Not the Sharpest Knife

With two weeks of the rotation over, I am finding myself getting less stressed out by not being able to answer the impromptu quizzes thrown my way on a daily basis. I must be getting used to it. On a good day, I may be able to answer half the questions. Sometimes when my rotation partner and I get grilled together, it really takes the pressure off, even if the other person is just standing there for moral support. Other times, I am give a reprieve and get sent to do some practical things like putting in cannulas in patients’ arms and taking bloods. My fine motor skills are leaps and bounds better than my ability for memory recall. Find a vein in a frail and dehydrated old lady with paper-thin skin big enough for a medium gauge cannula? No problem, I’ll give it a go. List the causes of pleural effusion? Out of the dozens of causes, I’m stuck after listing four. If the career of a physician is predicated on the ability of memorizing long lists, I may have better luck at surgery where manual dexterity counts for something.

Post Mortem

Eight o’clock, my rotation partner and I walk through the green doors. In front of us, the body of an old man is perched on top of a stainless steel cart. Next to the cart is a sink with a spray hose and a stainless steel bench with a cutting board. To the right is a bench with various sharp tools designed to cut through any organic material. The man on the cart died suddenly last week at home. Today the pathologist is going to perform a autopsy and try to find out the cause of death. In Queensland, all autopsies have to be witnessed by the police, so two police officers are also present.

In walks the pathologist. We exchange greetings and he starts working. Wielding a scalpel, he expertly makes an incision from the man’s jawline, down his neck, through the middle of his chest and abdomen, all the way through to the pubis. As he peels back the chest tissues and abdominal wall, the room is immediately permeated with the smell of three days of decomposition, despite the refrigeration. I look around: the smell does not even register with the pathologist, my rotation partner and the police officers start breathing through their mouths. Luckily for me, I am not bothered by the smell. Having peeled back the man’s chest, the pathologist takes a bolt cutter and snaps the ribs one by one until he can lift up the whole front rib cage off the chest like popping the top off a tin can. Next, he frees all the internal organs from the chest and abdominal cavities, slices the tongue from the mouth through the chin, and in one fell swoop, picks up the whole collection of internal organs from tongue to anus and everything in between and lays it down on the bench. The pathologist’s assistant picks up the oscillating saw and goes to town on the skull. In no time, the brain, covered in its fine web of arteries, is presented to the pathologist.

Each organ is weighed, catalogued, sliced, and examined for abnormalities. In the mean time, the pathologist’s assistant sews up the body, leaving a small opening in the abdomen into which he puts a plastic bag. All the chopped up organs are returned to the body into the bag, like so much table scrap being swept down the garbage disposal. The whole procedure is cold and clinical, without any emotional attachment. The person on the table was someone’s father, someone’s husband, someone’s grandfather; but in here, he is just a body whose cause of death the pathologist is trying to determine.

Toward the end of the autopsy, the door to the room swings open. Another body is brought in on a steel cart. “Suicide by hanging,” announces one of the wardies, pointing to the noose still around his neck. The pathologist’s assistant takes the spray hose and cleans off the ants still crawling on the body, then pushes him into the morgue. “We’ll do a post mortem on him later to make sure it was a suicide and not a homicide,” says the pathologist.

With that, the autopsy comes to an end. We thank the pathologist and head to the ward.

Back to the Grind

I am scared.

Today was the first day of the last, and the toughest, rotation this year: internal medicine. Ward round started in the intensive care unit, where I met the consultant I would be attached to for the next four weeks. Immediately, I found myself struggling to answer the questions he threw at me as we saw each patient: chest x-ray interpretation, causes, investigations, and treatments for secondary hypertension, community-acquired pneumonia, and heart failure. Standing in front of the consultant to my left, a senior medical officer (SMO) and a principal house officer (PHO) to my right, I tried to wrestle my brain back from the beaches of Fraser Island as steam started to build up under my collar. It was like playing dodge ball while being chained to a fence post. Two hours later and satisfied that I got a taste of what was to come in the next eight weeks, the consultant left; my battered body sat in a heap on the floor. I picked myself up and finished ward round with the SMO and the PHO.

I finished the day with a long list of things to look up: too much information to learn, too little space in brain.

The Three Amigos

Another break, another walk on Fraser: 110 kilometers, five days, three guys, two camp stoves, and one grand time. The route was similar to the walk I did in July, taking in Lake McKenzie, Lake Wabby, Valley of the Giants, Lake Garawongera, and Seventy Five Mile Beach. It was back to basics: wake up with the sun, have breakfast, pack up, hike, rest with or without a swim in one of the beautiful lakes, hike some more, set up camp, have dinner, go to bed; repeat the next day.

James and Mike on the trail

At Lake Wabby Lookout

James surveys Hammerstone Sandblow and Lake Wabby

My strategically-taped feet enjoying the fine beach of Lake Garawongera

Wild flowers by Lake Garawongera

Walking down Seventy Five Mile Beach under ominous skies

At Rainbow Gorge

Walking out of Kirrar Sandblow

Walking down the beach as the tide recedes

Keen fishermen waiting for a bite

Mike trying to dissuade a dingo from following us

On the late afternoon of day four, after setting up camp at One Tree Rocks Camping Zone on Seventy Five Mile Beach, James and I walked to Lake Wabby, about four kilometers away, for a swim. When we reached Lake Wabby, the sun was starting to dip behind the trees in the west. People were streaming out to head back to their four-wheel-drives. As we were getting ready to jump in for a swim, we noticed someone lying motionless on his back, covered in towels, with a few people standing nervously around. Sensing something was not right, James and I walked up, introduced ourselves, and asked if there was anything wrong. It turned out that Evan from Ireland, like so many visitors to Lake Wabby, ignored the posted warnings and did a dive into the lake. Immediately, he could not move his limbs. He soon recovered movement in his arms and his friends dragged him out of the water. Their tour guide went to get the ambulance while his friends stayed with him. We went up to Evan and quickly did a peripheral nerve examination. Evan had injured his spinal cord at the C6/C7 level from the dive.

Freightened, Evan’s eyes darted around, not sure what was happening to him. Hoping that he would remain stable, we reassured him that the ambulance would come soon and take him to the hospital. As the last bit of daylight faded away, the paramedic arrived and brought the news that a helicopter was called from Brisbane. He quickly examined Evan and expertly put in an IV drip. We stood around and waited impatiently for the helicopter.

At about eight o’clock, we heard the sound of a helicopter approaching, then saw the search light beaming down. Finally! After circling a couple of time, the chopper landed on the massive sand dune next to Lake Wabby. James and I climbed up to the top to check it out. What a sight! The red-tinged bright full moon was hanging low in the sky, casting a surreal glow on the bare sand dune. With the helicopter perched atop a flat section of the dune and the paramedics milling around to get their equipment, the scene was a rescue mission straight out of a movie. How I wish I could capture it with my camera! But the setup would take too long and we needed to get Evan out of here. The paramedics strapped Evan to the stretcher. All of us gave a hand and carried him up the sand dune to the chopper. Whipping up a whirl of sand, the chopper took off to Brisbane.

A goana sunning itself

Reflections off my sunnies

The next day, we spent the afternoon lazing around the fine white-sand beach at Lake McKenzie. And with that, our walk came to and end. Casualty count for me: three subungual hematomas, two fallen-off toenails, three big blisters, four small ones, a sore Achilles’ Tendon, and two sore shoulders. And my inner Masochist says it was all worth it.

Four Down, Six To Go

Another rotation is over! That means another week off. What do I want to do with myself for a whole week?

I could lounge around and do nothing (and be bored to death), I could go to Brisbane (not all that exciting either), I could study ahead of time for the next rotation (yeah right, as if), or I can do what I have really enjoyed doing for break this year. How about going to Fraser Island again? Six days, 100+ kilometers, me and nature. Sounds like a good idea. This time will be even better, because my mates James and Mike from Brisbane are coming up to join me for the walk.

Good times!

Wrapping Up

Where did the rotation go? It feels like I just had exams last week and all of a sudden it's time for end-of-rotation exams again? I guess I shouldn't be complaining; it probably means this GP rotation has been so good that time just flew by.

In the last seven weeks, I have seen more sore throats, coughs, and tonsillitis than I care to count. But it was presentations like hyperthyroidism, management of diabetes-related complications, evaluation and dressing of wounds, and hands-on procedures like cutting out skin lesions and suturing cuts that made the days full of variety; an eight-hour day would be gone before I knew it. The days were definitely more than just about "tears and smears" (tears - depression; smears - Pap smears) that specialists often say disparagingly regarding general practice.

Another aspect of GP I find enjoyable is that GPs, at least the good ones, really do treat the patient and not just the disease. Specialists are like service stations where patients stop to get their problems fixed, but GPs go on the journey with them. Getting to know the patients as people, not just someone anonymous with gallstones or broken wrist you probably will not see again, is what really appeals to me. This rotation was the first rotation in which I had a lot of one-on-one contact with patients. They seemed to like me well enough. And it was reassuring that most patients found me easy to talk to. Some of them even called me "doctor." By now, when the patient says "doctor" at my general direction, I find it a lot easier to suppress the urge to look around to see where the doctor is.

Well, all good things have to come to an end. Now I have to study for exams, the bane of my existence! Why does a rotation so enjoyable have to end this way?

Shamu!

After a week of gray and wet weather, the sky cleared up again today and the weather returned to the normal winter day in Hervey Bay - dry, sunny, and warm. I felt like I was coming down with cabin fever after a week of being indoors - I tried to study but I couldn't sit still and had the attention span of a nat. So I went to the pool and had a swim to get it out of my system.

The Hervey Bay Aquatic Centre, with a 50-meter pool open for the summer and a heated 25-meter pool open year-round, is where I go for a splash every few days. A lot of people consider swimming pretty boring. In a way, I guess it is: all you see is the black line at the bottom of the pool, all you hear is water sloshing around, and you don't get to listen to your tunes during the work out. But that's the appeal for me; it's a sort of sensory deprivation that I find therapeutic. Also, you don't get sweaty as your sweat is constantly being washed off. No music? No problem. I just set my mind free and let it wander. At some point, a soundtrack would come out. I don't pick the tunes, it just plays. Today's soundtrack consisted of the leitmotif of Requiem for a Dream, which morphed into Carmina Burana, which then turned into Santana, and then Branford Marsalis popped up, which carried me through the cooldown lap. See, who needs an iPod when you've already got one built in?

Feeling spent after the 2-km swim, I made myself a protein shake, then started making dinner. I know I am going to sleep like a coma patient tonight.

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Dinner: simple but tasty stir-fried lamb and broccoli