Monday, November 29, 2010

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 was I... oh yeah. The important thing was that I had an onion tied to my belt, which was the style at the time. You couldn't get white onions, because of the war. The only thing you could get was those big yellow ones...

And then if I'm really tired I'm in danger of laughing really really loudly while the old person is telling me, "...oats aren't what they used to be. Oats these days, they come in a box. You see I'm used to storing my oats in a jar..."

2. Old people would be great in a zombie movie!!
On Black Saturday last year- the day of the Victorian bushfires- I was the general medical resident at the Werribee Hospital. (already a black Saturday, I know). I knew it was going to be hot, but the weather was actually apocalyptic. The skies were black and enormous tumbleweeds tore past the windows. At 3pm it reached 46 degrees and the airconditioning broke. By 4pm the old people ARRIVED! A stream of delirious, dehydrated old people. I was sweating like a runner putting in drip after drip. Meanwhile, the old people roamed the hallways, mumbling, calling out, "Vernon. Vernon?". Some of them just sat at the 'bus stop'- a row of chairs near the nurses' desk.

A solid start to an awesome zombie movie!

3. Old people can fall over
One of the my favourite medical school tutorials of all time- assessing an old person for falls:
-ask the person to stand up, and see if they fall over
-ask them to close their eyes and see if they fall over
-if, perchance, the old person is still standing, give them a little push and see if they fall over.

Oh dear. Next time: children and the middle-aged!

Tuesday, November 23, 2010

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 to negotiate the ridiculous hospital bureaucracy and advocate for their patients in the under-funded public health care system. Identifying the treatment or test your patient needs is often the easiest part- then comes the frustration of speaking to six different administration staff, four registrars, a pharmacist and a chaplain in order to line it up for them.

For this reason that the only medical show I’ve ever been able to watch is (the early seasons of) Scrubs. It captures this aspect of medical work perfectly. In one episode a patient needs an operation that his health insurance does not cover, and the patient in the next room qualified for the operation but didn’t need it- so they swap the patients temporarily in order to get the first patient’s operation done. This is so close to the truth it’s not funny: for example trying to ‘trade’ with another inpatient team for a spot on the endoscopy list: if you let us take your patient’s spot on the gastroscopy list tomorrow, we’ll insert your patient’s port on the afterhours list tonight…

On my second day of internship, I had an unbelievably quiet afternoon. I was working on the renal team, and we shared a workspace with the neurosurgery team. James, the neurosurgery resident, came into the workroom looking stressed and demanding help from a female doctor. My (male) registrar quickly volunteered me for the task.

As we walked down to the operating theatres together, James explained his problem to me. He had been told- on pain of death- to book his patient for an aneurysm clipping that evening. But operating theatre bookings for the after hours list didn’t open until 4pm, and at exactly 4pm residents from all the surgical specialties- vascular, orthopaedics, plastics, hepatobiliary- would begin ringing the bookings nurse to secure their patient’s spot on the list.

James realized that the only way to ensure his patient got their aneurysm clipped was to be there at 3:58, to ask the nurse in person. “But she hides in the change rooms, Lucy!! You need to find her in there!” He laid out his plan: he would be out in the theatre recovery rooms, “sweeping the area” for the bookings nurse, whist also serially phoning her every 30 seconds. I would ‘stake out’ the female change rooms.

The funniest part about this procedure was that it worked, and James was considered one of the best surgical residents in the hospital. He subsequently got into one the most competitive specialty training programmes in the country.