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At a met call
Ok oxygen turn it up full via hudson. What’s her sats. Can we get an ECG… 
Oh hey. Are you plastics? 
Urr yeah.. Have we got a line in? 
Mrs blah wants to discharge with some endone. 
Um not a good time.. Blood pressure? 
Oh yeah. Sure. 
Have we got an old ecg, take usual blood and a gas. 
Is just that she wants to go and you haven’t written her up…

Arch bars are painful.

Arch Bars


They’re often used in maxillofacial surgery to fix busted up mandibles (of which we see an awful lot of)
They are not comfortable with sharp metally bits sticking into gums.

A patient of ours was recently rediscovered from the wild, as it were, with arch bars half on. 8 years after having them placed and subsequently lost to follow up.
8 years. More interesting is that he had come into hospital on several occasions and no-one had noticed them
Crazy

More unrelated photos

Libibing Village, Lesotho


Sunrise over Kibo Crater, Killimanjaro

12am, Hospital in the middle of buttfuck nowhere

Code 2 – Chest Pain, shortness of breath

Sotto voce
‘Hey doc, do you think you can get me some of dem cock stand pills?’

needless to say there was no chest pain, and only a mild exacerbation of asthma.

More picatures!

Showing how it's done

We get to see amazing things – like the beautifully insufflated and illuminated pelvis during an exploratory laparoscopy.
She had amazing anatomy* you would almost expect to see Netter signed in the lower right hand corner.
Textbook, pristine.

I saw her at the shops today, and wondered where I knew her from, before realising. And I couldn’t help by cringe when she lit up a cigarette as she exited the shopping centre.

*not in this picture, I just found this for illustrative purposes

There had been a drought just a few years ago but things were looking up. There had been rain, the stock was looking good and there was plenty of feed. In 10 short hours, 10,500ha were burnt, six homes lost, 580 cattle, 2451 sheep, 2990 tonnes of fodder and hundreds of kilometres of fencing.
By chance I had been with the vet that day and in late afternoon we were called up to assess the animals. It is something I will never forget and hope never to have to see again. The charred and still smoking landscape was disorientating, the smell of smoke, charred flesh and burnt hair thick in the air around the bodies of badly burnt animals. The worst off were calves, unable to get away fast enough. The most unfortunate were paralysed by their charred flesh, but still alive with airways destroyed and frothing from the nose. Others were laying down, but staggered up as we approached. The landscape was quiet with occasional plaintiff cries from injured animals punctuated by the brutal sound of gunfire. We shot those which couldn’t get up, though others would return to cull more as the extent of injury became more apparent.
Horses too were caught up in the inferno, a mare and her foal particularly caught our attention, suffering deep dermal and full thickness burns to their heads, legs and flanks. They would die in the coming days, despite our best care.

I work in pathology, I take bloods, urine and poop (they do last two themselves. I just package it and send it up the magical chute thing)
Usually when they come in with the poop sample it’s wrapped in all manner of plastic bags, tissue paper etc as they’re embarrassed.
Today had the total opposite, wanders up to the counter, plops the container on it, opens it up, displaying a healthy scoop of greenish brown, foul smelling crap and asks ‘ do you think i got enough’?
Nasty

In $clinic, coal face medicine.
This past year, medicine is often like a quiz show – BZZZZZ! acute intermittent porphyria, BZZZZZZ what is hypertrophic cardiomyopathy with outflow obstruction.
It’s filled with enzymes, cells, pathological flow charts, and algorithms. The cases exist on paper and we play guess the diagnosis, a la Gregory House.

The doctor leaves, casually tells him to come to see me.
My first patient.
He’s a man’s man. Proudly independent, worked on the land his whole life and still looks like he could take on a bear and win despite being on the other side of 70.
He’s come in complaining of burning on urination.
Score! We just did genitourinary, I follow the algorithm, urine MCS – E coli. treat with antibiotics and treat all UTI in male as suspicious, so take bloods.

His PSA comes back a few days later >20. I close the program. Re-open. Enormous.
Follow the algorithm
We do a DRE. Prostate is hard and lumpy, non tender
Crap.

The PBL case of Mr $prostate is real and is sitting in front of me. We tell him that its probably cancer. We start him on the road of specialists, biopsy and imaging.
He’s stoic, but there is no hiding the concern in his voice and his eyes.

We talked about it afterwards, the doctor is clearly fond of this man, and I had grown to like him over the short time I had known him – his generosity, his direct honesty, his good humour. And now for Christmas we set on him cancer.
He left thanking us warmly, if a little distracted, and strode away, a bit less invincible.

I think it’s easy to get lost in the game of medicine in these first few years. We have little to do with patients, and when we do we often compare who got the ‘coolest’ case. We idealise the super specialists – Charlie Teo, Chris O Brien. Pioneers, giants among men, fighting the impossible fight and winning. We scoff at our Doctor, Patient and Society subjects, giggle at the so-called ’empathy score’, and a good number of students openly deride GP’s professing $chosenSpecialty as superior. We rote learn the method of delivering bad news, regurgitating for examination purposes.
This was not exotic, it didn’t happen in a rarefied tertiary hospital, no machines went ping, there won’t be any books written on it, no superstar surgeons were involved and this story won’t compare to tales of heroism, of snatching patients from the brink of death.
But for me, it was a timely reminder that the cases I learn, the books I read, ultimately it becomes real, the flow charts end with a real person, with fears, concerns, families, loved ones and that I should never forget it.

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