Tempus Fugit

Time Flies…

   Dec 09

Ageing – One Way or Another

Well. Here I am. In my 3rd decade.

It may not be what I was expecting but I guess I really can’t complain about it.

  • I am reasonably healthy.
  • I have a good bunch of friends and great family.
  • I am currently working as a PHO.
  • I have a position on the anaesthetic training program for 2008.
  • I am about to move into a very nice two bedroom woolstore apartment in Teneriffe.
  • I’m currently sipping chandon and nibbling on a nice blue vein cheese in the QANTAS club prior to my three week holiday in Singapore.

Having said that I guess there are a number of other things I have on my list of things I intend to achieve before I am forty. I guess it all comes down to tenacity, willingness, direction and to a large extent karma and fate.

I was over enjoying a nice glass of rose the other night with a few good mates and watched a film called “Harold and Maude”. Quirky and enjoyable but a very timely reminder to seize the day.

   Nov 27

The Last Post

… this would be my last post as a twenty-something.

I feel ancient – that ominous third decade hits tomorrow.

I am not sure what I was expecting to achieve by the time I hit 30 but I’m not sure I’m where I wanted to be.

For some reason I feel incredibly underachieved and unfulfilled which really is to some extent sufferingly self-indulgent self-pity because I’ve managed to do a lot in 30 years – just not enough to make me feel like I’ve made the most of it.

By now I thought I’d be married with kids, or galavanting around the world. Instead I’m stuck working, still studying, generally feeling like there should be or could be so much more.

Which I guess means that I really must make an effort to make the most of the next 30 years so that I don’t have regrets on my 60th.

   Nov 04

Bollywood Dancing for Dummies

I had the opportunity to attend the wedding reception of one of my good friends this evening. The reception was an Indian wedding reception (in no small part due to the fact that the groom was of Indian descent).

I seems that the reception was a somewhat lavish affair with decorations that made me feel as though I had wandered onto the set of a Bollywood film. The bride wore a dress that looked like it weighed 20 kilos (and apparently felt like 20kg according to the much bemused bride who had to resort to Nurofen among other things to endure the extra body weight).

The weight was in no small part due to the countless beads sparkling in every colour of the rainbow stitched to every last piece of fabric real-estate. It was an impressive creation. I didn’t envy the bride not only having to wear it all night, but dance in it (made all the more precarious because the length of the dress would surely have contravened occupational health and safety length requirements).

An entree was served….that was practically the size of a main course – complete with tandoori chicken, samosas and some mystery deep fried substance that I think might well have been tofu. We were all wondering how on earth we’d fit in main course until it was announced that there was to be dancing between entree and main course.

I was initially alarmed at the thought of having to venture forth onto the dance floor. Like any self respecting Aussie bloke who wasn’t already two or three stubbies to the wind I stayed and minded the handbags with the other blokes at the table. I’ve never quite understood why it is that at the mere hint of a dance, the ladies are clambering for the dance floor.

Before long the Bollywood DJ (wearing a track suit top that said “Mutha Funkin Punjabi”) was pumping out tunes that were definitely not out of place with the surroundings. There was no stopping the tsunami of saris that flowed out onto the dance floor. Very soon the clashes of very bright and beaded colours were gyrating in time to the rather addictive beats.

One-by-one the stoic gents firmly seated, arms crossed at the table, were summonsed to the dance floor by a beckoning finger and a stern “if you don’t get your arse out here now there will be no booty call later” look from their respective partners.

There comes a critical mass where when there are only one or two blokes left at the table that it starts to become awkward and you’re looking like either a Nigel No-Friends or a stick in the mud spoil-sport.

Weighing up the options, I caved. I stood up and waved farewell to the remaining stragglers at the table (who lifted their stubbies in solidarity for another comrade who’d fallen prisoner to the cacophony of sound and colour that would have put Lloyd Webber to shame) and moved towards the hypnotically gyrating throng that could easily pass for an acid trip.

Arriving on the dance floor and mingling, I was immediately aghast. Not only do I not know how to dance (aside from the stock standard “lawn mower”, “walk the dog”, “do-the-shopping” and the infamous “sprinkler”), but I have not the foggiest how to Bollywood dance.

Suddenly I simultaneously felt like a deer in the headlights and that I was experiencing that dream where you stand up to present to your class only to discover you’re naked (cue the violins from the Psycho shower scene). Luckily, whilst it felt like it was an eternity, a few seconds later my attention was caught by a friend who was madly gesticulating to me.

I explained my consternation about not being able to dance let alone Bollywood dance to her. She smiled and gestured for me to lean in….

“It’s easy”, she said. “All you’ve got to know to be able to Bollywood dance is how to screw in a light bulb whilst patting a dog and then act surprised”.

I looked at her as though someone had slipped her something in her entree samosa.

“Let me explain”, she went on. “First of all, put one of your arms up in the air and pretend you’re screwing in a light bulb. While you are doing that, imagine you have a dog by your side who you are patting. That’s the first move you need to master. Secondly, after you’ve done that for a bit, throw your arms up in the air in an ‘oh wow’ kind of appearance and gyrate like that for a bit…and that’s it, that’s Bollywood dancing!”

I was dubious at her explanation until she did a quick demonstration. I looked around at the people nearby. Lo and behold she was right. I immediately saw a mass of multicoloured people screwing in light bulbs and patting their dogs, and then doing a camp cabaret interpretation of Edvard Munch’s ‘The Scream’.

It was hysterical. After a few side splitting minutes of raucous laughter, I felt no qualms at joining in. I actually felt I wasn’t a complete idiot….at least not more of an idiot than any of the people around me.

In the end I think I might actually have enjoyed it (but I’ll deny it to anyone who asks). So the next time you hear that Bollywood beat strike up (rinka tinka tinka tink tinka, rinka tinka tinka tinka tinka) remember these three easy actions….screw in the light bulb, pat the dog, act surprised. Bollywood is your oyster you mutha funkin Punjabi!.

   Nov 03

Malaena in the Morning

…sounds like a bad rip off of “Mornings with Kerri-Anne” or something.

Am not sure which is worse – that….or actual Malaena in the morning.

Nonetheless it was the latter not the former that I had to deal with on my last night before a glorious eight days off.

I wandered into the unit to note that we had two patients both of whom I was familiar with.

One patient was CTD (circling the drain….you know like a bug trapped in a sink of water as the water slowy and inexorably spins toward the plug hole before a final glug glug glug) who really should have been sent up stairs to await celestial transfer. Owing to a bed shortage upstairs she remained on the unit. Which meant she probably received far better care – I was touched to see that the nurse assigned to her spent the entire shift holding her hand and making sure she wasn’t restless or uncomfortable (vs being left alone in a room upstairs on her own).

The other patient was one who had been extubated that morning and was now on BiPAP. My hope was that he would make it through the night without tiring and consequently needing to be reintubated – meaning dragging the consultant out of bed since I wouldn’t trust myself with an airway that would have already been oedematous from several days of intubation added to the pendulous tissue around the neck and the santaclaus beard.

It was with a sense of calm alarm that I was handed over these two patients. The alarm was not because the patients were unstable or in any way a problem….but for the sheer fact there was only two patients. Two patients in a unit capable of taking another 3 ICU or another 6 HDU patients only meant one thing….. a busy night.

Within the hour of my arrival I’d already had to phone the consultant to accept two patients – one with a gastro bleed who we’d had earlier in the week and another who was a transfer from a hospital on the far side of town (allegedly every ICU between here and there was full – or pretending to be full given the type of patient).

Settling the first of those admissions and knowing the other admission could arrive at any time in the next 8 hours, I took the opportunity to lie down and catch some ZZZZ.

It was not to be. I was just about to arrive in dreamland when the piercing godawful pearls of the MET pager yanked me unceremoniously back to my poor imitation for being awake and alert. Remarkably I think I was actually already on my feet and heading out the door before I’d realised that the MET pager had gone off – kind of like a reflex arc that notifies the brain at a later stage.

The MET was somewhat of a bloodbath(room). A patient had decided to defecate copious amounts of blood all over the bathroom, the room and the bed so that the end result was something that resembled a B-grade horror movie.

I’m guessing though the actors in the B-grade horror movie though only had to deal with the smell of strawberry sauce. Malaena or perhaps in this instance haematochezia (both pertaining to blood coming out the back end), has a far different more pervasive lingering scent that even in the light of day is not easy to deal with.

Walking into the room and being closer to the nadir than the zenith of my wakefulness, meant the smell hit me like a Mack truck and I was forced to retreat and gag a few times before I could venture forth any further.

That patient went to the unit for observation. So did the smell. Although I think even if the patient hadn’t gone to the unit, the smell would have hitched a ride stuck firmly to my nasal mucosa – not to be dislodged even by Agent Orange (the name affectionately given to the citrus smelling stuff we use to try and shift malodorous odours).

The night was not to end there – the transfer from the other side of town had arrived in my absence meaning more work.

The patient awaiting celestial transfer must have seen the starlight express approaching and consequently started Guppy Breathing otherwise known as agonal breaths that were accompanied by a Death Rattle (terminal secretions if you want to be more professional about it) as the lungs slowly filled up with fluid – a common occurrence towards the end.

I can usually handle Death Rattle and not have it phase me, but I guess that’s because it’s usually only a brief encounter to check on a patient and be on my merry way. Unfortunately due to the open plan nature of the unit, the rattle rang out above the “silence” (silence being a relative word and in this instance included the hiss of the BiPAP and the cacophony of alarms signifying the various parameter derangements on the other patients) like one of those church bells that mournfully (bonnnnnng) and forlornly (bonnnnnng) signifies the end of another life (bonnnnnnng) and chilled me to the core. Fortunately the rattle was short-lived both due to the fact that I had ordered some glycopyrrolate to dry up the secretions and because the patient was also short-lived.

By the time I’d finished the life extinct entry in the chart, the sun was coming up and casting an ethereal morning glow on all of the patients – both those still clinging to life and on those who had departed this plane and now watched the scene from above.

Thankfully my shift soon drew to a close and I was able to head home to a blissful sleep and 8 days off.

   Oct 31

Breakfast Voyeurism

“BiPAP” is not a common word outside of intensive care units.

Consequently when it is used in two unrelated breakfast conversations at the same cafe it’s somewhat intriguing. Oh okay not really – but cause for comment. Which I have just done….commented that is, on the events of this morning…

Last night was my first night in ICU. I survived – and so did all the patients – remarkably — and I do mean remarkably.

I walked in last night to be told by the day P-HO that I was in for a busy night. Fortunately it wasn’t busy. Just the awkward task of removing ventilatory support from a patient with umpteen tearful relatives surrounding the comatose patient. The patient was not expected to make the night.

That being done, the rest of the night was unremarkable. It’s amazing how soothing it is to sit and watch the hypnotic squiggles of various bodily parameters zip …or mosey (as the case may be) across the monitors with the background hiss of ventilators and the occasional mellow alarm (as if the monitor was trying to say “terribly sorry to bother you old chap but this patient has a mean arterial pressure – MAP – of 59, perhaps you’d like to look into it…there’s a good lad, no rush, so awfully sorry to have bothered you”).

The most taxing post-ventilator-withdrawal event of the evening was solving the last few crossword clues of the mega crossword one of the nurses was working on. Who would have guessed an Ocarina is a terracotta wind instrument.

One of the other patients was a tad loopy and it was somewhat humourous to hear him first of all offer to make room for one of the nurses to join him in his bed, and then to tell us all he was taking a bath with six gorgeous young lasses.

It’s a bit bizzare sleeping on the job but apparently it’s quite accepted – all the nurses took it in turns to snooze in the isolation rooms and so I grabbed a quick 3 hours in the education room. Unventilated CTD patient was amazingly still alive when I woke – she had sats of 67 percent – and looked somewhat cyanotic.

…and so post-handover, I find myself sitting at a coffee shop eating a good helping of the old favourite – EB. I had a call from a friend and I was relaying the events of the evening – hence the use of the word BiPAP. Not five minutes later, the conversation at the next table mentions the use of BiPAP – apparently a group of interns discussing patients from a different hospital. It seems I can’t escape the grip of healthcare not even when enjoying a cup of coffee. Still it was amusing to listen to the conversation.

The remainder of my breakfast was spent watching other cafe patrons – particularly the guy trying who was preening himself in front of the woman sitting nearby – it looked particularly blatantly obvious what he was doing….not sure if she was deliberately ignoring it, or being blissfully ignorant of his valiant attempts to gain her attention.

   Oct 18

The Lark Ascending

…. is the name of a piece of music.

This piece of music is not what I am writing about today.

Yesterday I received a phone call from the Director of Anaesthetics informing me of two things – firstly I have a PHO job next year and secondly I am about 10 or so places from the top of the waiting list for the training program.

Both of these pieces of news made me somewhat rather elated.

Last night, having a day off today, I went to investigate a new and rather up and coming establishment in Paddo – The Lark. A cocktail/speakeasy kind of place you can go and enjoy good food good drinks and fantastic coffee.

Highly recommended if you don’t mind paying a little more.

   Oct 15

The Interpretative Bronchoscopy Dance

I’ve been in this job now three days and I’m amazed at how many things get poked into how many holes – and how many holes get made by poking sharp things in to get to places that aren’t accessible by natural holes.

I put in my first central line this week. There is something slightly disturbing about sticking a very sharp and very long thing into someone’s neck (albeit with an ultrasound and some anatomical landmarks to help)….trying to find the jugular vein whilst avoiding other somewhat slightly important structures (say for example the carotid artery). Not only that, once said vein is located, the next step is to feed a somewhat long wire downwards….towards the heart before feeding an even bigger tube over the wire (whilst holding on to the wire at all times ———allegedly there’s several wires that need to be retrieved each year in this state alone because somebody forgot to hold onto the wire).

I was successful in my first central line placement. **golf claps**

I was going to also insert a VasCath (that would be a vascular catheter) into someone also to allow them to be dialysed. Fortunately or unfortunately the patient turned out to be coagulopathic (which for the layperson means they could easily bleed like a stuck pig). The consultant had the honour of inserting the aforementioned catheter – with a diameter only slightly smaller than a garden hose into the groin of the renally compromised patient.

Perhaps the most intriguing thing I did this week was a bronchoscopy. Bronchoscopy is the art of feeding a fibre optic cable down into the lungs of a patient and among other things sucking out mucus. This seems fairly straightforward in theory until I was informed that there are a number of areas of the lung to be visited (a road map was drawn for me). To make things a little more challenging, the control of the direction of the bronchoscope is controlled in one dimension by a joystick kind of device but for the other dimensions you actually have to physically twist your entire body around an axis in order to safely rotate the fibre optic cable. This has the appearance of an interpretive dance – the operator has an eye attached to the bronch’ and is hunched over the patient’s head with the cable feeding down the tube into the patients lung. As the operator navigates and traverses the various segments of the bronchial tree (and seriously down there you just about need a GPS), they can be seen writhing and twisting in a hypnotic manner in order to align the scope in the right direction.

… an art that I am yet to muster. I think these devices should come with driving lessons. Luckily after I managed to view a few of the lung segments, the consultant was on hand to locate the other segments and aspirate a creme-brulee-like substance from the lungs. Mmmm tasty.

   Oct 09

Oh a P-HO-HO we G-OH-OH

Speaking of -OH, I could do with a splash of semichard or something a little crisp and refreshing.

Six months almost to the day since I was last arsed to write.

And my writing ability, let alone powers of narration have been shot to all buggery.

So a quick round up of the last six months in a single…..neologism:


(I wonder how much that would score in Scrabble – assuming there was a board big enough and enough tiles… I might one day get around to expanding on the above.)

….which brings me to today.

PHO (Pronounced P-HO – as in just a little skanky)….Principal House Ossifer (the lysdexics I’m sure will sundertand) in ICU and Anaesthetics.

First 12 hour shift.

I’m still alive.

My patients are still alive.

So in a nutshell….probably could be counted as a success.

Pros of the job:

  • 12 hour shifts mean rostered paid overtime and only needing to work for days a week
  • I save half an hour of driving not having to come home in peak hour
  • I feel less tired even though I’ve done more work (this may change – it’s only day one)
  • I don’t have to iron or wear shirts/ties
  • Patients with tubes in their throats can’t bore you with mundane and seemingly irrelevant facts – “it was a monday…no it was a tuesday…..yes yes I remember it was a tuesday because Gladys bakes for the CWA cake raffle on tuesdays….” (I only care about the fictitious Gladys’ cooking if she’s laced it with strychnine in a bizarre misguided homocidal geriatric way and I have to deal with the aftermath of said axis of culinary evil)

Cons of the job:

  • 12 hour shifts completely fuck any chance of a social life on day of work
  • People expect me to know things, people come to me for advice
  • It’s harder to pass the buck – I can’t use the phrase “I’m only a resident check with the reg” any more
  • I not only have to carry the MET pager every shift but chances are if it goes off it means I’ll have to rush off to someone doing their darndest to die and actually do my darndest (isn’t that such an Enid Blyton gingerale and teacake kind of word) to stop them from said dying – unless said dying is what is best for the patient. I also can’t use the aforementioned phrase (I’m only a resident….) to abrogate responsibility for running MET calls
  • It amuses me that the people who I was phoning for advice last week are phoning me for advice this week. This does not seem right.

    I will either get really fat or really skinny – not sure which yet – no time to eat, but when there is time, there’s only junk food (unless I get of my buttoony on days off and cook….thank you Dr Joshi and your chicken soup recipe…and of course to Miss Ali for introducing me to Dr Joshi).

    I’ve graduated from sticking sharp things in a short distance in a limited number of places to “sticking sharp things in a bigger distance and poking longer things in many more places “. It still sucks to inflict pain though – especially when the patient gives you a look that says “you’re enjoying this you sad sadistic bastard” to which I return the look with a look that says “if I had a choice between sticking sharp things into you or relaxing with a cup of coffee and a game of Scrabulous….I’d choose the latter – so long as it’s a good cup of coffee (and plunger-at-the-very-least-as-a-bottom-of-the-barrel last option and we will not even permit anyone to suggest that anything with the word “granulated, international, caterer’s, or 43″ is even a poor subsitute for coffee)”.

    Enough rambling. Sleep is necessary if I hope to pull off another 12 hour day.

    Note to all and sundry (particularly the sundry): There is a very large amount of tongue in cheek in this post in case you were not aware so before anyone thinks this is newspaperworthy-scandalous-health-revelation material, think again.

       Apr 10

    Running Hot

    Well both the water and my motivation are running hot.

    When one is to turn on the cold tap out here, cold water is not something that should be expected.

    My shower last night was a ‘cold shower’ that was about as warm as my normal shower.  The water being bore water is hot when it’s pumped out of the ground. 

    It also smells like rotten eggs.

    I’m sure that you could charge a fortune if it were relabelled as a health spa.

    My motivation to study is also running hot.  Not sure why.  Might have been motivated after a day of slothfully watching Austar and getting fed up with rerun after rerun.  None the less, I spend a good solid evening actually answering SAQs and found it thoroughly fascinating actually understanding a thing or two.

    Of course study motivation turned into a late affair so minimal sleep last night made for a tired and cranky soul this AM.

    A nanna nap at lunch time rectified the situation.

    What was not so hot today was the realisation (after a phone call to pay office) was that I was not going to be paid this fortnight unless I submit signed timesheets.  Nice of my beloved employer to inform me of this fact.

    Frenzied emailing of forms and faxing of forms needing to be signed by everyone short of the upstairs.  I will however allegedly be paid. 

    Off to TCLT No. 2 tomorrow.  An hour’s drive from TPLT No.2.  Morning clinic and then back to TPLT No.2 for an afternoon clinic.  Fingers crossed there aren’t many bookings in either.  Surprisingly enough I want to get back to the books.

    Hope the motivation lasts.

       Apr 09

    Country Tucker

    Remember when you would go to visit Gran and Grandad on a Sunday and the whole house would be awash with delicious scented tendrils hinting at the epicurean delights that awaited you at Sunday lunch?

    Every day out here is like a Sunday at the Grandparents.  Wandering in to the hospital each morning, your nostrils are assaulted with the smell of a silverside boiling away or a roast beast of some sort cooking sizzling and crackling in a hot oven.  By morning tea your stomach would be rumbling at the anticipation of the impending luncheon.

    Certainly I have had my fill of roast dinners in the last few weeks followed by delicious treats such as steamed pudding, jelly and custard and bread and butter pudding.  It sure is good old fashion wholesome country tucker, and since it is provided to me free of charge, three times a day every day, one would think it almost heretical to cast aspersions on such an apparently idyllic setup.

    However, there is this concept of “too much of a good thing”.

    Coming into my third week, I have probably consumed more meat than I have in the entire two months prior to me heading off into the sunset.  I have eaten probably thirty percent more meals than I would usually (allowing for the fact that I am normally in such a rush to get out of bed on to work that I usually don’t eat brekky).

    To tell the truth, while all of this food tastes really good – I am reminded once again of the visits to Gran and Grandad where the meat and three veg meals usually meant vegetables boiled in brine to within an millimetre of their blanched existence and roasts that you had on Sundays – and then saw cold for lunch or refashioned into something else every day for the next week until the side of roast had been used up. (Blood hell that was a very long an protracted sentence – one that I really don’t feel cogniscant enough to reword).

    I find that I am pining for a spicy curry from Punjabi Palace or a plate of yiros from Lefkas.  When I feel like a salad, I long for the friendly dark-green leaves of baby spinach instead of anaemic looking lettuce leaves.  Bring on the cubes of fetta, kalamata olives and garlic dressings.

    I guess in the twenty years or so since I last had a Sunday dinner at the Grandparents (who have since moved twice – first to a retirement village and then onto an address with a celestial post code), my tastebuds have broadened their horizons.

    While it’s nice to take the occasional gustatory walz down memory lane – I think I will be glad when I am back to a more cosmopolitan smorgasboard of flavours.



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