I recently admitted a patient with end stage kidney disease on dialysis who came to the hospital for nausea. When we checked a troponin to make sure he wasnt secretly having a heart attack, we found out that, in fact, he was. Cardiology was urgently consulted, and he was rushed off to the cath lab the same day to have his arteries revascularized and now he is currently awaiting a full coronary artery bypass graft, meaning his heart disease was fairly serious.

In the midst of all this commotion, I did not have time to talk to the wife, but I went back the next morning to answer some of her questions. On my way out she asked what my name was again, she had missed it. I told her I was Dr D****. She said she used to know someone with that name.

My surname is fairly unique so I told her we were probably related, I asked if the person she knew ever lived in New York. She said he used to, but had moved to california a long time ago to work as a teacher, and ultimately with NASA. The last time she saw him was several years ago, shortly before he died of a heart attack.

At which point I realized she was talking about my father.

My patient is employed as a baker, at a bakery in which my father used to apparently visit on a regular enough basis that the name stuck in this womans memory.

Small world, isn’t it?

1)A 36 year old drunk gentleman comes in to the ED; the start of any good joke right?

Dr J: any history of cancer in your family

Patient: no, nope, no sirree doc. My parents were both gemini.

2) Or the schizophrenic pt who comes in complaining of back tumors. I look at his back which seems normal enough, if a little, shall we say, fragrant, and dont appreciate anything out of the ordinary. So I start a phyiscal exam, pressing all over as well as auscultating. When I reach the center, he exclaims, yes! there! and there! and a little below, that’s one too!

Dr J: sir, that’s your spinal cord.

Pt: That’s what all the other doctors said too, why doesnt anyone help me!

Of course if the Hospital gets to be too much, I can always go back to clinic…

Dr J: So you said you’d bring in a stool sample this time?

The patient opens up his backpack, pulls out a paper bag, tries to hand it to me. “No, no, we’ll give that to the tech– the specimen cup is in the bag?” He gives me a blank look.

Dr J:The specimen cup is in the bag– the cup with the sample in it.?

Pt: Oh, you gave me a cup?

Dr J: And you carried this in your backpack?

Pt: Yes

Dr J: Okay, I’m going to get the tech. Next time, just a little bit, in the sample cup. Not the whole thing, not lying in a paper bag. Okay? “okay.”

Returning to the AUstralia trip, my trusty travel quartet and I decided to continue exploring the environs of Sydney, namely Darling Harbour. We decided to take the ferry from Circular Quay to the harbour

“I’m on a boat, muthaf**ka” became a regular catchprase and inside joke during this trip. You will see it come into play later as we include such variations as “I’m on a plane!”, “I’m on a rock!” and “I’m on a kangaroo!”

After a short 10 minute trip we arrived in what I can only describe to my fellow Californians as a nicer, cleaner version of Long Beach. Our Quadrumvirate set out looking for the next adventure!

Actually, Koh and Ward decided to take some R&R time, leaving Crystal and I, the Dynamic Duo to amuse ourselves like the mature responsible adults we are

Or Not…

That stuffed kangaroo and I have come to the decision that this instrument should be called a digiri-dont.

Crystal geared up like some sort of wolverine/crocodile hunter fusion

Crocodile Hunter, you say? All the Ho’s will love action adventure Josh

Of course, what would Crocodile Hunters be without Crocodiles?

Having Narrowly escaped certain death due only to our quick wits and definetly not by being kicked out of the store, Crystal and I decided to go find some easier prey…like whale

And then we decided to package it up for you and put it over an elevator.

Alright folks, more travel blurbs and tales as time permits…that said, it’s good to be back and writing again.

-J

I’m counseling a clinic patient this afternoon about obesity and her high cholesterol, and as we’re talking she reaches into her purse…

And pulls out a hot dog. Wrapped in foil, but still… a hot dog. And she unwraps it and starts eating. While we are talking. About her eating habits.
I am literally dumbstruck. This does not happen often. I inform her that she can not have a hot dog in the middle of clinic. Doubly so while I am telling her to lose weight.

“I didn’t get a chance to eat lunch.”

That is entirely beside the point. you can eat before or after your appointment but not during.

“I didn’t get the french fries. I’m trying.”

There is a fundamental connection here being missed. I tell her again she will have to put it away, or throw it out.
And then she stuffed the entire thing into her mouth, chewed it up, and swallowed.

“You didn’t give me much of a choice.”

Ah, clinic.

A Question posed by fellow xangan GreekPhysique in response to his Ask YOU anything post:

“By the very nature of your field (and mine), we end up giving some of the very best years of our lives to hard work for little pay in exchange for a much better deal after 30 (or 40, depends). How do you feel about that trade you have made right now, and how do you keep yourself from thinking you made a bad deal?”

Well Greek, I would start by saying I disagree with your fundamental assertion. From a young age we constantly hear how whatever period we are currently in is “the best years of your life” whether it is elementary school, highschool, college, early 20′s, etc. Making the statement that something is the best implies that all the things following simply cannot measure up, whereas I find that each year my life just gets better and better. Not every moment is full of sunshine and lollipops but neither have I noticed a downhill trend as of yet

However, that said, I can appreciate that we do sacrifice a number of potential high earning years until later, while my friends who went into business or law started pulling down six figure incomes before I even was done taking loans or beginning residency. As to how I feel about that trade, I dont regret any of it. I chose to apply myself to medicine with full knowledge of certain aspects of what I was getting into, and I still feel that I would not have been nearly as happy or satisfied in any other field. My other interests, comedy and cooking, I have continued through residency, and when I finally retire from medicine I will pick up and develop those in further detail. So I keep myself from thinking I made a bad deal by continuing to enjoy my life and what I am doing

“Of all the patients in all the clinics in all the world, she had to walk into mine”

During my intern year oh so long ago (over a year! ) I recall seeing an elderly lady who was visiting me for high blood pressure. She mentioned that she wanted to start taking cozaar, a specific anti-hypertensive drug to control her blood pressure. Scrolling through her medications, I saw that she was already on an ACE inhibitor, a similar class of drug and so asked her why she wanted to switch. Was she having side effects? did she feel her bp wasnt controlled?

It turns out all her friends were taking the same drug for their hypertension so she thought she should be on it as well. I explained to her that just because all your friends are doing something is not a good enough reason for me to change your medications. Then, because I was an intern and had to run all my cases by the clinic attending physician, I left the room to go present the case, explaining my absence with a simple “I am going to confer with another doctor and return to let you know the plan.” The plan was exactly what I had told her to continue her regular medication but it still had to be presented.

And that was the end of it.

Until about a week ago, when I learned that that patient had gone home and googled me, found out I was a freshly graduated intern (not that I was trying to keep it a secret) and felt that I handled the situation inappropriately, both in my flippant response and my apparent self doubt, as I told her the plan then said I had to check with another doctor for something as simple as a prescription question. She then lost all faith in my diagnostic abilities and decided to go see another physician at a later point to follow up.

How did I learn all this?

The patient is the grandmother of my current girlfriend

Talk about your chance encounters.

I need to find a way to work this into everyday conversation. more australia posts to come

The last time Koh and I traveled together, it was on a 21 day tour through Egypt and Jordan. During that time, we were fortunate enough to make the acquaintance of the Wilsons, who in addition to teaching us how to throw a frisby forehand and play a number of card games, also happened to mention they live in SYdney and to drop by if we were ever in the neighborhood. We managed to keep in touch through the years vis a vis our blogs, so it was a simple matter to look them up when we arrived. As a welcome to Sydney they offered to take us out on their boat

I’m  on a boat muthaf**ker dont you ever forget!

yes, this is a real nautical signal AND concern. cant stop drop and roll on the ocean

Sailing Sydney Harbor we were exposed to sun, sea, and sand (although I personally only took part in two of the above. I leave it to you to determine which) and even learned a couple basics of sailing like tacking (and how to dodge the boom!)

Above is fort dennison, a former garrison and penal colony when australia was first being colonised by British convicts, and now a restaurant and museum. That tower you see on the end is a Martello tower, an early siege defense fort that became outdated in the 1850′s with the introduction of rifled artillery. It was also the last Martello tower built in the British empire

Our mate, in both the nautical and australian senses of the word was Andrew. The captain, TD, is not pictured.

Andrews lovely wife Jess (aka FushMush) who came along for the ride and packed a heaps of sandwiches. Good times were had by all

Yes, by the end of this trip we had all become mighty seafarers, some of us using the assistance of dramamine to quell our seasickness, and some of us using beer. Having no more fears we decided to go on a ghost tour of SYdney

Were my blogging muscles not so sorely atrophied, I would happily relate a number of tales we learned that night, from the apartment where multiple 21 year olds met their death on their 21st birthday, to the ghost of the sydney harbour bridge or perhaps most disturbing, the grisley tale of the madames boarding house and the dismembered member (that was a penis joke). However, the tour itself was quite amusing and well worth a story in person should we ever meet. So on from sailing to our next adventure…

-J

Once again, dear readers, it is time to embark on another whirlwind tour around the globe. Having traveled through europe, asia, africa, and the middle east, It was high time to get low…below the equator that is. So I gathered up the usual traveling companions and off we embarked for the counterweight continent, the land down under, the empire of Oz, the country and continent all in one that is Australia. By this point I am sure you know my international adventure posse, but let me take a moment to once again introduce the key players, named after the band for whom this post is titled, the Men At Work:

just kidding, of course. Here is the real Australia crew

On the top right of course, is yours truly, Dr J, international man of mischief and trip planner extroirdinare; bottom right brings us to the conscience of the group, the honest, the financially astute and the unfortunately gullible Koh, aka “short round” for those of you who remember the Road to Jordan trip; moving along to the bottom left is emergency physician, outdoors lover, and all around survivalist ward from the Bangkok Dangerous Trip ; and a new addition to the group although not to this blog itself, my enabler and partner in crime, purchaser of plush animals and maker of pithy observations, crystal.

Our first destination in Oz was Sydney, one of the most well known and beautiful harbors in the world

.

Completed in 1973, The Opera House is easily one of the most iconic sights of Sydney and Australia in general. The design, depending on which australian you ask is mean to represent anything from a ship sailing into the harbor, to eggshells, to a bowl of fruit (yeah i didnt get that one either) The Grand Organ is located in the Concert Hall and is the largest pipe organ in the world, boasting over 10,000 pipes. It is 16 metres high and 13 metres wide and can also be played remotely by way of an electronic console.

By contrast, the largest organ in the world belongs to yours truly

Anyone expecting a higher level of maturity than that should probably leave now.

Lunch was at Chef Neil Perry’s Rockpool Bar and Grill, a remodeled Bank from the 1930′s done in the gothic/art deco style.

We stayed in the Sydney Harbour YHA Hostel, recommended to us by FushMush, a friend from the Road To Jordan Adventure who Koh and I had kept in touch with. More on them later. Our Hostel was actually built over an archaelogical dig site. At first we were all impressed until we found out that the ruins we were sitting over were from the 1800′s. The conversation was something like this:

Koh: Wow a hotel on a dig site? that’s pretty cool
Ward: yeah how long has this stuff been down here? how old are these ruins?
Random AUstralian: bout three weeks mate
Dr J: god dammit.

As you can tell the rooms were quite cozy, but we had our own shower and an amazing view from the roof of the Opera House. But enough of my droning on and about, there will be plenty of time for that, lets get some pics from that first day of Sydney and the new culture we were to immerse ourself in

The QVB mall (queen victoria building) and Luna Park

The Sydney Harbour Bridge and more art deco architecture

We were so Manly, that one of the local aboriginal tribes invited Koh to join them for a sacred male ceremony. More on that later as well.

And now, SYdney at night

As I am making a gentle return to blogging after yet another extended vacation (in both the literal and physical senses of the word) I will try and ease back into the stories while letting the pics speak for themselves. 

If you are new, welcome.

If you have been following for a while and stuck around, thanks! I’ve missed you.

Until next post

Dr J