Tempus Fugit

Time Flies…

   May 11

A Powerful Read

There are a lot of crap books written out there.

Some can just be chewed up and spat out like a used piece of chewing gum.

Others can evoke a violent emotional response.

I’ve just finished reading a book that had me bawling my eyes out even though I already knew what the ending was.

Just goes to show what good writing or a good story can do to affect you in a profound way.

Now, to work out how to emulate that sort of writing style.


   Apr 29

An Organic Dilemma

Is it just me or does it seem monumentally wrong, that unless you say otherwise, potentially when you die, your organs could be taken and given to someone else.

To me the ‘opt-out’ organ donation scheme mooted for Qld is almost akin to someone saying “when you die, unless you say you don’t want us to, we’ll take your house and give it to some homeless person”.

I’m all for choice.

I have seen the benefits of organ donation.

What I disagree with is having a decision made for me by default if I don’t choose to make one myself.

Frankly, donation by default doesn’t seem to me to be ‘donation’. Imagine if there was a law that said ‘Unless you tell us, we’ll assume that you want to donate your excess assets to charity’. Donation by default I think detracts from the enormity of the generosity a person shows when they choose (of their own volition) to donate organs when they die. In fact, exercising your right NOT to donate could be then seen to be selfish.

It doesn’t sit well.


   Apr 17

An Arresting Performance

Well.

I’ve been to cardiac arrests before. I’ve jumped on chests. I’ve uttered the words “charging to 200 joules….stand clear”.

In fact, it’s refreshing to go to a real MET (Medical Emergency Team) call instead of the usual “I can’t believe this is not a MET call!”.

I have to admit though, I’ve never RUN a cardiac arrest before, but given my chosen specialty it was bound to happen sooner or later.

I’ve given up RUNNING TO MET calls because 9/10 times times they’re not really MET calls and, let’s face it, if it’s a real one, an extra 30 seconds isn’t usually going to make a difference.

This evening, I was bemused when there was a MET call in the Crit. Care Unit today – only minutes after I’d left the unit in search of food.

I wandered back up (steak sandwich in hand) to see it was in fact a real “Bona Fide” heart-has-stopped arrest.

Well actually when I got there, the heart was still beating.

Not for long.

Looking briefly at irregular rhythm on the monitor and saggggggggggging S-T segments, it was pretty clear the heart was complaining bitterly about a lack of oxygen. (screw you guys, this piece of ischaemic myocardium ain’t gonna take no more of this “thrombosis stealin’ muh air shit”….this little ticker is bustin’ its troponin-leaking myofibrils outta here!)

Now, usually it is the job of the med-reg to run METs. I’m quite happy to do my job – that is to say, I’m the airway guy. You need an airway, I’m there. I’m quite happy doing my bagging and masking and occasional tubing.

Today however, airway management just wasn’t enough. There was a Med Reg and an ED Reg running around like blue-arsed flies effectively achieving nothing other than stirring up the chaos and making a difficult task appear impossible.

The patient in question had decided to enter a peri-arrest state whilst on the commode. He had since been relocated to the floor….with his head in the corner of the CCU.

Bagging and masking, let alone intubation is not an easy task on the floor. Trying to do it squished in a corner was even more challenging (not to mention the aspiration of the dinner consumed moments before).

So with chaos abounding, defib pads flying everywhere and an awful lot of nothing happening fast, I took the opportunity to run my first cardiac arrest.

I was amused how cliched it sounded barking orders for adrenaline and atropine STAT! and muttering things about not having shockable rhythms whilst asking a nurse to get me intubation equipment. Simultaneously another nurse is cracking ribs with a pretty good CPR pace and the two other regs try to get IV access (why does the cannula always tissue just before an arrest).

When sipping delicious caffeine in Melbourne yesterday, suctioning vomitus from a peri-terminal patient’s oropharynx was not something that crossed my mind, and yet, as my steak sandwich sat cooling it’s tasty heels on the nurses’-station bench, I was down on my hands and knees sucking out chunks of custard from this poor gentleman’s lungs.

It’s amazing how easy time can distort. In the frenetic pace of an arrest, time simultaneously stands still and passes instantly. The time it takes to get an IV in seems interminable. A few minijets of adrenaline & atropine later accompanied by a disappointing asystolic “flatline” with it’s accompanying blood-chilling asystole alarm signals 15 minutes of futile advanced life-support. It seems like milliseconds have passed.

It’s amazing how strange it is to be the one person to call the arrest….that is to say to everyone, this is a futile effort, and then, with that, the compressions stop, the flesh turns a greyer shade of blue, and the fixed and dilated pupils stare emptily up at you as you momentarily glance at the clock…..

…time of death 1817hrs.

Requiem aeternum Joe Bloggs.

The asystole alarm continues to announce to the world the terrible event that has occurred. The staff look around at each other in an exhausted manner – physically, mentally and emotionally exhausting.

I go back to my (now cold) steak sandwich.

An in-hospital cardiac arrest is not a dignified way to go. Statistically there is about a 1 in 20 chance of surviving an unwitnessed in hospital cardiac arrest. I think if patients and their families knew what actually goes on at an arrest – and the dismal outcomes that happen more often than not….they would be more willing to accept an NFR status – that is “Not For Resuscitation”.

An NFR is like a “get out of medical jail free” card. Free from the undignified futile last attempt at keeping a soul on earth for as long as we possibly can. When your number is called, if the cards are stacked against you in the age and medical morbidity stakes….take the easy option – leave with dignity and speed.


   Feb 25

Sleepless sleep

It seems it’s possible to sleep, without actually feeling like you’ve slept. Which is to say, the last three nights I have had at least five hours sleep (and then some), only to wake, handover, drive home, and sleep some more.

It seems that the quality of my sleep at work (and even now at home) is poor. Every time I wake up during my sleep at work it’s always in a frenzied panic thinking I’ve missed a MET call or the like. A quick check of the MET pager reassures me I haven’t and I can calm down and nod off to sleep again. Problem is, it’s now happening even when I’m at home. No less than three times today whilst I was sleeping, I woke with a start thinking there was a MET call to attend to….only to then realise that I was in fact at home in my own bed.

So it seems that no matter where I’m sleeping, the sleep I’m getting is not good quality sleep. Which means I’ve spent the better part of the last three days ‘asleep’ and yet I’m still very tired.

I think I need to chill out a little.

In other news, I did an ICU transfer via ambulance last night. Suffice to say I was not impressed bumping along in an ambulance trying to prevent an ET tube from dislodging every time we went over a bump (cursed roadworks). I got the impression the ambos were not quite comfortable with intubated and ventilated patients and their spaghetti of inotropes, propofol, opiates, meuromuscular blockers etc and the accompanying infusion pumps, art lines and monitoring leads.

I nicknamed the ambos tweedle dum and tweedle dumber – they had their keystone cops routine down pat, complete with attempting to blow us up by not turning the oxygen cylinder off before disconnecting the gas line – lucky there wasn’t the usual dolts smoking in the ambulance bay. Fortunately, aside from a briefly unnoticed disconnection of one of the ventilator hoses whilst unloading the ambulance (which caused the sats to drop into the 80s), the patient arrived in one piece and no worse than when we left.


   Feb 22

“Oh my god! It works through leather!”

Well I never thought a piece of plastic could cause so much ado.

It really is “Much Ado About Nothing”.

I got on my bus this morning to venture forth into the city to achieve an odd errand or two (the even ones being saved for another day).

I almost felt like was the Messiah turning water into wine. I did the ‘usual’ thing I do with prox card ticketing systems (ie the Oyster or EZ link cards in London and Singapore respectively) which is to say it lives in my wallet and there it stays – I simply swipe my wallet accross the proximity reader.

No less than two bus drivers where agog and amazed when they saw lo’ and behold my wallet caused the ticket reader to validate my trip.

A couple more senior in their years must have seen my “parting of the sea” party trick of not handing over cash to the bus drive and demanded to see the fandangled bit of plastic that I’d had in my wallet….along with a barrage of questioning about how it worked and where to get one and how exciting it was.

Now if only I could work this magic on an attractive young lass….”I’ll show you mine…..”


   Feb 22

On becoming a piece of furniture…

Last night I went to the trainee committee meeting (just to see what it was all about).

Somehow I walked away as the new chair of said committee.

Not sure how that happened. Or if it’s a good thing.

Time will tell.


   Feb 22

It’s all Go! Go! Go!

The new Go! cards are now in operation in Brisbane. I guess this means supposedly Brisbane has dragged its sorry transport arse into the 21st century.

I dropped into a 7-11 last night to pick up a card and had an incredulous minion amazed that anyone wanted to buy one (yesterday being the first day they were up for sale). Of course he then became very excited at being able to use the new card top up device that looks remarkably like an EFTPOS machine with a proximity reader attached to it. I had the dubious honour of being his first Go! card sale.

I telephoned this morning to register it so as to be able to top up my card on line. I had a momentary thought that it seems to me to be potentially very big-brotherish in that I can see where I have used my Go! card (ie routes and times)….an underhanded way of tracking movements. For the sake of convenience though I think I’ll forgo my transport privacy. I’ll just have to remember not to use my go card if ever I’m planning on doing anything clandestine (note: tongue firmly in cheek).

In other unrelated matters….

First bread batch attempt was abominable with the yeast well and truly dead. Fortunately I found some other yeast in the freezer and made a second batch of very tasty homemade bread.


   Feb 18

Resorting to Risotto

A day of sleep all day. Means I’ll be awake all night. Means I’ll sleep all tomorrow. Means I’ll be awake all tomorrow night….which means I’ll be fucked at work on Tuesday.

Creme brulee with Imma. Noice.

Resorted to making risotto whenst I got home. A mushroom risotto. I think it could have done with some shaved truffle. The person who gave me the recipe reckons it needs salt.

Attempting to make bread (really should be studying). The yeast was expired….so I put in twice the amount hoping that there was at least some spores still alive. It’s bubbling….but not quite up to the standard of its usual self.

I may have to abort.


   Feb 17

February and Stuff

The roster looks like a dog’s breakfast. The haphazard manner in which days and nights are worked is screwing with me big time.

Can’t decide whether to sleep or wake. When I want to sleep I can’t, when I need to be awake I’m not.

Study.

Should be happening more than it is.

It is not. Something must be done about this. Buggered if I know what.

Breakfast this morning at Belle Epoque. Rudimentary. Overpriced. Atmosphere and coffee was nice.

Wandered aimlessly through Coles. Uninspired by the fresh produce and the lack of ideas in the dry foods sections.

White oil from Mitre Ten. Damn bugs on my frangipannis. Cursed little blighters. If I have to squish each one individually, so be it.

Must do some cooking today.

Sleep must happen first.


   Jan 23

Eine Kleine Nacht Musings

Tonight is night three (of three) of my first run of anaesthetic nights.

The consultants have been kind enough to sleep on site….lest there be some disaster or indeed just a straight forward case that I need assistance with (yay for hand-holding).

The last two nights have been “not busy” (on principle we won’t mention the Q word – especially since it’s only 2030 and I go through until 0800). I have been able to sleep a good seven hours a nigh the last two nights….there is a room with a comfy bed….well comfy as it could be with the MET pager and the Anaes Reg phone colluding malignantly together by my pillow threatening to ruin my pleasant employer-funded slumber.

So here I sit…twiddling thumbs….waiting for something to happen.

Pipedreams or Pipemares?
To make things a little more interesting….there is a series of pipes running through the dead space above the anaesthetic room. Honestly it sounds like they’re desperately trying to break free of their bindings. The ruckus is almost interminable. There is a constant knocking that is puncutated periodically by an almighty cacophony of shaking, shuddering and thudding.

It’ll be just my luck that one of the pipes will burst and I’ll be deluged with liquid of some sort.

I may well have a headache by the morning.

In other news…..

Yarning For Home
The packing/sorting/throwing is all but done. I am now happily ensconced in my Teneriffe “woolshed” (as certain friends are heard to call my woolstore apartment). The frangipannis are thriving in their new environment and my entire apartment is awash with a mixture of the scent of frangipannis and the smell of freshly brewed coffee.

Crashing Down To Earth
Shame about my bed which collapsed a few days ago as I woke from the most ghastly nightmare. Still…it’s an excuse to go shopping for a new one. It’s time I graduated from a room that looks like it’s straight out of an Ikea catalogue (assuming the decorator and photographer had taken acid prior to arranging the photoshoot).

Satisfying Catharsis
Today Mum and I took an entire 1 tonne truck load of stuff from the old house to Lifeline. I suspect that at least half of it will be turfed by them…but…who cares…it’s good ju-ju giving stuff away and it saves us having to turf even more. We took a truckload of stuff to the tip today….or should I say “Transfer Station” as it seems they repackage all the garbage elsewhere in shipping containers…..I’m not sure where…. maybe there’s a burgeoning export industry in Australian garbage.

Throwing old monitors and computers and other assorted flotsam and jetsam into the pit was quite satisfying. Similarly satisfying was the sickening crunch that one of the old monitors made as it was run ove by a bulldozer.

I did wonder what nasty spores and toxins were airborne in that closed in environment – especially when one of the garbage trucks decided to empty its putrid load just as we arrived.

ADSL non-plussed
I am most upset about my internet connection…or distinct lack thereof
Last Friday was allegedly the day it was all to be connected by Telstra followed by a connection by the ISP a few days later. Today I get another email telling me it will be connected by Telstra next TUESDAY for fucks sake. I rang them to find out what was going on. Apparently, there was a problem at the exchange so they’d rescheduled it.

They neglected to inform me of this rescheduling until now.

I was non-plussed. I am wording a “rocket” to provide feedback.

Bad Behavior has blocked 81 access attempts in the last 7 days.