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Showing posts from 2010

Apocalypse in the ED

Following on from my idea of a post-apocalyptic geriatric-zombie movie set in the Werribee Hospital: the apocalypse came to Melbourne!

On Saturday there was a flash flood which affected several parts of the hospital. We even had to go on bypass for a couple of hours while the PSAs were tried to stem the tide. You know, stop the life-support machines getting too water logged. Simultaneously, a code red (FIRE!) was called for another part of the hospital.

Usually if there's a code red it's only called once, then presumably someone takes the smoking piece of bread out of the toaster and it's all fixed. This time the code was called every three minutes or so, indicating an ACTUAL FIRE! So for about an hour there were announcements every few minutes, "Respond Yellow: Flood, level 1", then a couple of minutes later: "Respond Red: Fire." Hilariously, the location of the code red kept sounding like: "Respond Red, Evil Child Unit. Respond Red, Evil C…

Old person-a-rama!

One thing about my job is the old people. Here are some observations about old people. (Don't get me wrong, I defected FROM paediatrics to do Emergency Med. I like old people).

1. Some old people can talk a LOT. Especially if you ask them about what they've been eating, or who does their grocery shopping. When I listen to an old person talk I can't help but think of the Simpsons episode where Grampa Simpson tells a really long boring story as an old-person weapon:

We can't bust heads like we used to. But we have our ways. One trick is to tell stories that don't go anywhere. Like the time I caught the ferry to Shelbyville. I needed a new heel for m'shoe. So I decided to go to Morganville, which is what they called Shelbyville in those days. So I tied an onion to my belt. Which was the style at the time. Now, to take the ferry cost a nickel, and in those days, nickels had pictures of bumblebees on 'em. Gimme five bees for a quarter, you'd say. Now where…

Pen V. Stethoscope

I have nearly finished reading ‘The Pen and the Stethoscope’, an anthology of writing by doctors, edited by Leah Kaminsky. The book is approximately half non-fiction and half fiction. I admit that I enjoyed the non-fiction more- there was a predominance of doctors writing about their early experiences as interns and residents. The stories were often familiar to me- a missed diagnosis of leaking AAA, the frustration of continuing intensive care on people who should be allowed to die in peace. But I was thoroughly impressed at how exciting the stories are- these doctors can really write!

I think that the early years of doctoring- internship and residency- provides the richest fodder for writing. In these early years you are most acutely aware of the chasm between your experiences as a doctor and your previous non-medical experiences. You are innocent enough to be properly awed or disgusted by things. The junior doctors are also the ones most often put in ridiculous situations trying…

online wino

Yesterday one of my colleagues had an alcoholic patient, who gets all her wine via online supermarket shopping. She need never leave the house again!!

Today my love for you...

I used to ask Jason, "Will you leave me this week?" And he would say, "Hmm....no, not this week." "Okay!"

Now I tell him,

"Today my love for you is as big as Uluru."

"Today my love for you is as big as Chadstone shopping centre, including the carpark!"

"Today my love for you is as big as the Pacific ocean"

"Today my love for you is as big as the Royal Exhibition Building." (Jason: "Hey, that's not very big!")

He told me,

"Today my love for you is as big as the shipping yards."

"Today my love for you is as big as the spaces between the stars."

Kickboxing, dinge etc

Today a patient presented after participating in a 'no-rules' kickboxing match. Apparently the bouts go for 9 minutes- the winner taking home $15 000 and the loser a measly $5000. In this chap's case I don't think the $5000 will begin to cover his rehabilitation costs. But who even knew this type of match happened here in Melbourne?? It sounds like dog-fighting or cock-fighting.

Last weekend Jason and I went to see Sifter's Dinge, a Melbourne Festival show (Goebbels) with a fantastic mechanical set and no actors. I suppose it's an audio-visual installation, but presented as a discrete performance- unlike the looped installations more commonly found in galleries. It was enthralling. There were four pianos that played themselves with mechanised arms, a steam-engine type contraption and spooky constructed trees. At the start two 'stage hands' come on to shake some sand into enormous containers. Then they turn on taps of three large watertanks allo…

The TV and the couch

When did I start watching all this TV?? When I first moved out of home in 2002, we didn't have a TV. In 2004 we got a TV, but the only show I watched was Twin Peaks- which is *practically* film. In 2006 I started watching Six Feet Under, which singlehandedly converted me to TV. Now I watch:
-Mad Men
-Thirty Rock
-United states of Tara
-The Wire
-Freaks and Geeks
I can't even remember them all! I keep telling myself that it's because TV is smarter now, edgier. BUT WHAT IF I'VE JUST BECOME DUMB?? A DUMB AND LAZY COUCH-SITTER??

Excuse me I have some TV to watch.

Intensive Dream Unit

I have just started a week of night shifts. Seven long nights in a row, but in what other job do you get a full seven days off every 8 weeks?? And it's not all bad- nightshift can be freeing to the mind! As Daniel Kitson described in his awesome show 'It's the Fireworks Talking', staying up all night can make you feel INVINCIBLE!!! Or at least give you the type of meandering, loose-associations-type thought pattern that 9-5 never delivers.

Last night on my drive to work I was thinking about the amazing monitoring capability of the intensive care unit. When you first start working with intensive care patients- those in an 'induced coma'- it is completely bewildering trying to figure out if they're okay or not. The senior staff will suddenly become very concerned about one particular patient, who to the casual observer, looks identical to all the other apparently sleeping patients in the intensive care unit. Of course, the senior staff are responding to t…

Blow darts

Sometimes I get very anxious, this doesn't seem to correspond to particular events. Some days I'll just wake feeling diffusely anxious.

Today Jason suggested that he get some tranquilliser blow darts to shoot at me when I'm getting anxious. "See, I will support you with love. Love and blow darts."

Out of Oz

We returned to Melbourne 10 days ago, and I am haunted by the sense that i have returned *from* Australia, to *another place*. My idea of Australia has grown so much that Melbourne seems like an international city, part of an international community of cities, but certainly not integral to the Australian identity.

We spent a week travelling from Broome back to Alice Springs, through the Tanami desert. I had decided to read Australian books on my holiday- I read 'Cloudstreet' and 'Dirt Music' and a true crime book about Bradley Murdoch. I had attempted Cloudstreet before, and found it unbearably kitsch. A story from my parents' childhood. This time I loved it. I suppose things can seem kitsch just because they are unfamiliar.

Crocodile fever

Jason and I have made it north of the Berrimah line to Darwin. We may have caught a bit of croc fever on the way- it being clearly too early in the year for mango madness. We saw seven crocodiles on our wetlands cruise at Yellowwater, then set off intrepidly the next day to Koolpin. In order to get to this 'jewel of Kakadu', we had to cross a river containing an *actual saltwater crocodile*. I was so scared!! I told Miriam that if she was killed by a crocodile- and therefore definitely frontpage news for the croc-obssessed NT Times- I would be sure to tell them she was wearing her lovely Gorman bathers at the time of death.

Crocodiles are basically primordial monsters. They sit on the banks as still as rocks, then slip soundlessly into the water and *completely disappear*. Their teeth sit outside their mouths, giving them an evil grin.

On the way back we opted to scale a sheer rock face in order to avoid the river crossing.

Leaving the desert

Ahh, gloomy old day in Alice Springs. I have no contingency plans for inclement weather here! The fact that our house is at least half packed up isn't helping.

Last night one of our friends reflected that it wouldn't be "so bad" moving back to Melbourne. After all, she said, "You can walk along Merri Creek and pretend that you're in nature!" Which, from a Central Australian point of view, is simply hilarious. In this town, you can ride a bike for fifteen minutes in any direction and end up in proper, unadultered BUSH.

I will definitely miss the sky- 360 degree horizons!! The feeling that the sky is so big and round above me that I am actually a tiny figure in a snow-dome.

It is going to take some getting used to the plush environs of a big city ED. In the department here I can sit at the main doctor's work desk, and, if I reach my hand behind me, tickle a patient's toes as they lie on their trolley.

I also suspect that the Melbourne patients will b…

Big Smoke

Today Jason and I officially became locals in Alice Springs- the Todd river has flowed three times whilst we've lived here!
I will tell a story, but not in a Crocodile Dundee, or Gods-Must-Be-Crazy way, I hope.
One of my patients was a middle aged Aboriginal lady, who came from a long way out bush. At least one day's drive. She had never been to Alice Springs before in her whole life. As luck would have it, she injured herself whilst here in the Big Smoke, and had to come to hospital.
She sat in the cubicle looking terrified, and told me quite frankly, "I'm very scared. I've never been to Alice Springs before." She asked if her husband could be called in from the waiting room- unlike the locals, she didn't realise that most people bring a family member through to the department with them. So he came through. When I told them both that she would need to stay in hospital, her husband said- so very softly that I had to literally put my ear up to his mou…

Working too hard

By early last week, I had done so many ED shifts in a row that I felt constantly on the verge of a temper tantrum.
Nurse: "What time do you want the next troponin on Mr Smith?" Lucy: "WHY DON'T YOU JUST LEAVE ME ALONE???"
I found myself seeking solace in the more boring ED activities- quietly suturing a large stab wound on a drunk man's chest, or moulding a plaster for the broken ankle. I felt completely incapable of making any clinical decisions.
On my precious days off we cycled to Simpson's gap. The bicycle track was stunningly beautiful: 20km of meandering paths through low lying, scrubby bushland interspersed with huge ghostgum trees. We scrambled up the gorge to reach the sunny rocks and ate an amazing picnic of roast beef sandwiches, apples and chocolate cake. Enid Blyton would be proud!



Magic

Many of our indigenous patients also receive traditional healing from a Ngangkari. I would love to find out more about this. I understand the ceremony often involves removing an errant object that is causing illness in the body, for example a misplaced rock.
I often think that medicine as we practise it does not have enough magic. It is thoroughly transparent and mundane, and doesn't engage the beliefs of our patients well enough.
Early Western medicine had more magic! For example, the secretive use of obstetric forceps during a difficult delivery: the forceps hidden under the operator's gown, before bringing forth the (often dead) baby. Though this particular example is mired more in patent concerns than the powers of culturally-embedded healing.
The other day I sedated an Aboriginal boy with ketamine and when he awoke he spoke English for the first time. Perhaps I shall have to settle for this small wonder.

Rock vs Stick

I had a throughly awesome weekend with Deanne, who flew up from Melbourne for a holiday.

We started off at the pub on Friday night, discussing an important teaching of the Alice Springs ED: all assault weapons are either rocks or sticks. A stick is an object that the perpetrator holds onto whilst hitting their victim, whilst a rock is any projectile weapon. A tin of food and a TV are both rocks. A nulla-nulla is a stick, but so is a cooking pot. A children's tricycle could be either a rock or a stick. This expedites clinical handover; '28 year old man hit to the head with a stick;' and speaks volumes of the ridiculous amount of violence in this town.

Saturday morning we went to the Steiner School Fair. I admit to being fairly cynical about Steiner schools, particularly as there is apparently an outbreak of whooping cough at the Alice Springs Steiner school at the moment. (Insert disparaging comment about hippy parents and vaccine-preventable illnesses). But by the ti…

The Outback Wedding

This weekend was the festival of Miriam and Marcel's wedding. The Outback Wedding, and my first ever Jewish wedding.

We were super-excited about attending our first Jewish wedding. Jason carefully packed a bobby pin for attaching his yarmulke, and then was quite proud when it stayed on of its own accord. We practised our three Yiddish expressions; schvitzing, schlepping and alter kocker; and carefully read the 'Guide to a Jewish Wedding' enclosed in our invitation. I even befriended a teacher of Jewish studies who told me about klezmer music and the hora. So exciting!!

We gathered at the entrance to Alice Springs' botanic gardens, and were lead into the desert garden by two traditional owners and a klezmer band. Several people (including my Jason!!) carried colourful flags in the procession. It rained during the procession, but during the ceremony the sunlight snuck in right under the huppah. Miriam's little nieces sat around the huppah clutching their banks…

tummy bugs

I was struck down by a tummy bug at approximately 5:30pm yesterday. I feel this is the best way to describe it- 'hit me like a ton of bricks', 'struck down' or 'knocked out'- a sudden outbreak of WAR IN MY TUMMY!!

I am now convalescing with Sarah Waters' 'The Little Stranger'. Things could definitely be worse.

Outback Doctors

I saw an ad for the ABC documentary series 'Outback Doctors' and immediately thought, "I should be on that show! I'm an outback doctor!"

And I am Outback Doctor now, of sorts. I've worked in Alice Springs for nearly 4 months. I know about nulla-nullas and redback bites. I'm no longer surprised by the pus or the maggots, or the patient who sprints off half way through the consultation to retrieve his swag from the Todd riverbed before someone nicks it. Actually, I understand this one now: a good swag costs about $300.

Of course, the real outback doctors consider Alice Springs to be the 'big smoke' so I guess I've got a way to go before I'm a documentary star.

My friend Marcel is a paeds registrar working in community paediatrics. He likes to make fun of the short-term mindset of the ED doctor: after all, he works in preventative medicine. When he visited the ED the other day I gleefully said, "Slow day for preventative medicine Marcel…