"I'm Fine", and other Stories.

I had anorexia (loss of appetite), the correct pain
symptoms, elevated CRP, slight nausea, but normal
WBC, and no fever for a score of 6.

 So, last Monday I felt crummy.  Not a specific, put-your-finger-on-it set of symptoms like coughing up a lung or vomiting; just...unwell. Yucky enough that I stayed home...Tuesday it evolved into a generalized abdominal ache. By Tuesday night, the ache had become actual pain and had moved to the right lower quadrant, or "iliac fossa" (when doctors wish to sound doctor-y).  I asked Anne, my housemate and another med student, to do an abdomen exam on me. Sure enough, I had pain over McBurney' point and Rovsing's sign, which are signs of acute appendicitis.  However, I did not have a fever and was not chucking my cookies, so I decided to try an ibuprofen (which fixes almost everything, right?) and go to bed. No sleeping ensued.  By 3 am the pain had gotten bigger in the dark and I was trying to pick the most opportune time to present to ED ("not during heart attack prime time: 5-7 am; not during handover: 8am....um, I guess I should go now") So I decided to wake up Rob to take me to hospital. I must say he was a gorgeous man and got up to ferry me to the Prince Charles Emergency.  I was seen within 10 minutes of talking to the triage nurse.  Clinically, it was appendicitis, but I wasn't running a fever and did not have an elevated white blood cell count, which are also suggestive features (see the MANTRELS Scoring system).  They did an ultrasound to rule out any gyne problems and look at the offending appendix, which indeed appeared angry and inflammed.  Then I was seen by a surgeon and admitted to the ward by 8 am.  I was fortunate enough to have friends doing their rotations at Charlie's, and Kelsey and Emily came to visit and have a bit of fun as they prepped me for surgery at 4 pm.  By this time I was on morphine for pain and could play along:

"What does appendicitis sound like?"   "Like Nickleback."

When I arrived at operating theater, I was greeted by more familiar faces. The anesthetics team I had learned under only a few months before was putting me under. They promised they'd take good care of me, and I could believe them, because I had watched them at work.  I woke up after surgery feeling less pain and horrible-ness than before.  The nurses were beyond wonderful. One of my roommates had animated conversations in her sleep, so I got up and wandered the ward four times the first night, since the earlier you get moving post surgery, the better you tend to recover.  The next morning the surgeon did his ward rounds and explained that we were fortunate, as the appendix was inflamed and indeed needed removal; however it was neither perforated nor gangrenous, which would have necessitated extra days in hospital and more extensive surgical work during the procedure. I spent the rest of the day in hospital getting IV antibiotics, and was discharged by that evening.
  From ED presentation to admission to surgery to discharge was only 44 hours!

 

Scumbag Appendix!

Friday at home was a slow day, but I no longer needed any pain medication by the afternoon, and even managed to make Rob supper by the time he came home from work. I am amazed at how soon I am feeling well.  Once again, Prince Charles Hospital staff has reason to  be proud.  And by way of post script: Cephalexin tastes and smells terrible, and permeates your breath. But it still beats sepsis.

I guess this is all part of studying medicine immersively?

 

The Saturday (3 days post op!)  following, Rob and I attended the Queensland Symphony Orchestra presentation of Lord of the Rings. It was a neat way to experience the movie, as it was played on the screen with subtitles. The orchestra and choir with soloists played the entire Howard Shore score for "Fellowship of the Ring".  It was a brilliant performance!

Holidays with the Fishes

During the break between blocks, we decided to go to Hervey Bay and watch the whales.  We went on the first sail of the season on the Blue Dolphin.  We saw four magnificent humpback whales!

Our captain Pete with Phil and Bruce!

We also had a chance to snorkel with sea turtles and sharks at Neptune's Reef Aquarium. So cool.  I even "surfed" on a turtle- he was passing by at leg level, so I stood on his shell and he took me for a ride. After such an adventure, you need to have fish and chips!!

We also enjoyed a twilight market and walking around on the beaches and the pier (which stretches 800 m into the Bay). A lovely escape!

Don't mess with Canada's BBQ chips!

So this is what makes crime news in Canada.
I love how the police chief does his best to keep a straight face about it.

Our Modelling Careers

Over the weekend, Rob and I were models. It's true!

AHAHahaha!  No.

The 3 muscle layers that help keep your insides, inside.

However, the people watching us strut our stuff knew it was what's inside that counts.
This is because we were models for an ANZCA conference, demonstrating our abdominal muscle layers and lumbar/sacral vertebrae.  This was to teach anaesthetic consultants how to perform nerve blocks and epidurals under ultrasound.  I have done this type of modelling for Sonosite a number of  times now.  It's an easy job (hold still) and I always learn a lot.  They like having Rob for demonstrating echo cardiograms because he has very nice landmarks and good valves.By the end of the workshops we usually have a couple bruises from 3 dozen people poking us in the same places over and over.  Fortunately, they practice putting needles into a silicon phantom instead of us. They would have to pay a LOT better for me to be willing to be a pincushion!

Jesus and Coffee are getting me through....

 It is a well known fact that caffeine makes the med student's world go round.
This is hanging in the Toowoomba Clinical School coffee room:

 And a few other favourites!

Things I wish I knew before leaving Canada

As many of you already know, I could not get a medical training spot in Canada, as the system is so competitive that there are 5-6 QUALIFIED applicants for every med school spot, and provincial bias makes it even tougher. So Rob and I explored or options elsewhere in the Commonwealth. Australia has been a great place to live, and a great place to learn.  But not seeing a job at the end of the work and debt is very unnerving.  Bettina Arndt, a social commentator, was published today, June 26, 2012 in the Australian:

Education system turns its back on young doctors
        FOR months now, the saga over Australia's failure to complete the training of international medical students has been in the headlines, with up to 500 of them facing the prospect of missing out on the vital internship year. The latest slap in the face for these students came last week with the Victorian Health Department's decision to suddenly change the criteria for allocating their internships, effectively locking out international students from their merit-based system. Victoria had been the only state offering such a system to these students and many of them had completed the application process only to be told in the hour before applications closed they would not be This bizarre, insensitive action is merely the latest in a sorry tale of incompetent decisions, buck-passing and policy failures that have left these students stranded, damaging Australia's reputation as an appropriate provider in this most prestigious area of professional education.
       It isn't as if the crisis came as a surprise. Ten years ago the decision was made to respond to a shortage of doctors by opening new medical schools and increasing class sizes, welcoming many high fee paying international students to help subsidise the costs of the courses. In the decade to 2009, the proportion of international medical students grew by 223 per cent compared with 52 per cent for domestic students. Last year 16 per cent of graduating medical students comprised international students who had paid about $60,000 a year for their course. It has long been known the crisis would hit home this year. Domestic students rightly are given priority for intern places but, as their numbers have gradually increased, international students have been left with fewer opportunities for the hospital training required for them to practice medicine in this This year the demand for internship places greatly outstripped supply yet many of our state health departments are still pretending it's not their problem. Their concern is the cost of this training, yet the hospital system is propped up by employing large numbers of international medical graduates - who some in the system refer to impolitely as cannon fodder - working under supervision in our hospitals. That's the crazy thing; visas are handed out to about 3500 foreign doctors each year, including recent graduates from some universities that aren't so well regarded, with many paid to work in Australian hospitals while our well-trained international students can't find places. Many of the locally trained international students show a strong commitment to remaining in this country. Research by Lesleyanne Hawthorne from the University of Melbourne showed 78 per cent of international medical students completed their internships in Australia, 99 per cent were employed in medicine within four months of that time and were likelier than domestic students to work in regional areas. It makes far more sense to offer opportunities to these locally trained graduates than continue to import international medical graduates who may not have the interest or the knowledge base required to make it through the tough entry requirements for joining our permanent medical workforce. Health Workforce Australia predictions assume these locally trained students will form part of our future medical workforce. So why isn't more being done to make sure this happens? This issue was on the agenda at the recent meeting of the Australian Health Ministers Advisory Council, which commissioned urgent work to quantify the shortfall in internships and possible solutions. Hopefully this may lead to policy changes beyond the scramble to find intern places in private hospitals. The proper approach requires the states to rethink their employment of hospital medical staff to include more interns instead of international medical Extra places could also be created by spreading the significant workload on our current interns, given many of these hard-working young people are being paid overtime for working extra shifts, with consequent risks to their health, let alone that of their patients. Training a medical student costs about $85,000 a year. With the international students paying about $60,000, this means each of the present crop of 2500 international medical students studying in Australia will cost us about $100,000 for their four-year programs. It's a dreadful waste of money if failure to provide the critical final year of their hospital-based training means we force them to leave the country. But the issue here is also about fair treatment for young people who were often not properly informed about the risks of this happening and who must deal with their stressful courses with the added burden of constant uncertainty about their future. These smart kids rightly feel let down by Australia's incompetent handling of this issue and, if they are forced to leave, news of the deficiencies in our higher education system will travel with them.
Bettina Arndt is a social commentator.

And now the word of their deficiencies is out.  My advice to Canadians wishing to train as a physician in Australia?  Stay home and find something else to fulfil your career passion.  You will end up with a lot less debt and uncertainty.

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