This Blogger Has Moved
Monday, October 02, 2006
In the end, I was just getting too many hits from people searching for a hot milf to make their night a little less lonely. Milf's Anatomy was a porrly thought-out blog title, and I'm shedding it once and for all.
Please be so kind as to follow me to Just Up The Dose - my apologies for any inconvenience caused.
posted by Karen Little @ 7:19 PM, ,
Saturday, September 30, 2006
Yesterday was the Last Day of Family Medicine, and we did our exams. The first exam was an OSCE (after six years I can still never remember what that stands for - I think it's Objective Skills Clinical Exam, I think. All I can say is - 'Objective' my ass). The OSCE consisted of a few written stations, asking us to do things like write out a script and fill in the J88 (the legal document that needs to be completed after someone has been assaulted). The other stations were all practical, and required us to perform a consultation with a simulated patient (ie: an actor) whilst a doctor watched and marked us through one-way glass. Of course, we all felt entirely relaxed and unflustered in this super-natural and non-stressful environment, and so none of us babbled or fumbled or stuttered or forgot any of the things we would usually do, say or ask in a normal consultation.
Anyhoo, the first station was a 'chronic' patient, and had a woman following up for her hypertension. The second was an 'unselected' patient, and turned out to be a man with the main complaint of erectile dysfunction. In this completely natural environment where there was no pressure to behave perfectly and to not put a foot out of place, I just couldn't seem to stop glancing at the man's crotch. Well done, Karen.
The third station was a patient that needed counselling - she'd just been diagnosed with a sexually transmitted infection, and it was our task to convince her to modify her sexual behaviour. This station passed fairly uneventfully for me, but unfortunately for Iwan he was called on to demonstrate the use of both a normal condom and a female condom. Hardly a raging nymphomaniac himself, Iwan has never applied any sort of condom to anything. Also, the examiners weren't so kind as to supply a dummy-penis or even a banana for Iwan to demonstrate on, and so the 'patient' watched aghast as he first roled a condom onto his own hand, and then inserted the same hand into a femdom, at the same time consulting the instruction sheet that came in the package. There was also no paper towel in the room, so his next patient was the surprised recipient of a lube-enhanced handshake. Yummo.
On monday I start my final rotation, and it's the surgical sub-specialties: orthopedics, urology, neurosurgery and vascular surgery. If allgoes according to plan, I'll be a doctor is seven weeks. Wish me luck!
posted by Karen Little @ 10:30 AM, ,
Cookies and Milk
Sunday, September 24, 2006
The first was vomit, which came from a man who'd just overdosed on an antidepressant. Because the pills were so recently ingested, we filled his stomach with two litres of saline via an NG tube, to induce vomiting. Because he was comatose, we had to intubate him. The first attempt was unsuccesful, with the tube ending up in the patient's eosophagus. The casualty officer left that tube in place whilst she inserted the second one. Naturally, when this second tube touched the patient's epiglottis he gagged, and emptied half of his stomach via the tube in his eosophagus. I was standing a good two metres away from the bed, but that was still not far enough away to be out of range of the shower of vomit that this man produced. In fact, it's almost as if he aimed for me - from my nose to my belly-button, I (and only I - all the other doctors and nurses got off scott-free) was covered in the stuff.
The second deposit was in the form of breast milk, which came from a mental health care user with bipolar mood disorder. Her family were trying to have her involuntarily admitted after she 'got a little over-excited at church' that morning. I sat next to her and took a good, long history from her. We were having quite a nice conversation , and I really felt like I was having some good rapport going with her. Right at the end, I asked her if she had any other problems, and she stuck her hand down her blouse and hauled out a breast. This in itself didn't really surprise me - this is Africa, baby. People whip out their boobs all the time here. What did surprise me, however, was the soft 'tsssssst' that followed, and the sudden feeling of something warm and wet landing on my forehead and eye. Gross! Turns out she was lactating as a side-effect of her medication.
Now, whilst projectile vomiting is slightly more socially acceptable than projectile lactation, I would probably (given the choice) go for the breastmilk again. Less offensive in texture, smell and appearance, it doesn't induce a gag reflex in the recipient the same way that vomit does. The big question was, of course, to PEP or not to PEP? Breastmilk-in-the-eye is a rather obscure kind of injury on duty, and isn't really discussed with us when the matter of Post-Exposure Prophylaxis is brought up. The doctor on call with me said she wouldn't bother, but I know myself, and I know that if I didn't take all the necessary precautions at the time, that when I develop a cold in a few weeks' time, I'll be almost certain that I'm seroconverting. Fortunately, the lady was HIV-negative - and so am I - yay! If nothing else good came out of it, the experience entitled me to a free file and HIV test at the hospital I was working at. So now I know that the tonsillitis I'm currently struggling with really is just a regular infection, and not the result of a hideously suppressed immune system. As Pollyanna said, 'There's always something to be glad about!'
posted by Karen Little @ 9:01 AM, ,
Grand Rounds is up!
Tuesday, September 19, 2006
Check out this week's edition of Grand Rounds over at Tundra Medicine Dreams. TheTundraPa has a great selection of posts, beautifully complimented by pictures of the Alaska and it wildlife.
Labels: Grand Rounds
posted by Karen Little @ 7:57 PM, ,
When You've Earned a King Cone
Monday, September 18, 2006
Why is it that it's always at home-time that we find ourselves in the most frustrating situations? Or is it the very fact that it's home-time that makes some situations so frustrating? From the rude doctor, to the two screaming patients, to a woman who only seemed to have 2.5ml of accessible blood in her entire body, it all just seemed like too much to bear. I bought myself a giant chocolate King Cone on the way home. And it was good.
posted by Karen Little @ 4:26 PM, ,
Friday, September 15, 2006
I was given his file and told to see him. Now, I was still a teenager when this person's court case was underway, and although his name was familiar to me and i knew he'd done bad things, I wasn't really sure what those things were.
Walking into Theatre Two, I was met by a clean, fit-looking, middle-aged man. He greeted me, and thanked me for seeing him. I explained that I was a student doctor, and asked him what his complaints were. He explained them to me concisely, and gave me an excellent history including past and current illnesses, operations, chronic medication, and so forth. I drew some blood on him and explained what we were going to test for, which other special investigations we were going to do, and then told him to tell a nurse or call me if he experienced any symptoms or distress.
Although I only Googled him and discovered the full extent of his crimes the following day, his name was familiar enough to me that I knew in my heart that he was a mass murderer. I knew that he'd probably killed with impunity, and that by rights I should loathe him. And yet, I found that I wanted to give him good service. I drew his blood very carefully, and went to a lot of effort to make sure he wasn't uncomfortable - checking up on him perhaps a little more often than I usually do on my patients. I kept him updated as each new result came out, explaining each one to him, and asking him if he had any questions. When one of his guards tried to hurry me up and get his results out quicker, I actually called the lab and demanded that they speed up their testing. It's true that many of the Casualty staff were hurrying me too - the man's presence was causing some of them considerable stress - but I think I gave him slightly better service than what I usually give my patients. I always do my best, but here I think maybe I did just a little bit better than my best.
And this bothered me a lot post-call. Had I really given a convicted mass-murderer preferential treatment? Had I really apologised when I put a needle in the arm that held a gun that killed so many? And if I had, why had I done it? Was it because the man was, in a way, famous, and I wanted to impress? Was it because I felt a rapport with the man because he came from a social class more similar to mine than many of the patients I see?
These questions hassled me all day, and left me heavily doubting my integrity. But now, I think, maybe I was being a bit hard on myself. You see, I took the patient the same way I take all my patients: at face value. If I took extra time to explain his results to him, it was because he asked me to, and questioned me in detail about them. Later that evening I took the same amount of time to explain what exactly angina is to a rehabilitated alcoholic, one I didn't know from a bar of soap, because he also asked me to. The prisoner was polite, and he didn't swear or spit at me, like so many of the patients we see in Casualties do. He was undemanding, and thanked me for my help and professionalism, and never once complained that he never saw a real doctor, and never told me that I look more like I belong in a high school uniform than in pair of scrubs. I appreciated his conduct, and reciprocated with good conduct. I wouldn't say that my conduct is ever bad, but there are times when I've been sharp with patients who were drunk and hurling abuse at me, or impatient with individuals who were uncooperative and stubborn.
There are a few things to learn from the whole situation, I think. The first is that you truly cannot judge a book by its cover: the physical appearance and conversation of an individual can easily hide the true person underneath. The second is that having a good patient makes it easy to be a good doctor. And the third is that there are times when we are bad doctors, even if we don't realise it. It is perhaps when we are with patients that we subconsciously believe deserve the least care, that we need to work the hardest to remain fair, consistent, and unjudgemental.
posted by Karen Little @ 7:59 PM, ,
Sunday, September 10, 2006
Basically, anybody can pitch up at Casualties. In a well-functioning Casualties department there's supposed to be some sort of triage system, where those who urgently need medical care are sifted from those who can wait. The district hospital I'm currently at is massivley understaffed, so the triage system is a rather rudimentary one that basically consists of the sister sitting at the reception desk. The general rule is that anyone who has been brought by an ambulance, anyone who has a referral letter, and anyone who is bleeding or unconscious can come in. Otherwise, it's up to the patient to convince the sister of their disease severity, and up to the sister's gut to decide who needs to come in. A kind of uber-bouncer, I wouldn't want that sister's job for all the money in the world: several times I walked past the desk and saw patients screaming at her, threatening her with legal action, physical violence and lifelong misery.
Anyway, the result is that the casualty officer's next patient can be suffering from absolutely anything. On Friday night, I saw women with threatening abortions, appendicitis, dysfunctional uterine bleeding, urinary tract infections, soft-tissue shoulder injuries, asthma attacks, broken wrists, hyperglycaemia and possible deep vein thrombosis. I saw an eighteen year old boy with diabetic ketoacidosis (DKA), several stabbees (and trauma still ticks me off), a man with a ruptured-something in his abdomen after being hit by a car, and one man who (rather oddly, I thought) said he was a sexual predator and wanted to be admitted to the local psychiatric hospital. (After I'd finished interviewing him, I presented his case to one of the casualty officers I was working with, a superwoman of a doctor from Burma. 'This is a very danger-wous man, Ka-wen,' she said. For the rest of the evening I couldn't help but feel a little bit nervous every time I walked past him, and caught him staring at me.)
The thing is, the generalist has to know how to handle everything really well. Yesterday, explaining this newfound wisdom to Rowan, he said 'No duh!'. I suppose he doesn't really understand because he's a Lay Person. You see, if you're a urologist, you only have to do urology really well. Everything else is somebody else's problem. The generalist, on the other hand, has to know what to do for anyone in any kind of acute situation, and has to be able to do it well. For me, the most terrifying part of this is that I could miss something really important. The teenager happily typing an sms on his phone and telling his mom he wanted to go home was not someone I suspected of suffering from the life-threatening emergency that DKA is. The only sign of a ruptured hollow viscous in my pedestrian-vehicle accident patient was an abdomen that was a bit more resonant on percussion than usual. When he discovered he couldn't pass urine and we placed a catheter for him, the bag filled up almost instantly with bright red blood, and when his X-Rays came back there was a sliver of air under his right diaphragm - the man needed an urgent operation, and the only hint that he needed it on clinical examination was a bulgy tummy.
For my family medicine I have to complete a portfolio, and one of the components of this portfolio is a list of all the problems I manage during the rotation. Next to each case, I have to write one thing the case taught me. On Friday night I learnt a lot - from the art of reassurance to the use of a glucose sliding scale, it was probably the most practically challenging night of my degree so far. And although it was long, and tiring, and I barely had time to eat, I really enjoyed it.
posted by Karen Little @ 4:32 PM, ,
Wednesday, September 06, 2006
posted by Karen Little @ 9:16 PM, ,