When asked to describe the events of our Kokoda Challenge post hoc in two words, Hunter replied strongly;

"UP" and "DOWN"

I reckon he was totally on the money. For the first part of the race we were 'up', for sure, managing to run the first, say, 15kms, and staying in the top 15 teams. We were running the downhills and making great time. It was a beautiful day, not too hot. Our spirits were flying pretty high.

The terrain was not as we'd expected. The part of the course we'd already walked was completely different to the majority. Picture sheep tracks and 4wd tracks that had been gouged deep by rain only days prior, with rocks littered across varying from pebbles to half a brick. Keeping the ankles and knees majorly intact was a mission in itself, and hence smaller injuries were unavoidable.

The course has three major climbs, at the pace we were going, it was one before lunch, one after lunch and one after dinner. The first two were hard bloody slog, and I struggled up 'em at a pretty slow pace by comparison to the rest of the team. After the second hill, all four of us started to show the first signs of injury. No-one broke a leg or fell heavily or anything, just the repeated trauma of walking and running for 7 hours (40+km) on terrain we were unprepared for. We began to slow down quite a bit, but in the light of day, it wasn't so hard to have a stretch, shake it off and compensate by walking differently.

Night fell at around the 50km mark, and we were still making good time, remaining inside the top 40 teams despite having slowed markedly. Torches on and about an hour from dinner, we trudged on to the checkpoint and some warm spaghetti and a good rest.

The next part of the trek was by far the hardest of the event; 18km of night walking including the toughest peak on the course. Once we'd knocked that over, we'd be 30km from home; including 4km of very steep downhill, some road walking, and two short but brutal climbs.

Walking at night, our spirits fell. We were down. The night had closed in and wasn't about to bust into dawn anytime soon. Every single foot placement was precarious. Our aching bodies lurched this way and that to remain upright, moving and safe. There was no telling where the track went outside the 10m of torch-provided visibility and a glow stick some 80m in the distance. The night was young. The night was long.

The full severity of our injuries revealed themselves. One of us was heavily Trendelenberging, and I had reverted to using a stick. Ah, if only we'd not ridiculed those with walking poles all those hours earlier at the start line. All of us were quiet; fighting the battle within as much as the trail and the night without. At a snail's pace, we climbed to the road and checkpoint 9. We were about 5km prior to the major checkpoint, where the support crew, food, drink and possibly a seat were waiting for us. Trendelenberging became sitting, and after a ten minute rest, we were down to three.

We trudged on along footpaths and inched up the climb into the checkpoint. Thanks to my sticks and the nature of my injuries, I was much much faster up the hills than down them. I was at the head of a wounded team. We fell into the checkpoint, two hours behind schedule. It was after midnight; we had 30km to go. We were spent, wasted and down. The three of us had a long talk - about 15minutes - about what to do. Each of us fleetingly expressed a desire to continue, but several factors beat our spirits down. We were going to take about 11 more hours. Could we even last that much longer? I was to be cripplingly slow down the next hill, and the others likewise up them. Up and down.

It was game over.

Batman and Wonderwoman had been the support crew all day. By the time we'd made it back to camp and collected all the gear, stoves, food, clothing and other miscellany, they'd had a 24-hour day. The other guys had fallen asleep about 15 minutes after we withdrew, whilst Batman drove us back to camp. I stayed with her and Wonderwoman in a trance-like state, just to make sure that no-one fell asleep at the wheel. It was 4.30am. Everyone slept in their race gear.

At 9am, everyone was up. We cleaned and packed and made our way back to Brisbane. For sleep.

I'm writing this post four days later, and I've had a few talks with the other guys about what went wrong. There are plans for next year, and by gum there's unfinished business.
We will succeed.

It's Kokoda Challenge time!

It's been quite a while since I've done a true locum shift, but today is it. I'm filling in for a friend who's having a long weekend.

Locum is a shortening of Locum Tenens, which translates literally as 'place holder'.

A locum shift can be great fun; it's a good chance to meet some new people and patients and everyone's usually very helpful and makes you feel more than welcome. Also, you're not expected to know all the ins and outs, so you get cut some slack; just dispense without mistakes, counsel new medications and write in the controlled drug book. If you're so inclined, you might read the paper (I'm not a fan of this; I'll elaborate more later) or maybe have a wee browse on the internet. Good times, really.

The flipside, of course, is when it turns to shit. The shop assistant is late. The alarm code is wrong. The computers won't start. You've got methadone clients baying for your blood because you used too much orange cordial. Your shop assistants are morons. The EFTPOS craps out. The manager hasn't left you an emergency phone number. You do 300 'scripts. Before lunchtime.

Luckily, today has been the former; I love my job.

Whilst several of my colleagues have been at the annual AMSA conference in Melbourne, this week has been a good chance to not only indulge in some relaxation, but also to catch up with my family. Tonight, my grandfather regaled me with the following story that is at least fifty years old;

"I remember, when I had just finished university, I was at the local hospital for some operation or another, and my friend was a first year house officer .

He came to me, just to say G'day, but in passing mentioned that the chap in the bed next to mine was displaying some very odd symptoms and he couldn't work it out. The chap had been in for nearly a week and they were stumped.

The next day, I had the answer. At around 1am, there had been a rattling below our window, and the chap next to me had woken with a start. He'd clambered to the window and grabbed a piece of string and hauled up a bottle of whiskey. By the morning the whiskey was well drunk, as was the chap, his symptoms having returned."

This reminded me of an excellent anecdote from the preface of the first edition (1985) of the Oxford Handbook of Clinical Medicine (my current favourite)...

One should not miss alcohol withdrawal as a reason for post-operative confusion.

Peaceful, fresh Autumn.
Stop! Cease! Desist! Go away!
I am not alone.

In two weeks, I'll be either on or recently finished the Kokoda Challenge; all the planning is done, and the rest of the team and I have made our minimum donations (read: entrance fees). It's just a case of stretching out the legs regularly and taking it easy up 'til then. There's been some talk of carbo-loading. I'm inexperienced in these matters, but I guess it equates to doing a wee bit more than having a bowl of spaghetti the night before. Mmmmm. Spaghetti.


As you may have guessed, this post isn't really about Kokoda. It's about a guy in my class who has twice now weirded me out just a little bit too much.

The first 'incident' was last year during an antomy prac. It was the first prac in the year where we were able to do actual human dissection, and hey put this prac far enough into the year that people who are generally a bit soft and/or get queasy with the rawness of cadavers have had time to adjust before actually slicing someone up, and there's no actual compulsory cutting. Just give it to the baby-surgeons in the room.

I had joined another group because I had to work at the time my group was doing the prac, so I had been slotted into this one, and didn't really know anyone. The demonstrator was indicating correct technique on the cadaver's thigh, being the area of focus for the prac, and at this point it's all pretty normal stuff, ie. don't go to deep, take it in steps etcetera. I notice out of my eye, that one of my classmates, whom I've noticed before but never heard speak, is touching the cadaver's nipple. With his scalpel. He's flicking at it, trying to lift it up and see what's underneath. He does this for a full five minutes, before being asked a question by the demonstrator. He shrugs his shoulders indicating that not only does he not know the answer, he also doesn't want to speak. The prac finishes and I think 'Weirdo!'

Fast forward to Tuesday. The groups have of course been reshuffled, and whilst I don't share a group with Nipple Guy, we now are in the same Pathology Tute of about 45 people. He was teamed up with three mates of mine for an practice quiz that was to last about an hour. They'd not met him before, nor had I told them the story I've mentioned above. Anyhoo, as one does, one of my friends introduced herself. Here's how the conversation went:

Spidergirl: "Hi, there, I'm Spidergirl".... extends hand.
Nipple Guy: "Hi, I'm Nipple Guy". Shakes hand, awkwardly.
Spidergirl: "Cool, nice to meet ya. This is Flash Gordon and Wond..."
Nipple Guy (interrupting) "Look, I don't think introductions are necessary for just one tutorial."

Okay then. Eyebrows are raised, and the quiz begins. At the first station, Wonder Woman isn't certain about the answer to a question and she asks Nipple Guy if he know the answer. He repeats the information in a direct manner. Not in the "hmmm, I'm thinking" kind of way, more in the "It's this." kind of way. The answer stays the same, no stress. At the end of the station, a meagre ten minutes into the quiz, Nipple Guy quietly walks out.

I don't know what's going on with Nipple Guy, but it's pretty unfortunate that he doesn't appear to have anyone in the class he talks with regularly. I appreciate that it's not always easy to chat to new people in a class of 400+, but seriously, we're more than 18 months into the course. Safe to say, if he's such a hoplessly ineffective communicator now, he's gonna get torn limb from limb by the nurses and consultants in the clinical years.

Already a week into the second semester, I've got three things to say today;

Firstly, the case for this week was Drug Overdose. It focussed on a bunch of harm minimisation therapies and other behavioural, social and pharmacologic therapies. One such therapy mentioned was the methadone programme. I'm well familiar with methadone/subutex etc through work, and most of the intricacies of being on the programme. I was staggered to find out what they consider a success rate. Here was me thinking that a an average methadone patient might use heroin (or other IV opioids), say, two or three times a year. Turns out that a 'success story', would be someone who uses about once a fortnight. I've discussed this with some other pharmacists, and they reckon they're being had. By comparison, all the med students were thinking "Gee, that's not bad." After a bit of consideration, I realised that I shouldn't be as shocked as I initially was, after all, the first maxim of pharmacy is "Never trust a junkie."

Secondly, a big shout out to a guy called Dion Lane. I've never met him; I watched him on ESPN's lumberjacking series last week, and he was the only Kiwi in the comp. He blew the competition away and set a few world records. He's obviously a big man with a big heart. Purely by coincidence, he also appears in another blog I read regularly; Depth of Field. Random. Awesome.

Finally, I've been reminded by one of the Medical Misadventures about a curious sighting at Airlie Beach. The first thing I noticed was that there was a 2006 BMW 325 in the carpark of the backpackers. Possibly, it belonged to the owner, but no, it had Tasmanian plates. And it was filthy. And it had a Jesus fish across the back windscreen. And shirts and ties hanging in the window. Maybe a traveling salesman, I thought? Still, unlikely at the backpackers.

Eventually, I caught sight of the owner, and it all made sense. He was the epitome of sleazeball. Just the kind of guy you'd expect to be hanging around a place full mostly with 20-something buxom British backpacker birds. Greasy, curly hair forming an oily halo around the sun- and sun-bed ravaged face, adding years and wrinkles of a man pushing forty. The guy easily had a BMI of 30++, although the gold chains he was draped in would have pushed him neared the 40 mark. Here, I should describe the silhouette of a keg on legs, to actually see the guy's (minimal) clothing of (old school) bike pants/swimmers and chest hair was trauma enough. He strolled over to his car, opened up the passenger door and sunroof. He took out a $3 deck-chair and lit himself a cigarette. He smoked it whilst listening to a tastily ironic CD..... Greatest Hits by Dire Straits.

Overheard on Sunday;

Assistant "Would you like a generic or a less expensive brand?"

The patient replies, in all seriousness.....

"No, I'll have whatever costs the most, please."