Monthly Archives: January 2011

Uh, Wait, I’m Only A….

Back to school today, which meant back to hospital, specifically an oncology rotation, out of town. As you may recall, my revision schedule took a bump so I was not feeling prepared or in any way competent when I walked into the big ole hospital building and blessed its airconditioning.

For once a medical school pep-talk-slash-boot-up-the-can worked on me, and I left the morning intro session feeling like I had a mission and a purpose. Maybe even some chance of passing exams in count-em-four-months. (sorry if you study with me and just puked a little at the thought)

Oncology, day one, awesome. It is said that one learns best on the margin between the zone of comfort and the zone of distress. This concept was neatly represented throughout my day. I felt comfortable enough to admit I didn’t know things, and distressed enough to actually learn them.

Well, I actually didn’t feel either particularly comfortable or particularly distressed, but the Consultant and the Registrar I am working with for the week were both very keen to get me doing things, and very keen to help me learn. Which is comforting, overall.

And then there was the moment. It was late in the day, there were just two new patients to see. So I sat down with one of them, explained my role (medical student, ask some questions about why you’re here, your medical history, some details of your life… pass that on to the doctors who will then see you…).

This was my third or fourth such consultation for the day, and I like taking histories, so I was reasonably within my comfort zone. These are not patients who will be finding out for the first time that they have cancer, so there’s not much risk of me having to break that kind of news.

This patient had undergone surgery to remove a tumour some two weeks earlier, and was not dealing well with the aftermath. She expressed some distress, there were some big big psychosocial issues, and I could see she was fixing for a cry, or more.

And so I had the moment. The one where you think “I’m not ready for this, I’m only a [insert role title here],” and you mentally cast your eyes wildly around the empty room in search of someone, anyone, more senior, more experienced, more appropriate.

But the train was on the tracks. I was on my own, and so was she.

Sure, I’m only a med student. But I’m a human and a grown-up, and I was in the room.

I won’t go into the detail, but I’m damn proud of how I got through that moment. She had the cry she needed, she told me how she felt, I listened to her story. I kept good hold of that train, and had a solid history to hand over when our time was up.

That moment, however fleeting it may be, is when you choose whether to really learn or whether to just go through the motions. I could have skipped past her ’emotional stuff’ and kept to the hard facts; I could have excused myself and asked her to wait for the registrar.

Medicine is about more than the hard facts, and if you can’t deal with the human aspects of a diagnosis, you should probably not deal with humans.

I fully acknowledge that my comfort zone tends more to the human side than the hard fact side, but it’s only ever the medicos who get to push my hard fact comfort zone. I’m used to that particular zone of distress.

I feel like I passed a test today, or cleared a hurdle. It was one that was only in my mind – for sure the patient didn’t know she was about to push me. No one else saw it happen. It’s not an assessable part of the course, though I honestly wish it was.

I’m not even entirely sure that I’ve articulated what it was that happened today. I had a moment. I squared my shoulders and reached for a box of tissues and found my way to make it work.

The hard facts and the human. I found my way to make it work.

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So Now I’m A Swimsuit Model

Yesterday I planned to take the dog to the beach, but it was a gorgeous sunny day and still holiday season.

City visitors walk their dogs in a bubble. You know them on our beach because they are afraid to meet eyes. They walk like they might get knifed, like their dog might get bitten, like we might steal their teeny Precious. Like her pedigree might be tainted by the merest whiff of a rustic mongrel. They stake out their territory right by the beach access. They swim in rips. They squeal and smoke and leave their rubbish.

Instead we went to the local creek and swam in the murky brown tea-tree stained water. We stirred up mud that smelled of sulphur. We swam from shore to shore and squidged our toes in the leafy mulch. We didn’t get eaten by sharks, the kookaburras found us hilarious, and the only interruption to our fun was from a couple of bushwalkers who took our photo.

It was blue-bottle free and I have not developed a rash or gastric upset.

The creek. I commend it to you.

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The Things I Missed

Wednesday we drove out to my aunt’s farm. It was an overcast day, and Ma told me to take a jumper. I don’t get to the farm much, so I thought, maybe it’s cooler out there. I was hot in shorts and a tank top. Ma had long pants and a jumper on.

We arrived bearing some fairly solid iced finger buns which had been in the fridge at least six days, and the remnants of a barbecued chicken which had been uncovered in the fridge for at least four. Did I mention Ma was recovering from Salmonella? Thanks to the wonders of text messaging, my aunt was forewarned and thus armed with a fresh chicken roasting in the oven. The old one quietly disappeared.

We ate, I hung out with my cousin, we watched some coverage of the floods, we left. Ma looked peaky. She napped in the car. Overnight I could hear her coughing.

Thursday morning, back to the doctor, No, Doctor, I feel much better. My stools are normal. I feel fine. What about that arthritis in your finger, Ma? It came up overnight. It was red and swollen. No, no, that’s just my arthritis. But I will get my pills in a bubble pack after all. Hurrah! We’d been applying subtle pressure on this for a year. Off to the chemist with all the scripts. Walking up the ramp to the chemist she was breathless and we took it very very slowly. Come back and get them at three? Sure.

Lunch was scheduled with my mother. I thought Ma looked overtired. She insisted she was fine. I insisted it would not be rude of her to stay at home. That I would be fine on my own. She refused.

She ate a bit of soup. We stopped back at the chemist on the way home and picked up the bubble packed pills. We got home. I went to do some washing. She put on a coat and started peeling vegetables.

A coat?

My uncle fetched the thermometer. 38.9°. I grabbed us a bag of clothes and we headed for Emergency. Her first set of rigors started in the car.

The triage interview happened fast and then we sat in the waiting room. When the hallucinations started, we went straight through.

Fluid resus. IV antibiotics, complicated by allergies. I sat with her all night while her blood pressure swirled, her heart raced, and her body convulsed with rigors. She kept trying to send me home. I held her hand through the wild-eyed terrifying half hour that we all thought would kill her. I talked her through the hallucinations and the strange surrounds and the man who was screaming all the foul words down the hall. I talked to the Med Reg and to ICU. I held her hand through her “final indignity” of insertion of the urinary catheter, keeping her eyes on mine while we talked about the beach and old holidays. I bossed her around for the first time: We are not having this conversation; I am not going home until you are on a ward.

She stabilized, more or less, so they sent her to a ward rather than ICU. I went home and cancelled my flight and called my dad and my aunt. When my uncle woke up, he asked what I thought would have happened if we hadn’t been staying.

What would have happened? She would have put on another coat, and gone for a lie-down, and covered herself with all the blankets she could find. And when those rigors hit her and she was wild-eyed and thinking she would die, with her failing heart desperately trying to keep her brain alive, if she thought to call for help she’d have not been able to dial the numbers. There would have been no one to hold her hand. And that would have been how it ended.

Septic arthritis in the finger. Incontinence pads in the bedroom. Increased work of breathing. Intermittent fevers. Thermal flaming underwear. Intermittent confusion, query delirium. Those are the things I missed, even though I saw (most of) them.

The answer, med nerds, is severe sepsis. The bug was e.coli, origin UTI. It’s a damn scary thing to see in your 87-year-old grandma. Especially when she says she’s fine.

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And So It Continued.

The next day was Tuesday. We saw the GP in the morning and she thought Ma looked a little jaundiced in the eyes. We did bloods for liver function, and then we tootled off for the weekly hour-long drive to the central markets.

We all like the market trip because it reminds us of Pa. But it is completely unnecessary. The money we save on meat, we blow on petrol.

Before we go home Ma bought me some doughnuts, and as we passed the queue for the ATM she said, let’s stop at the Local Shops, I need to get some money out.

On the trip home she changed her mind. Oh, let’s stop at the Not-So-Local Big Supermarket, we need milk and I can get money out there.

We parked in the disabled parking space and as we walked up the ramp to the shop Ma took out her ATM card. Wait on, Toast, she says, I need to get some money out.

As she turned to insert her card into this machine, she realised her mistake.

Not A Money Machine.

Well, it is a hole in the wall. And she was after liquid assets…

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I’ve Been To Google, But I’ve Never Been To Me

It’s the time of the year again where I get to hang out with my grandma. If you’ve been following this blog for a while you may remember she’s had some issues with her memory. And that I’m nuts about her.

New Year’s Day, while I was busy not getting nekked, she was showing the first signs of the effects of eating the Christmas chicken a week past its best. My uncle bought her some Imodium and some Hydralyte. Four days later he took her to the doctor.

By the time I arrived on the 8th for my holiday vsit, she claimed to be feeling much better. She was eating and bossing me about and grumbling about the two liters her GP insisted she drink. On Sunday night she barely slept, and on Monday morning we set off to the GP for a follow-up blood test.

She is an inveterate backseat driver, which these days manifests itself in instructing us all on which route to take to our destination. On this trip, we started by dropping my uncle at the station. From there, I drove toward the GP. She became quite insistent that I was heading in the wrong direction, though it was a familiar road and well-signposted. I pointed out old landmarks. “I’ve never seen this place before!”, she insisted.

While I can follow the ant trails between this city’s suburbs fairly well, and know the road to her GP, I didn’t have the address of the clinic, and with my grandma insisting we weren’t there yet, we overshot the destination by a good ten kilometres. By this time she was quite distressed. We were passing windmills, so we agreed it was time to pull over and let Google Maps do the talking.

I handed Ma the iPhone to settle her down. “Here, Ma – we’re following the red line down to the bottom left of the map. We’re the blue dot. Can you watch the blue dot and tell me if it goes off the red line?”.

She applied herself to the task at hand, offering frequent updates. Then, out of the blue: “It says we have to go to Google!”. Huh? I took a look. She’s not so silly, the logo overlay does kind of look like a suburb.

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Not Nearly So Nekked

Once is funny. More than once is still funny, but starts to look oddly deliberate. Thus, my main goal for the first day of 2011 was to not make a New Year’s tradition of getting myself locked outside naked.

In preparation for this challenge, I made sure the laundry was stocked with a clean, dry shirt and a number of towels. Words were spoken with my beloved co-habitant regarding appropriate house-departure procedures. I sourced shorts with pockets for my keys. I left the bathroom window open.

Waking, as usual, at a geriatric New Year’s hour – that is, the time usually reserved for actually going to bed after New Year’s Eve – I resisted all urges to make breakfast and deferred doing any laundry until I could be assured that no-one was home to lock me out. Instead I dressed in my key-holder shorts and a t-shirt, and set out on a merry morning adventure to walk the hound.

While perambulating with the Yellow Dog of Happiness, I encountered many elderly people also walking their dogs. All other folk under the age of sixty-five were either at work already, or snoring, or still on their way to bed, drunk as skunks and reeking of fireworks.

Several of the elderly citizens made conversation with me as we enjoyed the last vestiges of sunrise over the river. Had I been less clothed, I doubt I would have had the pleasure of such conversation.

When I got home, I brought the rabbit inside, made a coffee, and wrote the world’s second-most boring blog post.

I managed to go the whole day without getting locked outside in the nuddy.
However, I am so thoroughly bored with myself that I think I am changing my mind a little about the whole tradition thing.

Maybe just every second year…

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We Officially Own A Phone Line Together

A few days ago I had cause to call the telephone company, and when we were finished with the business of changing phone plans, the customer service rep asked if there was anything else she could do for me. Yes, I said, I’d like to enquire about having my partner named on the account. “Sure,” she said, “what’s his name?”

Here we go, I thought. “Her name…” Immediate profuse apologies followed, and my partner’s name was duly added to the account.

So what?

Well. For as long as I’ve been in same-sex de facto relationships, I’ve been told by utility companies that you can only have two names on the bill if we are blood relations or married or in a heterosexual de facto relationship.

Every relocation or change of provider, we try again. The closest we got was with a gas company who listed my partner as Mr., much to her annoyance.

Two years ago, with both our names on the mortgage? Still not good enough.

So strike me down, After ten years living together, we have a phone account in both our names.

I don’t know exactly what just changed in the world, but apparently 2010 will go down in history as the year we gained the right to adopt as a couple, and the year the phone company decided we exist.

I’m being somewhat facetious, but honestly, it feels good to be acknowledged as a couple even in such a tiny tiny way.

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