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Scruffy (aka Carmel)
22 May 2007 @ 08:11 am
...  I'm knitting

This isn't actually that odd - I like to knit, and usually knit at least one project a season.  However, I can usually gauge how much I'm procrastinating by how much I knit, and this weekend I actually contemplated taking my knitting with me to a study group.  I think I have a problem.

Hi, I'm Scruffy, and I'm a Knitaholic. 

It's for a good cause, though - I'm knitting a baby shawl for Squishy.  It's very pretty - lots of lacey edges and stuff.  And there is something relaxing about only having to worry about how many stitches you have and how many rows to go before you change pattern.  It's certainly more relaxing than thinking about ECGs, chemotherapy drugs and the haemotological profile of various disorders...
 
 
I'm feeling: happyhappy
 
 
Scruffy (aka Carmel)
17 May 2007 @ 05:48 pm
I don't normally meme...  But I have an exam in 4 weeks, so today, meme's are my friend.

Milk&TwoSugars tagged me this meme, which is essentially 8 random things about me...  So.  Here we go...

1.  Mr Scruffy and I are so incredibly slack that although we've been married for 18 months, we've never picked up our wedding album.
2.  In my past, I have been a PhD student, a researcher, a sales rep, a sales consultant and a manager at a Harvey Norman store.  In that order.
3.  I'm eating Sour Cream & Chives flavoured rice thins, which I suspect have too much salt in them to be healthy.
4.  I play the trombone.
5.  I sleep on the left-hand side of the bed.
6.  I sometimes think that for all the internet was supposed to bring people together, it sometimes seems like a very lonely place.
7.  I broke my ankle 3 years ago going for a jog - I got to the end of our driveway and tripped over a tree root.
8.  I never wanted to be a doctor, because generally, people annoy me... 

And that's my meme.  :)
 
 
I'm feeling: refreshedrefreshed
 
 
Scruffy (aka Carmel)
16 May 2007 @ 04:32 pm
(hold yourself up - three posts in as many days...  It must be coming up to exams!)

DrScruffy's pathology lecturer:  Barrets oesophagus is the change in the lining of the oesphagus to a glandular epithelium.  This can lead to the presence of adenocarcinoma in the oesphagus, where it would not normally be seen

DrScruffy makes the notation: barret's oesophagus --> adenocarcinoma

DrScruffy's pathology lecturer:  If you find an adenocarcinoma in the oesphagus, you can diagnose Barret's oesophagus.

DrScruffy makes the notation: adenocarcinoma --> barret's oesophagus

Excellent.  So I learnt that cause leads to effect and that the presence of the effect is caused by the cause.

 
 
I'm feeling: sillysilly
 
 
Scruffy (aka Carmel)
15 May 2007 @ 05:53 pm
Up until tonight, I had kind of thought that I was in the majority of women who have no real "risk factors" for my pregnancy.  It's strange, because most medical people I know tend to be a little bit inclined to over estimate their own risks of things - I guess because they know what the consequences are.

Tonight though, I had a phone interview with the midwifes at the hospital I'm planning on delivering at (the same place I was at over summer).  The lovely midwife asked me all the questions I expected her to ask, and as she did so, I began to realise I had some pretty significant risks... 

Firstly, two of my aunts (one on my mother's side, and one on my father's), both under 50,  have both died as a result of pulmonary embolism.  This a condition where a clot forms somewhere in the body and then travels to the lungs and "gets stuck", and large enough ones can result in death.  This condition which is common in pregnancy, and my family history implies I'm at a greater risk than most. 

Secondly, when my Grannie was pregnant with my mum, she had was is called a "complete placental abruption" - this is where the placenta comes away from the uterus before the baby is born, and can be life threatening to both mother and baby.  There are many reasons for this, some of which are inherited, and some are not.  Unfortunately, Grannie was never told why this happened to her.  However, when my mother was pregnant with me, she had a "partial placental abruption" - this is where the placenta only partly comes away.  It would have progressed to a complete abruption, except her very astute ObGyn noticed the signs and delivered me by c-section, preventing too much damage to me! Although, according to my brother's, this is strictly a matter of opinion.  In this case, it was due to a very, very short umbilical cord (only 15cm long).  No one seems to know if this is an inhertied condition or not...  However, two generations of placental abruption were enough  to make my midwife make unsettling clucking noises and ask if I'd told my Obstetrician.

And so, suddenly, I have been thrust from having a wonderful, problem free pregnancy with no worries at all into a world filled the terrors of PE and placental abruptions.  I feel like I've really crossed that threshold now, between being one of "us" (doctors and medical people) to one of "them" (a patient).  I know what I would say to a patient in this circumstances, and I know what all my favourite doctors would say to me, but somehow, it doesn't stop me from feeling very out of control.  I'm not an "earth mother" type, and I'm not afraid of medical intervention when it's needed - but it's one thing to pay lip service to that idea, and a completely different idea to actually be living it. 

Having said all that, I'm only 13 weeks, and I have a long way to go. 

I guess until you really write it all out and look at it, you don't know what's lurking in your family.  And that's the point of a good history. 
 
 
I'm feeling: anxiousanxious
 
 
Scruffy (aka Carmel)
14 May 2007 @ 02:45 pm
What do you call a collection of interesting events?  Is there a collective noun for such a thing?




I find that I'm learning so much in this course, that's not in the text books.  Infact, most of what I learn can't be found in text books...  When I was younger, I never understood what people meant by "medicine is as much an art as it is a science".  Now though, I see what they mean - sometimes you have to "feel" your way.
 
 
I'm feeling: thoughtfulthoughtful
 
 
 
Scruffy (aka Carmel)
01 May 2007 @ 08:47 am
Last night was incredible.

I've seen LOTS of ultrasounds, and I remember the first one I ever saw and thinking "wow, that's a baby and it's growing inside this woman!"  After a while though, that sense of awe and wonder kind of faded, and even thought it was always a thrill to see a scan, it was more of a "what will see today" kind of thrill, not a "miracle of life" moment.  So, when our doctor assked us if we'd seen the baby yet, and would we like to, we said yes.  I was expecting that Mr Scruffy would be amazed and excited and awe-inspired, but I thought that for me it would just be a kind of academic confirmation that i was really pregnant (because you know, the lack of periods, the morning sickness and the not fitting any of my clothes wasn't enough).

How wrong could I be?

As the little grainy, fuzzy picture appeared on the screen, I heard Mr Scruffy gasp "Ohhhhhh.......  that's......" and grab my hand.  I watched the little teddy-bear shaped figure gracefully flip over and seemingly snuggle into the placenta, almost like a soft blanket and suddenly my eyes were pricking with hot tears and my throat felt choked.  That little, tiny teddy bear is my baby...  I felt a sudden rush of love for the small, wriggling shape on the screen, and certainly nothing even remotely close to "academic confirmation".

Dr K point out the various anatomical parts for Mr Scruffy (head, arms, legs, placenta, uterus), and just lay there staring mesmerized at the screen.  I was suddenly aware of the fact that I'm growing a baby - it's small (about 5cm long), beautiful and it SNUGGLES!!! 

This was basically a "peek-a-boo" scan.  We are going to the hospital in the next week or two for our "proper" screening scan (the "nuchal screen", essentially to calculate the odds of chromosomal anomaly), and at that scan, we'll get a picture to keep - so you can all have picspam of my beautiful telly-tubby shaped Squishy.
 
 
I'm feeling: enthralledenthralled
 
 
Scruffy (aka Carmel)
30 April 2007 @ 03:26 pm
SQUEE!

I'm running out the door to go to my first obstetrician's appointment.  I'm very, very excited....

(Somehow, I think hearing our Squishy's heartbeat is going to make this all seem so much more...  real...)

*happy dance*
 
 
I'm feeling: bouncybouncy
 
 
Scruffy (aka Carmel)
We had the privledge today of meeting a former head of *insert specialty* surgery.  Dr Surgeon was a patient, and we were sent to give him a mini-mental state exam.

The MMSE is a series of questions designed to assess the mental capacity of a patient by looking at recall and cognition.  The test asks for recall of information like the date and location, a memory test, sentence construction, that kind of thing.

Dr Surgeon is a delightful gentleman of around 60, with a charming smile and a sharp wit.  In a short conversation, he seemed prefectly lucid.  However, only a few questions into the exam it became clear that his recall and cognition were markedly impaired.  This is why, I guess, we do standardised tests rather than simply judging someone by how they cope in a day-to-day conversation.  In the end, he failed the test. 

We left the room and went to discuss what we had found.  Our clinical coach pointed out that Dr Surgeon had been a man of supreme intellect, and although he was able to maintain a lucid conversation, something was badly affectinig his cognitive processing and his memory.  Then he told us what Dr Surgeon has - he has melanoma that has spread to his brain.

For goodness sake, wear your damn sunscreen.
 
 
I'm feeling: sadsad
 
 
Scruffy (aka Carmel)
16 April 2007 @ 09:44 am
On Thursday night, my friend Little Mother Meg had her baby - a not-so-little girl weighing in at 4.1kg and 56cm long (that's over 9llb and just short of 2 feet in the old speak!).

The birth was pretty traumatic, which a wicked little part of me (the part that is feeling nauseated 24-7, probably) though was a counter-balance to the fact that LMM had no "symptoms" of pregnancy what-so-ever!!!  However, the part of me that is kind and compassionate and human (and maybe thinking "I have this to look forward to!") was very concerned.  LMM's blood pressure rose dramatically on Wednesday night, so her doctor decided to induce her - she was 10 days over-due, so it was probably about time anyway.  Unfortunately, things didn't go according to plan, and despite having pretty serious contractions, she simply didn't dilate.  So, 24hrs later, they decided to go for an emergency ceasarean.  However, this didn't go according to plan either!  For reasons unknown, the spinal block didn't actually block - she could feel the scalpel!  They topped up the block three or four times, and then decided to go for a general... 

Despite this traumatic entrance, the little mite is gorgeous - perfectly cute with an adorable little face that she wrinkles up beautifully.  She's very yellow at the moment, but every indication is that she's a healthy, happy little tiger and after a few hours under UV light, she'll be apples.

The only sour note in this whole extravaganza is that LMM named her baby "Eleanor".  Elly for short.  Eleanor has long been our number one name for a girl, and now Mr Scruffy and I are at a loss.  Our child and Miss E are going to spend a lot of time together, so we really can't use the name anymore (it's actually a traditional family name in my family, which is kind of sad).  However, when we look down our list of names, a great many of them are similar to Elly in some ways...  Mr Scruffy now tells me we can't use any names with "el" as a prominent accent (such as Elsie, or Ellen or Elise) and we need to be careful with names that even sound SIMILAR to it (like Emily or Nell).  And apparently this applies to all our future children!  I think this is pretty extreme, but I'm also willing to accept that my crazy hormones are to blame... 

Having said all this, Little Miss E is adorable, and has totally stolen my heart.
 
 
I'm feeling: confusedconfused
 
 
Scruffy (aka Carmel)
11 April 2007 @ 04:13 pm
At some point in our development, we learn to go from wanting everything that is nice/tasty/chocolate/feel good/cuddly/belongs t our sibling, to prioritising these things in some sort of order.  The things we want or need more than the other things...  We learn to  evaluate the pros and cons of having our cake, or eating it and decide which way we are going to go.  We may still want everything, but at some point we learn to appreciate that we need to decided between things.

This is a process which takes time, and which, in my experience, is largely acquired by trial and error - "learning from our mistakes" as our parents tell us, is character building.    We learn to make decisions on small things first - which present to unwrap first, which teddy we want our Grandparent to buy us, which peice of chocolate to have.  Regardless of our choices, we are always the winner in these simple choices.  At some point, though, we learn to start making decisions where our choice means that someone doesn't win - do I eat the last cookie, or do I give it to mum?  And then, one day, we are making life changing decisions - do I apply for med school or not?  Do I agree to marry this person?  Do we want to start a family?  And somehow, it's not until we have to make these big decisions that we realise the complexity of what we are doing.

And then, one day, some people have to make even bigger decisions....  Life and death, as opposed to life changing.  Do I run into the burning building to rescue that child?  And suddenly, every other decision you make seems paltry and insignificant...  How do you learn to make these kinds of choices?  To be honest?  Deciding  to invest your life savings in Telstra III or not seems pathetic incomparison...  And yet, there are people out there who are expected to make these kinds of choices daily...

I've just read this little article:  "Doctor 'too tired' to help injured girl"

It's about a girl in Sydney who died after a doctor "opted out" of a decision.  Unfortunately, there really is no such thing as "opting out" of a decision - our inactions are as important as our actions.  In this case, there was confusion as to whether or not the patient was allergic to the prescribed medication.  A junior doctor asked what should be done, and the more senior doctor said nothing.  In refusing to answer the question, the doctor sealed the fate of the patient - the medication wasn't given, and the girl died - possibly as a result of this.  On the flip side, she may have died if the doctor HAD given her the medication.  Were there other options?  I can't say, but the doctor has told a Sydney court that they were too tired to think of this, after 9 hours in surgery and many days of long hours at work.

In hindsight, it seems too simple - prescribe a different drug, phone a consultant, track down medical records which might have told if she was allergic or not...  And yet...  in some ways... 

Flipping a coin was so much easier when I was a kid.
 
 
I'm feeling: pensivepensive