Tempus Fugit

Time Flies…

   Mar 29

Screw You! (or…more correctly…Un-screw you)

I screwed a patient today while they slept … with four people watching.

Boy does that sound like a boundary violation.

It is however not quite so nasty.

What I am referring to is the removal of two screws from the femur of a patient. For those who have never heard a femur that’s the bone in your leg that runs from your hip to your knee.

Now it’s hardly something to get excited over really….I mean, it’s not hard to use a hexagonal screwdriver. What made it more exciting for moi, was that it was the first time I performed surgery unassisted from go to woe on a patient under a GA (general anaesthetic).

Who would have thought a sane person would let me loose with a scalpel… who would have thought unscrewing two screws would have rated me writing about it. It’s a little more involved than your average handyman job…there was some blunt dissecting down to the bone and then blindly feeling about along the bone until you find the hole.

Other fun things I got paid to do today included using funky pneumatic powertools to ream out (that means hollow out) bones so as to put bits of metal in. Pneumatic powertools are pretty funky cause they make “whoop whooping” noises when you’re using them….

…small things amuse small minds.


   Mar 25

Something about frying pans and fires

Handover this arvo from the current incumbent in the position I take over on Monday.

An hour long!!! Holy crap that would have to have been the most elaborate well prepared handover I have ever seen or heard of. Usually handovers take all of ten minutes. Not that I am complaining.  Will mean I might not look like such a prat come 0700 Monday morning.
Am approaching Monday with trepidation and fear. I am returning from The Booners (affectionately referred to as Wandin Valley Hospital) to the Big Smoke.

Orthopaedics. Bone doctoring. Egads. Orthopods are scary people. They play lots of football. They grunt. They eat their young.

Ten weeks of being in orthopaedic surgery.

Ten weeks of overtime every day. (The only thing consoling me here is “Cha-Ching Cha-Ching”).

Good bye social life as I know it. From Monday I suspect it doesn’t exist.

In other news… I missed the train going out tonight because I didn’t have enough coins (by 20c) to make up the fare… so had to bus it. Grrr. Stupid pubic (sic) transport.

I was dropped home by Mickus at 2am….to discover (after he’d driven off) I forgot to take my keys with me tonight when I went out. I also discovered my housemate can sleep through Armageddon (and I mean the end of days….not the film…shit even I would sleep through that crock of shite). I spent two long hours on the cold concrete out the front until I heard him get up to pee. (Thank goodness for small bladders I say…othewise I’d still be sitting out there in the cold).

Ah well. Home inside snug as a bug.


   Mar 15

Hue the years…

I am not sure how swayed my memory of the past is by media such as television but it seems to me that each decade bears a different hue.

The eighties I recall as yellow…the nineties were light blue and the noughties are darker blue.

What drugs am I on?

Actually what triggered my thoughts on such an asinine topic was my recent outing to the cinemas to see Rent – the motion picture interpretation of the Broadway musical.

I saw Rent when I was in New York in 1999.  It has since become one of my favourite musicals.

Consequently I did not know what to expect of the silverscreen portrait.

Initially I was offended and bemused.  I thought it to be utter crap and a travesty to such an awesome (and Pulitzer prize winning) work.  It took me a while to work out what it was that was not quite right.

Then it dawned on me – deliberate or not, the movie was directed in a 1980s style.  It was almost as if I was watching a film that had been made in 1989 (when the story was based).  The bad acting (what do you expect when you put singers – the original broadway cast – on screen), cinematographic techniques, filmstock and set dressing all smacked of a music video seen on Countdown – right down to the pre-recorded vocal tracks that sounded completely studio-created in spite of the fact they were being sung in downtown New York.

I’m not sure if it was intended to be this way but fuck me it was effective in adding an impressive dimension to the film that would otherwise have been lacking.  I can see though that if the film were critiqued without this in mind, it would be easy to bag it as a badly choreographed fame-esque singalong complete with bad 80s haircuts.  I do wonder if perhaps the story (which is a modernisation of La Boehme) would have been better portrayed with less of the music (which is better suited to the stage interpretation).
So what to make of this overall….good or bad?  I honestly don’t know.  It was not what I had been expecting and I am not sure if I like what I saw.  I think it will require seeing again going in without whatever preconceptions I’d had.


   Mar 14

Short and Concentrated.

Happily savouring the crema of my tasty beverage in Newfarm today when my phone rings.

It’s the boss.  That is the head of department.  Would I be able to come in and work a half shift this evening….two staff down and the floor is ‘diabolical’ and the boxes are overflowing.
(For the uninitiated, the floor refers to the main area of the emergency department, and the boxes refer to the triage category boxes).

Having nothing better to do, and needing some extra dosh I agreed.

Whilst driving to work I noticed the moon looking rather full…. a poor prognostic indicator.  Last full moon I worked was suboptimal with patients climbing over bedrails and landing on their heads.

On arrival I passed the ambulance bay where a ventilated patient was being loaded into an ambulance as another patient was wheeled into the department.  I was non-plussed to see harrowed staff hurrying left right and centre.  I was even more crestfallen when the corridor was stacked two deep with patients stretching down towards the x-ray department.

Extra staff had begun to arrive, exhausted staff from the morning remained on to do overtime.  Several category ones (imminent impending death) and category twos (if you don’t get to me bloody soon I’ll be knocking on heaven’s door) had meant that the category threes (shit mate, there’s something wrong that probably should be seen to today) and category fours (I really should go and see a GP in the next week or two but I am too much of a cheapskate to make an appointment and pay the gap) had piled up and were piled in precarious towers heading skyward.  Today was obviously a day when the category fives (FOOMERs – Fuck Off Out Of My Emergency Room – that is, you don’t need to be seen today) were not going to be seen any time before hell froze over.

All the monitored beds were blocked with HDU (high dependency unit) patients awaiting processing by the frazzled medical registrars.  There were several stable chest pains shafted to the corridors. The frenzied bustle was punctuated by howling kids, demented frail GOMERES (read the House of God by Samuel Shem if you want to know what that is) calling out to long lost husbands.

A drunken, maudlin female known to the mental health service kept security busy by pulling a knife out of her pants.  Her nearly full bottle of vodka stood like a totem beside the triage boxes hidden out of her sight less she decide to drink herself into even more of an oblivion.

Xrays on xray boxes illuminated the walls with eerie glows – pulmonary oedemas, bowel obstructions and comminuted fractures announced their presence to any passerby who cared to glance their way.

Machines that go bing …. went bing. Phones rang.

In the resus bay, a central line was being inserted…. in the procedure room the smell of congealed blood pervades the air as a gruff bloke with a somewhat rather large laceration to his thigh is sutured up.

In the centre of the floor – the fishbowl…we all sat in the relative sanctuary of the writeup area – as though barracaded from the encroaching hubbub.  The green glow of the HBCIS terminals, the pretty colours of the Auslab pathology results – green for good, yellow for ‘uh-oh’ and red for ‘holy fuck’, the squiggles of the telemetry (and streams of rhythm strip paper recording for posterity arrhythmias and ectopics) beamed from the banks of computers standing between us and them.

The writeup table was festooned with patients’ charts, path pads, xray forms, referral letters, ECGs, coffeecups and (thankfully) the omnipresent bowls of lollies that keep us all going.

Knowing I was being paid double time and knowing I only had to work for half a shift – that is five hours… I attacked the cat 3′s with a vigour and energy that I had not seen in myself before.  Three chest pains and a talfibular ligament strain later I had reached 11pm without even realising time had passed.

I wish all shifts were so quick.  I think if I were to be paid double time and only had to be working half the number of hours I would be so much more efficient and enthusiastic.

Fortunately I guess, it’s not always this busy.  What alarms me is that it is not a full full moon until Wednesday.  What the fuck am I to expect when I goto work then?


   Mar 08

GP? or not GP?

FORFUCKSSAKE!

Why can’t people learn that an EMERGENCY department is for…..hang on…no, it’s not a day care centre for old farts…..no… it’s not a place where you can come hang out and talk to people…..no…..it’s not where you come to with a problem you have had for three weeks…..no…wait for it, I know it’s going to blow your mind….and EMERGENCY department is for……..EMERGENCIES!!!!

Give me an E

Give me an M

Give me an E

Give me an R

Give me an E

Give me a G

Give me an E

Give me an N

Give me a C

Give my a Y

Yes folks….that spells EMERGENCY

I know, I know…it’s totally flabbergasting. Who would have thought.

Apparently not most of the population of the Halfwitsundays (another name for the islands in the bay), and apparently not most of the local population.

Today I felt like I was swimming in a pile of shit – it was smelly, unpleasant and frankly I can think of better things to do.

I was however amused by how effective it was in clearing the waiting room out when a hysterical mother came in with an EMERGENCY. Kind of made all the dickheads with subacute GP problems realise that perhaps they should go and see their GP on another day.

I really love the EMERGENCY part of EMERGENCY medicine…but frankly I can’t stand the GP stuff…that sort of stuff we shouldn’t have to see. Hell will freeze over before I become a General Practitioner. I think I would rather work in a coffee shop making coffee all day being paid shit wages before I would choose to do GP work. Is it any wonder there’s a shortage of GPs in this country….you couldn’t pay me enough dollars to make me want to be one.
Okay rant over.


   Mar 02

The Looooonnnngggggeeeessssstttt Day

To say today dragged would be an understatement.

It was as if each second had suddenly developed emphysema and couldn’t pass more than a few inches by at a time before desaturating and having to sit down for a break. The day was scattered with puffed-out seconds. Had we had a pulse-oximeter capable of taking oxygen sats on seconds then I am sure it they would have been saturating well below 90%.

So I guess you could call my day an exacerbation of temporal-spatial-COPD (Chronic Obstructive Pulmonary Disease for those who know better than to dabble in the Health-Arts ….medicine is indeed an art…the art of amusing the patient whilst nature cures the disease …thanks to Mr Voltaire for that pearl of wisdom).

And the wheezy pink-puffer of a day (though it felt more blue-bloatish if the truth be known) was jam packed full of annoying patients…. I mean come on people! Do you not have better things to do with the precious time you have before you’re worm-fodder than to rock up to the emergency department and fill my day with things I’d rather not have to do.

Life drags on.


   Feb 28

Shiny New 19inch Toy

Mind out of the gutter people.

It does not vibrate and you don’t stick it places.

Well actually the only place I plan on sticking it is on my desk where I can stare longingly at it.

It is in fact my new 19 inch LCD monitor.  MMMMMMmmmm screen real estate.  So bright I need never go out in the sun again I will in fact be able to tan in front of it.

Soooo much space.

So crisp.  So clear.

Okay… am over it now.


   Feb 27

EtOH Withdrawal

Oh deary me… I should know better than to drink copious quantities of alcohol.

Sure…it’s fun when you’re anaesthetised and dissociated from reality….but hangover or not…the withdrawal process is not pretty.

Today I was not affected by a hangover. I am not sure why. Maybe I was adequetely rehydrated. No headache. No nausea. All good. Until my body went….’hang on a tic….there’s no more alcohol….bugger’…and rebounded.

For anyone who is not familiar with how the body reacts to substances (medicinal or otherwise)…it adapts to the presence of a substance. So when that substance is no longer there the body is still trying to compensate for its presence….meaning that the effects of withdrawal of a substance should be the exact opposite of the effects of the said substance.

In this case…ethanol…which depresses your inhibitory centres in the brain…instead of elation and social disinhibition…you end up with depression and social inhibition.

I can see why some people would become dependent on alchohol…because the feeling of withdrawal sucks. What better way to prevent withdrawal than to keep drinking…. (except perhaps abstaining in the first place).

So really when placed in this situation…there’s not much more that can be done than to batten down the hatches and ride out the storm while your body neurochemistry tries to right itself. Thank goodness for having three days off now.


   Feb 09

For Whom The Bell Tolls

Dead eyes are freaky.

Not sure why – have seen heaps of dead people. Have assisted in failed
arrests previously. Old people die regularly.

But the dilated pupils of the guy who arrested last night keep haunting me.

I’m not sure if it was a combination of the slowly cyanosing face and the
pupils or if it was just the piercingly wide pupils on their own but every
time I close my eyes I see them. and it’s as though they are somehow
sucking my soul from me as I see them in my mind’s eye.

I should never have looked into them when I was intubating. It feels almost
as if they are cavernous black holes that connect the living world to the
underworld.

I should stop being so melodramatic. Better to go out in VF->PEA->Asystole
arrest than a painful slow respiratory arrest drowning in a pool of your own
secretions or a widespread metastatic illness. One minute you’re eating
dinner…next minute you’re not.


   Jan 29

More means less

Why do I always write less when I have more to write about?

I’m chockers full of things to say about new jobs and new people I’ve met and new things I’ve done.

But the problem is…where is the time to write about them?

Live consists of…work….sleep…move house…move mum’s house…rehearsal….

…and what time I have off is spent….snoozing or veging in front of the TV.

Soon. Soon I will write something. Hopefully. Maybe.

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