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Saturday, March 27, 2010

Why I did not become a dentist



Why does this type of 6 year old patient come to the Dr?

I don't know anything about teeth.

I refuse to know anything about teeth.

I hate teeth.

Something to do with the fact that I was born with very malaligned ones and had to endure 5 years of braces, and the nickname, Bugs Bunny.

Normally I stay well away from teeth. But when mommy and daddy insist on feeding their son sweeties, and don't brush his teeth, and Junior starts to look like an extra from a horror movie...well, then I feel the need to step in and make a plan.


My treatment plan included:

1 X smack through the head for mommy, PRN.
2 X punch to the groin for daddy, PRN.

Referral to those people like my dad and my sister who really really adore teeth, namely the Dentists.

Thursday, March 18, 2010

Survival of the drunkest.

There are certain things patients do when they enter the GP's office which indicate that the consultation is going to be interesting.

For example:

My last patient of the day, Mr V, introduced himself by politely lurching over the desk, slapping me on the shoulder and saying:

"Jammer Dokter, nuh!? Jammer nuh! Ek vra verskoning, ek wil nou nie ombeskof wees nie, en ek moet eerlik wees,maar ek het 'n paar biere gesuip voor ek nou hier gekom het."

"Forgive me Doctor,hey,forgive me for being rude,hey! But I must be honest and tell you I've had a few beers before visiting you today."
English doesn't do it justice.

Having been taught never to judge the patient I ignored his chronic pancreatitis history and did not immediately assume that he was an alcoholic.

In fact, it's probably most likely that he was just someone who has had such shitty experiences with the health service in the past that he knew he needed alcohol to survive a visit to the doctor.

I could understand this completely.

I mean, sometimes I feel like I need a few drinks just to survive some of the patients!

And that scene would go:

Goodmorning patient, I'm slightly sozzled right now, so do forgive me for having accidentally palpated your thyroid through your rectum instead of your prostate...yes?

Wednesday, March 17, 2010

GP VICTORIES!

Gastro for a week?

NO! Ruptured appendix in septic shock - surgical emergency - rushed off via ambulance to hospital.

Neck pain post rugby match. Cervical myalgia?

NO! C-spine disruption! Immobilised and sent off to trauma unit STAT.

Normal period 4 weeks post last menses?

NO! Missed abortion - off you go to the gynaecologist.

Circular lesions on anterior shin? It's just eczema isn't it doctor?

NO! It's actually a classic ecthyma!

Today, I was, the GP QUEEN!!!!!!!!!!!!!!

Woop Woop!

:)

Sunday, March 14, 2010

A Private Problem

I remember puberty.

(Unfortunately)

Specifically I remember developing breasts and how unbearably ashamed I was of this fact.

Puberty is a painful, agonising, angst-ridden, awkward time where one is basically a confused child struggling to deal with the sudden onslaught of adulthood.

It is also the time one becomes both secretly thrilled, and horrifically aware of the sexual organs...both one's own and those belonging to others! Eek!

But then, one grows up, studies medicine, becomes a doctor, is exposed to naked flesh of all shapes and sizes on a daily professional basis...and suddenly there is no difference between a nose and a penis, or an ear and a vagina.

They're all just organs to us.

(Even the diseases of these organs are the same: a penis gets syphyllis, and a nose gets sniffle-less!!! Hee Hee!)

This has put us totally out of tune with our patients' embarrasment at revealing themselves physically in our consulting rooms.

My elderely, conservative Muslim uncle of a patient with testicular pain, couldn't understand my insistence at physically examining his genitals.
And I couldn't understand his resistance.
I had to pull out all my medical knowledge, and subtle scare-tactics about cancer before he would let me anywhere near his genitals. I even mentioned Lance Armstrong. Livestrong, Uncle, Livestrong!

He eventually reluctanctly relented.

After the physical assualt on his privates he remarked quietly that he felt sorry for a "young girl" like myself having to deal with such terrible things on a daily basis.

Stupid, desensitised, Doctor that is me, didn't even realise what I was saying when I responded that I like it and try to have as much fun as possible with the patient.

It was only after he gave me a sly grin, and winked on his way out the door, that I fully understood the ridiculousness and possible inappropriateness of my statement...

In the words of Homer Simpson, DOH!

Wednesday, March 3, 2010

Baby Fat

A few days ago two young parents brought their baby in for a consultation.

They were so terribly worried that their pigtailed 2-year old child had a runny nose.

When I looked at the child I nearly fainted.

"How many children do you have?" I asked them nervously.

"Just this cute little one." The dad beamed proudly.

"You're lying!" I almost screamed at him! "You actually had THREE kids and this child ATE the other two!"

This kid was the size of three kids.

What in the hell were they feeding this child?

Fried fat wrapped in pastry covered in cream, basted with lard and a side-order of baby?

And she had that hungry look in her eyes.

I examined her very quickly with my left hand.

The left one I was prepared to lose in case she desired a quick snack.

The right was too precious to risk.

Nothing wrong with your child, folks, except that she's morbidly obese.

I explained to the parents the horrors of this delicious death trap they were setting for their little one, and how I would be referrring them to a dietitian for expert advice.

All the while I kept one eye nervously on Junior, and one hand gripping my patella hammer in case she decided to attack me.

With each stomp around my consulting room desk her pendulous belly rippled and a tsunami of fat travelled infero-superiorly up her abdomen, threatening to engulf her head, but then thankfully richocheted off the two Dolly-Parton-sized fat pads that should have been her chest.

It took all my strength not to jump through the window behind my desk and run for the hills screaming that The Blob was going to eat us all!

Baby fat is cute.

Obese fat baby monsters are not.

Friday, February 26, 2010

Show and Tell: Crabs

Doctors are like hookers, I've already explained that in earlier posts.

Doctors are also like priests, in that we are in the very privileged position of being told secrets.

(This humbles me without fail. Every time I am privy to such sacred and volatile information, I am humbled immensely.)

Totally top secret.

Makes me feel like a supercool secret government agent handling top secret state-of-the-nation information.

Like James Bond.

Oh yes!

Did you see how I did that? Are you smart enough to follow my logic?

I just proved that doctors are cool like James Bond.



Uh...Oopsy...sorry!

Don't mind me, just got a little carried away there.

I should have warned you that my mind is usually served twisted, not stirred.


What I mean to say is this:

We are human vestibules for people's secret fears and whispered confessions...

For example, "Hi Doctor, I have crabs."

Which was how my last patient of the day introduced himself.

I was thereafter also politely introduced to the actual crabs, enshrined in a little plastic bag and thrust in my face for me to inspect.

"Hi crabs." I said.

They were dead though, suffocated I think, so they didn't return the greeting.

The recognition of crabs (pubic lice or pediculosis pubis to those in the know) is immediately followed by the feeling that one has them crawling all over one's body.

Suddenly scratching myself vigorously, I thanked him for being clever enough to bring the offending evidence in for me to scrutinize.

I do love it so when my patients play "show and tell" with me.

Reminds me of being at pre-school.

(Hey Teacher! Look what mommy got as a present from the poolboy!)

Tuesday, February 23, 2010

Why I will NEVER be a paediatrician.

I just remembered the reason I will never ever ever ever ever ever EVER be a paediatrician.

Not because I hate children.

Nope.

I love children, and I feel too much pain when they're ill.

But that's not the main reason.

The main reason is that children come with MAJOR baggage.

Two big lumbering overladen travelling trunks of baggage,

Namely...

THE PARENTS!

I just really can't deal with the parents.

Sorry.

The Sore Sound

This one's for you, Dr MJ.

There is a sound, made by patients, that I am incapable of reproducing.

This sound is akin to nails screeching down a chalkboard in its ability to cause me physical pain.

Needles, like poison-tipped needles puncturing my tympanic membranes.

It is not the agonising groan of the patient with the ruptured appendix.

Nor is it the gasp of the patient being given the horrifically painful bicillin injection to cure their syphilis.

Oh no, it is the sound made by the “otherwise well” patient.

The patient that you spot happily chatting away to the receptionist in the waiting room.

The patient, that jumps up when the receptionists calls their name.

The patient that, as soon as they walk into your office, and see your face, immediately makes “THE SORE SOUND”.

No, “ Hello Doc”.

No, “This is my problem”.

Just. This. Damn. Sound.

I can’t even describe it – let me try,

“SSSsssthhhhhhmm”.

NO wait, that’s not right, it’s more like,

“Phffffffffffffffhhhhhshhhtttmmmm”.

Jees, I’m not doing this properly...

It’s like the sharp indrawing of a breath while at the same time exhaling and whistling through one’s teeth and moaning.

It is also invariably accompanied by sorrowful head shaking, the avoidance of eye contact and the slow rubbing of a fat thigh.

They make the sound for about sixty seconds. Unmercilessly.

By this time I am hiding under the desk...whimpering, clutching my knees, and rocking slowly back and forth while a little drool dribbles out the side of my cheek.

My regression into a basket case is due to the knowledge of what the Sore Sound actually means. It is signal that announces that the next seven hundred hours of your life are going to be spent listening to this patient complain about a painful something - usually a knee, or foot.

A knee or foot, that is under immense physical pressure from the unjust weight of the gargantuan monstrous thigh and buttock that is certainly the cause of the pain in the first place.

Oh no you don't, don't you dare call me a fattist!

Only when you have a morbidly obese patient sitting across from you making the sore sound, who:

1:Refuses to listen to your multiple counselling sessions to lose weight.

2:Refuses to keep the many appointments you have made for the dietitian because they coincide with the annual church cake sale.

3:Never went to the orthopaedic surgeon you referred her to because the state health service is so overwhelmed that an appointment could only be made for 7 months down the line and therefore was forgotten about.

4:Prefers to sit in your office and make the sore sound, and complain about the pain, so that she can just be prescribed the damn voltaren tablets that, "the other doctors know to give me, Doctor."


Then, only then, after suffering all of this, are you allowed to tell me I'm being rude...

Of course,by then it will be too late...

I won't be able to listen to you seeing as the patient has just successfully worked on my last nerve, namely the cochlear!

Wednesday, February 17, 2010

A little pee to help you see?

Please note:

Urinating onto a dirty washrag and then squeezing drops of urine into your eye is NOT the correct treatment for conjunctivitis.

Regardless of what 'Aunty Marie down the road with the daughter who is a cleaner by the chemist' told you.

Wednesday, February 10, 2010

Private Practice

A young lady Dr, beaming, opens the door of her very own, clean, air-conditioned GP consulting room. Feeling particularly professional in her black satin pencil skirt, silk blouse and expertly applied make-up, she represents the polar opposite of the cranky, pee-stained, sleep deprived trauma doctor she was a few weeks ago.

A mornings only stint in a lovely private practice for the month of February.

This should be a breeze.

Would she like it? A gentle GP breeze as opposed to the tornado of trauma she's used to.

Snotty noses versus gunshot face?

Sore throats versus panga to the cranium?

Will she even have to engage in any taxing cerebral activity?

Flashing a radiant smile at the long queue in the waiting room she welcomes her first patient.

The patients all look at each other nervously.

Nobody makes eye contact with her.

Nobody stands up.

This is not going as planned.

She tries again, this time clutching the stethoscope around her neck. This serves both to remind the patients that she is a doctor, and to remind her of what that stethoscope has helped her to achieve in terms of patient care.

Number 5 in the queue, a middle-aged gentleman, eventually stands up and makes his way into her office.

“Are you new here?” He asks her.

She responds, “Yes, I’m filling in for one of the doctors who are on leave. How can I help you sir?”

“Are you really a doctor? You look too young. And you don’t look like a doctor. They are saying outside that you’re too young to know anything and that they would rather wait to see the older Doctor that’s been here for years. But he’s not here yet and I’m in a rush so I thought I’d try you out. I hope you can help me.”

She takes a deep sigh, this is not the first time she has been sorely accused of youthfulness.

She wonders if a few greying streaks and some crow’s feet would help instill confidence in her patients.

As the morning progresses and she is confronted with skin rashes that didn’t read the textbook definition of their supposed morphology, vague symptoms that do not tie neatly into one specific diagnosis, complaints of being stressed, and other such symptoms that she was not taught how to treat at medical school...it dawns on her that there is more to being a GP than meets the eye.

Thankfully, The Universe has decided not to punish her completely for being so blasé about GP’s in the past, and has given her the gift of Dr BD in the consulting room next to hers. Dr BD, is a bubbly, enthusiastic doctor with what can only be described as an inspirational passion for GP medicine. (Who knew these Dr's actually existed!)

Dr BD is in possession of all the little secret GP tricks that one can only gain with experience and she makes excessive use of his knowledge throughout the day.

Luckily for her he is keen to teach her the art of this general practitioner stuff!

That first brave patient who took a chance on her poured out his soul in 20 minutes, and discussed very intimate details of his troubled relationship with her.
She is supremely humbled by this, and unsure of what concrete medical treatment to give him, she lets him talk, probing gently here and there for signs of depression or suicidality. There are none that she can detect. He leaves her office with a referral to a psychologist and social worker.

“I hope that I helped you in the end, sir.” She says before he leaves, wondering if the patient would be satisfied with the lack of anti-depressants/anxiolytics she had not prescribed.

“You’re young, but at least you listened to me.So yes, you did help me.” He says.

Hmm...Listening.

A new weapon to add to her medical arsenal?

Sometimes no medicine is the best medicine, apparently.

And like a war veteran returned home after surviving the battle, nervous that she would be bored by anything other than the constant adrenaline rush that had so dominated her life, she ended her morning satisfied that wherever she goes, there are knew things to learn and secrets to discover, both about herself and the world around her.

It's just a matter of being receptive to the lessons...






p.s. Stupidosaur, Deluded, Ketan...this one's for you. I have recently moved residences and have been without an internet connection for days, with no wifi on the horizon for at least a few more weeks thanks to the non-efficiency of our telecommunications company in SA. I won't go into the details of the killing,maiming, pleading and selling of my soul I had to go through to be able to publish this post...I'm just saying...I hope you're satisfied?!?! :)

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