Crazy Paeds

Paeds is totally crazy at the moment. There's people running up and down the wards, just everywhere. And that's just the students! The kids are another thing altogether...

We have to write up two case reports by next week - and so we're all going crazy trying to find patients to fit the cases. Which means there's a lot of angst with people poaching others' patients. It's really annoying - I went to see a patient today, only to find that they had already been poached by another student.

I have this idea that I'm going to get there really early tomorrow and find the new admissions, but I don't know how likely that is!

Busselton was good. It's nice to hang out with the family now and then.

Busselton

On a spur of the moment decision, I've decided to go to Busselton over Easter. That means no updates whilst I'm gone! I'm going to miss some birthday parties too, so that will suck - but it'll be good to get away from it all.

I still haven't seen any paeds patients yet. There's a lot I need to read up on.

Sherlock

Sherlock died today.

RIP.

He was the best dog I ever knew.

Something must be wrong

I don't know. It's 2.40 am, and I still can't sleep. And I've only had 9 hours sleep in the last 72 hours.

Will I eventually eradicate the need to sleep? What a concept.

Paediatrics

Started paeds today. I've got a bit of a funny feeling about this term - everyone we met today seemed to be angry. (?) Kind of weird in a childrens' hospital.

Anyway, one bad thing about this rotation is the starts. 8am every day - I think I'm going to have to pretend I live in a different time zone or something.

I'm thinking of calling Brigette to change my clinical option from gastro to something else. I enjoyed it all at Freo, but doing it again at RPH might be overkill. Especially if I end up getting a successful application for gastro again in Edinburgh.

Eskimo Joe: the aftermath

I'm back from Eskimo Joe and I'm slightly deaf. We were very, very close to the stage, and some weird things happened, but it's best if I start at the top. (pics not from the actual gig)

Left home at 5.30, in an attempt to get to Dino's by 6. Got there at 6 and then got a lift with Lin into Freo, no dramas. Found parking at 6.45, concert starts at 7, it's all sweet.

Walk up to the door of Metros only to be greeted with a sign: "Due to liquor licensing laws, the concert advertised at 7 will now begin at 8."

*sigh*

So we had some time to kill, we walked to Fast Eddies and got some wedges and calimari rings. Which were actually quite tasty, and killed the time a bit more than we had liked as we got to the club at 7.50 with quite a line in front of us. We waited though and little by little we managed to get in.

8.05: We're in. And as expected everyone else there goes to the bar.

8.10: We decide to make the first move toward the stage. About twenty people join us at the very front, in the spitting zone of the singers.

8.45: We're getting restless. We know there's a support act first, and we're all getting tired. The others moreso after having ridden 30km in the morning on the freeway bike ride thing.

9.15: We're getting kind of pissed off. There's no sign of anybody starting although there's some roadie movement on stage.

9.45: Steve Parkin and the Foreign Films start playing. It's just loud, loud rock. Some acoustic moments but just really, really loud.

10.15: They still haven't finished their set and the crowd is getting bored. There's a big sheer when they announce their last song.

10.30: Still waiting for the Eskies.

10.45: BANG! And we're underway. The first song is Come Down.

Other songs they played included Older Than You, Smoke, I'm So Tired, Seven Veils, Life is Better With You, a superb rendition of Aint No Sunshine, Liar, and the last song From the Sea.

One very weird thing happned near the end of the set. This girl, kind of dirty looking, blonde, came up and barged past Dino and stood at the front of the stage. We all looked at each other, and shrugged. I thought to myself that we can't let this stand so I had a word to her, which she fobbed off with some weird reply. Anyway, I resigned myself to having this weirdo girl next to me.

But then it happened. I glanced over to my right and saw her taking off her panties.

Yes. Taking off her panties.

She then put them in her bag and mouthed something to the guy on keys, who couldn't hear her. When I looked again, she was dancing and moving her head around.

I took a pace back and mouthed something to the others, which they couldn't understand. The next thing I knew, she had thrown them on the stage.

They were bright pink, and huge! It was disgusting.

Anyway, she eventually walked off, having done the deed. I guess that's all she wanted to do.

Before the last song there was another intruder however. She came up and decided to dance right next to us, almost knocking Dino over in the process. She jumped about, and must have seen the weird look I gave her and asked me to join in.

"Come on, join in!"

"I don't think so."

"You're at the front, you have to!"

"No, I'm not."

After the song she walked off and wished me a good night, and apologised for being annoying. Well, maybe not for bing annoying but she did apologise regardless.

Eskimo Joe finished off with a song I had never heard before and Wake Up, my favourite song off the first album.

It was a great evening, although the lateness of everything was a bit annoying. The strange girls made the night a little more interesting than it would have been.

Eskimo Joe

I have finished my report, and to reward myself, I'm going to watch Eskimo Joe tonight!

I remember when I first got into the Eskies back in 1999. They were a completely different sound, very raw, youthful, exuberant. I liked it a lot. I was going through some changes in my life, and their music really helped me to cope with the pressures coming with the teenage years.

However, as I've grown up, my taste has predictably changed. And funnily enough, so has the sound of Eskimo Joe. They've become a whole lot more melodic and reflective. When Their album Girl came out in 2001, I knew exactly what they were trying to achieve. They made the album cover look snazzy and modern, and the songs were more layered and intricate. Whilst it was good, it was probably a little too contrived for the alterative scene, and a little too surprising for the mainstream.

2004 - and the success of bands like Jet, the Vines and Coldplay have made it cool to have genuine melodies behind songs. Eskimo Joe has tapped into that and they've stripped back their songs, boosted the vocals and gone simple with the album look. Their second album A Song Is A City is great. It fits my muscial preference perfectly.



http://www.eskimojoe.net/

Medical Student Blogs

Some interesting links about the supposed lack of medical student blogs.

Glorfindel of Gondolin - "Who blogs more, law students or medical students?"

The Lingual Nerve - "Med students on the net migrate to 'old-fashioned' web sites, mailing lists, and discussion boards. Questions (mostly technical or career-oriented) are answered faster, resources and helpful links are centrally located, and time doesn't get wasted addressing comments and updating the blogroll."

Lit Review part 2

Don't you hate it when you're already over your word limit but are nowhere close to finishing?

I wish I could design like this guy.

Oesophageal dilation

Yesterday was my last day with the gastros at Freo. A bit of a sad occasion, but it was time to move on. I had a great time, the people there were a really nice bunch and they taught me a lot without knowing it. Gastro seems to me to be a really good specialty to consider in future, as long as I can get over having to stick the finger up people's bums. >:O

There were again two interesting cases yesterday. Both were of guys with oesophageal strictures. The first guy had a narrowing that had been dilated before, so we did the same thing again. It's called a CRE dilator (controlled radial expansion) and it's pretty much just a balloon. The baloon is attached to a length of guidewire which is threaded down the oesophagus (you observe with the endoscope). And then once it's in the correct place you can inflate the ballon with a fixed amount of water. It was kind of cool, and the trauma to the oesophagus isn't that huge, although there were a few bleeding spots when we looked again. So pretty much you just blow it up bigger and bigger each time until you get to the size you want to get to. In this guy's case it was 15mm.

The second case was another guy with a similar problem, except that it was much more severe. This guy couldn't even talk. He had a trachesotomy tube and had been quite sick in the past. The oesophageal narrowing was so marked that we actually planned to use a paediatric scope. We ended up using the XP one, ie 'extra-paediatric', meaning really really small. John managed to just get into the stomach using the scope. With this guy, we planned to use the push dilating method, in which you just push a dilating probe down the oesophagus to open it up. There's lots of risks involved with these procedures, and this guy was in a lot of pain. It was my job to hold him down, and even with the heavy sedation we gave him (as usual fentanyl and midzolam) we struggled with a great deal of vigour.

The problem in this case was the fact that the stenosis was very high up. This meant that pushing the dilator down didn't work as the angle was wrong. We couldn't get the dilator in enough before we hit the stricture, so the force just created trauma instead of pushing down the lumen (hole) of the oesophagus. It was a failure, but it was a good learning experience for both me and John.

After that, there was the gastro grand round, where I got a free lunch. And that was it for the term!

On to paediatrics.

Beautiful

Time lapse photography can be so beautiful.

Interesting Day

Saw some interesting cases today. The morning was full of normal stuff, like colonoscopies and gastroscopies - with little more to find than polyps and ulcers. That stuff is kind of boring - its the same thing all the time. But in the afternoon, things picked up a little. There were two patients, both with alcoholic liver disease, both presenting with haematemesis and malaena.

The first guy was an IV drug user (he shot up on speed). He came in with a history of vomiting up blood for the last few days, and was rushed to the endoscopy suite from ED. Anyway, when we went in there was blood everywhere. It was difficult to see anything else really. We looked around the stomach and duodenum, ascertained that it was all normal, and then went back to the oesophagus to see where the blood was coming from. There were two longitudinal tears in the mucosa which were obviously the source of the bleeding. So we looked at them, and then the consultant suggested injecting them with adrenaline, which they did. And the bleeding gradually stopped: a) because of the mass effect of the adrenaline blebs, and b) because of the vasoconstrictive effect of the adrenaline. It turned out that they were both Mallory-Weiss tears. John told me about something else I hadn't heard before, Boerhaave's Syndrome, a complication of an oesophageal tear in which there is a pneumomediastinum. Diagnosis is by CT.



The second patient was pretty interesting. He was completely off his face, hepatic encephalopathy in full effect. He was totally disoriented, didn't know anything about his surroundings. On top of that, he was Hep C positive and had massive ascites. He had to be scoped on his back, with lots of us restraining him! Anyway, we went in and saw nothing much really - there were a few varices but they weren't bleeding (most likely due to the fact that his fluid had all shifted into his ascites). Then we saw a small tear in one of them. That was it! Out came the bands (variceal bands, duh) (which I hadn't seen before). Anyway, that was cool. They suck up the varices into a port which they attached to the end of the scope. There's a wire that runs from that port to the control trigger in the operator's left hand. So as they suck up the varix, the scoper releases the cord, and a little blue rubber band is released and gets stuck on the varix! Problem solvered. It was great!

Remember this?

This website is full of pics of old operating systems, Linux, Windows, Mac OS. There's also screencaps of other apps too. It's a nostalgic walk down memory lane.

Potentially handy links

• Startup Control Panel is a nifty control panel applet that allows you to easily configure which programs run when your computer starts.
• PowerToys are additional programs that Microsoft developers work on after a product has been released to manufacturing. They add fun and functionality to the Windows experience.

Altoid mp3 player / iPod Hacks

• Another article

They have other things too, like hacking iPods and putting Linux on it, with more games, apps, and better sounds recording. I wonder if I'm game enough to put Linux on my iPod.

Lit Review

The assessment for this unit is to write a lit review. This is how I'm going.

Lit Review: Flexible Sigmoidoscopy as a screening test for CRC
Colorectal cancer (CRC) is the most common internal cancer in Australia. Close to 5% of Australians will develop the disease, and of those, about half will die from it. However, it is known that CRC develops in a stage-wise method, and that early detection of the disease can be life-saving. Furthermore, detection and removal of high-risk polyps can decrease the risk of CRC by up to 90% in those screened. Accordingly, there has been considerable research into the evaluation of potential tests that could be used to screen a population and detect CRC at an early and curable stage. Tests currently under consideration include faecal occult blood tests, flexible sigmoidoscopy, and colonoscopy.

Rivetting.

Fun

I'm having fun at Freo. I really enjoy the hospitals much more than the GP surgery. It just seems to be a bit more interesting. More things to do. Different people to look at. You can just nick off if you want to. I like that.

Anyway. It's been a good experience so far. The consultants and nurses have been generally quite nice. You know, they talk about funny stuff. One of the nurses is a Geordie and likes Newcastle. It's kind of funny having a football conversation when there's a patient with a scope up their bum.

There's this nice reg called John, and he's from PNG. He's really good, and tries to get me involved all the time. Apparently his family are in a bit of strife over some immigration thing though. It's unfortunate cos he's a really good fella. Very competent and seems to know a lot, which he tries to teach me.

Today there were some interesting scopes. There was a Dieulafoy lesion that they blasted with the cauterising thing. On the monitor it looked like Star Wars, when the Emperor is electroshocking Luke Skywalker. I thought it was brilliant!

Another thing that was cool was watching the insertion of a PEG into a guy in ICU. This guy was in an unfortunate accident where he fell off a motorbike. In the impact of the accident, he completely transected his spinal cord at the level of the brainstem. Not a nice thing to have happen to you: his function has been reduced to blinking and a few facial expressions. Anyway, the PEG insertion was interesting because they actually did it in ICU, after carting all the equipment and nurses there. The ICU guys were freaked out by the food in his oesophagus. It kinda looked like old cheese.

Fun!

CRC/Endoscopy

Time to put the disappointment of GP behind me and start afresh with this option. Hopefully it will be good. The people at Fremantle are generally quite friendly - that's got to be a plus.

I expect this week to be a whole lot of sticking my finger up people's bums. Literally.

Rectal examinations and colonoscopies are what I can expect with this option. Could be good, or very, very bad.

Failed the exam!

Yep, failed the exam. I was too nervous, worried about it too much - ended up giving a bad account of myself. The dude was a guy with a migraine and a hidden agenda: he had unprotected sex two weeks ago. Unfortunately I brushed over that aspect of it (or so they tell me).

So I have to sit the damn thing again in 8 weeks.

No sense in crying over it.

Exam tomorrow

I'm sitting that GP exam tomorrow. I hope I do ok.

Sheffield Utd 0-0 Arsenal (FAC)
Arsenal won 4-2 on penalties. Its the first time any team of mine has won a penalty shootout.

Morals

Your Score

Your scored -0.5 on the Moral Order axis and 0.5 on the Moral Rules axis.

Matches

The following items best match your score:

1. System: Socialism
2. Variation: Moderate Socialism
3. Ideologies: Social Democratism
4. US Parties: Democratic Party
5. Presidents: Jimmy Carter (84.38%), Gerald Ford (84.38%)
6. 2004 Election Candidates: John Kerry (84.38%), Ralph Nader (75.59%), George W. Bush (65.62%)

Statistics

Of the 55069 people who took the test:

1. 2.3% had the same score as you.
2. 31% were above you on the chart.
3. 57.2% were below you on the chart.
4. 27.9% were to your right on the chart.
5. 60.3% were to your left on the chart.

Moral Politics

Strange happenings

After finally handing in my logbook yesterday, I have just so happened to have come across patients I could have written in there. My logbook did not contain a single presentation of headache, but today, I got one.

Brief notes:

• 34 year old woman
  
• Headaches seem to be related to menstruation/hormonal changes
• Unilateral headaches can be either side
• Cross the entire side of the head
• Feels nauseous
  
• Tablets are not good
• Panadol has no effect
• Nasal spray works

Feeling tired

"Doctor, I'm feeling tired."

"Well have you been getting enough good sleep?"

"Well I only sleep three hours at night, but then I nap for another three in the afternoon."

"Well that's why you're tired."

"Oh."