Just remember, I get to open my presents about 16 hours earlier than my brothers...:)
Wednesday, December 23, 2009
Merry Christmas!!
Just remember, I get to open my presents about 16 hours earlier than my brothers...:)
Monday, December 21, 2009
Merry Christmas!
Apologies for the blog delay-- been trying to work a few things out here in prep for heading back home. Apparently, I'm in need of a "career." Who knew?
In any event, the days have brightened up and here the solstice in December is the longest day of the year. Back home, my brother is dealing w/ mountains of snow in DC. In HI, my other brother is I'm sure doing just fine (sigh!).
The TED website really is fantastic and I wanted to share the following link:
We'd heard all about General Buck-Naked while in Liberia, though I never met him (obviously).
These are a few pictures from around the 'Merican Thanksgiving table:
And here are a few of the DEM Christmas Party:
Time has gotten away from me and I need to head in for another shift. Things are a little tough @ the hospital now w/ staffing issues, so that's an excitement. I'll likely be off camping for the actual Holidays (nothing says "Christmas" like scraping a leech off your skin w/ the back of your knife...), but hope everyone enjoys them at home. There's a postal strike on in Aussie now, so I'll pretend that's why I haven't gotten your presents in the mail!!! :(
cheers, --aws
Saturday, November 21, 2009
Royale with Cheese...
It's just the little differences, really. McDonald's is referred to as “Macca's,” Burger King as Hungry Jack's. The big things missing from my diet? Cherry coke zero, Diet Dr. Pepper and good sushi. No great loss, I hear some of you say, but do not underestimate these things. However, one awesome thing about the sushi/Japanese restaurants--
And the ever-popular “haema-chuk,” or what is spilled onto the floor when an upper GI bleed makes itself apparent. As an aside, to “root” for a team is an expression that has a very different meaning here and should probably not be used in polite company (though I'm curious to see what it would look like in practice...). To say you're a fan of a certain team in, Australian rules football, for example, you would say that you were a “supporter” of that team. “Root” is the unpleasant and impolite equivalent to “shag.” Similarly, “how are you doing?” is here “How are you going?” (how is “it” going does not exist), but I just can't get it in me to say, “I'm going well.” Saying so makes me feel like I'm making good time on some sort of river voyage. Not sure why.
I showed a co-worker here a section of my blog from back in Liberia that had my photo on it, and came in to sign out the next day with this as the computer wallpaper:
Apparently there's a website where you can upload your pictures and do things like this to them. With friends like these, who needs friends, right?
Speaking of marauders, I awoke one morning to find this bad boy trying to die on my oven range:
He is a fine specimen of what I believe to be a “huntsman” spider, one of the rare varieties of Australian flora/fauna that are not imminently deadly to humans.
For the medicos out there, this is an interesting piece on the over-importance placed on medical care and documentation done for “medico-legal” reasons. I agree with his point, but the problem is as long as there's someone out there who's willing to say this or that to make a buck (which is always), it's going to be a long road to hoe.
Finish off with some pictures of the Gorge, where the kayak championships were held recently, and a view of the North Esk River as it comes in to the Central Business District of Launceston.
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Yup, little plastic fish-shaped soy sauce capsules. They are awesome. And re-sealable.
In terms of the DEM (dept of Emergency Medicine, vs. ER or ED), there are also quite a few useful terms I've added to my vocabulary. My personal favorite is “acopia” (pronounced “a-cope-ia”), used to designate someone or someone's family member unable to deal with their issues (sometimes medical, often not) at home. It was apparently at one time an honest to God diagnosis that they would enter into the computer before a memo put an end to it-- formally at least. It's equivalent back home is my favorite (or, favourite) FTC for “failure to cope,” applied to patients in the same situation beyond the age-range of the more traditionally accepted “failure to thrive” diagnosis. Close seconds are the expressions “fronto-palmal” and “fronto-dorsal” to describe Pt “affective types”:
And the ever-popular “haema-chuk,” or what is spilled onto the floor when an upper GI bleed makes itself apparent. As an aside, to “root” for a team is an expression that has a very different meaning here and should probably not be used in polite company (though I'm curious to see what it would look like in practice...). To say you're a fan of a certain team in, Australian rules football, for example, you would say that you were a “supporter” of that team. “Root” is the unpleasant and impolite equivalent to “shag.” Similarly, “how are you doing?” is here “How are you going?” (how is “it” going does not exist), but I just can't get it in me to say, “I'm going well.” Saying so makes me feel like I'm making good time on some sort of river voyage. Not sure why.
Oh and a few other things. This sign is up in the utility room in the DEM. I tried to get it in focus, but it didn't come out right. It is a conversion chart for converting between kilogram and, wait for it, stone. That's right-- stone. As in, “He probably weighed about 13 to 14 stone.” I just have images in my head of a code in which someone is calling out drug dosages in “mgs/stone.” 
For those of you who are fans of The Daily Show, you may recall their “Pantry of Shame,” which includes microwavable blueberry pancake-wrapped sausages on a stick and something called “Baconaise,” which is mayonnaise w/ bits of artificially flavored bacon already mixed in. Well, I saw this ad for Beconase, trade name of an inhaled nasal steroid, and couldn't help the mental
connection (much like the Ceylon industries bakery that produced the chocolate cookies mentioned in a previous Liberia post...).
I showed a co-worker here a section of my blog from back in Liberia that had my photo on it, and came in to sign out the next day with this as the computer wallpaper:
Apparently there's a website where you can upload your pictures and do things like this to them. With friends like these, who needs friends, right?For those interested, I saw the group Tripod the other day on television. Like it sounds, three guys who do music and comedy. I noticed them while in Melbourne when I came upon an ad for their performance of “Dungeons and Dragons: the Opera.” I couldn't go because of my work schedule, but was really close to shelling out $300 for last minute plane fares... Anyway, they may be playing this upcoming Friday and I hope to swap shifts around to head out there. Some of the lyrics from the tv performance I saw follow. Imagine sort of a jazz quintet doing a little bossa nova number, the lyrics to which describe the lead singer's anxiety that as a bookish geeky technophile he likely does not have the skill set to compete under the new conditions created by the collapse of modern society...
“...when the polar icecaps melt and the oceans rise / just like in Waterworld, well / I'm pretty sure I don't have the upper body strength / for all that much rowing.”
“...And even if the post-apocalyptic dystopian wasteland of the future / isn't exactly like Mad Max, /
there'll probably be a healthy amount / of fending off marauders, / and I'm not very good / at
fending off marauders.”
“...And even if the post-apocalyptic dystopian wasteland of the future / isn't exactly like Mad Max, /
there'll probably be a healthy amount / of fending off marauders, / and I'm not very good / at
fending off marauders.”
Speaking of marauders, I awoke one morning to find this bad boy trying to die on my oven range:
He is a fine specimen of what I believe to be a “huntsman” spider, one of the rare varieties of Australian flora/fauna that are not imminently deadly to humans. 
Interestingly, 10 of the 15 most dangerous snakes in the world live in Australia. Clearly, God does not want us here... :)
For the medicos out there, this is an interesting piece on the over-importance placed on medical care and documentation done for “medico-legal” reasons. I agree with his point, but the problem is as long as there's someone out there who's willing to say this or that to make a buck (which is always), it's going to be a long road to hoe.
And this snippet is from the article referenced below which itself is extremely moving. But I enjoyed the emphasis this little bit puts on how our job changes our perspectives on things. Most people's jobs don't involve people dying every day, or pregnancy losses or broken relationships (“No, Miss. Regardless of what he told you, trichomonas is not something you 'just get' from having sex. Well, people who have sex with him could 'just get' it I suppose...”). I don't know-- for me personally it's led me to be a bit of a nervous Nellie when it comes to crossing cross-walks or having first aid kits and fire extinguishers in the car or not drinking on nights I'll be driving. But I also hope it's made me appreciate those moments I have with the people in my life, be more straight forward and up front about some things. Certainly this little bit is a reminder to be understanding of the people who've not had the same experiences you've had. The author is finishing describing the passengers/family involved in a collision in which one of the parents has died, and the other was driving intoxicated.
“The son has abdominal pain, which ultimately proves to be from a small bowel perforation. One laparotomy later and he's fine. (The most traumatic event of his life, possibly ever, and it warrants only 2 sentences. The ED has shifted my perspective so far that my own kids won't come to me for their minor [“trivial” to me] injuries. “Dad's only interested if there's an exit wound,” they say. This can't be good for me, my family, my patients.”
JR Suchard. Unhappy Birthday. Annals of Emergency Medicine 54(4). October 2009, Page 627
Finish off with some pictures of the Gorge, where the kayak championships were held recently, and a view of the North Esk River as it comes in to the Central Business District of Launceston.
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Tuesday, October 13, 2009
Nice to have a little appendicitis to finish out the day
The past few days have been a little rough for a few reasons. I have to admit I'm not a huge fan of being the doctor to people I know or co-workers. It almost never goes well because you know the person, and even when it does it makes the follow-up awkward or difficult. One of the things about DEM is that it is not kind to those who re-think and wonder if they've made mistakes. Because, let's be honest, they probably did. I like the passive voice that makes its way into medical documentation. It seems like an attempt to diffuse responsibility in poor outcomes (ie “the bowel was entered inadvertently during the procedure”) in the process destroys physicians' writing abilities. Eschew the passive, say Strunk and White! So, it is kind of nice when you have a clear-cut case that you manage well-- like an appendicitis-- probably even more so than a tough case that you finally figure out after a lot of work. Poetry in action...
"But then there are the other times, when everything goes perfectly. You don't think. You don't concentrate. Every move unfolds effortlessly. You take the needle. You stick the chest. You feel the needle travel -a distinct glide through the fat, a slight catch in the dense muscle, then the subtle pop through the vein wall - and you're in. At such moments, it is more than easy: it is beautiful." –Atul Gawande from Complications
Recently went down to the local fair (“show” here). I keep telling people Tassie is a little like WV, where I'm from, and the show more or less proved it. It was a pretty typical fair situation, with little portable rides and toss-and-win games. But what was a little extra awesome was the agricultural flavor to it. There was a dog show that breeders came from across a few different states in Tassie. Favorites included the huskies and the Tasmanian “labra-doodles” (hypo-allergenic & non-shedding, apparently; http://www.labradoodle.com.au/ for those interested). Also ideal were the “suspend your child from bungee cords over trampolines,” the wood chopping competitions, the chainsaw sculptures, and the horse jumping (English saddle). Some of the pictures are attached.
Also, with all the rain down here, it had to happen sooner or later....
In other news, recently found out that an Attending and friend from my residency passed away. In the words of another good friend via email, “in case you haven't heard, today the ground shook.” This doc was one of the first EMTs that graduated through the NY training system, then went on to be one of the pillars of the system where I trained. No graduate from our program was untouched by his personality, or failed to tighten up their sign-outs when he was the one coming one-- and that included the grads who had become Attendings! One day I was wearing striped socks and working alongside him. Another Attending approached and asked “Did you see the guy with the shoulder?” His response? “Ask Dr. Seuss over there.” I remember in particular an episode when I was running Fast Track cases by him. A schizophrenic patient was there for unrelated complaints, but he seemed a little disorganized and distracted, though not actively psychotic. Still with vestiges of my undergraduate empathetic self intact, the conversation went something like this: “This guy seems all right, but I don't know-- there's some things that are a little off, he's got some flight of ideas and loosening of associations...” “Christ, the guy's not suicidal or seeing monkeys or anything, send him out!” Thus was born the eponymous “Sensori-neural Simian Criterion for Patient Reliability,” which I've used ever since-- anyone seeing monkeys should probably not be discharged.
So, in honor of Dr. Gary Lombardi, I'll post a few of the thoughts I've had when thinking about the best of my profession. I'm sure Gary would make fun of me for it...
First and foremost, EPs have to be physicians. But their most important contribution or skill, unlike surgeons (surgery) or ophthalmologists (eye exam/Rx) for example, is communication. EPs are resuscitation specialists, certainly, but surgical resusc is also in the purview of surgeons, medical resusc in the realm of internists or intensivists. So, while the spectrum of the initial management of critically ill patients is certainly our emphasis, it is our personal skill at communicating during and about the care of the critically ill, or potentially ill, or not-so-ill-but-think-they-are that sets us apart as “good” doctors or not. As team leaders during a resusc, patient flow managers in a crowded department, providers of potentially critical patient assessments to consultants over the phone, re-assurers to patients being d/c'd, it is our ability to manage information and risk, in situations in which both can be incomplete or unknown that others count on. We are the improvisational obstetricians and the midnight therapists. We are the weekend dermatologists and the after-hours sonographers. We know which pills and why and will make sure you get them. We will get the iv, the pain medication, the tube, the turkey sandwich. We are emergency physicians, and you will do our best to get you our best.
-------
As an addendum, the following anecdote was emailed to a list of graduates of my program by one of the same. It's spot on. --aws
Gary Lombardi was an imposing individual, a bit hot-headed at times, and fiercely protective of his staff. One night, about 2:00AM or 3:00AM in the middle of a very busy shift, a gentleman was acting in a somewhat menacing and combative manner toward the staff. When Dr. Lombardi heard about it the veins on his temples throbbed and he started pacing about urgently. Finally he went over to the cube, threw the curtain open, glared at the gentleman lying there, and shouted, "Do you have a problem? Maybe you want to share that problem with me! What do you say? You want to share that problem with me?" The patient was stunned into silence.
Several minutes later one of the nursing staff tugged at his shirt. "That was the wrong one. It's the guy next to him, the one to the right of him." More pacing. Veins nearly popping now. He went over to the neighboring cube, threw its curtain open, glared at this new gentleman, and shouted, "Do you have a problem? Maybe you want to share that problem with me! What do you say? You want to share that problem with me?" He too was stunned into silence.
Then he leaned back a bit, glanced into the first cube, opened up the curtain about half way, stared at the first gentleman, the one whom he had mistakenly addressed that first time, and said, "And I'm keeping an eye on you too, buddy."
Oh, how I miss the Bronx! And Gary Lombardi. How I miss him!
"But then there are the other times, when everything goes perfectly. You don't think. You don't concentrate. Every move unfolds effortlessly. You take the needle. You stick the chest. You feel the needle travel -a distinct glide through the fat, a slight catch in the dense muscle, then the subtle pop through the vein wall - and you're in. At such moments, it is more than easy: it is beautiful." –Atul Gawande from Complications
Recently went down to the local fair (“show” here). I keep telling people Tassie is a little like WV, where I'm from, and the show more or less proved it. It was a pretty typical fair situation, with little portable rides and toss-and-win games. But what was a little extra awesome was the agricultural flavor to it. There was a dog show that breeders came from across a few different states in Tassie. Favorites included the huskies and the Tasmanian “labra-doodles” (hypo-allergenic & non-shedding, apparently; http://www.labradoodle.com.au/ for those interested). Also ideal were the “suspend your child from bungee cords over trampolines,” the wood chopping competitions, the chainsaw sculptures, and the horse jumping (English saddle). Some of the pictures are attached.
Also, with all the rain down here, it had to happen sooner or later....
In other news, recently found out that an Attending and friend from my residency passed away. In the words of another good friend via email, “in case you haven't heard, today the ground shook.” This doc was one of the first EMTs that graduated through the NY training system, then went on to be one of the pillars of the system where I trained. No graduate from our program was untouched by his personality, or failed to tighten up their sign-outs when he was the one coming one-- and that included the grads who had become Attendings! One day I was wearing striped socks and working alongside him. Another Attending approached and asked “Did you see the guy with the shoulder?” His response? “Ask Dr. Seuss over there.” I remember in particular an episode when I was running Fast Track cases by him. A schizophrenic patient was there for unrelated complaints, but he seemed a little disorganized and distracted, though not actively psychotic. Still with vestiges of my undergraduate empathetic self intact, the conversation went something like this: “This guy seems all right, but I don't know-- there's some things that are a little off, he's got some flight of ideas and loosening of associations...” “Christ, the guy's not suicidal or seeing monkeys or anything, send him out!” Thus was born the eponymous “Sensori-neural Simian Criterion for Patient Reliability,” which I've used ever since-- anyone seeing monkeys should probably not be discharged.
So, in honor of Dr. Gary Lombardi, I'll post a few of the thoughts I've had when thinking about the best of my profession. I'm sure Gary would make fun of me for it...
First and foremost, EPs have to be physicians. But their most important contribution or skill, unlike surgeons (surgery) or ophthalmologists (eye exam/Rx) for example, is communication. EPs are resuscitation specialists, certainly, but surgical resusc is also in the purview of surgeons, medical resusc in the realm of internists or intensivists. So, while the spectrum of the initial management of critically ill patients is certainly our emphasis, it is our personal skill at communicating during and about the care of the critically ill, or potentially ill, or not-so-ill-but-think-they-are that sets us apart as “good” doctors or not. As team leaders during a resusc, patient flow managers in a crowded department, providers of potentially critical patient assessments to consultants over the phone, re-assurers to patients being d/c'd, it is our ability to manage information and risk, in situations in which both can be incomplete or unknown that others count on. We are the improvisational obstetricians and the midnight therapists. We are the weekend dermatologists and the after-hours sonographers. We know which pills and why and will make sure you get them. We will get the iv, the pain medication, the tube, the turkey sandwich. We are emergency physicians, and you will do our best to get you our best.
-------
As an addendum, the following anecdote was emailed to a list of graduates of my program by one of the same. It's spot on. --aws
Gary Lombardi was an imposing individual, a bit hot-headed at times, and fiercely protective of his staff. One night, about 2:00AM or 3:00AM in the middle of a very busy shift, a gentleman was acting in a somewhat menacing and combative manner toward the staff. When Dr. Lombardi heard about it the veins on his temples throbbed and he started pacing about urgently. Finally he went over to the cube, threw the curtain open, glared at the gentleman lying there, and shouted, "Do you have a problem? Maybe you want to share that problem with me! What do you say? You want to share that problem with me?" The patient was stunned into silence.
Several minutes later one of the nursing staff tugged at his shirt. "That was the wrong one. It's the guy next to him, the one to the right of him." More pacing. Veins nearly popping now. He went over to the neighboring cube, threw its curtain open, glared at this new gentleman, and shouted, "Do you have a problem? Maybe you want to share that problem with me! What do you say? You want to share that problem with me?" He too was stunned into silence.
Then he leaned back a bit, glanced into the first cube, opened up the curtain about half way, stared at the first gentleman, the one whom he had mistakenly addressed that first time, and said, "And I'm keeping an eye on you too, buddy."
Oh, how I miss the Bronx! And Gary Lombardi. How I miss him!
Saturday, September 26, 2009
For medical practitioners only...
So clearly this is terrible. And obviously me finding this even a little bit funny means I am a terrible person. But, I mean, _come ON_!!!
Emergency response pendant implicated in cases of strangulation, FDA warns.
MedPage Today (9/23, Petrochko) reported, "The Philips Lifeline brand of emergency response pendant may strangle its wearer if it becomes snagged, the FDA cautioned." This holds especially true for "patients who use wheelchairs, walkers, beds with guardrails, or other objects that could entangle the object." Already, "at least six occurrences of serious injury or death have occurred since 1998 when the device's cord became caught on something."
Sigh...
Emergency response pendant implicated in cases of strangulation, FDA warns.
MedPage Today (9/23, Petrochko) reported, "The Philips Lifeline brand of emergency response pendant may strangle its wearer if it becomes snagged, the FDA cautioned." This holds especially true for "patients who use wheelchairs, walkers, beds with guardrails, or other objects that could entangle the object." Already, "at least six occurrences of serious injury or death have occurred since 1998 when the device's cord became caught on something."
Sigh...
Saturday, September 19, 2009
Merrily We Go Along...
Huh. Not much to tell recently. Working a lot because several of the other Registrars have asked to switch shifts w/ me to take exams and so on. I've been doing a few things, including my first solo Bier's block the other day. Getting the system down at work. To be honest it's still a little odd to me. “Bacteremic dialysis patient? Sure, give him some vanco and I'll follow it up in my office.” I guess you can handle it that way... And mental health services in Tassie are just beyond my understanding. Oh, the view from the hospital toward my house...
Let's see-- what else? The Daily Show is back on the web; every few days I watch an episode of Battlestar Galactica on mail-order DVDs. Finished a book a friend gave me about an emotionally distant physician who can't make a romantic commitment and then contracts TB (yeah, some people are hysterical). Made it to lesson 7 on “Introducing Guitar: Book 1,” which is just beyond “Mary had a litt
le lamb,” though here the tune is called "Merrily We Go Along." The cold/swine flu/pneumonia complex has gone, and I'm now no longer short of breath walking to and from work, so I'll start exercising again (goal: 9:00 min mile for ½ marathon...). The ants have been subdued and a study schedule posted. Plans have been made for my first trip to Melbourne for a medical procedures seminar. Now, time to get a car to see about doing some hiking here in Tassie-- already marked some trails.
le lamb,” though here the tune is called "Merrily We Go Along." The cold/swine flu/pneumonia complex has gone, and I'm now no longer short of breath walking to and from work, so I'll start exercising again (goal: 9:00 min mile for ½ marathon...). The ants have been subdued and a study schedule posted. Plans have been made for my first trip to Melbourne for a medical procedures seminar. Now, time to get a car to see about doing some hiking here in Tassie-- already marked some trails.
Attached are a few pictures of the environment. Many houses have this elaborate trim which is apparently typical of Victorian architecture (and knowing is half the battle). What I love is the one for sale sign that mentions the benefits of "Inner City Living." That's awesome.
All's well so far. There are definitely some frustrations at work, battles that should've been fought, etc. But all in all it's not too bad. Now that I'm feeling a bit better, it's time to do some exploring.
For those who don't know, a little wisdom from Queen and Bowie...
'Cause love's such an old fashioned word
And love dares you to care for
The people on the edge of the night
And love dares you to change our way of
Caring about ourselves
This is our last dance
This is our last dance
This is ourselves
Under pressure
Cheers,
--aws
--aws
Tuesday, September 8, 2009
Down time
So, still under the weather in Launceston. Not so good. Being sick sort takes the wind not only from your lungs, but also from your sails... The good part is that sleeping all day is easier in Lonnie than in NYC. No one's jack-hammering or refurbishing next door, so that's good.
As a result of not feeling all that well, been spending a lot of time on the internet at my favorite sites. For those interested, I've copied the links of a few of my favorite TED talks below. Don't know TED? Seriously, check it out. It's part of why having an internet make sense!
Also, in keeping w/ my first post ("Questions of Travel"), I've copied Robert Service's "The Men That Don't Fit In" below as well.
In terms of work, I guess I really do like the procedures and so on better than the rest. We (finally!) had an intubation the other day and I was so happy! Unfortunately, because the closest required specialist a 2-hour ambu ride away, it may have been simply a prolongation of the inevitable. Still, it kind of balanced out some terrific misses I've been making recently. Sigh. Anyway, hope all's well.
--aws
There's a race of men that don't fit in,
A race that can't stay still;
So they break the hearts of kith and kin,
And they roam the world at will.
They range the field and they rove the flood,
And they climb the mountain's crest;
Theirs is the curse of the gypsy blood,
And they don't know how to rest.
If they just went straight they might go far;
They are strong and brave and true;
But they're always tired of the things that are,
And they want the strange and new.
They say: "Could I find my proper groove,
What a deep mark I would make!"
So they chop and change, and each fresh move
Is only a fresh mistake.
And each forgets, as he strips and runs
With a brilliant, fitful pace,
It's the steady, quiet, plodding ones
Who win in the lifelong race.
And each forgets that his youth has fled,
Forgets that his prime is past,
Till he stands one day, with a hope that's dead,
In the glare of the truth at last.
He has failed, he has failed; he has missed his chance;
He has just done things by half.
Life's been a jolly good joke on him,
And now is the time to laugh.
Ha, ha! He is one of the Legion Lost;
He was never meant to win;
He's a rolling stone, and it's bred in the bone;
He's a man who won't fit in.
http://www.glumbert.com/media/everydaynormalguy (ribald lyrics)
and of course http://www.theonion.com/ and http://www.thedailyshow.com/
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