Happy Birthday Becky

Happy birthday to Becky! Hope you have a really great day!

Had a crap day. Well it ended crappy with a surg reg who was quite mean about something that wasn't my fault because when I saw the patient she was mad at me about I had immediately involved a senior doctor because I realised they were sick. Grr arrg. Anyway. Plus this pt who I'd seen the week before who'd had a positive CSF and who we'd all thought had meningitis, probably has primary meningeal lymphoma or somethingarather. Which seems like a bit more of a bugger.

For the past two days I've had a "shadow". A medical observer awaiting their registration. Basically follows me and watches everything I do. He's a nice guy, otherwise it might be a little disconcerting. Luckily I love to prattle on and on, and having someone with me makes it more socially acceptable.

Incidently the nice man from my story yesterday, did have a #NOF! The ambulance had told them that he didn't have one, and they didn't want to bring him to hospital, but the family insisted, which was lucky because he had to have an operation.

mmm... I think I smell dinner... braised fennel and steak with a red wine jus. Yumm. Must away to see if he needs help with dinner.

This post was interrupted immediately after I wrote that thing about dinner by a big yell from the kitchen. I walked in to find Matthew, the kitchen wall, the stove and the floor all covered in splashes of red wine jus..... apparently when he "flamed the wine" or whatever he was doing, there was a small explosion of red wine jus... He had red dots all over his face and neck. It was quite amusing. The dinner was quite yummy though, and we followed it up with a divine self-saucing chocolate pudding. Now I feel almost ill from all the rich food.

Must away to bed.

Thanks

Big thanks to Suze:) you're awesome. I got all the cinnamony goodness today and it made my day:) There is nothing better then a parcel.

Have seen some really interesting cases at work lately, unfortunately "interesting" in medical terms almost always correlates to sad. Children are tricky. They apparently can have really high pain thresholds which is quite deceiving. You see you might think a child who says they have "a small headache" hasn't really got a major head injury, but when you do a CT face, you might discover that they have multiple fractures of their orbit, as well as a fracture beneath their laceration (therefore an open skull fracture), as well as air inside their skull (ie pneumocranium). Then you have to transfer them to another hospital.

Or you might think that an old lady with really severe abdominal pain and a delirium looks sick and probably has a surgical abdomen, but isn't that sick. Then when you get your tests back you realise she has an ischaemic gut (with a pH of 7.16) and is not a candidate for surgery and isn't going to make it.

Today I met this sweet 98yr old man with no previous medical history who probably had a #NOF. He was quite funny. When I asked him why he was on valium (the only medication he took) he said "that's that small tablet that they give to try and keep me quiet" . To think, I sighed when I picked up the chart thinking "oh dear, this will take forever, he's older", but he was one of the best patients of the day. You never can tell.

Saw a dislocated patella today as well, that looked really, really painful. Bones in the wrong place, are very painful, but cool to look at. I can't help it, it's fascinating staring at a knee that's totally the wrong shape.

Anyway, must go take a relaxing candlelit bath, as I am weary. Hope everyone is having fun.

Home is where the tea is

Yes I've been slack, haven't been really blogging at all. Haven't really read blogs, commented or blogged, but I have a good reason. I have been in Brisbane on a visit:) It was such great fun. For starters, I got the mug in the picture (yay, Rachem). On the Friday night I had a BBQ and it was lots of fun. We cooked lamb souvlaki and flat breads on the BBQ and had them with salad (the lamb and salad all rolled up in the flatbread thingy), we drank red wine, and we chatted and socialised. Then Muppit said I was allowed to have a go at the poi that you set alight. So I twirled fire around my head and only slightly singed my hair when I hit myself in the head with the on fire things.

Saturday I had breakfast with Matt's familly, had lunch with my sister, had my GP assessmenty thing (showed the lady how to turn her phone on silent without going through the menu - see I'm useful!). We then went to Matt's school reunion. That was okay, there were some nice people to talk to when you could hear what people were saying. If anyone's organising a school reunion - pubs aren't necessarily the best environment - the music was so loud that you couldn't hear what anyone less then 30cm away from you was saying.

Sunday I hung out with my mum and Matt helped his sister fix the chicken shed. She has baby chickens that were going to be culled for being substandard that she rescued from one of her vet pracs.

Monday I went and saw the cutest little bub around - munchkin:


I then visited my nephew's and niece's - they have two cute little baby guinea pigs, a boy and a girl. I tried to take a photo of them with my phone for those who like guinea pigs:

The boy one (the one with black on him) basically is white on one side down his back, and black on the other, in a perfect even split. He is very cute. My 3 year old nephew delighted in showing me how the girl guinea pig tries to bite the boy one if you bring her close - this resulted in my finger getting bitten as it was in the way.

Had a yummy seafood platter at the Roman Empire, one of the best places to have dinner in brisbane (especially on a monday as it's two for one night, although that doesn't include the seafood platter and you do need to book) with Matt's family.

Tuesday I relaxed and then went home.
There were many other things in the trip, but I think those are the main things... I will do a better post when I'm not so rushed and tired.

I lay my head down

I lay down my head
But where is my rest?
As the storm begins
Conversations
I relive them, I remake them
I wonder what will happen tomorrow
More conversations
I frame responses
I am trapped inside my mind
Everything that has been
Attacking me
A storm
Not the good kind
Yesterday, yesterday
It was all too hard
And today?
Will it be better?
Will I face the same things again?
Will I do better
Angry faces
Angry people
Nothing I can do
They just keep coming
The rock
The hard place
No escape
Except for the moments
When I go to the bathroom
My hang heads low
And I weep
Step out, return my face
To it's everyday posture
Shoulders back
Facing it all again
And again, and again.
I lay my head down
But where is my rest?

Nobody said it was easy

Perhaps because of Matt's PhD writing, I've had a few lines from this one song going over and over in my head today "Nobody said it was easy, No one ever said that it would be this hard" (The Scientist, Coldplay). Probably Rachem can relate to that at the moment with the impending med exams.

On the title of things that are not easy. Congratulations to Sally and Andrew:) James looks adorably cute, I can't wait to cuddle him:) It's important that I meet him before he learns to cry really loudly, as I think that's one of the cutest stages of a babies life:) Next weekend seems so long away...

On exciting news, I'm going to Brisbane next weekend. Have a GP training thingy, have Matt's school reunion, have to meet a new baby... So many reasons to go back. Will be a flying visit, but I'm looking forward to it!

Anyway, seeing as this is just another rambling post, I might go and help Matt in the kitchen. Having a simple dinner tonight - steak, egg and tomato sandwich. Yum.

Dreaming

I am a very active dreamer. I sometimes wake up and remember several dreams rather vividly. This morning I woke up and I was mulling over in my mind several of the dreams I had during the night, by the end of my busy day only one of them was left in my head. Of the rest not even a glimmer remains.

In the dream I remember having, I was walking down the street of a town I didn't know looking for a special shop. It was a candle/cafe store. It had all these amazing hand made sculpted candles, and it was a funky cafe. I was looking for it because it was Jade's shop. I walked in and it had all these funky thick rustic wooden tables and bench type chairs. There were all these people in the cafe from all different times in my life. Because of the atmosphere and the type of place it was, you just expected that you would run into people you know, even though it was in the middle of nowhere. I took a seat in the corner and tried not to be seen, because I wanted to watch Jade work without her knowing I was there. She sasheyed around the room like some presentient being, knowing exactly how to put each person at ease and what they wanted before they asked. Then suddenly she swung around and looked straight at me, came running over and hugged me and said "You made it". Then I woke up. But what I was trying all day to relive was the feeling in the dream. The atmosphere. Do you ever have that? Where the most important thing about a dream is the atmosphere, and you wish that you could find that somehow?

Moving on in my fairly random rambling post. I'm wondering how Sally is going... today the day a certain little munchkin is supposed to make a grand entrance to the world... I hope s/he is doing their thing!

I am very drowsy. I'm not sure why, it's not that late and I haven't worked that hard today. I just feel like closing my eyes. In fact currently my eyes are closed and my chin is resting on the desk as I type (courtesy of the fact that I am sitting in a camping chair and it is quite low and I'm all slumped over).

I wish I had chickens. Matt's sister has some chickens at the moment. Little baby ones. I wish I had baby chickens. They are so cute, and if they're the right kind of chickens they grow up and make eggs for you. I miss having birds. they're so soft and warm and friendly.

Well I must go, because otherwise I will just continue to ramble aimlessly, every so often opening my eyes and correcting my mistakes.

Not Forgotten

I have many friends whom I haven't spoken to in a long time. Somehow with the passage of time, we've let things slide. But they're not forgotten. These friends I think of often, longingly, wishfully, wondering. I long to see them again, to regain what we've allowed to slide. I wish that I could rebuild all the bridges that we didn't burn, we simply neglected. And I wonder where they are and what they're doing. In fact I often spend long periods of time thinking on these things and these people. None of the people are forgotten, each friendship is a treasured memory to me that I'm forever grateful for, even if now, I don't know where they are.

Earlier this evening I was talking to Matt and my mother in law about one such person. Melanie. Melanie was my first best friend. The first friend I can really remember. I grew up with her and her family. My fondest childhood memories involve her and her family (especially Grandma G). I remember climbing mulberry trees and popping warm juicy mulberries in our mouths at an astounding rate, as we tried desperately to eat them before her mum could pick them and make them into mulberry pie. I remember green ants biting us as we sat in the mulberry tree. I remember staying at her grandma's house on magnetic island. I remember going to the beach and catching crabs and bringing them back to the house. I remember the taste of purple hubba-bubba as we ate so much of it at the island (and my mum didn't let me have bubble gum normally). Whenever I smell purple hubba-bubba I am transported to magnetic island and being small again. Sometimes I buy purple hubba-bubba and chew it just for that effect. I remember walking (in our sandshoes) on the reef at low tide and I can remember a man showing us what we thought was a rock until he poked it with a shell and it darted away - a stone fish. I can remember us being to afraid to jump back to the piece of reef we'd jumped from because toad fish were circling the reef we were on. We were always together. When I left Townsville we wrote letter upon letter to each other. For years and years and years. As time went on we both got busy, got degrees, got married, and we just didn't keep in as close contact, until now, when I'm not sure I even have her number or address anymore.

Anyway earlier this evening I was remembering the one and only time I have eaten choko. It was when I was at Melanie's for dinner. I hate choko it turns out. With passion. After reminiscing about choko for 30 minutes this evening, my mum called. Melanie had a baby today, I found this out moments after having a large conversation with Matt and his mum about my choko experience. Congratulations Mel!!! I wish I could call and say hello. I wish I could turn back the hands of time and write more letters. I wish I could see you now, a mother.

Dreaming of Simple

Spirals and layers
Of hope and energy
And the permeating blackness
That I fight like waves
Again and again
They come and sting
Trying to dump me
As I seek peace
And I duck and I weave
And I ride them out
And try to hide in the inbetween
Flowers and birds
Breathe in the air
Admire the beauty
Dream the dream
And hope eventually
You'll rise from the mire
Enslaved in the cycle
Of more begets more
Closing your eyes
And dreaming of simple

And there endeth my nights

Well you may all be very disappointed to know that I didn't end up writing an incident report. The night after "the incident" I decided I would do it when I got time. That night I did five admission as well as all the usual ward stuff, and at about 7ish when I got a bit of a break, I didn't have the energy or the care-factor anymore. Although every time i went to the particular ward she had worked on the nurse who was her boss was very quiet and avoident of me.

By the next night I was just bored of the whole thing. I didn't work that hard, but at about 6.30 in the morning one of my pts had a code called on them/ By the time I got there the nurses were bagging and masking and doing CPR and the patient had a pulse and had resumed trying to breathe on his own. Then everyone pretty much arrived at the same time so I spent the next hour and a half watching/vaguely helping the med reg, ICU reg, anaesthetic reg, emergency reg and all the other various people doing various things to the patient (like putting them under and tubing them). I think I mostly did things like take blood gasses, check blood results, get cotton balls, get blood tubes, write up xray forms for CT brain and chest xray, swear when I saw that their blood gas showed their pH was 7.01 and lactate was 10 (although that may have been elevated from the nurse giving the pt CPR before I arrived). The funniest part of the code (if there can be a funny part) was when the ICU reg was arranging to tube the patient and one of the administration type nurses said "do you really think you should tube them if there's not an ICU bed available?". Honestly people!!!! Intubating a patient is a clinical decision based on if the patient can breathe adequately on their own or not, not one you decide based on bed availability! The patient was intubated and transferred to recovery in theatre (because there were no ICU beds). Not really the way I hoped to end my week of nights, and certainly not the way that patient probably hoped his post-op recovery period would go for his elective surgery.

Things that happened in my week of nights: one of my patients stopped breathing and had to have CPR and be tubed and transferred to theatre recovery because there were no ICU beds. A patient went into rapid AF because they hadn't had their regular meds written up for them when they came into hospital (because they were taken from emerg to theatre and never had an admission done) and I had to dig load them. I tend to check pts electrolytes before writing up fluids, and two pts who I did that on hadn't had bloods recently, so I wrote them up path slips, they both ended up needing a blood tranfusion because their Hb was less then 80. I cut one ladies backslab off because her hand was swelling up and watched all the veins in her arm fill up as I cut away at the cotton underneath the plaster (I guess it was just a little too tight). Some young guy did an awesome tib-fib fracture that I wished I'd copied the xray and brought it home with me to put on the net - his fibula was in nearly three equal pieces and the middle piece was at an angle to the other two pieces, and the tibia was fractured right through the middle displaced anteriorly and the sharp shard of the bone was only just not breaking the skin, it was right there underneath it (young people - do not play basketball, it is a dangerous sport). One man had to be held down while I put an IV in because he gave me crazy eyes and has a history of hitting the nurses, and he was really angry at me - until I had trouble putting the IV in and was swearing under my breath - then he started laughing at me as I had to try again to put the IV in. One of the patients in short stay unit in emergency (which surg night cover also has to cover) went psychotic and started stealing the other patients stuff and behaving all paranoid - she was 80 and didn't speak english at all (she told one of the nurses who spoke her language she didn't trust us and would only take medicine if her family were here, and that we were always watching her etc). I guess there were lots of other stuff too.

The worst thing was when I was in emergency I saw the most awful, classic, child abuse xray of a little 5 month old baby, with various rib and arm fractures at different stages of healing:( We were looking at it and the med reg was swearing and we were all just in total disbelief about how awful some people really are. I didn't even see the child and it was still probably the most horrible thing that happened in the week. It reminded me of a song that I'm really quite a geek for even knowing. It's a song by a christian singer called Michael W Smith and the first verse goes "What of the children who have never felt a love, Tender as the morning, Nursing the bruises, And the scars that never seem to go away, What of the babies who have never left the womb, Breathing in the lifeline, Angels in waiting gone, Before they could be given wings to fly, Calling heaven, Seeking mercy, Tell me there's a place for these"

After my last night, I didn't go to bed, I went out for the day with Matt and his parents who are down here in Brisbane at the moment. I slept in the car while they went to the diggers nursery (which has all heirloom seeds and breed of stuff which is supposed to be better for lots of reasons). Then I had lunch with them and then we went to a winery and did some wine tasting. The lunch was really yummy, kangaroo loin with a rocket salad and some really yummy crunchy potatoes. All the salad stuff was grown at the garden and had been harvested that morning. I was pretty exhausted by the time Matt and I got home, we had a roast pumpkin soup that we'd half prepared the other day when Matt had made some chicken stock. It was delicious. ummm.. I think that's everything.

Oh, Happy Birthday to Steve. It's his birthday today. Apparently he must be planning a fairly wild night out because today he is at a first aid course. People who know him should email him, you know he'll love that:) I can say anything here because I don't think he reads this:) :)

Every Single Night

It was a very busy night last night, either that or everything took me ten times longer then normal because I have night duty brain and can barely function. On top of everything all night I was humming/singing/had going through my head, what I like to consider as Joss's ode to night duty. That is, I had a song from the Buffy musical episode in my head. Now all of you must have it in your head too. Being a vampire slayer is probably a lot like doing surg night cover I think...

*Going Through the Motions* (written by Joss the guy behind buffy)
(Buffy) Every single night, the same arrangement
I go out and fight the fight.
Still I always feel this strange estrangement,
Nothing here is real, nothing here is right.
I've been making shows of trading blows,
Just hoping no one knows,
That I've been going through the motions,
Walking though the part,
Nothing seems to penetrate my heart.

I was always brave and kind of righteous,
Now I find I'm wavering.
Crawl out of your grave, you find this fight
Just doesn't mean a thing
(Henchman) She ain't got that swing.
(Buffy) -pause- Thanks for noticing.
(Demon & Henchmen) She is pretty well with fiends from Hell
But lately we can tell
That she's just going through the motions
Faking it somehow.
(Demon) She's not even half the girl she...owww!
(Buffy) Will I stay this way forever?
Sleepwalk through my life's endeavor.
(Handsome Young Man) How can I repay...
(Buffy) Whatever!
I don't want to be
Going through the motions,
Losing all my drive.
I can't even see,
If this is really me,
And I just wanna be alive.
**************************************

That's just how night duty feels..... *bec walks away from computer humming "going through the motions"*

Dear agency nurse, you chose the wrong day

Dear agency Nurse,
You chose the wrong day to piss me off. Five days into night duty and I'm feeling fierce. Let me start by telling you, I've never yelled at a nurse or had a confrontation with them. For someone who loves confrontation, I am mild and friendly when at work. I like to please, I like to get along with people. For you I have made an exception. Let me tell you why.

You called me and began your conversation in an aggressive, rude, demanding and accusatory tone, you said "When you were up here you didn't write up the IV abs". I politely asked which IV abs you were talking about you said "Bed X" I said and who is that, you said "bed X" in an exasperated voice I said "What is their name" you said "Such and such". You accusingly said "It's written on the board", I asked you "Which board" you said in a scornful voice "You must be new" and I explained to you that all the doctors who do surg night cover are new because we work in emergency and only do one week of nights as surg night cover in that time. You angrily said "Well they would have told you in your orientation", I refrained from asking you what dream world you lived in that there would be an orientation for a doctor starting a job, and said "no, we don't get an orientation". You said "well there's heaps of jobs waiting here to be done" and I asked you "What jobs", you said "You'll see when you get up here" and I asked you to tell me what jobs there were and before I could finish my sentence, you hung up on me. That was a mistake. You should not have hung up on me.

I called the phone back straight away. You ignored it. I called another phone on the ward and your supervisor answered. I asked to speak to the nurse who called me. He questioned my motives, then went to find you. After a long time he came back and said you were too busy to talk to me. I asked him for your name, he asked me why, I told him you were rude and hung up on me. He said I could ask you for it when I came up. I said I wouldn't be able to find you if I didn't know your name. He told me your first name.

I came to the ward when I was available to write up the IV abs. I found you and asked if you had called me, you said no. I asked you if your name was Chris you said yes, and that you had called me about some IV abs a while ago. I told you that it was inappropriate and rude to hang up on people. You said "did you just come here to argue with me because I have things to do". I said "no I have come here to write up the IV antibiotics, but I would like to talk to you about how you behaved on the phone, I asked about the other jobs because I had to know if there was anything urgent". You said "The IV abs were urgent". I said you called me at 5.30 about IV abs due at 6, I am here before 6, they are not that urgent (what I didn't say: besides if they were given at 6.30 it wouldn't actually be the end of the world!). You walked away in a huff and ignored me trying to talk to you. That was a mistake.

I did all the jobs written on your %*&^ing board, except rewriting an entire med chart - that is a job for the day team.

Let me explain a few things to you at this point. I needed to know what jobs were on the board, not to be difficult, but because I have to triage my calls, I can't do that if you won't tell me what they're about. I am a fair person. If I have a problem with you, I go to you about it, not someone else. Unfortunately you wouldn't listen to me, and I'd had enough of this kind of shit. If you'd listened to me, we could have discussed it like two reasonable people. Unfortunately that would have required two reasonable people in the conversation, and apparently you didn't have the necessary qualities to be in that catergory (ie - reason). Therefore I did something I have not done before, I escalated.

I went to your supervisor I explained what had happened and I flatly said to him "if I ever spoke to a nurse the way she spoke to me and then hung up on them, they would instantly write an incident report, and I'd be in a lot of trouble". He said to me as you can see we're very busy and that's why she did what she did, and at any rate an incident report wouldn't get me anywhere. I said to him "We're all busy, I worked yesterday for 9 hours without getting a break, nurses always get their breaks, I don't". Your supervisor asked what it was I wanted. I told him that I thought you needed to apologise for being rude and inappropriate. He told me it wouldn't happen. He said "this is obviously a personal issue between you and her, I have no issue with her work". This is not personal, I don't know you, I only know how you treat people when you're calling them and asking them to do something.

I went back to the resident's quarters and discussed thing (ranted) with the other residents. They said I should talk to the nursing supervisor and do an incident report. I called you and asked for your last name, you asked me why and I told you that I thought your behaviour was rude an inappropriate. You told me your last name and said that you had been busy and I asked you too many questions. I told you that I cannot triage my pages if I don't know what they are about, and being busy isn't an excuse to be rude.

The thing is that doctors never do anything about bad things that happen to them at work, we don't do incident reports, we just whinge to our spouses, which is why this kind of thing happens, you think you can get away with it. As a doctor I don't behave as you did because I know you would instantly write an incident report and I would get hauled in to explain myself. That is why today I have chosen to be a bitch. I have chosen to at least make you think that I am willing to take this all the way. So next time you think twice before treating someone that way. You chose the wrong day. Today I was a bitch. Next time choose the easy way, choose to have a conversation with me, don't make me talk about you to other people.

Surg Night Cover

Ps - I talked to the nursing co-ordinator, and I am contemplating an incident report, just to show you that that kind of whining bitchy shit that we tolerate all the time can work both ways.