Ponderous

Does anyone remember this song? I loved it back in the day:



So the Hottest 100 of All Time has come and gone. No surprises about #1 (Nirvana, "Smells Like Teen Spirit"), though I was very pleased with #2 (Rage Against The Machine, "Killing In The Name Of"). Thought there would've been more women in the list - the only lead vocals were Massive Attack's "Unfinished Sympathy" (LOVE that song, and the video) and "Teardrop" (not a fan, can't believe it charted so highly). Surprised that Björk didn't make an appearance, let alone Tori Amos and PJ Harvey. (I know I didn't vote for them, but they're JJJ favourites.) Only one of my top 10 songs made it into the list - Jeff Buckley's "Lover, You Should've Come Over" at #56. No R.E.M.! Devastating.

In other news, I've pretty much finished my GP rotation. Just one presentation and one quiz left on Wednesday. The second part of my rural placement in Menindee was, as predicted, very dull. Many days with no doctors and very few patients. As planned, we got our assignments done, and I also worked a lot (gotta keep earning the big bucks).

We were in Menindee for a weekend without a car, and it was very painful. We asked to borrow one of the Health Service cars, but we were declined in no uncertain terms. In fact, the whole time we were there no-one took us for a drive around town. And seeing as Menindee is all about the lakes outside of town, we were not impressed. The sunrises and sunsets were lovely though. And we frequented the pub, playing pool (badly) against the locals. Aaaand of course there were some good photo opportunities.


Foggy sunrise in Menindee


Alongside the Darling River in Menindee (I really like this one for some reason)


Pro Hart sculpture in Broken Hill

Back in Sydney (finally), I started my three-week urban placement at a bulk-billing GP practice in the city. I expected a lot of transient patients, but was pleasantly surprised to find that a lot of people use the GPs there as their regular GPs, because they don't have time to visit their local doctors outside of work hours. Unfortunately, being a bulk-billing place we had SO MANY people with colds, wanting medical certificates. If they'd had to pay, there's no way they'd have bothered coming to the doctor. I caught two colds during the rotation. Plenty of 'flu cases around too, including swine 'flu.

My GP supervisor was very friendly. He was happy for me to see patients, so I was relieved that I didn't have to sit there and watch him all day. (Watching him type notes onto the computer was especially painful, but he soon realised that and let me do the typing.) We alternated with each patient who came in (unless it was a WorkCover matter, which I let him deal with). I did heaps of vaccinations and am very confident with those now. Far too many patients needed their ears syringed - gross! I'd be happy to never do that again! Lots of STIs, a bit of this, a bit of that. It wasn't too bad.

My supervisor gave me some nice feedback. He said that I'm a good listener and can quickly establish rapport with patients (which I knew already, but it was nice to hear anyway). On my evaluation form he wrote, "Will make a great doctor". Awwwww.

So why am I ponderous? Well of course doing this rotation makes me think about my career path again. My main areas of interest so far have been Psychiatry and Anaesthetics. GP is also a possibility, because I could do a lot of Psychiatry as a GP. I'm good at establishing rapport and talking to patients - considering that, perhaps Anaesthetics isn't for me? Perhaps I wouldn't be playing to my strengths. Hmmm much to think about, but no rush...

Spinning on that dizzy edge

Triple J are running the Hottest 100 of All Time in July. They last did it back in 1989, when this song was number 1 (I suspect it'll be up there this year too):



I voted this week, and it was difficult! First you creat a shortlist, and then you select up to 10 favourites from that list. You can also nominate your number 1 song, which enters you in a prize draw.

I browsed my iTunes collection (over 10,000 songs) to create my shortlist of 55 songs. From that, I had the torturous task of selecting just 10 songs. Here they are (in no particular order, apart from number 1), with my reasoning behind each choice...

1. 'Just Like Heaven' The Cure

Click here (YouTube embedding disabled).

This song just makes me happy - the melody, the lyrics, and the association it has with happy moments in my life. Also, I love to dance to it. In my loungeroom.

(The Cure's 'In Between Days' could've easily made it into the top 10. I love to dance to it too.)

2. 'Find The River' R.E.M.



That's the acoustic version - you can find the original music video on page 2 at this site.

R.E.M. are my favourite band, in case you hadn't already figured that out. 'Find The River' and 'You Are The Everything' are my two favourite songs, but 'Find The River' wins for the sheer joy I feel listening to it. The instruments, the harmonies, the lyrics - perfect.

3. 'Disarm' Smashing Pumpkins



This song reminds me of uni in the early 90s. I have a specific memory of a summer holiday down the south coast of NSW, listening to this song over and over. We especially loved the line, "To wither in denial".

Oh yes, and I should mention - as a (bad) violinist, I love string arrangements in pop/rock songs. *swoon*

4. 'Light & Day' The Polyphonic Spree



This one should also come as no surprise. A beautiful, joyful song. Great to sing along to in the car. It's a good motivational song too.

5. 'I've Got A Plan' My Friend The Chocolate Cake



One of my favourite Australian bands. I first discovered them in the early 90s with my first boyfriend (he's now gay, and one of my best friends, and isn't that a whole other story?), and I've lost count of the number of times we've seen them live. This song in particular resonates for me, but there are so many to choose from.

6. 'Lover, You Should've Come Over' Jeff Buckley



The 'Grace' album is amazing of course, and many people love the more well-known songs like 'Last Goodbye', 'Grace', and 'Hallelujah', but I adore this one. My favourite line is, "She's the tear that hangs inside my soul forever". I was lucky enough to see Jeff in concert in 1995 - amazing.

7. 'At First Sight' The Stems



My favourite Aussie love song. "Just say the word and I would die for you."

8. 'The Rainbow Connection' Kermit the Frog



What's not to love? I saw The Muppet Movie at a drive-in in 1979 or 1980. We owned the LP soundtrack too. Hmmm, I wonder if my Mum still has it somewhere...

9. 'Even When I'm Sleeping' Leonardo's Bride



Another wonderful Australian love song. I saw Abby Dobson perform this at The Famous Spiegeltent in December last year, backed by her old bandmate Dean Manning. It brought a tear to my eye.

10. 'Crash Into Me' Dave Matthews Band

Click here (YouTube embedding disabled).

I was a late convert to the Dave Matthews Band - they're not hugely popular in Australia (at least not on the radio), and I first heard this song on an American workmate's computer back in about 2005. I quickly amassed all their albums, and saw them live in 2007. They've just released a new album, which I need to buy. I love many of their songs, but this one is my fave.

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So - what's your top 10?

Country feedback

It's the beginning of week 3 of my GP term and, as predicted, I'm bored.

I'm on my rural placement in far western NSW with another student from my uni. We thought we were going to Broken Hill, but we've actually done one week in Wilcannia, and just started a two-week placement in Menindee. They're both very small towns.

Wilcannia was an eye-opener. It's a really depressing place. It used to be a thriving riverside town - the beautiful old sandstone buildings are a reminder of that time. But now it has one shop (a supermarket where, for example, broccoli costs $13 a kilo), one pub, and one club - and a raft of social, cultural, and health problems. There is a large indigenous population.

The hospital is very nice (another gorgeous sandstone building), and our accommodation was better than expected. But we couldn't go out at night, and felt very isolated. Even walking to the supermarket at 4pm on a Wednesday meant encountering groups of drunk men walking the streets.

It's a frustrating place. I have a lot of respect for the people who are trying to make it better, but I don't know how they can handle it. Small steps, I suppose. Health has improved in recent years with the implementation of a chronic disease monitoring program, and an early childhood program. Change is coming - slowly. But there's just so much that needs to be done - not just in healthcare. It's a place that many people have tried to fix over the years, but the list of failures is long.

One night we put our names down for ambulance/ED callout, and were woken at 1am. There was a brawl - one man had been glassed and he was in the ED, very aggressive and not allowing anyone to examine him. It was obvious that he hadn't just been drinking. Drugs are having more and more of an impact on the community. The perpetrator was there too - he'd broken his arm.

I was given the task of examining a woman who'd come in after having the crap beaten out of her by her drunk partner. I'd never examined an assault victim before (I'm sure it'll be all-too-common next year though), and I was pleased that I stayed calm and got a good history and did a good examination. In the ED we have to phone the on-call doctor at the RFDS base in Broken Hill, and she was happy with my assessment. Thankfully, the woman was not too seriously injured (no broken bones).

We found it hard to learn much about general practice because the doctors weren't there every day. One day, the RFDS doctor couldn't land due to fog, so we ran his clinic and called him to sign off on what we were doing. Sounds interesting, but it wasn't too challenging and we weren't getting feedback on our performance, so it didn't feel worthwhile. The clinic staff were very grateful for our help though. The worst thing we saw was a child's infected scalp still crawling with lice. (I just typed that and then scratched my head - happens every time I think about lice.)

We arrived in Menindee this morning, and the healthcare setup is more of the same - except there are even fewer doctors here, and fewer patients coming to the ED. Today dragged like you wouldn't believe - and I'm here for 11 days. Thankfully this town is more functional than Wilcannia (two shops, two pubs!), and we feel safe walking around. But it's cold and windy and rainy, and we've already had enough.

The aim for the next two weeks is to knock over all of my uni assignments so that I can relax when I get back to Sydney. It'll be good to do my urban placement with one GP who I can build a relationship with over the three weeks, and hopefully learn from.

PS. We were quite amused to see that Wilcannia Hospital made the news while we were there! Thanks to Yay for letting me know...

That shrinking feeling...

I've been absent for a while - a couple of months I guess. I thought about posting during that time, but Twitter seemed to suffice.

I wanted to talk about how much I was enjoying my Psychiatry rotation, but as I got closer to exams, I started to worry about failing again, so I decided not to tempt fate and only post if/when I passed.

Well, I'm posting, so that means I passed! Yay!

It'd be ironic if I ended up as a Psychiatrist. My first degree was in Psychology, and by the end of it I was pretty sure I didn't want to be a Psychologist. I distinctly remember saying, "I'm not interested in listening to people talk about their problems all day". Such a load of crap - obviously there's a lot more to Psychology than counselling, and if I'd gone on with it I imagine I would've ended up doing some sort of HR role. But at the time, the thought of doing a year of supervised training (with a small salary) turned me off the idea of Psychology as a career, and I never went back to it.

With Psychiatry, you can end up listening to people's problems all day, but that'd be more common in private practice I think. That's where the money is of course, but I know I'd get bored with it. Public psychiatry definitely has some appeal.

My first placement was with the drug and alcohol team. I mostly saw patients affected by alchohol dependence, though I did encounter some IV drug users too. It's a frustrating area, because relapses are so common, and recommendations so often fall on deaf ears. To work in that area, you'd need to redefine "success" - it's not curing someone, or even getting them off the substance they're using. Small victories are important - avoiding complications of their addiction, getting them into a rehab program (even if they don't complete it), and so on. I had a long chat with a 40-year-old man with longstanding alcohol dependence. He'd tried all the rehab programs, various pharmacotherapies, and so on. He had advanced liver disease and brain damage. He was due to be discharged the day after I spoke to him. I asked him the likelihood of him drinking again after discharge - that day, or that week, or that month? He said he would be drinking again by the end of the week: "I know I'm an idiot, I know it's making me sick, but I'm going to keep drinking."

My second placement was in the community. It was quite interesting, but I don't have any exciting stories to tell. The placement was interrupted by the Easter break, and also the registrar I was with had holidays in the second week, so I had a lot of spare time!

My final placement was in the acute unit at the hospital. I really enjoyed it. All the registrars were friendly and helpful, and I was lucky to be allocated to a good team with a friendly consultant too. I interviewed a lot of patients, mostly with psychosis. I practised my interview skills for the long case, which I did last week. My registrar also saw patients in the eating disorders clinic, so I attended that a couple of times. Those patients made me want to tear my hair out - so self-obsessed, so painful. Not an area I'm interested in. The consultant was really encouraging. One day she invited me to coffee with her and the registrar. All three of us were in our 30s, and had plenty in common, so it was great to just relax in the sunshine with our coffees and have a good old chat. We ended up being there for over an hour!

My long case went well. My patient didn't have many overt signs of psychosis, as she'd been in for a while and was medicated. I asked her whether she'd ever heard voices, received instructions from the TV, etc. and she denied it. However when I read her notes afterwards, she'd come in with all sorts of delusions and auditory hallucinations! After the long case, the examiner gave me some excellent feedback. He said that the questions I asked the patient were at the expected (medical student) level, but my interviewing style was more advanced. He said I'd fit in very well in Psychiatry. It was really nice to hear and I was a happy camper for the rest of the day!

The exam was a couple of days ago - 60 multiple choice questions. Some of the questions were easy, some ridiculous, many tricky. A lot of the questions had several reasonable options to choose from - for example: Naked man on a farm, talking to himself - what's your first step? Options included establishing rapport, asking if he has weapons, giving him some clothes, etc. We also got the pavlova and Vegemite question that Liz mentioned last year. Anyway, I felt OK about the exam, but I made the mistake of chatting to people afterwards and talking about the questions. I started to get nervous when I realised there were a few I'd stuffed up.

But I passed, and all is good in the world. I'm excited to have a week off! Holiday plans include exercising a lot, learning how to use Photoshop, playing with my camera, getting my recipe collection sorted and trying out some new recipes, working (my clients have saved up a lot of work for me because I've been unavailable while studying for exams), giving blood, watching lots of TV (the list includes Arrested Development seasons 2 and 3, Mad Men seasons 1 and 2, Scrubs season 7, Dollhouse, Brothers and Sisters season 3...), and playing my poor neglected violin.

GP rotation is next. I suspect I will be bored. Hopefully I'll get a chance to do things (e.g. procedures, examinations), instead of just sitting there watching the GP at work. I still don't know where I'm going for my rural or urban placements - apparently we'll hear about the rural placement this week.

Also - I submitted my preferences for internship. They're due on 1 June, so I've got time to change my mind, but I'm happy with them for now. Exciting! We find out on 20 July.

Holidaying and tweeting

So much for my resolution to post more on my blog!

I finished my elective back in Hanoi with O&G. It was certainly eye-opening (and eye-watering - brutal episiotomies!) but I found it quite frustrating and dull. Only one of the doctors spoke decent English, and he wasn't particularly interested in teaching or showing me around, so I often found myself at a loose end. And while I felt privileged to experience the miracle of childbirth (not first-hand, thank goodness), it got very boring with no-one explaining the finer points of the procedures.


A baby born via Caesarean

I witnessed an abortion that affected me more than I thought it would. The patient had rheumatic heart disease and was not expected to carry the baby to term, so the decision was made to abort the 15-week foetus. The patient had been given some sort of local or spinal anaesthetic before we arrived, but it was clear that she could feel the instruments and was in pain. She was not sedated. A 15-week foetus is about 10 cm long, so the doctors used the instruments to break it into pieces for easier extraction. At one point, a perfectly-formed foot was removed, about 8 mm long. That really got to me. It also bothered me that the doctors pointed out each part of the foetus as it was removed - in Vietnamese and English. The English was good for us because it helped us to learn, but I don't think the patient needed to hear the details. I wish she'd been sedated.

So with my elective finally complete, I made my way to Thailand for a long-awaited holiday! I spent a couple of days in Bangkok and crammed in some shopping and sightseeing, then headed south to Railay Beach, near Krabi. It was perfect - a sleepy resort peninsula only accessible by long-tail boat. It wasn't too packed with tourists, the beach was gorgeous, the sunsets were divine, and the food was delicious. I must admit I was feeling a bit of trepidation about spending a whole week at a beach resort by myself. It worked out well though, and I had a great time doing very little. I didn't realise how tightly wound I was until I started to unwind...


Transparent sea at Phra Nang Beach, on the same peninsula as Railay Beach


Sunset at Railay West Beach

Now I'm back in Sydney, with one more week off before I go back to uni. I start with Psychiatry, which I'll hopefully enjoy, considering I have a Psychology background.

Now to the blog. I'll continue to write here when I have something substantial to say (longer than 140 characters!) or photos to share. Otherwise, cast your eyes to the right and you'll see my Twitter feed. You're welcome to follow my tweets: @pathologic_kt