Track marks

Some events in health just stick in your mind. Obvious ones, like your first Rescus or a particularly abrasive patient, and other, rarer, stranger happenings. Today I was reminded of one such event by a regular patient.

I remember the first methadone patient who was younger than my little sister, half a decade younger than myself. He was a big bloke, in all directions. His knuckles wrote "SINK OR SWIM" and looked as if they'd been trying as much in dirty fuel. He had wisps of blond facial hair around his podgy babyface and better teeth than most opioid-dependant folk. Blond hair straggled from under his baseball cap and the glimmers of gang ink snaked towards his throat.

Despite his size and intimidating looks, He was timid, shuffling nervously like a naughty-schoolboy. I think that's what drove me to look at his age. He was old enough to be in Grade Eleven.

He didn't have a successful run on the program; only two monts later he disappeared, and I never saw him again. I hope he went back on the program; he has such a long time in which to change things for the better. For those few weeks, he was on a better track. That was five years ago.

Dr Shiner

My earliest memory of a doctor is Dr Shiner. I was in preschool with his daughter, and I remember visiting his office, walking up the dark-red brick stairs of his Coogee office, tightly holding my Mum's hand. My little brother was, I think, getting his two-year vaccinations. I was nearly four.

RICE vs. Not Safe For Work

Browsing through some bicycle forums a few days ago, I read a pretty hefty rant about a poster neglecting to label an image NSFW. The image was a pretty slick single-speed held aloft by a bare-chested woman. The debate ironically continued about whether there was a big difference between looking at 'bike porn', or 'soft porn' as a productivity aid.

Of course, NSFW can be taken in another (albeit rare) context. We can all think of people who aren't very good at their jobs. In Medicine and Pharmacy, these practitioners are actually Not Safe For Work. There are numerous reasons that someone might be unfit for practice, but as students the reason we're most familiar with is someone who's incompetent, can't pass exams and just doesn't get it. This level of potentially unsafe practice is usually under the control of the University or Medical Boards, and by and large, they do it well.

The next step above NSFW is the DNR list. That's Do Not Refer. A person, who through their skills, knowledge or interpersonal manner, you personally deem unworthy of any referral.

At the other end of the spectrum are the kind of Doctors (and Pharmacists) we rave about. The General Practitioners who, if pushed, you'd see yourself, and the Specialists and Surgeons whose opinions you'd seek for yourself or family. These doctors, as far as a student's interaction goes, are keen to teach, excellent team-players and knowledgeable seemingly beyond comprehension. Dubbed as Referred In Clinical Excellence (RICE), these folk are the staple to any medical professional network.

As final exams approach, I've overheard chatter about personal DNR and NSFW lists, and plenty of talk about RICE. In the meantime, most of us hover on a middle ground, ans the next few years of experience and work help define our skills as DNR, or hopefully, as part of RICE.

Med School Hits

This coming week, I'm in anaesthetics. It's a part of the Critical Care rotation which, thus far, hasn't exactly set my heart on fire. However, in the spirit of avoiding negativity or 'letting the man get me down', I'm going to share my top ten songs for Med School.

Not necessarily my favourite songs of all time, just ones that remind me of certain parts of Med School. The ones that refresh and conjure up some salient moments burned deep into the brain, the kind that both shape and describe what, for me, Med School is all about.

10. For You - Sarah Blasko. The first track on her album, "What the Sea wants, the Sea will have" went hand-in-hand with Curry nights. As Batman, Wonderwoman discussed Politics, Medicine and Literature as I tried to whip up creations that would both inflame and satisfy tongues and stomachs.

9. Fireflies - Owl City's catchy and absurdly over-played hit reminds me of Birth. Not mine, obviously, but the half-dozen catches and many more I watched whilst Obstetrics and Gynae earlier this year. The optimistic child-like tinkling electronica crosses between medical devices and babytoys.

8. Someone Else's Town - Josh Pyke. Sitting on a park bench in Sa Pa, Viet Nam during my first year Med elective, I watched the cool night encompass the valley. The 2007 Australian Election Night raged, on some far-off frequency. Aware of the occasion, but not the details, I instead observed evening life in Sa Pa. Ensconsed in Pyke's Memories and Dusk and relative serentiy of rural Viet Nam, I was truly watching someone else's town.

7. Three MCs and One DJ - Beastie Boys. It's only since I've been in Med School I've begun to truly appreciate the Granddaddies of Rap. After taking the time to actually listen to the lyrics, combined with their B-boy beats, my taste for the New York trio just flourished. Their 'To the Five Boroughs" album was on regular rotate through first year, when Med School was all about wading through large amounts of input to make sense and get the underlying vibe, not unlike the music itself.

6. Life In Technicolour II - Coldplay. The Prospekt's March EP featured heavily on my morning commute last year. Chris Martin's dominating and uplifting opening bars made driving through dew-covered cane fields half an hour after sunrise the best substitute for morning coffee one could wish for.

5. Please Forgive Me - David Gray. Remeber that scene from the Scrubs pilot, with JD standing in the Emergency Department at midnight, just out on his feet with everything rushing around him. It's supposed to engender a sense of exhaustion, of being overwhelmed. Watching that scene sets my heart on fire. It stirs something that makes me think, every time that I watch it, how much I'm looking forward to life in Medicine.

4. I am the Highway - Audioslave. For most of the last four years, I've worked some long, long shifts at the Pharmacy. This song, on a late night drive home, reminds me to pace myself both mentally and physically. Chances are, I'll have an early start the next morning and with the bare minimum of sleep, I'll be okay. And the riffs are epic.

3. Spirit - Moby. The entire B-Sides of Play appeared on my iPod at the end of Med1. The mix of deep, soulful melodies and swelling & inspiring surges make this an ideal travelling album. Spirit is one of those tracks that just makes my heart soar; it was playing when I checked my first year marks in a dingy Indian internet cafe, and the sensation of achievement and promise still hits me each time I hear it.

2. It's a long way to the top - AC/DC. This February, a visit to Fremantle Gaol re-introduced Bon Scott et al. to my eardrums. A Hospital Variety night on the eve of Pediatrics saw several department heads 'rocking out' to the bagpipes and a room full of moshing healthworkers. Seeing the consultants, at the top and enjoying it, refreshed that yeah, it's a long way to the top of a chosen specialty, but getting there (and staying there) is rewarding and fun. Are you ready to rock?!

1. Teardrop - Newton Faulkner's cover of Massive Attack. Most Medicals TV aficionados well know Massive Attack's Teardrop as the House MD theme song, but where the original is slick, shiny and a bit high-fa-looting, Faulkner's spin is raw and basic. A fine balance of cautious inspiration, the song lets us know we're both "stumbling in the dark" and "fearless on my breath". As the music swells, where Massive Attack's original is sad, Faulkner's Teardrop inspires and rejuvenates, without hiding the message. This song is, for me, what Med School is all about;


Introductions

Textbooks, as we know, can be both goldmines or empty shells. They can be full of biblical prose, disjointed, ambiguous, verb-less sentences of verbosity, or witty, concise, razor sharp and, most importantly, informative.

We're familiar with the cinematic line "open your books and turn to chapter...", or "we'll start at page...". In the world of academic texts, this is often the way. We pick up the tome with a question in mind, flick first to the index and then directly to the focus of our attention. Be it to describe the conflicting pressure gradients of the nephron, or the capital of Kazakhstan, we seldom languish in the remainder of the text.

Recently, I've made an effort to read the first few chapters of a textbook, particularly the introduction. I suspect that this is primarily because I'm reading specialty texts, and I'm keen to learn the basic approach. That is, how the author (and by extension, their specialist colleagues), approach their field.

How strange that, after nearly eight years of tertiary education, I'm reading books with fresh eyes. Not the fact-seeking ruthlessness of exam-study precision, nor the trivial style of someone looking for a tidbit to impress their consultant. Instead, before diving headlong into the finer points of the Pathologic Basis of Disease for another round, I'm trying to see how Drs Kumar, Abbas and Fausto think about their field.

Pointedly, page 2 of the Oxford Handbook of Clinical Medicine tells us;
"Decision and intervention are the essence of action: reflection and conjecture are the essence of thought: the essence of medicine is combining these realms in the service of others."