Accent

I have *got* to quit forgetting my brekkie.

A few weeks back, I forgot my breakfast; that was one of the most memorable days I have had in quite some time. (If you missed it, check out the story marked ‘pants’ on the blog: www.downunderdoc.blogspot.com) Well, I should have known something was up today when I got about halfway to the hospital and realized I was hungry. And I have learned something worse than being the closest thing to a doctor on the ward when a Code Blue is called:

Being the closest thing to a doctor on the ward when *two* Code Blues are called for different patients.

At the same time.

No, I’m not making this up. A Code Blue is called when immediate help is needed; if something doesn’t happen pretty soon for a patient, they may be leaving via the back door, not the front door. So it’s kinda nice to have some expert help when this is going on, as opposed to your friendly neighborhood med student who is still trying to figure out which end of the stethoscope goes into his ears. Happily, both patients survived - at least until I left about 90 minutes later. Two codes in a day is unusual, but it shows how sick the patients we have are. And we won’t even discuss the third patient; earlier in the day, he decided to have serious rhythm problems with his heart. The funny thing was he would only get them when he was laying flat. As soon as the back of his bed was put up – so he was sitting – the rhythm came back to normal. Flat, he gets short of breath and the heart goes funny; Sitting up, he goes back to normal. We experimented with this a few times, just to see if it was an anomaly or something that happened all the time.

Which really means I was playing with his electric bed controls while no one else was looking…

Earlier this week, we ran into a bit of a problem with an outside phone call. It seems someone from the renal team (Still haven’t gotten my jersey, although I have been promised they’ll give me number 1/2. But I digress.) called a patient’s doctor to relay some information about what needed to be done after discharge from the hospital. The call was disconnected about halfway through, leaving out some vital pieces of information. So the doctor called back. He said he didn’t catch the doctor’s name, but it was the one with an accent.

Now, while that may be a good way to identify folks in some places, let’s do a quick roll call of the renal team to see who he might be looking for: Raj? Shaundeep? Raj? Tasnim? Shantha? Bryan? Anyone else see the problem with this description?

And with that, it’s the weekend. With only one week left in Adelaide, I have big plans for this weekend: my favorite restaurant on Friday night, followed by lots of fun packing on Saturday. This is to be followed closely by a farewell party for me at a local pub. I’ll try to get some pictures onto the blog of all of this, if I get any free time. Not to mention pictures of me playing with the electric bed controls…

As always, Love to All and keep working on your 101 List!
Bryan

Wager

Better get your bets in soon – the good spots are going quickly.

No, this isn’t some kind of Final Four office pool, or even a ‘When Will The Baby Be Born’ pool. (Even though there *are* a few of those on the renal ward right now. Something like four of the nurses are pregnant! I have decided to drink filtered water, and to not sit on the seat in the ‘loo. Yes, I know the odds of me getting pregnant are rather slim, but better safe than sorry. But I digress.) Nope, this particular betting pool hits a little closer to home:

When will Bryan knock off another patient.

OK, I know it sounds mean. It was originally for when I would send another patient to ICU – which was yesterday, but as not everyone had sign up, they changed it so everyone could join in the fun. We had four patients pass away last week; three were expected and one took us quite by surprise. The common thread in all of this – aside from being patients on the renal ward – was that I had drawn blood from all of them.

Makes you wonder, doesn’t it?

But one patient in particular shows that, while I may be 8 months away from graduating, I am a looooong way from being a doctor. It was Monday, and it was busier than usual. About mid-morning the doctors asked me to see her; as there is not much to do, they new I could handle it I wander in and stand at the side of the bed. She was sleeping quietly; not wanting to wake her, I called her name softly. She didn’t move and was not in obvious pain, so I figured she was comfortable. She looked really peaceful, so I thought it best not to bother her. I left to get to number ‘4’ of my list of 73 things that needed to be done.

Now, don’t get ahead of me.

A few minutes later, as I was getting ready to draw blood from another patient, the head nurse found me and pulled me aside. She asked if I had seen the patient and how I was doing. I told her that I was fine, thanks, no hangover from the weekend or anything. And the patient was sleeping. She cocked her head at me and asked when I saw her. My flippant reply was something along the lines of 5 minutes ago and she looked very peaceful. To which the nurse replied that of course she would look peaceful:

She had passed away 30 minutes earlier.

And with that, it’s the weekend. With only two weeks left in Adelaide, I have lots to do: packing, shipping, selling, organizing, and meeting up with friends to say goodbye. Not to mention getting my bets on the board…

As always, Love to All and keep working on your 101 List!
Bryan

Ego

It’s a good thing I have a healthy ego.

Some of you might think it’s a bit *too* healthy, but I like to think it’s just right. What brings this up is a second-year med student doing a nursing attachment on the ward. I was sitting at the nurses station under the guise of looking up lab results on the computer (which really means I had a nice cup of tea and there were cookies around) when she mentioned how much I knew, and how she hoped to be as good as me in a few years.

I looked around to see who she was talking to.

I had been left on the ward to keep track of things while all the doctors were off doing clinics and running errands; of course, they had left 20 minutes ago saying they’d be back in 5. This is nothing new for me; they did it last year when I (theoretically) knew less. Anyway, the med student said they must have a lot of confidence in me, leaving a lowly 4th-year student to keep track of the goings-on of 16 patients. I decided I better bring this poor, misguided girl back to reality and get an outside opinion. I turned to the physical therapist who looks after some of my patients and asked if she was comfortable with the thought of me being a doctor in 8 months.

Sarah just looked at me and laughed.

She was joined very quickly by the nurses and most of the people in the nursing station. It spread throughout the ward…

But it reminded me of a story that happened a few weeks ago during my anesthetics term. It was just myself and the senior doctor; no junior docs around. We get set up, go through the routine, and then knock the patient out for surgery – him supervising me doing all the work. Things are going well, the surgery is underway. He looks at his watch, notes that it is time for morning tea, and says, ‘If you need me, I’ll be in the office’ and walks out of the operating theatre.

Leaving me alone with the patient, running the anesthetics side of things.

At about the same time, the surgeon looks up from his hip surgery, and asks what dropped. I told him I wasn’t sure what he was talking about. Looking puzzled, he said he thought he heard something heavy fall about the time the anesthetist walked out (leaving me alone with a very unconscious patient, I might add). Then I realized what he, along with everyone else in a 50-foot radius heard:

That was my sphincter slamming shut.

And with that, it’s the weekend. With more friends leaving, I have a bunch of dinners and going-away parties to attend to, plus a few academic activities (which really just means looking at my textbooks). Not to mention building up my ego…

As always, Love to All and keep working on your 101 list!
Bryan

Pants

Did you ever have a day so strange, so bizarre, and so *bad* you couldn’t decide if it was real or just a very bad dream? Well, read on.

One day last week I woke up, got dressed and went to the gym. After a few exercises, I looked down and realized that my *shirt* was on backwards. A while later, I was looking at my socks and realized that, while they were both white, they didn’t exactly *match*.

It was at this point I checked to make sure I was wearing pants…

I head home. It’s about 6:50am and I head to the back door to put some laundry on the line. It’s rather early, so Cane (the landlord’s dog) is still rubbing the sleep out of his eyes when he comes to great me. I wasn’t paying attention either, so when I opened the door I accidentally smacked the poor pooch square in the nose. He stumbles back a few steps, sits down with a plop and has a look on his face like, ‘What the heck did you do *that* for?’

After a shower and a shave with minimal blood loss, I head off to the hospital. About halfway there it dawns on me how hungry I am, and I wonder how I can be so hungry after eating breakfast. Then it occurs to me:

My brekkie is still sitting in the fridge at home.

I grab a few bacon-n-egg sandwiches from the cafeteria and head for the computer to print out my patient list for the day. After about 2 bites, a nurse comes out to me and tells me one of my patients is having a seizure, and could I please come. I look around the ward – twice – and I realize I am the closest thing to a doctor on the ward at 7:50am. While I can’t repeat in front of my mother the four-letter word that ran through my head (begins with an ‘F’), my first action was to do what any final year medical student would do in such a situation.

I grabbed my stethoscope.

Because, you know, it’s always good to have a stethoscope. (No one ever said I was the sharpest tool in the shed.) I go with the nurse and look at the patient. Yep. She’s having a seizure. (Remember that four-letter word I can’t say in front of my mother. Rest assured, it was going through my head on a continuous loop about now. But I digress.) So I head back out onto the ward and look around. I am *still* the closest thing to a doctor. (That continuous loop is getting faster and louder.) But I have been taught well, so I did the most intelligent thing one can do when faced with such a situation.

I found the head nurse and asked for help.

She and I were heading to the patient when one of the junior docs showed up. I have never been so happy to hand-over care to someone more senior in my life. The doc knew what to do – which was to call the emergency medical team. To be fair to *me* that was what I wanted to do – but to make that call as a student…

A little later, after the patient was transferred to ICU (Again with the ICU!), I realized the patient’s husband was still sitting in the TV room. No one had told him where his wife was. I look around again.

I am the closest thing to a doctor on the ward.

So I grabbed Ray, told him what we had done and why, and escorted him to ICU. I made it back to the ward in time for a department meeting. Remember that brekkie sandwich? I finally got to finish it about 9:30am….

But it gets worse.

The Renal Team (Yes, were called the ‘Renal Team’. I’m still waiting for my jersey…) heads downstairs in the elevator to the ICU to check on our patient. The attending doctor – who is also the head of the department – asks a question to which I not only have the answer, but I am able to express it with style and eloquence. I feel my stock going up with him, which is good, as I want him to write a recommendation letter expounding my virtues. The elevator doors open up, we walk out and turn right and I proceed to *trip* over the trash can sitting there.

It was at this point I checked to make sure I was wearing pants…

And with that, it’s the weekend. After a day like that (which I’d like to add is entirely true) I’ll spend some time this weekend with friends – lunch with some, saying goodbye to others. Not to mention making sure I’m wearing pants…

As always, Love to All and keep working on your 101 List!
Bryan

Tie

Has anyone seen my tie?

Well, *any* of my ties. I can’t seem to find them, and I kinda need them.

Let me explain. I always wear a tie when I’m around patients. While some of my classmates think I’m uptight or that it’s out of respect for the patient, it’s really just so folks think I’m important and let me in front of them in the lunch line. The exceptions have been during psych, when I was told to ditch the tie (something about it being a great way for a patient to hurt *me*); the other was during the last term, when I got to wear PJ’s, er, scrubs.

But reality reared its ugly head this week.

While most of my classmates are filling their fourth year with rotations in Fiji or surfing, er, studying in Samoa, I am returning to 6G, the Renal Ward. For those of you who weren’t around, or just don’t remember, I spent 5 weeks last year tending to patients with kidney problems. I decided it was a great experience, so I asked to go back this year for a 6-week rotation. (Of course, most of my classmates think I have lost most of my brain cells when I mention that I am voluntarily going back to 6G. But I digress.) This past Tuesday (Monday was a holiday) saw me searching in vain for a tie to match a freshly-pressed shirt.

And we won’t even discuss how many attempts it took to tie it…

While most wards have a rotating staff and whatever nurses they can find to work, the Renal Ward has a regular cast of characters (Rogues Gallery?) in both the staff and nurses – many have worked there for years. Most of them remember me from last year, which is both good and bad: good in that they know me; bad in they actually expect me to understand what is going on. The only group of folks who don’t me is the new junior doctors. While the docs are happy to have me help, they are still trying to figure out what I can do. On my first day, they asked me to draw some blood from 2 patients for some lab tests. It went well, which always helps with that whole first-impression thing.

But here’s where it gets interesting: I show up the next morning all chipper, which should have been the first sign something was going to go wrong. A nurse says that she has a bone to pick with me, as the paperwork I sent off with the blood yesterday wasn’t complete and the lab called and complained. I handed her a completed form and she said it didn’t matter: the patient was now in the ICU. I had a suspicion she was playing a joke on me, so I went to the computer to see where that patient was hiding:

Yep. ICU. While I was attempting to get all three of my brain cells firing at the same time to figure out how this could have possibly happened, I noticed we have *two* patients in the ICU – which is quite odd, as we only have 9 patients in total. So I looked at the name of the other patient to figure out why they might be there. Yes, Ladies and Gentleman, I have the golden touch: Both patients I drew blood from the day before were in ICU.

Imagine how the remaining patients are cowering every time I come near them with a needle!

And with that, it’s the weekend. I’ll have dinner with some friends tonight, and spend the rest of the weekend relaxing and surviving the heat. Not to mention learning how to tie this tie…

As always, Love to All and keep working on your 101 List!
Bryan