It’s About Medicine

Final year of med school has just hit me. There is a subtle shift – knowledge and facts coalescing, light dawning. I still feel like I know nothing, but every so often I feel like I know what I’m doing and why I’m doing it.

Another subtle shift is underway on the hospital floor. Next year I could be a colleague. People ask where I’m applying, offer advice, discuss cases of interest like my thoughts could matter.

I decided about ten days back that I needed to stop avoiding the things that freak me out – practical procedures. And Whammo! No sooner had I decided this than a flurry of practical procedures came my way. Under supervision, I drained 2.4L of fluid from an elderly lady’s chest (“I can breathe again!”), and did not generate a pneumothorax. I sutured (extremely badly). I backslabbed a man’s fractured wrist and completely failed to get a cannula into a vein for a man who desperately needed one. Two in fact.

Today I assessed a patient in ED, summarised my findings, proposed a diagnosis, recommended therapy, and discharged them home with scripts and instructions.

I second-guess myself.

“What if it was amyloidosis?”
“What if I sutured his skin all wrong?”
“What if he’d got fluids earlier?”
“What if I introduced an infection?”

What if I never made a mistake and never learned anything?

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The Numbers

From Home to General Practice Placement:

Total Distance (each way): 31.9km
Times per Week: 2
Speed Zones, Outbound Journey: 50 – 70 – 60 – 100 – 90 – 100 – 60 – 80 – 50
Speed Zones, Homeward Journey: 50 – 80 – 60 – 100 – 90 – 100 – 60 – 70 – 50
Speed Cameras (Fixed): 3
Traffic Lights: 7
Average Red Lights on Arrival: 6
Roundabouts: 2
Golf Courses: 2
Cow Crossings: 2
Cow Crossing Delays Experienced: 0
Rail Crossings: 1
Rail Crossing Delays Experienced: 2
Rail Crossing Delay Duration: 11mins / 8mins
Bridges Crossed: 3
Properties for Sale: 14
Wineries: 2
Winery Delays Experienced: 0
Factories: 2
Smokestacks (Gas Flame): 1
Hitchhikers: 1
Hitchhiker Sightings: 3 (Same Guy)
Minimum Journey Time: 24mins
Maximum Journey Time: 49mins
Early/On Time/Late Arrival (%, est): 30/40/30
Maximum Ground Speed Attained: Fine Exceeds Boyish Desire To Tell
Times Speed Limit Unconsciously Exceeded by Maximal Amount: 1
Times Rihanna’s S.O.S Unconsciously Played On Loop, Single Journey: 11
Total Distance Driven for GP Placement, Phase 3: 2424.4km

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;l.

The title of today’s post is brought to you by McCat, who joined me at the table on the laptop and somehow managed to type this ;l. into the Google search window AND hit enter. He also opened iTunes, possibly trying to find an appropriate musical message to accompany the emoticon. I’m glad he’s in a good mood.

Yesterday I stopped procrastinating on a core task – writing up a year planner with my timetable. If I had done this when I intended to, at the start of the holidays, I would most likely have done a bit more uni work and a bit less relaxing. Not that the relaxing hasn’t been fantastic.

I’m trying to develop a routine for the next semester, and the second-last week of holidays seemed a good time to kick it off. Up at 5:30, exercise 6:00-7:00, eat, get to work.

Today’s ‘get to work’ part started off with… well… taking the Yellow Dog of Happiness (who has been a bit down in the dumps) for a trot through the bush and a swim in the creek. I was more up for the trot than the swim, and had passed up swimmers for my pre-dirtied bootcamp shorts and socks from earlier, a fresh crop top and shirt, and my running shoes. Eyes peeled for snakes.

He had a lovely dog-only paddle in the first swimming hole, and as we trotted on down the track I pondered an impending visit from my paternal parental unit. I haven’t yet brought them to the creek. I must call them and get them to bring their swimmers. And maybe a fishing rod.

I spotted a faint track from the path to a shady spot on the creek bank and whistled the dog back to check it out. As I stood on the boulder overlooking a nice deep bit of creek, a school of eating-sized fish cruised by, followed by a dog-like splash.

Having taken a nice refreshing slide down the boulder into the creek, he paddled calmly for about three seconds before he realised the creek bed was far, far beneath his furry feet. He turned back to the mostly-vertical rock face. Oh SHIT, his face said. Quite futile even trying to climb out. Nevertheless he tried in vain to haul himself up with his front paws while scrabbling against, well, nothing with his back legs.

Stay calm, Dogface. I surveyed the surroundings as I stripped down to the crop top and my spotted undies. It was a big boulder, but either side was shallow bank covered by mangroves. Easy for a dog to climb out. Fixated on the rock face and hanging on with front paws for dear life, he could not be convinced to let go and swim to safety.

And so it was that I slid down the none-too-smooth boulder and into my new favourite swimming spot. Treading water just clear of the boulder, armpit-depth with my feet in the leafy mud near the edge. I tried to guide the hound around the boulder to the mangroves, but he would have none of it. Your hand is on my rump, clearly that means you can lift me out. He willed himself up the face of the rock, with me as his launch pad.

Admittedly I could now have swum around to the mangrovey bit and waded out of the water. But it was… creepy. And leafy. And there could be snakes. From water level, I could see the dog’s point.

Add rock-climbing to my skills list.

I gathered up the dry bits of my ensemble and we trotted on to his usual swimming hole, complete with jetty. Yellow Dog said no thanks. I said come on, Dogface, I’m still in my soggy cottontails, let’s get back on the horse. We swam. Neither of us drowned or were eaten by sharks. Passers-by failed to materialise until I had my shorts back on.

All up, a good morning’s work. ;l.

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How Sweet It Is

I can’t think of a more joyous sound than the sound of someone I love singing her lungs out in the shower.

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Homework I’m Not Doing

I actually have a whole load of urgent homework that I’m currently not doing. But I’m not writing about that.

If a patient asks me something and I don’t know the answer, I admit it. If it’s appropriate, I’ll look up the answer while they’re with me, or while they’re waiting for Part Two of their consultation – the part with the real doctor. If I don’t get the chance, and it’s important, I’ll just ask the doc when I’m handing over.

If it’s more of a point of interest and knowing the answer only matters to me, or if the patient is happy to wait for obscure info, I’ll look it up later. On that list: Effects of chromium supplementation, fructose intolerance, sugar content of soy milk.

Not going on that homework list, not getting looked up while he’s in the waiting room, and most certainly not during our consult: (and I’m paraphrasing here for the sake of already having enough dodgy words inviting creepy google-stalkers) is today’s special offering. “My junk has shrunk… Is that a normal part of getting old?”

I don’t know.

Apparently he’s discussed his concerns with the doctor before, and my ignorance was reassuring. “So if you don’t know, maybe he didn’t know either, because he didn’t seem to want to look into it…”

Maybe I should have taken baseline measurements so we could track the alleged shrinkage over time. Something about the fact his eyes had trouble elevating above my chest level gave me the feeling such a scientific approach would be rendered inaccurate by an excessive degree of operator dependance.

Some things, I’d just rather not know.

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Back in the Pool

I finally succumbed to the insistence of my knees (and my girl) and have given up on my current attempt to master the art of running. Having missed the first three weeks of seasonal swimming in the local pool, I dedicated 24 hours to rumination on the cost/benefit ratios of the casual visit vs 20 visit vs season pass.

I guess I enjoy maths more than I pretend to.

I spent some time wondering how four months of boot camp would affect my pool re-entry. My togs are too big. That was an encouraging start.

Too much maths meant I got to the pool just as school finished. Not quite so encouraging, but there were still two rugrat-free lanes.

My tiny brain: What if I’ve forgotten how to swim?

I am mildly fascinated by the self-doubt I can generate around a straightforward physical activity.

Naturally I had not forgotten how to swim, but my consistently lousy lap-counting skills suggest that my short-term memory could use an exercise regime all of its own.

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Apparently Crazy Cat Lady

Our two cats are brothers, different colours but with virtually identical markings. They have lived indoors (and within the limits of the backyard, under supervision) for their fourteen years of life. This has given us all plenty of time to bond as a tribe.

McCat is most closely bonded to me, especially since his brother has become irritable with hyperthyroidism. We have a few things in common. We both like birds. We both like my armchair and its lambskin throw. We both like raw salmon and roast lamb (not together). For a while there, unbeknownst to me, we shared a bedside glass of water.

One of us is a little OCD.

At bedtime, McCat enforces the following routine:

1. Human is to brush teeth.
2. Human is to fill cat’s bedside water glass with fresh water.
3. Human is to top up biscuit bowl.
4. Human is to pat Brother Cat.
5. Human is to seek out Superior Cat lounging place; this step to be conducted under cover of darkness, simulating safari conditions.
6. Human is to advise Superior Cat of imminent bed entry.
7. Human is to stop faffing and get into bed.
8. Superior Cat shall drink water; four swipes of paw on beside table to accompany drink, indicating primal origins.
9. Superior Cat shall sit staring at Human until such time as Human switches off light.
10. Superior Cat shall patrol perimeter, ensuring all doors and windows secure.
11. Human is to assume supine position; left arm to be bent like tea-pot handle.
12. Superior Cat shall grace Human with presence between left arm and left flank; Human is to remain motionless until 4am.

The penalty for deviation from any of the above routine may range from gentle rebuke to forced sleep deprivation, with such penalties administered vocally, by strategic bladder-trampling, or by judicious use of paws to ensure Human eyes are open and airways clear.

Every so often I escape desert the McCat for education-related purposes, such as placements away, or conferences. The Girl does her best to meet his exacting standards of bedtime care, however as she has the Yellow Dog of Happiness to care for, as well as Brother Cat, McCat tends to develop abandonment issues and his vocal and paw-to-face admonishments eventually become unbearable. Or so I am told.

And so it is that I find myself on the phone to the cat. I am fluent in McEse, and though it pains me that my communications are delivered via speaker phone for all to enjoy, it does seem to settle him down.

I can only guess at what “Brrt, brrt, micmicmic meow” means, but I think it’s something like “Hello, honeycat, I’ll be home soon.”

Mock me and I’ll scratch your eyes out.

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