Say what?! Keep wishing, it's not quite Christmas yet

OHHhhh hohoho. Christmas didn't come early, nope. Though I might be in the southern hemisphere where things are supposedly the opposite of normal and where the toilet flushes counterclockwise, it doesn't mean that Christmas gets to come early for chiropractors. It's weird enough to spend Christmas at the beach with the sun searing nice burns into your skin.

Sydney Morning Herald's "Emergency Department Turf War" was an eye-opener. I've depended on a chiropractor for a couple of years in the past, even following her to her new practice but stopped when I realized that I could crack my own back to achieve the same results with less frightening and sudden twists of my spine and neck. Suddenly, the $60 a pop (and that was a discount for being a long-time customer with weekly appointments that later degenerated to monthly appointments) seemed a tad too much and I stopped going.

"If chiropractic was [an] emergency treatment option, we could avoid thousands of patients being admitted" the chief of the NSW arm of the Chiropractors' Association of Australia was quoted as saying by the SMH. Goodness, where do I start?! I know the media is infamous for taking things out of context so I'm taking everything with large helpings of salt, but geez they did a good job this time around. Chiropractic practices has no place in the emergency department - I completely agree with several of the doctors quoted later on in the article.

First of all, how the hell is back pain amenable to chiropractic therapy life-threatening? Isn't that the whole point of the emergency department? For people with life-threatening conditions, ie an ee-mer-jen-see? Don't get me started. I'm the one that's always going on about implementing a public education campaign to educate people as to what an emergency is. That guy that collapsed on the street is an emergency. So's that woman with a river of blood pouring out from her netherbits. The graze you got while snorkling yesterday that's still painful is not an emergency. You broke skin. IT WILL HURT. Insomnia is not an emergency. It's an unfortunate inconvinience that you can see your GP about. The ED is not a 24h pharmacy, and the will not dispense drugs as you demand. Your cucumber up your ass is just plain hilarious and if you're able to walk in, it's not an emergency but we'll help you get it out eventually.

Also, tell me - if chiropractors were so beneficial, shouldn't all those people whom they're targeting at the ED... shouldn't they all have been seen in the community by a chiropractor as more of a preventative measure in nipping the pain before it got too debilitating? That being said, I would really like someone to explain to me how back pain warrants a trip to the ED when it's been grumbling along. Sure, when one's immobilized by the pain and requires analgesia only obtainable in a hospital setting.. sure, come on through. For the rest of you who refuse to take your pain medications and show up to ED a week later with back pain so bad you can't get out of bed.. TAKE YOUR FREAKING PAINKILLERS and then we'll talk.

Forget the oodles of studies disproving the efficacy of chiropractic therapy. Forget the fact that chiropractors as poo-pooed by the medical community as a whole. Really, forget all of that. Just concentrate on what they're currently proposing. Imagine your local emergency department.. yes, the one that looks (and sometimes smells like) an asian wet local market at times with the hours of waiting you need to do just to get seen by a nurse, let alone a doctor. Now imagine a section of that ED cordoned off with curtains drawn and massage oil in place next to the Aquim gel with patients being wheeled in, bed by bed, for their chiropractic treatment and seeing them walk out one by one. Seriously, if you were the patient in the next bed who had come in for acute abdominal pain because of gallstones, would you want your nurse pre-occupied with wheeling the next patients in and out of the chiropractic booth while you writhe in pain because she was too busy to give you that morphine the doctor charted up 3 hours ago? And also, why would the chiropractors need to take up already precious and scarce resources from the ED budget when they could very well run their own "emergency department" for people with back pain on a walk-in basis. Really. Christmas isn't coming early for you this year, go try to mooch off another system. hmph.

happy belated halloween!

seems like i'm half a step behind since starting psychiatry. it must have been messing with my mind...

anyway, the newest fluff (now, in aquatic!) wishes you a happy halloween 2009 - hope everyone had oodles of fun regardless of whether you chose to trick or treat!

what would you do for a klondike bar?

i'd do a lot, especially given the fact that they don't even have klondike bars in this country (not even at usafoods.com) but repeating this is not on the list..

the cast is as follows

me as myself

P for patient

B for blockhead aka patient's daughter

and away we go..

[hospital corridor]
nurse: B would like to talk to a doctor about her mother

me: sure
*turns to B*
how can i help you? (again, does it not remind you of the retail industry?)

B: I would like to now how my mother is going

me: she's doing great. they let her weight bear as tolerated on her broken ankle that we've fixed. the operation went well, we had to put in some metal plates and the xrays afterwards show that everything is in the right place. She's been seen by the physiotherapists and if safe, will be going home. If not, she will be going to rehab for more physio. She's doing quite well and we think she might be stable and independent enough by monday with her walking to go back home!

B: She can't go home. I was assured that she was going to rehab. Right from the start. P can't go home.

me: why not? a rehab spot may take weeks to become available. if it takes two weeks to get P to rehab and she is back to her baseline level of function before then, she will be fine at home

B: she can't go home, she needs rehab. she can't manage at home, i won't be there to take care of her all the time and she will be alone at times during the day. who's going to look after her when i'm not around? how will she walk to the toilet? she'll fall down again, she can't go home.

me: i understand that you're worried about how P will function when she goes home but she is being seen by the physiotherapists every day and she will only go home once she is able to walk safely and independently, by herself! if she can't make the cut and needs more help, she's not going home and will go to rehab. she will only go home if she is back to her baseline level of walking and function.

B: Ok. So how long will it take for her to get a rehab bed?

me: ...
*tries hard not to roll eyes or groan*
it's hard to say. P is on their waiting list. it could take weeks. she may not need rehab by that time because she is walking too well to need rehab. in that case, she would go home instead.

B: no, but she's not going home.

me: why not?

B: because she can't go home! she's got dementia and psych issues you know

me: ok, how was she like before the fall and fracture? was she at home by herself at times? you weren't there all the time, right?

B: yes, i had to go to work and i do odd shifts

me: well, was P able to manage by herself during that time?

B: yes

me: was she able to go to the toilet by herself when you weren't around before her fall?

B: yes

me: *thinking i've got this in the bag now* so you're telling me she was able to manage and do things by herself before her fall, even when you weren't around right. we aim to get her to the same level as she was before her fall and fracture. when she goes home, she will be able to safely and independently get to the bathroom and do everything else she did before the fall.

B: but she can't go home, she's got the fracture! she can't walk properly and even with the frame.. what if she falls again? no, she can't go home

me: *gnashing teeth by now* that's what i'm trying to tell you!! she WILL be able to walk properly because our physiotherapists would have made sure of that! we will ONLY send P home if she is able to walk the way she did before her fall. the fracture has been fixed now. that's why she. had. the. op.per.ray.shun. we put METAL in there to fix her bones. that's why she is allowed to walk.on.it... because her bones are now strong enough with the metal in place to support.her.full.weight. she will fall when she falls. it is not going to make a difference whether she goes to rehab first before going home, or if she went home straight from the hospital whether she will fall down again in the future.

B: but she's got the fracture and it's not healed properly! she can't walk on it! she can't go home!

me: yes, the bones will take about 6 weeks to heal but the metal plates we put are keeping the pieces in place so they can heal in the right positions. if it wasn't strong enough, the consultant wouldn't have let P put her FULL weight through it. she.can.walk.fine.

B: no, but i was assured right from the start that she would be going to rehab. she can't go home, sheblahblahblahblahblah

(you get the point. the conversation, if you could call it that, would go on for another 10 minutes in a moebius loop)

today was the second of such conversations i've had with her.
the social worker, the occupational therapist and both physiotherapists have had similar conversations with her throughout this week.

the blockhead made me miss the chance to pick up my mail from the post office. i got there as the roller door scooted its last few inches towards a resounding thud on the ground as the post office closed for the day.

saying i was irked would be the major understatement of the year.
wwwwwhhhhhhhhyyy... oh why did evolution miss these fine specimens of the human race?
gnnargh.

sorry, just had to get that out of my system. thanks for tuning in. until next time...!

The Perfect Patient

The Perfect Patient (as would only exist in the land of Mary Poppins)

[Spoken]
Wanted: a patient for one adorable doctor

[Sung]
If you want to be my patient
Have a cheery disposition
No nonsense, amaze!
Complies, all days.

You must be good, you must be with it
Proactive and smile a wee bit
Have some common sense, time will tell
Listen, don't yell

Never be coy or linger
Never you point or wag your finger
Respect me as your treating doctor
And never show me all that's under

If you won't scold and dominate me
I will never give you cause to hate me
I won't add more movicol
So you will poot
Put blood in your bed
Or needles in your boot
Hurry, Patient!

Many thanks
Sincerely,

Ay El Double Ee.

i understand but i don't believe

it's job hunting time. i never realized how stressful it would be. i never realized how calm i would be either, staring the very real possibility of having to leave the country in the face should i be unemployed next year.

everyone tells me to stop worrying, that there are plenty of jobs around, that nobody is jobless. everyone tells me i'll be fine, that someone will snap me up.

i spent the past week being very grouchy nevertheless.

what i can't reason out in my own mind is why they can get away with what i call discrimination. yes, i can play the devil's advocate and see things from their own perspective. it doesn't mean i agree though.

the policy states that visa holders can only be offered a job if all other applicants of the same job who are citizens or permanent residents have rejected their job offers - in other words, visa holders get treated almost as second-class, getting offered jobs that none of their own want. the scraps i tell you. the leftovers.

from their point of view, it would be less hassle to employ non-visa holders - less paperwork, protecting their own, ensuring a better guarantee that the person they choose wouldn't need to be suddenly deported or leave the country mid-contract and creating a position that needed to be filled. i get it. i just don't agree with it.

how is it fair that we go through the same education and training as the others, only to have a computer program shift us to the bottom of the list of applicants on the basis of our visa status and nothing else. it doesn't matter if we may be the best person for the job, that we might have more experience or qualifications. one of their own will get the offer first. all we can do is sit here twiddling our thumbs hoping one of them rejects their offer so we can move up a spot or two on the list and claim the position as our own. should we not be so lucky, we sit there twiddling our thumbs at a faster rate with the increasing frustration and angst building up at all this inaction.

to make matters worse, you hear stories dribbling in about others in the same situation. visa-holders. they were luckier. they were offered jobs. now, i don't hold anything against them - congrats to them for being able to find jobs with such harsh odds. my question would be to the employers of these aforementioned visa holders. how in the world did you manage to offer them jobs so early in the recruitment period? we're talking about the first week or so of interviews when some others haven't even gotten to that recruitment stage yet. do you mean to tell me that out of all the applicants you've interviewed that applied for that position (up to 75 in some cases) after culling some on the basis of their qualifications, visa status or both, that every single one of them rejected their initial early job offers knowing full well that might've been their one and only at the time? really now. how else would you explain offering the position to a visa holder so early on?

i knew the system wasn't perfect, i thought i had become cynical with low expectations but this..
tell me, have i been naive enough to be viewing the world through rose-colored glasses still? i thought i ditched those sometime through med school.

a farewell letter

dear moron patient,

do you too have fluff between your ears like the puppets of Avenue Q? you leave me with no choice but to assume so.

goodness, where should i start? shall we go into detail about that time you came with a week's history of lower back pain that was getting so bad you couldn't get out of bed? you know, it might have helped if you had taken some sort of pain relief at some point during the week. the walking thing might have been less painful. it would've also saved you about three hundred bucks to call the ambulance to bring you in.. well, the taxpayers i guess. and it also would've saved you a two hour wait to be given some paracetamol and ibuprofen before getting sent home.

what about the time you giggled your way into the department with your boy in tow to tell us that your netherbits were accidentally chomped on and you're now left with one nub less?

or that other time where you've had a few weeks worth of anal pain. shush, don't tell me, i don't want to know. that's what your gp is for. to treat your damn hemarrhoids. or wikipedia. good on you for braving the crowded waiting room for the past five hours. there was a reason why you were triaged as a category 4.

i guess this next one wasn't really your fault. you just picked a crappy gp to trust. why else would your gp send you to the emergency department at a bit past eight on a sunday night so you could get an xray of a wooden splinter in your finger just to see how deep it is. that being said, why did you listen to him instead of pulling the splinter out with tweezers like we eventually did, 4 hours later?

you should be ashamed of yourself - what kind of parent notices that the backing of the earring on your two year old daughter is starting to disappear but waits three more weeks until it completely disappears before thinking it might be time to remove that offending earring? your daughter is now going to be literally scarred for life. look at those dressings on her ear covering where we had to gouge out that earring backing!

and please, try to hang onto those memories tighter. the next time another doctor asks you if you've seen anyone for your cough of two weeks, do not look blankly at her and say no when you have just been to the same emergency department less than 24 hours ago for the exact same complaint. bloody liar. and when accosted with this information, please have the decency to admit that you're just an idiot forgetful instead of insisting that no doctor saw you that first time. and when further reminded that you were indeed seen and discharged by a doctor, learn when it's time to give up instead of complaining that you weren't sure who saw you but whoever it was only spoke to you from the end of the bed. you. bloody. fool. i'm sorry you had to find out that you were deaf this way. after all, i greeted you the same way i greeted all other patients. "hi my name is amy. i'm one of the doctors and i will be looking after you today." everytime i say it, i feel like a masseuse or an airline hostess but i put up with it for your sake. so don't you dare tell me you don't know who the hell saw you. i had to fumble through the folds of fat to reach your tummy and i had to listen hard to hear your distant heart sounds. i sat next to you to take your history and found you the cordless phone so you could call your husband to pick you up. don't you dare tell me that whoever it was that saw you spoke to you from the end of the bed.

ohhh, it's only been a short six or seven weeks since i've been here this year but oh, you have opened my eyes so. i didn't think they could've gotten any bigger but you proved me wrong.

if i had things my way (and i assure you that many of my colleagues would agree, for this was one of their wishes i've usurped), there would be a sign that covered all those huge shiny ones with the big red cross on it pointing you towards the emergency department. this new sign would boldly command you to keep on driving past, do not stop, do not pass go unless you fulfilled these next criteria - that you must have a saturation of 60% or less on room air, acopic at your nursing home, have an ejection fraction of 5% or less and still continue to smoke, unable to walk into ED, be an octogenarian or older and/or be bipap dependent. only then, are you allowed to step foot into the emergency department, let alone the rest of the hospital.

luckily for you, i have yet to receive news of any job promotion granting me such power to change presentation criteria. in the meantime, i wish you all the best in your endeavors and try not to win any darwin awards.

sincerely,
your caring doctor

eedee

ortho's come and ortho's gone
and it's been weeks since i've moved on

they chucked me back to ol' eee-dee
oh how it's disagreed with me!

i hate the fact that it never ends
that stream of patients makes no amends

headaches, toothaches and bleeding noses
life sure ain't a bed of roses

chest pain, sprains and broken bones
stuff that i greet with big fat groans

it's never enough that you do your job
patient expect more, or they will dob

and then you have 'em chinese-speakers
they latch on 'til i turn a streaker!

as if they deserve some special care
don't you assume, oh don't you dare!

my hat off to those who like the term
the thought of ed just makes me squirm

the only thing that gets me through
is the fact i love my ed crew =)

so on i stay for a month or so more
and then i'll be rid of this terrible chore!

but in the meantime, please bear with me
i'll be cranky and whiny and be hardly free!

let nature do its thing

Is it too cruel to sometimes wonder why we have hospitals at all, or why there's such a large R&D industry flourishing at the moment in various races against time to come up with the latest medical breakthroughs and drugs? Would it be better to let nature take its course and let the weakened and sick go on their own time, rather than prolong their misery both physically and mentally? Sure, we could come up with measures to make the process more comfortable.

In such a world, palliative care would be the end all and be all of medicine as we know it. ICUs wouldn't be filled with a geriatric population averaging 80 years old. Drunks who get into punch-ups and break their wrists wouldn't be allowed into the hospital. They would be able to smoke and drink as they like, with lots of painkillers prescribed until their fracture healed. They would be given advice on how to take care of their injury but their lives are their own to ruin if they refuse compliance. None of this would be the fault of their doctor and better yet, none of this would be known to their doctor if they were never allowed onto a hospital bed in the first place.

Blood banks would be non-existent because there wouldn't be a need to transfuse people. If they're anemic from disease, we would let the disease take its course. If they're anemic from huge blood loss from trauma, well then we let the survival of the fittest.. or luckiest continue. There would be no subspecialties. No cardiologists to put in pacemakers, no respiratory physicians to manage those who chose to smokebliterate their lungs, no gastroenterologists to worry over those whose first instinct is to reach for the booze nor surgeons to cut out tumors, let alone perform tummy tucks and facelifts. Wait, I take that back. I guess there should be cosmetic surgeons around. Those who choose to take that risk and encounter complications would just fall into the survival of the fittest category, seeing that there would be no resuscitative measures available in their world to save them from their own folly.

Is such a world really too cruel, or would it take us back to a simpler, less complicated world. Why is there such a drive in the first place to prolong our lives, to survive.. for what? The world as we know it has limited resources that can't keep up with the careless reckless nature of our existence, yet we strive to stay here for as long as we can with any means possible so we can continue with blatant disregard and misguided good-will to unbalance the cycle of life. Why do we bother, why does medicine even exist? Surely, we would all be better off letting nature take its course for no path would likely be worse than the one we've paved for ourselves already, no? Sometimes, I wonder..

typicalities

So.. my ortho term started.

My first week started in chaos and ended in chaos, w00t! go me.

Monday found me showing up half an hour late because Medical Admin sent me the wrong info pack and therefore, I got the handover last Friday from the wrong team. To think I was so happy to hear that all the discharge summaries have been done for all the inpatients... I showed up Monday to find that NONE of my patients had bloods ordered over the past weekend. Some hadn't had a blood result since the middle of the previous week. So wasn't impressed. Then there were the pre-admission clinics to attend, without a stethescope of course so I could assess my patients pre-operatively quite well thank you.

Tuesday found me telling an old demented chap from a nursing home that I had to put in a catheter. I was less than an arm's length away from his face - I thought he was deaf and drowsy. I was so wrong.. next thing I knew, he had taken a swipe at me and punched my right eye. By the time I got the catheter inserted, with the help of a male nurse.. both the nurse and I walked away with our battle wounds. The guy had dug his nails into us and clawed us relentlessly.

Wednesday found me in the operating theaters - short notice and short of staff due to sickies. Went in for the wrong operation so I ended up assisting in two rather than 1 surgery...

Thursday found me a sugar daddy. Well, he was a rich elderly stuck up and eccentric guy who said he had no daughters, how he wished I was his daughter and would I like to have lunch or dinner with him and his wife during the weekend, and how nice it would be if my parents were here so we could all have a group meal and chat. ....ahhuh.

Friday found me introducing myself to my boss twice, once in the morning and once just before he left. I had forgotten that I'd met him before you see....

I can only hope that the rest of the term gets better =)