Plan
Thursday, February 26, 2009
1. History of Presenting Complaint
2. Past Medical History and Systems Review
3. Physical Exam
4. Impression
5. ...
2. Past Medical History and Systems Review
3. Physical Exam
4. Impression
5. ...
Homesick
Wednesday, February 25, 2009
Do you think, perhaps, that it would be possible for a man of ninety to becomeI sometimes get homesick. It's not a debilitating kind of homesick, more the creeping, grumbling kind. The kind that dawns on you when you least expect it. When you think, "Gee, I really miss my fam right now. I wonder what they're doing? I wish I could just have dinner with them all."
homesick?
When I first moved away to uni (way back when), I got homesick for the place itself. I wanted to be in my old room, walk around my house and have that 'home' feeling. Over time, that became an idea; you can't simply recreate the past.
I got busy with uni and had a whale of a time and didn't think too much about home for 99% of the time. I had a plan and I knew what I had to do, and just now and then, I'd actually get home to see everyone and, well, be home. Uni was my 'real life'.
After graduation, I moved to Oz. It, too, was 'real life'; the first year I went home more than a few times to visit, and things stayed much the same to uni. Since starting medicine, I've been home for fewer than ten days in the last three years.
Sure, I've had visits from my parents and siblings and been interstate to visit extended family, but, well, there's something about sitting around the dinner table with my nuclear family.
Which is what the gentleman quoted at the outset of this post missed. His family, his surroundings. His 'real life'.
Qs and Os
Tuesday, February 17, 2009
I became aware of the whole 'medicine' thing aged about sixteen. Before that, when I was sick, I saw a doctor. Now and then my family might have to see a doctor, or even go to hospital, but I wasn't really aware of what all that was. I mean, I knew that they got better, and without some medical attention something bad would happen, but I, well, I hadn't much of a clue.
I know that it was when I was sixteen for several reasons; being an atopic kinda guy I'd had plenty of interactions with the medicos, inhalers this, allergies that, but really only knew about what was wrong with me. When I was fifteen, I remember having shingles. Big yellow pustules on my elbow. And I saw a doctor. And they went away. And I had no idea how or why. I just had the scars from scratching the hell out of them. Aged sixteen, I went on 'work experience' to the local hospital with my friend's father.
On day one I showed up, all excited and shiny, in a pair of pants I'd borrowed from my Dad, looking forward to learning about becoming a doctor. First up I was shown how to wash my hands. Then it was explained that the ward we were going to was a 'quiet zone' but that there was a lot of (rightly) worried friends and family and that it was not a place for a young man to muck around.
I was taken to the ICU.
It was precisely at this moment that my 'informal' learning of medicine began. We went into the fishbowl and the doctor told me, quietly and lightheartedly, about the three types of patients on the ward.
Now, ten years older, I can see where the doc's humour came from. I can appreciate it's dryness and pithy cynicism without offense. So can most people who watch Scrubs.
But, through my repulsion, I remembered the doctor's words. In fact, whenever someone mentioned the ICU, the O-Q-SpottedQ story would pop into my brain. I even came to think of it as some sort of initiation story, a 'Welcome to the team, kiddo, it's not all Roses here.'
Anyway, over the last week or so I've been trundling though Shem's House of God. Several of my friends are 'saving it' for Intern year. Others told me not to read it whilst on my Internal Medicine Rotation, and I understand why. It's not what I'd call a wholly optimistic book, and whilst I no longer have the sheer naievety as when I first strolled into ICU, aged sixteen in daddypants, I hope that it's a long, long time before I get that cynical about medicine.
But, crikey, I can see how it spelt out the feelings of an entire a generation of doctors. And I can sure as eggs see some of the remaining artefacts of paternalistic medicine each day on the wards. Not just from docs, or nurses or allied health, but from patients who still believe in it.
Anyhoo, just after the Fat Man describes the importance of Finesse in medical care, is the book's only illustration;
.
I know that it was when I was sixteen for several reasons; being an atopic kinda guy I'd had plenty of interactions with the medicos, inhalers this, allergies that, but really only knew about what was wrong with me. When I was fifteen, I remember having shingles. Big yellow pustules on my elbow. And I saw a doctor. And they went away. And I had no idea how or why. I just had the scars from scratching the hell out of them. Aged sixteen, I went on 'work experience' to the local hospital with my friend's father.
On day one I showed up, all excited and shiny, in a pair of pants I'd borrowed from my Dad, looking forward to learning about becoming a doctor. First up I was shown how to wash my hands. Then it was explained that the ward we were going to was a 'quiet zone' but that there was a lot of (rightly) worried friends and family and that it was not a place for a young man to muck around.
I was taken to the ICU.
It was precisely at this moment that my 'informal' learning of medicine began. We went into the fishbowl and the doctor told me, quietly and lightheartedly, about the three types of patients on the ward.
Os have their mouths open;I remember being shocked and a bit repulsed. And confused. How could this man, who I'd known for years as kind and caring and gentle, express such flippancy about patients, even as a joke.
Qs have their tongue out;
Spotted-Qs are very rare. They have flies on their tongue.
The aim is to stop the Os turning into Qs and the Qs into Spotted-Qs.
Now, ten years older, I can see where the doc's humour came from. I can appreciate it's dryness and pithy cynicism without offense. So can most people who watch Scrubs.
But, through my repulsion, I remembered the doctor's words. In fact, whenever someone mentioned the ICU, the O-Q-SpottedQ story would pop into my brain. I even came to think of it as some sort of initiation story, a 'Welcome to the team, kiddo, it's not all Roses here.'
Anyway, over the last week or so I've been trundling though Shem's House of God. Several of my friends are 'saving it' for Intern year. Others told me not to read it whilst on my Internal Medicine Rotation, and I understand why. It's not what I'd call a wholly optimistic book, and whilst I no longer have the sheer naievety as when I first strolled into ICU, aged sixteen in daddypants, I hope that it's a long, long time before I get that cynical about medicine.
But, crikey, I can see how it spelt out the feelings of an entire a generation of doctors. And I can sure as eggs see some of the remaining artefacts of paternalistic medicine each day on the wards. Not just from docs, or nurses or allied health, but from patients who still believe in it.
Anyhoo, just after the Fat Man describes the importance of Finesse in medical care, is the book's only illustration;
.
By Popular request, here are the answers to Round Two of The Pimpin' Quiz.
- Danger, Response, Airway, Breathing, Circulation, (plus, automated Defibrillator if available)
- Timentin contains Ticarcillin & Clavulanic Acid
- Meig's Syndrome, according to the Oxford Handbook of Clinical Medicine, is the triad of a pleural effusion, benign ovarian fibroma (or thecoma) and ascites.
- Rugby Union for the Springboks and Sharks (Super 14) at Flyhalf (First five, for you Kiwis)
- Left Anterior Hemiblock, Inferior MI, Ventricular Tachycardia from a Left Ventricular Focus and Wolff-Parkinson-White Syndrome. Thanks OHCM.
- B-Cells are the most common cell line from which Lymphoma occurs.
- Six Neuro/Psyche differentials for syncope could include Hyperventilation syndrome, Hydrocephalus, Migraine headache, Narcolepsy, Panic attacks, Seizure disorder, Stroke, among others. From eMedicine, it's gold.
- Escherichia coli is the most common causative organism in UTI.
- It's implied he's an alcoholic; 'Xanthias: "What's that they're trying to make you say, Dercylus? Dipsomania!" ' Aristophanes' The Wasps (translated by David Barrett, 1964, Penguin), 422BCE
- Diltiazem is a Benzothiazine Calcium Channel Blocker.
- I've just asked for an Anti-CCP titre for a patient, because I suspect Rheumatoid Arthritis
- Narrow complex tachycardias have an ECG rate of greater than 100 bpm and a QRS complex duration of less than 120 ms.
Wispy Ends.
Friday, February 13, 2009
An issue the wispy bits of my conscious have managed to identify past the glaring headlights occupying the central vision are the end of life issues associated with modern medicine. Gee whiz, you say, who wasn't aware of those. But, well, it's different seeing so many scenarios play out at once.
Issues that involve gulity children trying to 'do everything' for their demented and dying parents, in order to compensate for years of detachment. Issues that involve discordance between carers, parents and patients. Issues about patients endangering themselves and their loved ones.
Thankfully, it's not bleak like The House of God; in the last thirty years both doctors and society has become generally more understanding of the now medically controlled end of life passage. But, 'society as a whole' can't account for each individual case, and the phrase itself has an odd detachment to it.
Look, what I'm getting at is that whilst end of life issues creep up you sporadically in everyday non-health life, they sure as eggs jump out at you every single day on the wards. Not surprisingly, the people who deal with it every day know what they're doing, and how to differentiate and nut out the vital differences between patients and their situations.
A month or two ago, the Engage With Grace project was the subject of a 'blogrally' at numerous popular blogs, medical or otherwise. Take the time to answer the five simple questions on the card, and tell someone about it. Tell your kids or your parents, tell your sibilings or your grandkids. Just make sure someone knows. There's no reason to die without someone knowing how you want your end of life care managed.
Death moves in odd ways; sometimes
you might see it a mile off, creeping,
sidling up to someone. First death, taps them
on the shoulder and darts quickly away.
Or, death will tickle their arm, or gut, or lungs and watch them squirm.
Or, death will hang around, wafting over someone's shoulder, cold.
Or, death will slap someone hard. Too hard to live. And they are gone.
Or, death takes half a brain here, a lung there, and we bend and flex.
Or, death's auspices of peace float in the eyes, make the head swim,
and breaths shorten, and mouths suck.
Then breath is no more.
And footsteps rap
round the corner
and away.
.
Up until yesterday, rounds was an excellent chance to feel like a dumb-ass. Then something happened; I got things right. Not just one question, a whole line of questioning. It only happened the once, the rest of the round was typically challenging, but hell, I smoked Aortic Stenosis and Sclerosis. I'd studied it a few days earlier, and dead-set retained the knowledge, and knew it well enough to confidently rattle it off. Booyah. Then the consultant quizzed the reg about HLA-B27 and my eyes glazed over.
After lunch, I went to see the rheumatologist for clinic. It was easily the most intense teaching I've had so far. Manily because I was introduced thus;
Dr: "Today we have Dr. Atopic with us. He's going to look at your hands and tell you exactly what's wrong with you."
Pt: "Wonderful, I've been waiting for a proper diagnosis for twelve years."
Me: *gulp*
The teaching was direct, understandable, decluttered and well, memorable. It's nice to have several presentations not only drummed into your head by an insistent clinician, but also to be staring at typical said presentations. Plus, I got asked about HLA-B27; it turned out I had been listening earlier.
After lunch, I went to see the rheumatologist for clinic. It was easily the most intense teaching I've had so far. Manily because I was introduced thus;
Dr: "Today we have Dr. Atopic with us. He's going to look at your hands and tell you exactly what's wrong with you."
Pt: "Wonderful, I've been waiting for a proper diagnosis for twelve years."
Me: *gulp*
The teaching was direct, understandable, decluttered and well, memorable. It's nice to have several presentations not only drummed into your head by an insistent clinician, but also to be staring at typical said presentations. Plus, I got asked about HLA-B27; it turned out I had been listening earlier.
Applequack.com : Voting is now open Australian Medical Blog Awards
Tuesday, February 10, 2009
Straight From Dr. Cris @ AppleQuack.com...
Click here to vote!
Polls are now open for the Australian Medical Blog Awards, sponsored by sitepoint.com. The aim of the awards is to promote quality medical blogging by Australians and foster a community of bloggers that rivals the international scene.
The winner stands to win a package of top web coding and design books from SitePoint.
- Build Your Own Web Site The Right Way Using HTML & CSS
- The Principles of Beautiful Web Design
- Build Your Own Database Driven Website Using PHP & MySQL
Those who are blogging might like to check out some of SitePoint’s more interesting tutorials Learn HTML and CSS: An Absolute Beginner’s Guide, Video: An introduction to CSS or Master SEO Keywords: Give your site the kickstart it deserves!
Drumroll…..
The list of nominees has been scrutinised by a team of international experts and they have selected a shortlist (in alphabetical order):
Congratulations to all the nominees, and those who made the short list. Voting is open to everyone - you need not be Australian, you need not be medical, you just need to have an opinion. Polls close on the 20th of February, so get your votes in before then.
If you didn’t make the short list, you have 12 months before the second Australian Medical Blog Awards is launched.Click here to vote!
Nouvelles photographies. De l'Europe. Voila!
Monday, February 9, 2009
It's been quite a while since I've put any original photos up. I'm still getting my head around my new phone/camera combintation. These, however, were taken last November & December...
Aeroplane trails through the London Eye.
Sunset on the Somerset Line, ex Aquae Sulis.
London Bridge.
A fresh Parisian morning on the Right Bank.
Snow-covered tree, Interlaken.
Lights, Palazzo Labia, Venice.
Cathedral belfry, Sienna, Italy.
Amphitheatre, Pompeii.
Batman vs the hordes, Pompeii.
Steps en route to Pantheon, Rome.
Aeroplane trails through the London Eye.
Sunset on the Somerset Line, ex Aquae Sulis.
London Bridge.
A fresh Parisian morning on the Right Bank.
Snow-covered tree, Interlaken.
Lights, Palazzo Labia, Venice.
Cathedral belfry, Sienna, Italy.
Amphitheatre, Pompeii.
Batman vs the hordes, Pompeii.
Steps en route to Pantheon, Rome.The Pimpin' Quiz; Round 2
Saturday, February 7, 2009
Welcome to The Pimpin' Quiz; Round Two. It's Pot Luck again this time, don't forget the prize of a snappy, individualised Pimpin' Quiz Winner award for your sidebar.
The same rules as last time apply, with one change; the quiz will close at 10am QLD time next Friday, 13th Feb. Just pop your answers in the comment box below!
Ready to roll, team?
- What does the R in DRABC stand for?
- Which medications are in the Timentin(R) preparation?
- The triad of a pleural effusion, benign ovarian fibroma (or thecoma) and ascites is known as?
- Henry Honibal played what for whom?
- Name four causes of left axis deviation on ECG.
- Which cell line is most often implicated in Lymphoma?
- What are six Neuro/Psyche differentials for syncope?
- Most common causative organism in Urinary Tract Infection?
- In Aristophanes' The Wasps, what malady is Dercylus implied to suffer from?
- Diltiazem is specifically what kind of medication?
- I've just asked for an Anti-CCP titre for a patient, because I suspect which disease?
- Narrow complex tachycardias have an ECG rate of greater than ... bpm and a QRS complex duration of less than... ms?
Game on.
Yesterday after I got home, I hit the beach with a couple of mates. The wind was up and the waves were a bit choppy, but we went out to the sandbar, about 40 metres from shore.
The beach is an ocean beach, complete with breaking waves, surfers, swimmers, sometimes lifeguards and rips.
We were trolling around on the sandbar, quite aware of being sucked this way or that, and doing the usual 'playing in the waves' routine. The water, between waves was around shoulder height.
I felt the current sucking us to the left, and we'd seen the rip there from the shore. I waved to the other guys and we swam a good thirty metres to our right, back in line with the lifeguard tower that marked where our stuff was.
Now, as you might have guessed, I'm pretty freaking blind. As in, my glasses are strong. Most people don't need to mark where they've left their stuff with a thirty-foot high tower. Since glasses and surf beaches don't mix, I leave mine up on the sand, placed inside my shoe, (that safest fo beach hideaways).
On the flipside, I'm a strong swimmer. I played several years as a waterpolo goalie, did some semi-competitive swimming and lifesaving and that sort of thing. I've been ocean swimming blind for quite a while, including bodysurfing. I still remember my Mum teaching me to "Never turn my back on the ocean", aged about three.
Last night, though, the current was strong. It sucked and pulled this way and that. The waves got a bit bigger, and the three of us got a bit uncomfortable. The light was fading for the day, and the wind picked up.
We were being sucked right. Then the sandbar stopped, dropped and disappeared. All three of us were caught out of our depths. We put in a few hard strokes, and the Leprachaun made it back in. The two of us remaining were quite a bit further into the rip.
As taught, we both tried to swim out the side, despite the strong current getting stronger. After a few minutes of hardg swimming, Sgt. TriN managed to stand up at waist deep. I was about five meters behind him, still in the current.
Six brisk strokes. Can I feel the bottom? Yes.... wait. I can't hold it... damn.
Ten strong strokes. There's the bottom. Whooops. The current's got me again.
Ten more strong strokes. "Little help dude!" Sgt. TriN's big mitt comes out and hauls the last meter to the sandbar and my feet. The sand feels sliding and loose, but my feet hold fast and knees buckle only slightly.
We trudge back in, breathing deeply. Contemplating. Not talking. We can still feel the suck around our knees, then around our ankles, then around our toes. We were exhausted, but we were safe.
--
The whole experience scared the hell out of me. I've always been respectful of the ocean's power, and I'm not one to go diving into a surf beach without sussing out where's safe and where's not. What really caught me out was how quickly the channels chopped and changesd and, I guess, the small margin for error the surf affords. It also unveiled some harsh differences between swimming whilst feeling fresh as a daisy on a Saturday morning versus clagging around in the surf after a stupidly intense working week. I found myself a few more tips on Beach Safety, too.
The beach is an ocean beach, complete with breaking waves, surfers, swimmers, sometimes lifeguards and rips.
We were trolling around on the sandbar, quite aware of being sucked this way or that, and doing the usual 'playing in the waves' routine. The water, between waves was around shoulder height.
I felt the current sucking us to the left, and we'd seen the rip there from the shore. I waved to the other guys and we swam a good thirty metres to our right, back in line with the lifeguard tower that marked where our stuff was.
Now, as you might have guessed, I'm pretty freaking blind. As in, my glasses are strong. Most people don't need to mark where they've left their stuff with a thirty-foot high tower. Since glasses and surf beaches don't mix, I leave mine up on the sand, placed inside my shoe, (that safest fo beach hideaways).
On the flipside, I'm a strong swimmer. I played several years as a waterpolo goalie, did some semi-competitive swimming and lifesaving and that sort of thing. I've been ocean swimming blind for quite a while, including bodysurfing. I still remember my Mum teaching me to "Never turn my back on the ocean", aged about three.
Last night, though, the current was strong. It sucked and pulled this way and that. The waves got a bit bigger, and the three of us got a bit uncomfortable. The light was fading for the day, and the wind picked up.
We were being sucked right. Then the sandbar stopped, dropped and disappeared. All three of us were caught out of our depths. We put in a few hard strokes, and the Leprachaun made it back in. The two of us remaining were quite a bit further into the rip.
As taught, we both tried to swim out the side, despite the strong current getting stronger. After a few minutes of hardg swimming, Sgt. TriN managed to stand up at waist deep. I was about five meters behind him, still in the current.
Six brisk strokes. Can I feel the bottom? Yes.... wait. I can't hold it... damn.
Ten strong strokes. There's the bottom. Whooops. The current's got me again.
Ten more strong strokes. "Little help dude!" Sgt. TriN's big mitt comes out and hauls the last meter to the sandbar and my feet. The sand feels sliding and loose, but my feet hold fast and knees buckle only slightly.
We trudge back in, breathing deeply. Contemplating. Not talking. We can still feel the suck around our knees, then around our ankles, then around our toes. We were exhausted, but we were safe.
--
The whole experience scared the hell out of me. I've always been respectful of the ocean's power, and I'm not one to go diving into a surf beach without sussing out where's safe and where's not. What really caught me out was how quickly the channels chopped and changesd and, I guess, the small margin for error the surf affords. It also unveiled some harsh differences between swimming whilst feeling fresh as a daisy on a Saturday morning versus clagging around in the surf after a stupidly intense working week. I found myself a few more tips on Beach Safety, too.
The Pimpin' Quiz; Round 1 Winner is...
Friday, February 6, 2009
Okay all, time's up and we have a winner. Here are the 'official' answers, as put together by the marking board;
- Phenytoin - This was my first Pimp question from a new consultant. I looked it up. So did you.
- Viral is most common, then uraemia, then either SLE, MI, trauma or malignant
- Hodgkins' Lymphoma
- Angina
- CFTR gene
- George Lazenby; he's an Aussie, too.
- Degeneration of Articular Cartilage
- Shane Smeltz of the Wellington Phoenix
- Hydroxydaunorubicin or Doxorubicin also remembered as the 'Heart-toxic' anthracyclines
- Any of Pituitary Adenoma, phaeochromocytoma, iatrogenic/drugs, carcinoids, small cell lung cancer, medullary carcinoma or prostate carcinoma.
- Glossitis and Angular stomatitis
- Sturge-Weber syndrome; a type of brain hemangioma which results in a port wine stain of the face and contralateral focal fits.
Pimpin' Quiz; Round 1
Tuesday, February 3, 2009
Pimping - v. the act of singling out one person of the group and testing their knowledge by asking them a series of intense, difficult questions in front of everyone. - Urban Dictionary
I had a think about my previous post and I've decided in celebration all that is pimping that I'm gonna start posting a 'Pimpin' Quiz'. I'll try to make it a regular thing, say, once a fortnight-ish. There will be a prize of a special wee logo (as above) that'll certify that you, personally, got properly pimped by yours truly. It'll be small enough to chuck in your sidebar, too. I hope no one's blogging under the name Stevens-Johnson.There are only a few rules;
a) Submit your entry via commenting below the quiz.
b) You get one crack at the dozen answers.
c) Entries will close 60 hours after the post. If no-one gets all ten, then I feel like an uber-nerd.
d) If I get slack I may or may not put more pharmacy questions in than is absolutely necessary. Deal with it. It's what I get pimped on too, y'know.
e) There will always be two 'pot-luck' questions. Just to push the importance of the whole work/life balance thing.
f) I'm writing the questions with my references in hand. If you like yours better, I'm open for good-natured debate. It's a cool logo, I know.
g) Answers should be short. Like a word or maybe ten if you're in 'essay mode'.
This stuff isn't designed as elitist, although it's supposed to be pretty freaking hard in bits. Anyone can have a crack, and should; the answers are all out there somewhere. The first comment with all twelve answers correct will win the logo! Huzzah!
Round 1:
1. Which anticonvulsant can cause Lymphadenopathy?
2. What is the most common cause of Pericarditis
3. A Reed-Sternberg cell is diagnostic of which disease?
4. Perhexiline is used in the treatment of which disease?
5. Which gene is mutated in Cystic Fibrosis?
6. Which actor played James Bond in the film "On Her Majesty's Secret Service"?
7. What is the fundamental feature of osteoarthritis?
8. Who won the 2009 Johnny Warren medal, and for which team did he play?
9. What does the H in CHOP-R stand for?
10. Three ACTH-dependent causes of Cushing's Syndrome are...?
11. Name two key oral signs of Vit. B12 deficiency.
12. Which eponymous syndrome is also known as Encephalotrigeminal angiomatosis?
Game on.
I keep getting homework. It's almost like being back at primary school and learning things all over again.
See, back when I was 9, each week at school we'd have an Alphabet Quiz. For 26 weeks of the year, we'd get a quiz with twenty questions on it, all with the answers having the same first letter. It was, in truth, the birth of my love for trivia, and thirst for 'intellectual' competition. After six or seven weeks, the school Principal would read out a selected 25 questions over the PA, and we'd sit, like the good 8-11 year-olds we were, and answer them. At the end of each year, the pupil from each class with the highest marks would enter into the school Mastermind competition, a ruthless event in front of the entire school, parents, grandparents and neighbours' third cousins. It was an annual battle to the end.
Back in the day, there was no internet or other font of all knowledge from which the answers could be plucked. In order to find all the answers, one needed to be proficient in the use of encyclopediae, dictionaries and maps. First the research, then the recall.
Evidently, I have vivid memories of the thrill of 'recall', but, somehow, deep down in my conscious, I'm beginning to remember that feeling of looking something up and really, well, really feeling that I can use it. If only for the briefest of moments to impress a consultant, or to make a heroic and life-saving decision in later years.
Later on, that primary school trivia really helped me out. At Pharm school I'd hit the pub on a Monday night for trivia, along with five others. In our most successful year, we raked in nearly $1000 worth of bar-tab; at $100 for first, not a terrible haul, really. A few times we won four weeks in a row, which would result in a group shout because, well, crates were only about thirty-five bucks and there's no way six light-weights should drink ten of those. So we'd have a 'free' party at the pub. They'd usually give us free fish and chips before 9pm, too. Not a bad reward for knowing that the R. Hadlee's county team was Nottinghamshire, or that AC/DC's original vocalist was Dave Evans.
This week, the 'trivia' seems just that bit more important. I think. Maybe it's just another form of pissing contest, or some gladiatorial rite of passage. Either way, it's appealing to me, because I'm studying longer and more effectively than the last two years.
Except the bit where you have to keep your gob shut when know the answer. Like at handover when a consultant says to the registrar, "How would you test for Renal Artery Stenosis?", and you're screaming (on the inside) "Oh, oh, oh, pick me... It's like, totally, like, a Renal perfusion study with captopril. I know because we did it last year, and..." but the room is silent. And so are you.
Because deep down, even though you know that answer, not only do you not know the answers to the next six questions, even if you did you wouldn't say, because if you're just slightly wrong you're a little dweeb. And, if you get it word-perfect correct you just made your reg look like a moron in front of his boss, his buddies and the people marking your exam. Bad option, tiger.
So instead, you listen, you learn. And if you don't know it, by gum, you look it up in one of those three books, be it Davidsons', Harrisons', Talley or Bates. And you learn; Research and Recall. It's that easy. Homework time.
See, back when I was 9, each week at school we'd have an Alphabet Quiz. For 26 weeks of the year, we'd get a quiz with twenty questions on it, all with the answers having the same first letter. It was, in truth, the birth of my love for trivia, and thirst for 'intellectual' competition. After six or seven weeks, the school Principal would read out a selected 25 questions over the PA, and we'd sit, like the good 8-11 year-olds we were, and answer them. At the end of each year, the pupil from each class with the highest marks would enter into the school Mastermind competition, a ruthless event in front of the entire school, parents, grandparents and neighbours' third cousins. It was an annual battle to the end.
Back in the day, there was no internet or other font of all knowledge from which the answers could be plucked. In order to find all the answers, one needed to be proficient in the use of encyclopediae, dictionaries and maps. First the research, then the recall.
Evidently, I have vivid memories of the thrill of 'recall', but, somehow, deep down in my conscious, I'm beginning to remember that feeling of looking something up and really, well, really feeling that I can use it. If only for the briefest of moments to impress a consultant, or to make a heroic and life-saving decision in later years.
Later on, that primary school trivia really helped me out. At Pharm school I'd hit the pub on a Monday night for trivia, along with five others. In our most successful year, we raked in nearly $1000 worth of bar-tab; at $100 for first, not a terrible haul, really. A few times we won four weeks in a row, which would result in a group shout because, well, crates were only about thirty-five bucks and there's no way six light-weights should drink ten of those. So we'd have a 'free' party at the pub. They'd usually give us free fish and chips before 9pm, too. Not a bad reward for knowing that the R. Hadlee's county team was Nottinghamshire, or that AC/DC's original vocalist was Dave Evans.
This week, the 'trivia' seems just that bit more important. I think. Maybe it's just another form of pissing contest, or some gladiatorial rite of passage. Either way, it's appealing to me, because I'm studying longer and more effectively than the last two years.
Except the bit where you have to keep your gob shut when know the answer. Like at handover when a consultant says to the registrar, "How would you test for Renal Artery Stenosis?", and you're screaming (on the inside) "Oh, oh, oh, pick me... It's like, totally, like, a Renal perfusion study with captopril. I know because we did it last year, and..." but the room is silent. And so are you.
Because deep down, even though you know that answer, not only do you not know the answers to the next six questions, even if you did you wouldn't say, because if you're just slightly wrong you're a little dweeb. And, if you get it word-perfect correct you just made your reg look like a moron in front of his boss, his buddies and the people marking your exam. Bad option, tiger.
So instead, you listen, you learn. And if you don't know it, by gum, you look it up in one of those three books, be it Davidsons', Harrisons', Talley or Bates. And you learn; Research and Recall. It's that easy. Homework time.
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