down the line.

"Look, love. Take the plaster off, find him a boot, send him home. He's not coming into hospital"

The only upside was that my patient had serious DT's by now and really wanted to go home, where he could drink in peace. I cut the plaster off, found him a boot and sent him home.

Another fine day for intern medicine.

rite of passage

I stand over the ironing board, steam curling up into my eyes. I am thinking about yesterdays shift. Specifically, the moment when the nurse taking an ECG on my patient said, "He's in VT."

I have been trained for this scenario over and over. Vincent, our state-of-the-art mechanical patient, goes into VT all the time. I know what to do when Vincent goes into VT.

Call for help.
Oxygen on.
2 large IV access points established, fast.
Paddles on.
Read the rhythm again. Still VT? Shock.

etc etc

When Mr Smith went into VT, I froze. Luckily, no one else did. The nurses around me flew into action like the proverbial well-oiled machine. Within minutes lines were in, aspirin given, oxygen on, the paddles were tracking his heart and we watched as he flipped from runs of VT to bradycardia...

It was my first real emergency. Next time, I'm hoping to actually participate in the code. By my 25th time, I'm hoping it will feel natural.

As the steam rises up and I burn my shirt, I am re-living that sick feeling of panic. I no longer have nightmares about ex-boyfriends. One week in the ED brings a whole new set of nightmares.

That said, I have a beautiful new bed in which to have said nightmares, so being a working Doc isn't all bad. More tales to follow - ask me about the chick on LSD.