Category: Work

Ick!

One of the things they tell you about in Med school is the ability of certain medications to give you a metallic taste in your mouth.

Previously I had always though: “Metallic taste, that’s not that bad. I wonder why they make such a big things about it”.

That changed a few weeks back. With lunch I inadvertently had a glass of water that had come out of a copper pipe and it wasn’t until I’d finished most of the glass that I noticed the blue tint to the water and then started to taste the metallic taste. As the afternoon wore on I’m not sure if the taste got stronger or if I just became increasingly conscious of it, but it became highly unpleasant. Drinking water or tea didn’t decrease it. Eating didn’t decrease it. Even brushing my teeth didn’t help things. Eventually it disappeared (overnight I think), but it quite startled me just how unpleasant a situation it had been.

Another thing I suppose that I can learn to take people a bit more seriously about when they report it as a symptom…

Go crazy? Don’t mind if I do!

This week, as the latest delightful assignment in my term of relieving, I am working in the mental health department.

I’m there for 2 weeks.

In order to do any of the genuinely useful tasks as a doctor you have to be trained in and certified in the use of the mental health act (so that you can admit/detain/treat psychotic patients against their will etc). Unfortunately to get trained takes 3-4 days, so they didn’t have time/incentive to do that for me given the short time I’m around.

That fact, combined with the fact that I haven’t dealt with a seriously mentally unwell patient in almost 3 years, and even then it was in med school at a hospital where the mental health unit was spectacularly understaffed, and resultantly dysfunctional, and so we didn’t really get to actually do/learn all that much (general hint here – don’t come to me for treatment if you get schizophrenia or bipolar disorder, because I won’t be of much help to you).

So basically I am wandering around all day doing general medical things for the other doctors who have better things to spend their time on, and trying not to draw too much attention to the fact that I’m not really much use to anyone. I go and see patients, and diligently write down what I see and what they tell me, and generally have no idea what to do about it beyond saying “they seem better/worse than how they were described yesterday”.

That said, I did still feel quite chuffed this afternoon when I managed to get a patient to tell me all about how he was seeing things that weren’t really there, which is not always the easiest thing to do.

Wierd Signage

The other day on one of the wards I saw a sign that made me do a double take because it seemed so incongruous.

It was attached to a Zip hot water system, and I’ve included a picture of it below, but owing to the poor image quality I’ll also tell you what it said:

1161
Caution: Boiling water. Do not use to wash hands.

I mean seriously!??! would anyone honestly be dumb enough to try and use water out of a zip to wash their hands???

Presumably they must have for the signs to be necessary, but I would think they would have to be a serious contender for a darwin award.

What is a lift?

One of the things I found most disconcerting after the September 11 attacks was a story I heard about an american journalist who went into Afghanistan before the american invasion, and was showing afghani villagers pictures in glossy magazines of the world trade towers collapsing, and asking them what they thought about the attacks. The interesting thing which put many things in perspective, was that there were many villagers who commented that it was sad that so many people had died, but that they had never known that buildings could be built that tall, and additionally a number of them were fascinated by the magazine, having never seen a glossy magazine before in their life.

It created a nice contrast of priorities, when we were so outraged that 5000 people had been killed, but weren’t even aware, let alone concerned, that there were many people in the world who were so poor that they had never known highrises or magazines even existed (although whether this in fact made them very lucky is a matter for debate at another time) (and lets not even begin to get into illiteracy rates).

Now the reason that I was reminded of this story is because the other day I was on the ground floor of the hospital and an old aboriginal lady asked me how to get to one of the medical wards. I told her that it was on the 4th floor, and she asked me if I could take her there. She seemed quite nervous and so I took her up in the lift to the ward, and it was only afterwards that I realised that the probable reason for the request was that prior to coming to the hospital it was quite concievable that she had never been inside or operated a lift before.

I actually remember being told about this situation in some lecture in medical school, but it wasn’t until I experieced it that it hammered home the disparity of development that exists, even over relatively small distances within a supposedly first world country.

If (as I suspect) she had been flown in for treatment from a remote aboriginal community on the Cape or in the gulf, or even from one of the torres straight islands, then she may actually not have seen a building taller than 2 or 3 storeys. I take lifts for granted. For her it may have been a completely new and (at the age of 70-odd) frightening experience.

The Santa hat

Today, in response to a bet from one of the midwives, I wore a Santa hat to work.

Essentially the bet had been that I wouldn’t do it, and we all know how dangerous it is to bet me (with my well known stubborn and competitive streaks) that I won’t do something. (Just ask my friend James about the $10 challenge, or, on second thoughts, don’t…)

Anyway, the odd thing was how few people questioned, commented, or even appeared to notice the hat.

Big red hat with a pompom on the end. You’d think that would provoke a response or two, but people just seemed to take it in their stride.

Perhaps they just assumed I was really getting into the christmas spirit(s).

My next education campaign

One of the things which I have recently been finding quite unbelievable is how easy it is to confuse people with the simple question of “What is your ethnicity?”

As part of the booking in process when we first see soon-to-be-mothers in antenatal clinic we ask them a bunch of question relating to general health and influencing factors.

Because certain ethnic groups have different risks for certain conditions that can effect pregnancy we ask about ethnic background.

And what constantly leaves me wanting to slap people is the response to this question. I say “So, what is your ethnic background” (which I now usually follow with “…where did your ancestors come from” or something like that) and in response I still almost invariably get a look of deep confusion followed by a response along the lines of “Australia…. I’m… I’m Australian”. So seeing as they are almost all whites, I try to clarify with “But your ancestors, did they originally come from Europe, you know, caucasians?” to which I once again get a confused look and “No…. I’m… … Australian” at which point I do my best not to look exasperated, write caucasian on the form, and move on.
I don’t know whether it’s something to do with the demographic population group I’m dealing with here, or whether this is a wider Australian problem, along the line of the US theme of America is the best and we’re all Americans…

Coming from NZ where pretty much every form that required demographic information has the first two options being (1) New Zealand European (Caucasian), (2) Maori, followed by the other usual options, I find it interesting that there seems to be so much confusion and ignorance about the separation between ethnicity and nationality. My ethnicity is caucasion. My nationality is New Zealander.

Surely that’s not so hard? Is it?

Best laid plans

This is basically a public service anouncement to all those people who we have been misleading by telling them we will be going to Townsville next year.

Turns out we’re not. It now seems more likely that we will be going to Cairns instead (although this is still not 100% certain).

Now Cairns is still on the great barrier reef, so the offer still stands to come stay in our spare room and do some snorkling or scuba diving.
I won’t go into the details of how this all happened, basically because they’re long, complicated, political, and most importantly, boring.
Suffice it to say the College of Surgeons can be pretty disorganised and incommunicative (but then again I suppose what beurocracy isn’t).

Viva le grand finale

In a reminder that synicism is so easy when working in the health system, this weekend was grand final weekend, with the AFL final on saturday, and the NRL final on sunday, and I was working both days.

Now the bit which inspired cynicism is that normally saturdays and sundays in ED, particularly the afternoons, are hectic with millions of people presenting, usually with pretty mundane complaints (I’ve had a cough for 5 weeks, my little toe hurts, and the like).

Both days this weekend however basically from half an hour before kickoff to half an hour after the full time whistle there were maybe 2 or 3 people in the waiting room at a time. The masses may have been sick, but not sick enough to miss out on watching the beloved footy.

Meanwhile two dozen doctors and nurses sat around getting paid to twiddle their thumbs for a couple of hours.

Then as soon as the game was over they started to show up again. In droves. Admitting that they had had their ailments while the game was on, but that they felt it could wait.

You feel like giving them a good piece of your mind (ie. a slap around the head) and pointing out that if it was that unimportant that it came second to football, then it was probably the kind of thing that was better being seen by their GP the next day, and that they were just wasting our time and the taxpayers’ money be being in ED with such trivialities.
The quiet irony which does the hint of a smile back into my heart is that the masses who showed up after the game finished probably ended up waiting 2-6 hours to be seen, due to their large numbers and minor conditions (people in ambulances automatically take higher priority when they arrive), whereas if they had showed up while the game was on they would probably have been seen almost instantly.

Junkies of the world lament

Today we had a number of very sick people come through ED.

As such we had been breaking out a fair amount of the good drugs which, in other times and other places, people would pay good money to get their hands on.

One guy was having a heart attack and we were giving him large quantities of morphine to control his pain.

Another lady was having intractible seizures, and again we were using fairly decent amounts of sedatives to stop her from fitting for long enough to stabilise her airway and CT scan her head.

And when all the excitement wore off, and things had settled down, I got to take all the unused morphine and valium and squirt it down the sink.

In my mind I could almost hear the cries of anguish from all the junkies of the world, and it amused me.

Geographic nomenclature

The other night I was musing with one of the other interns about the names of young patients we had been seeing, and the following question formed in my mind:

Why is it that there are so many kids around today (the parents of whom should have been given a good slapping) with names like Dakota (or Dakoda or Dekoda or…) or Montana, or Dallas?

Additionally why is it that Australian parent see fit to name after American geography, and yet you never see kids named Tasmania, or Adelaide, or Canberra? Canberra’s a nice name for a girl don’t you think?

:-s