Thursday, December 31, 2009

A new year's resolution

May next year be better than this year. Much better.

More satisfaction for hard work, less BS, thank-you.

Good-bye, 2009. You were challenging and saw a lot of changes, but I never want to go through you again.

Saturday, December 26, 2009

Merry Christmas

I hope you all had a lovely Christmas!

We had a fine time, probably the nicest day in years.

The weather was perfect, everybody was pleasant, and I even went swimming a few times, which made the warm day much more bearable.

My brother managed another truly random and interesting present (a tradition of his) - he gave me a voodoo doll toothpick holder. It may have a similar future to that of Yay's family Christmas pigs, we will have to see.

For us, Summer Christmas in the tropics consists of cool drinks, cold meats, salads, cold desserts, snoozing, backyard cricket and swimming in the pool. People from the northern hemisphere often complain that "it just isn't Christmas", but to me, it is perfect.

Sunday, December 20, 2009

The spirit of Christmas future

I'm scared.

I have found out that my Uncle and his new wife are both big Elvis fans. She is very new, both to him, and to the country, so we are all being quite polite and friendly.

That said, if Elvis goes into the CD player on Christmas day, there are many things that can and WILL happen to it at my parents' rural property. The nice thing is that there will be no way to tell who did what.

I don't go and put on Tori Amos and expect everybody to love it. That would be ludicrous.

Really, when you go to a group event with a very mixed demographic, you need to be a bit careful about what music you put on, particularly if you intend to play the whole CD, and play it loudly.

It is Christmas, for crying out loud. It is a time for jingles, for "togetherness", for loads of drinking and eating and relaxation. Some of my family will be working my last nerve. Put on Elvis, and I won't be responsible for what happens.

(One or two Elvis songs might be okay. But these are a group of people with so little insight into the diversity of human opinion or taste that they will put on Abba really loudly - for hours - and expect everybody to love it. Because the Abba movie was popular. Therefore, all young people must love Abba, too. FFS.)

Friday, December 18, 2009

Wine drinking tip for hot climates

I have grown up in the tropics, and always wondered why reds didn't taste as good as they should.

Apparently, the ideal drinking temperature for a red wine is around about 60F - or 15C.

If you live somewhere warm and drink the wine at "room temperature" (i.e. straight out of the cupboard) then it will be around 28C in summer, and probably warmer than 15C even in winter. You think you are doing the right thing, drinking reds at room temperature, when you are drinking them a lot warmer than they should be. Wines are all about releasing the right flavours, and if you drink them too warm (or too cold), they can be foul.

Those of us who know that traditional reds should not be served cold from the fridge can have a happy medium. Keep the wine in the fridge, or chill it a little prior to drinking, let it breathe a bit after you pour it so that it warms up a little (but not quite to room temperature) and it may be a lot nicer.

Or drink it at 30C and think you are being a traditionalist. It takes all kinds. Whatever makes you happy.

Things are looking up

I had such a happy day today, walking around the hospital (and working, of course!). One thing that has really struck me this time around is how much better the day seems when I'm friendly and helpful to the people around me, be they staff or patients.

I have also noticed the difference in attitudes that you get when you wear your own clinical clothes and a stethoscope, compared with when you wear a uniform. Most of the differences seem to come from junior doctors. Anybody who treats another person poorly or ignores them because they are wearing a uniform is a jerk and needs to wake up to themselves.

I hate it when somebody looks straight through me, and this happens a lot less when I am dressed in "doctor" clothes. Most interns are nice, but I have had one or two look down their nose at me and be very rude a couple of times when I have gone to the bed of a patient in my role as a radiographer. Seriously people, wake up.

Now that I have passed third year, I am getting VERY excited about fourth year. The big rotation that I looked forward to last year was psychiatry, and I did it first, so the rest of the year was a hard slog. It was all very interesting, but there were no other rotations that held the same sense of "ohboyohboyohboy".

Most of fourth year is exciting for me. I don't plan on working in any of the areas, but they are all very interesting.

I'm doing:
Neurology, Clinical Pharmacology & Obstetric Medicine
ENT, Opthalmology and Emergency/ICU/Anaesthetics

I'm the least thrilled about neurology, but I chose it because it is interesting, and it is an area that I want to get better in. The same principle applies with clinical pharmacology. I think I should be good at these areas, both as a future intern, and as a potential future shrink.

They are also very varied, which will make it all fly by. I can't wait!

Wednesday, December 16, 2009

Time to celebrate!

I am now a fourth-year!

I passed all components of surgery and can now move on to the final year of the degree.

It is such a relief!

This is the best Christmas present ever. :)
Our exams results may come out at some time in the next week. Possibly. According to rumour.

Is it normal for a medical school to never let its students know what is going on?

Bah. One year to go. Hopefully.

Saturday, December 12, 2009

The screening x-ray on the dementia patient

Two weeks of work down, four to go. I'm still enjoying catching up with other people, although there are parts to the job that I find painful and mind-numbing.

Medical imaging is a lot harder physically than medicine. You have to move patients around all of the time - pulling them across the imaging tables, moving them into position, lifting them, pushing heavy equipment, pushing the imaging cassettes under 10+ intubated people in ICU rounds, as well as doing a lot of walking all day. It is quite hard work, and takes me about a week to get used to it again after I return.

I also find that I get a little angry when asked to do examinations on extremely demented elderly patients when the exam is pretty much for screening purposes. I understand that the doctors want to check for things, but I think that sometimes they send these patients to imaging because they can't talk to them and they just run as many "simple" tests as possible to get a profile of the patient's health.

My main issue with this is that a "simple" examination can turn into an ordeal when the patient is unable to comply or move. We have to force them into positions that are uncomfortable, push and pull them around and cause them quite a bit of pain and upset them, all for an exam that is effectively for screening.

A normal patient who can move onto the imaging table and stand up can have an abdominal and chest series finished in under five minutes - and most of this is paperwork time. (Yes, I know you are supposed to wait to take the erect abdomen - I do it first, after the patient has been sitting up in their chair for at least 10 minutes on the way to the department/waiting, and then do the supine. This saves time.) They walk over to the erect bucky (the upright thing that you use for chest x-rays and erect abdomens) for two/three shots, then lie down on the table for the last one. Easy. Fast. Painless. We have a little chat while I take the images (generally the highlight of the exam for me - I get to meet some truly interesting people), then they move on.

An elderly patient with severe dementia or severe illness who is unable to remove or respond, and who gets sent to the x-ray department on a trolley or bed is quite a different matter. We have to force them into the upright position by having a radiographer/wardsperson sit them forwards, jam a heavy block behind their back, force a cassette behind them on top of this, lean the back against it, and then run out of the room to take the image before their hands move across their chest fields or they slide off the cassette. Similar thing for the lateral chest, if we can do it - we turn the bed sideways and try to use the erect bucky. We often have to do it more than once, because they are quite difficult to take.

For a supine abdomen (you really aren't going to get an erect abdomen on a patient like this, unless you REALLY need it and can manage a decubitus), you have to force the patient to lie down flat, get them flat on their bed, then wedge a hard, thick block of plastic (the x-ray cassette) directly underneath their back, make sure it is in place, then run back out of the room again to take the image. If you are lucky and have trauma trolleys and your patient happens to be on one, this is much easier.

And this is if you ask for a simple abdomen/chest series. I have taken full spines on patients like this - for trauma, so it needed to be done, but it takes a lot of time and energy and is a challenge and a half.

I am gentle and patient. I always address the patient by name, regardless of whether they can respond or not. Other people aren't, but that isn't a topic for this post. The process is a lot more uncomfortable for the patient than I can get across in writing. They don't understand why somebody is hurting them, or telling them to do things that they don't want to do.

To top it all off, most of these x-rays are normal. It was a screening exam for a patient, and may have been much more acceptable if the patient would have a better outcome and prognosis with treatment. Extraordinary measures for patients who are not going to understand what is happening and have bad prognosis - well, that is just cruel. I have heard it referred to as "atrocities" in medical circles, moreso when talking about extreme medical intervention for patients who won't recover and should be make comfortable, but it is a similar principle.

I often wonder whether the doctors who order these would think more carefully about whether or not they needed them if they knew what we have to put the patient through in order to get the images. One of my favourite physician teachers told us that you should know (or at least suspect)the results of the test before you order it, and you should always be able to give strong reasons for every test you order.

Obviously the doctor is the person responsible, which is why I do the best images I can for them, so that they can decide where to go from there. I just can't wait for the day when all I do it the physical exam - it is a breeze compared to the imaging, particularly for the patient. It would also be nice if the doctors had any idea about what they were asking us to do to their patient. Not all chest x-rays are equal.

At the start, I found it really hard to get back into imaging because you have to make people uncomfortable to get diagnostic images. I shied away from making patients experience pain. It isn't pleasant, and I won't be upset when I don't have to do it any more.

Sunday, December 6, 2009

We still won't be finding out whether we have passed for another week and a half, which is a bit cruel, but probably convenient for me - I will be finished my first stint of work and can celebrate the end of that and either celebrate or mourn the exam results, depending on the outcome.

It is nice going back to the area I worked in before I did medicine.

It is an area that I actually really enjoy and have seriously considered specialising in. The doctors I work with are very encouraging, and have always given me a lot of support when I thought about jumping ship into MBBS-land.

I was a radiographer for a few years before going back, so going into radiology would seem like a natural progression. I like talking to patients, but there is also something exciting about making a diagnosis from images.

The technology is absolutely incredible, as is the pathology (when it is there) and the anatomy isn't too bad, either. The advances, particularly in MRI, are mind-blowing, even since I started work less than a decade ago.

One major concern that I have had about this field is that it is reputed to be very hard to get into. I am still dealing with feeling quite inferior - my results don't reflect this, and my image interpretation skills are certainly well and truly about the rest (for obvious reasons - it really is an unfair comparison). Because part of me lacks confidence, I often talk myself out of pursuing this.

When do you get to the point when you say to yourself, "Sod it, I'm going to go for what I want anyway!"?

I have changed a lot in the past year in particular. I'm a lot harder and tougher. I'm much more pushy and I say what I mean a lot more than I used to. One area I have noticed this more is with the nurses when I do ICU mobile x-ray rounds. I am never mean and am always respectful and helpful, but I am more inclined to say what I need, and when one of them is really grumpy and rude to my face because they don't want to move their patient for an x-ray, I'm more likely to start poking fun about it (all in a respectful manner) rather than just rolling my eyes and being another bitter radiographer. I guess my communication skills have improved a lot. (Note to others who haven't seen this in action - nurses can be REALLY rude to allied health staff. It is not professional or mature to give the radiographer shit when they are only there trying to help your patient, too.)

I have noticed that I'm a lot more cynical. I have to try not to death-stare salespeople when I'm dragged along to Tupperware parties and they start talking bullshit. (I don't care how much food you put in that Day-Glo orange salad bowl, it will NEVER look anything other than fracking ugly.) We re-watched Death To Smoochy the other night, and I spent the whole movie laughing at the Smoochie character because he was such a twat rather than feeling bad for him like I did when I first saw it a few years ago. Is this cynicism or realism? The character actually IS annoying - I know that is the point. Perhaps I'm just more grounded.

I think that by the time I finish, and particularly when I start working, I'll be ballsy enough to say what I want and go and get it. I know I can do the job well. It is just a matter of chasing the dream.

So much of the time I have to be careful that I don't talk myself out of what I want because I am afraid I'll fail. At least I'm aware of this. If I were guaranteed to get into what I wanted to, what would I do? Radiology would be right up there. I don't think it is an impossible plan.