Progress Notes-By System

This post outlines my medical history organised by system, since being diagnosed with advanced melanoma in October 2013. To see my medical history organised chronologically, see this post here. It remains a work in progress as new issues arise, and as I go back through my records and find things I’d overlooked.

Cardiovascular System

2014

  • During the period of hospital admissions for bowel resections, and starting the Checkmate-067 clinical trial,  I had recurent episodes of sinus tachcardia for which no cause was found.

2018

  • Found to have mild-moderate hypertension. Not currently in anti-hypertensives.

Respiratory System

2013

October

  • Presented to ED on the 30th with left sided abdominal and flank pain. The workup included a chest x-ray which should a large mass in the left hilum
  • Had a chest/abdo/pelvis CT scan which showed the large mass in the mediastinum, as well as some smaller lung masses more peripherally in both the right and left lungs. Additonal masses noted in the abdomen and pelvis.
  • Discharged and asked to represent for a broncoscopy 2 days later.

November

  • Had a bronchoscopy on the 1st, which showed a lesion in the bronchial tree suspicous for melanoma. This was subsequently confirmed by histology on the biopsies taken.

2014

February

  • Had first infusion as part of the Checkmate-067 RCT, which was comparing ipilimumab alone, with nivolumab alone, and with a combination of the two.

April

  • CT scan performed during admission for a bowel obstruction showed lung lesions had shrunk significantly since starting immunotherapy.

May

  • Shadow discovered on routine chest CT, along with an ongoing, mildly productive cough. Referred to infectious diseases, who suggested bronchoscopy.
  • Repeat bronchoscopy on the 22nd. Washings showed RSV pneumonia.

2018

February

  • PET scan showed low grade focal uptake in the left lung hilum.

2019

January

  • PET scan showed persistant FDG uptake in the left hilum with the SUV max increasing to 5.15 from the 3.72 reading in February 2018.

March

  • PET scan again showed focal FDG uptake in the left hilum., but the SUV max fell from 5.15 to 3.06.

Nervous System

2013

November

  • Brain CT and MRI showed multiple brain metastases. One large one, two smaller ones, and dozens of tiny ones.
  • Had a craniotomy to remove the largest metastasis. The surgery and recovery were “uneventful”.

December

  • 15 rounds of whole-brain radiotherapy with integrated boost and hippocampal sparing.

2014

February

  • Had first infusion as part of the Checkmate-067 RCT, which was comparing ipilimumab alone, with nivolumab alone, and with a combination of the two.

2016

February

  • Reviewed by neurologist as part of a return to work plan. Underwent neuropsychological assessment and EEG testing. Given the ok to return to work.

2017

  • Reviewed by neurologist due to symptoms of headaches, scotomas and word-finding difficultes.
  • Also repeated neuropsychological testing.
  • Diagnosed with migraines with aura, but neuropsych testing was fine, so OK to continue work.

2018

February

  • PET scan showed no focal uptake of FDG in the brain.

2019

January

  • FDG distribution in the brain remained normal.

March

  • FDG distribution in the brain remained normal.

May

  • Woke up at 5 am on the 8th with left-sided numbness. Got up, went to the toilet, had a drink of water and went back to bed. Symptoms subsided quickly and I went back to sleep.
  • Woke up later with a mild headache, but was able to go to work in the morning.
  • Headache became worse again after I returned home in the afternoon. About 3 pm, I took some aspirin and went to bed.
  • Headache continued to worsen and I developed nausea, word-finding difficulties and right-sided numbness.
  • Started vomiting, and word-finding difficulties progressed into expressive aphasia, with a “word-salad” and incomprehensible sounds.
  • Driven to the ED and admitted into the stroke pathway. Ruled out any acute pathology with a brain CT, so given a provisional diagnosis of partial seizures and started in IV levetiracetam.
  • Symptoms had resolved by the next morning. MRI confirmed no stroke, and an EEG the next day while asymptomatic didn’t reveal any pathology.
  • Discharged on the 10th on oral levetiracetam and told not to drive for 6 months.

July

  • In the early hours of the 24th, I woke up with a numb left middle finger.
  • The numbness progressed to include all of my left arm, and I developed a severe headache with nausea and vomiting.
  • I took some aspirin, and tried to go back to sleep but with not much success
  • Began to feel better by about 8 am, and the symptoms continued to improve and were gone by about midday.

Vision

2014

July

  • Developed blurred vision.
  • MRI didn’t reveal any new issues. Reviewed by ophthalmologist on the 21st, and diagnosed with bilateral macular oedema. Started ranibizumab.

2016

  • Vision improved with ranibizumab so continued with monthly injections, alternating between left and right eyes.
  • Was eventually able extend the interval between doses and wean off it completely.
  • Last visit to ophthalmogist for review was December.

2018

  • Developed bilateral cataracts, most likely secondary to numerous periods of high dose corticosteroids since diagnosis

2019

February

  • Left cataract removed.
  • After ~2 weeks of significantly improved vision in that eye, it began deteriorating again.
  • Reviewed by ophthalmologist who diagnosed me with macular oedema again.
  • Initial management was conservative, with continuation of steroid eye drops, and ongoing review.

April

  • Macula oedema hadn’t improved. Had a single injection of ranibizumab.

August

  • Macula oedema had significantly improved, but still some blurred vision. On examination, noted to have cells on the front of my lens indicative of inflammation.
    • Restarted steroid eye drops.
    • Right cataract remains stable.

Gastrointestinal System

2014

January

  • Developed increasing lethargy, diarrhoea, nausea and decreased appetite.
  • GP ordered stool MCS, but did not show any abnormalities.
  • On the 26th, this worsened and developed a fever with nausea and vomiting, and mild abdominal pain.
  • Presented to the emergency department, and passed out in the ambulance bay.
  • Admitted under oncology, and started antibiotics.
  • Overnight, the abdominal pain increased and localised to right iliac fossa.
  • Referred to surgery, who found a mass in the right iliac fossa, and organised a CT scan.
  • CT scan showed bowel obstruction with a phlegmon in the right iliac fossa, with appendicitis as one of the differential diagnoses.
  • Progressed to emergency laparoscopy that day, but quickly converted to laparotomy.
    • Showed melanoma deposits throughout the abdomen.
    • Had a right-hemicolectomy and 3 small sections of the small bowel removed, with diathermy to numerous other small melanoma deposits.
  • Admitted to intensive care post-op, with a thoracic epidural in situ.
  • Epidural initially good, but became patchy so removed after a few days.
  • Ongoing fevers, tachycardia, diarrhoea and anorexia during admission
    • Abdo CT and CTPA excluded obstruction and PE
    • Maintained on antibiotics throughout admission

February

  • Discharged on the 2nd
  • Ongoing poor appetite and diarrhoea post-discharge, and occasional vomiting, with associated weight loss.
  • First infusion as part of the Checkmate-067 clinical trial on Friday the 21st. I was randomised to receive either ipilimumab, nivolumab, or a combination of the two.

March

  • Started acupuncture to help with the ongoing vomiting.

April

  • Woke up on the 11th with severe nausea and vomiting.
    • Advised by oncology nurse to attend the ED.
  • CT abdomen showed bowel obstruction.
  • Made nil by mouth, given IV fluids, and a nasogastric tube on low-wall suction.
  • Laparotomy on the 12th, which showed a small bowel obstruction secondary to adhesions.
  • Difficulty reinstituting diet post-op, with ongoing anorexia and vomiting.
  • Significant weight loss, malnourishment and electrolyte depletion.
  • PICC line inserted, high-level electrolyte replacement given, then started TPN.
  • Slowly reintroduced diet. Bowel activity slow to restart post-op, and then developed diarrhoea.
  • Pyrexia of unknown origin, and started IV antibiotics.
  • Discharged on the 20th on a light diet, but still ongoing issues with vomiting, diarrhoea, anorexia, and weight loss.
  • My surgeon performed a colonoscopy and gastroscopy on the 29th to investigate the persistent gastrointestinal symptoms.
    • Nothing obvious macroscopically, but biopsies revealed gastritis and colitis.
  • Reviewed by gastroenterologist. Prescribed domperidone to help improve gastric emptying.

May

  • In late May, the regime for the clinical trial changed to fortnightly infusions, as the ipilimumab component, whether placebo or actually ipilimumab, stopped after 3 months.

Late 2014

  • Gastrointestinal symptoms gradually improved over the rest of 2014, and the lethargy and fatigue also began to improve.

2016

November

  • Diagnosed with iron-deficiency anaemia, likely secondary to GI losses.
    • Started Spatone iron replacement.
    • Referred back to gastroenterologist.

December

  • Gastroscopy and colonoscopy performed on the 12th
    • Showed pre-pyloric gastric erosions and a nodule at the bowel anastomosis which was biopsied.

2017

January

  • Reviewed by gastroenterologist. Confirmed colonic biopsy was normal.
    • Advised to stay on proton pump inhibitor because of the gastric erosion.

March

  • Ongoing anaemia despite Spatone and PPI.
  • Reviewed by gastroenterologist on the 9th.
    • Suggested a “capsule study”.
  • Reported on the 21st. Showed an ulcer in small intestine which was slowly bleeding.
    • Suggested an MRI of the small intestine, which was performed on the 28th. Did not reveal the source of the bleeding.
  • Had 2x iron infusions at GP surgery.

August

  • Reviewed by rheumatologist and commenced methotrexate to help control inflammatory arthritis in the left knee.
    • After only 3 does, developed significant diarrhoea, with frequency and urgency.
    • Ceased methotrexate and increased prednisone dose which improved symptoms.

September

  • Reviewed by rheumatologist again. Keen to start a TNF-blocker such as infliximab or adalimumab, as it should help with both the colitis and the arthritis.
  • Referred to respiratory physician to assess for risk TB reactivation secondary to TNF blockade.

2018

February

  • PET scan showed “prominent uptake in bowel, particularly the transverse descending and rectosigmoid colon.” This was most likely due to colitis.

April

  • Gastroenterologist confirmed diagnosis of colitis on the basis of the recent scopes and biopsies.

2019

January

  • FDG distribution in the bowels had returned to normal.

Casting the Pods Far and Wide

I’m a big fan of podcasts. I first got into them when I was diagnosed with advanced melanoma in late 2013, and my use of them has only grown since. After that diagnosis, I, all of a sudden, had a lot of time on my hands as I could no longer work, and I was spending a lot of time in hospitals and medical waiting rooms. Due to the brain mets, I was prohibited from driving so I was doing a lot of walking and catching public transport, and there were also times where I didn’t want to be alone with my thoughts and podcasts were a good distraction. They have now become a thing I do, when doing something I’d rather not be doing, such as housework and exercise. I’ve even bought a waterproof speaker so I can listen to them while showering.

People often ask me what podcasts I listen to, so I thought I’d document them here so I could refer people to it in the future. I wasn’t sure how best to categorise them, as many of them overlap in terms of topics, themes and relevance to my own situation. In the end, I decided to break them into two categories along the lines of Christianity and Religion, and my own hospital-based work as an Anaesthesia Quality and Safety Fellow. There is also a “Miscellaneous” category for anything that doesn’t neatly fit into either of those. And as well as “actual” podcasts, I will also include any one-off recordings or interviews I come across that I think are worth sharing.

Christianity and Religion

Unbelievable!

(Access here)

By whichever metric you use, Unbelievable! would probably have to count as my “favourite” podcast. I’ve listened to the entire back catalogue, going right back to 2017 so it’s a lot of episodes. The episodes are quite long as well, so the total time listening to Unbelievable! would also be very high. It’s probably also the one I’ve got the most out of, certainly from a Christian faith perspective, and it’s also opened my eyes to a lot of opposing viewpoints from other religions, different strands of Christianity, as well as from the secular and atheist viewpoints. Justin Brierly, the moderator does a fantastic job, of maintaining a civil debate between what can be two (or more) very different points of view. He doesn’t hide the fact that he is a Christian (which shouldn’t surprise anyone given its a Christian radio station), but he’s very good at playing devil’s advocate and making sure both sides get heard, as opposed to some podcasts where it’s just a single person ranting into a microphone.

Reasonable Faith

(Access here)

Reasonable Faith is another one I’ve Been listening to for a long time, and I’ve got a lot out of this one too. It’s quite different to Unbelievable! as it’s much shorter, and it’s more of your “traditional” podcast where it’s two regulars, each week, discussing a particular topic. William Lane Craig’s main areas of interest tend to be the philosophy of religion, arguments for the existence of God, and defence of the Christian faith, and it was these podcasts, and the associated website, videos and books that really provided me with a good introduction into philosophy generally, and helped me to see that there are significant evidential and philosophical arguments in favour of Christian theism. While there is no guest with an opposing view like there is with Unbelievable, Craig does engage with alternative views and counter-arguments at times.

Life & Faith

(Access here)

This one is from the Centre for Public Christianity in Australia (CPX), and pretty much does what it says on the box. It explores various areas where life and faith intersect in the modern world, though will often touch on historical aspects as well. They are generally shorter than the other podcasts, but usually jam-packed with nuggets of wisdom. It’s also nice to have some good quality, locally produced content as well. CPX is also responsible for the fantastic “For the Love of God: How the Church is Better and Worse Than You  Ever Imagined” which is also well worth a look if you get the chance.

God Forbid

(Access here)

I started listening to this one quite recently, but have been enjoying it a lot. It’s produced by the Australian Broadcasting Corporation (ABC), which has quite a large Religion and Ethics component in its online, radio and free-to-air TV presence. The ABC is government funded, and as part of its charter it is required to provide “balanced” programming, and I suspect as a result of this, this podcast isn’t presented from a specific religious perspective but covers a  wide range of views as it seeks answers to life’s big questions. The host, James Carleton, does a really good job of keeping the discussion going with quick-fire questions, a fair bit of humour, and tough questions when necessary. He does seem to have a faith position of some sort, but, not surprisingly, from the episodes I’ve listened to so far, he’s not really discussed his own beliefs. This combination of public broadcasting and a neutral host makes it a great place to go if you’re looking for discussions on these big questions that aren’t coming from a faith-based producer.

Quality and Safety Fellow

Pre-Accident Investigations

(Access here)

I was put on to this one via Twitter, and from a work perspective, it’s probably the one that’s had the biggest impact on me. Both from the content Todd Conklin provides, but also from the guests he’s interviewed, which have given me additional leads to follow up. It’s comprised of a short “Safety Moment” during the week, and a longer podcast episode on the weekend. If you are interested in Safety Science, and particularly the “New View of Safety”, “Safety-II”, or “Safety Differently” concepts, then I’d definitely recommend listening to this. I’ll admit Todd’s accent and style took a bit of getting used to, but it was worth it, and I’ve now come to find it quite endearing!

Disaster Cast

(Access here)

This is another one I discovered through Twitter and is presented by Drew Rae, an Australian safety engineer who, having worked in various roles around the world, is now based at Griffith University in Queensland, Australia. As with the Life & Faith podcast, it’s nice to hear some Australian voices, both literally and figuratively. As the name suggests, it is about disasters that have occurred throughout history, and Drew provides an analysis of these disasters from his safety science perspective. I’ve been a fan of shows like Air Crash Investigations, so this podcast was a natural fit for me. These podcasts tend to be a scripted presentation by Drew, rather than the more interactive, spontaneous and unpredictable podcasts out there. However, this means he is able to present all the information he wants to which is great, because it’s obviously well researched, and has the added benefit of transcripts being available which most podcasts don’t have.

99% Invisible

(Access here)

This podcast is about design, with a particular focus on architecture. I didn’t really have much interest in design until recently, probably because I thought design was just about making things look pretty. It wasn’t until I became interested in Human Factors/Ergonomics, and realised that the discipline was primarily about “work design”, that I began to see the impact that good and bad design can have on users and the wider system that the artefact resides in. Indeed, I first became aware of this podcast and website after seeing a video they made in conjunction with Vox on Norman Doors, which are a classic example of poor design, that I have become somewhat obsessed with! The podcasts are short, entertaining, well produced and to the point, and are probably best described as a radio story or audio documentary. Well worth a listen.

Miscellaneous

Hidden Brain

(Access here)

I wasn’t quite sure how to categorise this one, so here it is in Miscellaneous. It was recommended to me by a friend from church but it’s definitely not a Christian podcast. And while a lot of the episodes are relevant to my job,  many are more relevant to other aspects of my life, and while some overlap both my faith and my work. Its primary focus is psychology with an emphasis on the “hidden”, unconscious aspects that have such a big impact on our behaviour and relationships. It’s well researched, entertaining, and has really made me think about the way we think.

Revisionist History

(Access here)

This one is from Malcolm Gladwell, the author of books such as Tipping Point, Blink and Outliers. It’s one I’ve only recently started listening to, and I’m slowly working my way through the back-catalogue. It’s well researched, and covers some very interesting topics from recent history, often with a different spin on them compared to the prevailing view. In a similar vein to 99% Invisible, it’s in the audio documentary genre, with Gladwell narrating and providing commentary with additional audio from interviews etc. Some are more relevant to my situation than others, but so far, they have all been interesting.

 

Sibling Rivalry

Image Credit: @KassiIsaac (http://kassiisaac.blogspot.com)

I’m sure I’m not the only one, but I’ve often thought of the relationship between my home country, Australia, and that of New Zealand as being much like that of brothers. This brotherhood stretches back more than 100 years before the more well-known voyage of James Cook, to that of Abel Tasman. He sighted Australia on the 24th of November, closely followed by  New Zealand on the 13th of December, in the year 1642. So Australia can claim the title of older brother by a mere 19 days, but we also have landmass and population (excluding sheep) on our side as well. You can also see the family resemblance just by looking at our near-identical national flags.

Fortunately, this fraternal relationship has always been a very close and loving one, particularly following the formation of the ANZAC Corps during World War I. It’s also reflected in many medical colleges and associations, including my own, the Australian and New Zealand College of Anaesthetists, as well as in numerous other strategic and cooperative partnerships between our two countries.

However, close family relationships are often characterised as much by their differences as their similarities. For example, we have our weird marsupials, while New Zealand has their weird birds. Then there’s the typical family behaviour of holding differing, unimportant, and strongly held opinions, such as who actually invented the lamington or the pavlova. As is often the case, this sibling rivalry is most evident on the sporting field. Here however the relationship has resembled the type where the bigger, stronger, older brother is frequently being outwitted and outshone by their smaller and more nimble younger brother, in much the same way that Jacob got the better of Esau. As the song goes “It’s just not fair, but I don’t care, as long as we beat New Zealand!“.

So, for example, the All Blacks have consistently had the upper hand over the Wallabies, and while the Socceroos have generally had the measure of the All Whites, New Zealand had the unusual honour of being the only undefeated team at the 2010 FIFA World Cup! Similarly, in cricket, we have generally been able to keep New Zealand in their place, but unfortunately, we’ve needed to resort to, quite literally, underhanded techniques to maintain our dominance at times.

As well as bad sportsmanship, we often resort to other classic big brother tactics like teasing with endless sheep jokes (even though we have more sheep than they do), mocking their accent, and attempting to steal their celebrities.

This habit of being shown up by our younger brother is apparent in other areas too. You only need to look at the state of politics in the two nations in recent years, and our respective responses to refugees, and you can see what I mean. And while they live in our much larger shadow when travelling abroad, and are constantly mistaken for Australians, even here they seem to have the upper hand when it comes to our unique vernaculars, where “New Zild” tends to outperform “Strine”. Strayans are often the laughing stock of the world because we keep showing off our” thongs” in public, while the Kiwis are wearing the much more sensibly named “jandal”. We have the potentially offensive “esky”, while they have the much more obvious “chilly bin”. Furthermore despite its Maori warrior roots, New Zealand has become a decidedly peaceful, almost pacifistic nation, with a strong anti-nuclear policy, and the Royal New Zealand Airforce going so far as to retire its entire fleet of attack aircraft, knowing full well that big brother will bail them out if they get into trouble, because that’s what big brothers do.

And indeed we have. When Christchurch was shaken by natural rather than military forces in the 2011 earthquake, our response was quick. More akin to Jacob and Esau’s reunification rather than their parting. Perhaps the response and the philadelphia that prompted it, is best summed up by the story of a Kiwi anaesthetist on his day-off, and an Australian surgeon 1 attending the Annual Scientific Meeting for the Urological Society of Australia and New Zealand, working together in horrible conditions, to save the life of a man trapped in the rubble by amputating both his legs.

So, just as any brother would be, I was shocked when I first started hearing reports coming out of Christchurch about the terrorist shootings. It was tragically fitting that the first I heard of it was from a Kiwi anaesthetist now living in Australia. These kinds of brutal shootings are bad enough at the best of times, but they hit that much harder when they are close to home, both geographically and emotionally. It really did feel like an attack on a family member.

Can you imagine my horror then, at hearing the news that the perpetrator was Australian? Yet more tragic were the final words of the first victim as he saw the terrorist approaching: “Hello, brother.” Our long brotherly relationship had taken a tragic detour. Away from the niggling, banter-filled, comparatively benign narrative of Jacob and Esau, and back to the much more brutal and primitive narrative of Cain and Abel. Through the heinous actions of one man, we, as a nation, now have blood on our hands. We will forever bear the mark of Cain.

I’m sorry that we have done this to you. The lone terrorist needs to be dealt with to the full extent of the law, but we shouldn’t comfort ourselves that this is a one-off aberration, and won’t happen again. It seems the racism and xenophobia that we’ve been struggling and often failing, to get under control for over 200 years, has yet again reared its ugly head. Not content with damaging those on our own shores, it has now crossed our beloved “dutch” and caused irreparable harm to our closest family member.

We can’t blame you if you point the finger at us, the same way we point the finger at other countries that breed terrorists. This will likely change our relationship with you forever. What that change looks like long term is largely up to us. There were some good early signs. Volunteers from Australia have flown to New Zealand to help out with burial rituals. Others not so good. One in particular, shamefully from a member of the Australian parliament no less, was particularly atrocious. But many other politicians and media personalities have a long history of, both implicitly and explicitly, promoting the kind of xenophobia that breeds the conditions and context that allows individuals such as the Christchurch terrorist to be created, nurtured, and released on an unsuspecting public. The contrast in responses from our  Prime Ministers couldn’t be starker. You are outdoing us yet again, even in this time of deep tragedy, where you could be forgiven for letting loose on us.

We, as a nation, and as the individuals making up this nation, need to do better. On that proviso, I hope and pray, that one day you, as a nation, and as the individuals that make up that nation, will be able to forgive us, in a similar vein to Joseph ultimately forgiving his older brothers for the wrong they had done to him. I’m also hopeful that by working through and dealing with the conditions that lead to it, and helping you to heal from its terrible aftermath, that maybe our brotherly bond can come out the other side stronger than when it went in. There is still the option within the Australian Consitution for you to become the seventh state of the Commonwealth of Australia. Part of your refusal to join when first given the opportunity were concerns around our treatment of Aborigines. Sadly, some things haven’t changed. Perhaps it’s time we should start looking at becoming the West Island of New Zealand instead.

Sorting the #DudScrubs Laundry

This is where I’ll be picking my way through all the dirty #DudScrubs laundry. Tighten those side-ties, because there’s a lot to get through!

For an explanation of what #DudScrubs is all about, read my more detailed post on it here.

Below I’ve started organising the various tweets into different categories to make them easier to find, and because different aspects may be of more interest or importance to different people. But I think it is the overall picture that makes the case for change so compelling, and that hospitals need to sit up, take notice, and start asking their staff what they can do to make their scrub provisioning system more fit-for-purpose.

Many tweets fall into multiple categories, so that’s why there is some duplication. Also this list will continue to grow and evolve over time. Please let me know if anything is mis-categorised, or if you have suggestions on for the blog posts or the campaign itself.

If you would like to contribute anonymously, you can email me at drgetafixthedruid@gmail.com, or send a Direct Message via Twitter to @DrGetafix @emergency_CNS, @GongGasGirl or @ketaminh. It will be de-identified and posted for you.

#DudScrubs

Unavailable

Unsuitable

Unprofessional

Thin and revealing scrubs, which leave little to the imagination do not project a professional image to staff, patients and visitors

 

Similarly with poorly fitting scrubs

 

I’m not sure staff getting around wearing paper uniforms is a great look either.

 

Visitors and families also have to put up with them. This negatively affects the publics perception of the hospital

Unfit for Purpose

The number, style and location of pockets are important considerations in terms of the functionality of scrubs

 

A system for the provision of scrubs should be designed in a way that makes it easier for staff to do the right thing, not harder. It definitely should not make staff late for work!

 

And to be effective, it needs to designed with reference to the population it is serving. This includes staff, including pregnant staff, patients, family and visitors

 

Uncomfortable

Unsafe

Patients

Many of the workarounds staff use to maintain modesty have the potential to damage the scrubs, or interfere with their laundering. These in turn can reduce their effectiveness as a means of reducing surgical site infection.

Staff

Being a mandatory uniform, integral to our work, they should be managed like other WH&S issues, and ensure they are not jeopardising  our health. Both physical

 

And mental

Hospital Responses

 

Staff Responses

 

#ToitScrubs

Suggestions for Improvement

It’s Time to #ScrubOut #DudScrubs

An unavoidable part of working in operating theatres is the requirement to wear what is formally known as “Perioperative Attire”, but casually known as “scrubs”. While the term “scrubs” is now used to refer to similar clothing worn anywhere in the hospital, the primary purpose of theatre scrubs is to reduce the introduction of environmental pathogens into the theatre environment, thereby reducing  the incidence of surgical site infections. Most hospitals require staff to wear scrubs supplied and laundered by the hospital. So essentially, scrubs are a mandatory workplace uniform, supplied by the hospital, to be worn by staff to improve patient outcomes.

You would expect therefore, like uniforms in other safety critical industries, that appropriate time, attention, and cost would be expended in order to ensure that scrubs were fit-for-purpose and available when necessary. Furthermore, along with staff, equipment, medications, regulations etc, scrubs form part of a complex system of patient care. Therefore scrubs need to interact with other elements of the system, especially the staff wearing them, in such a way “to optimise human (staff and patient) well-being and overall system performance”. Unfortunately, a lot of the time, this is not the case. Continue reading “It’s Time to #ScrubOut #DudScrubs”

Day-to-Day Living in Suva c.2012

I spent three months at the end of 2012 working in Suva, Fiji as the ASA Pacific Fellow, which was a position they created and funded in order to help prepare anaesthetic trainees for their exams. At the end of the stay I wrote a short piece describing some of the practical aspects of living there with my young family, in case it proved helpful to other Fellows that came after me. I thought I’d re-post here for similar reasons, but also as an historical snapshot as a significant part of my medical career that has had a lasting impact on me and my family. Fiji is a strategic hub for training doctors working all around the South Pacific, so if you get the chance to contribute in some way, I highly recommend you do.

Continue reading “Day-to-Day Living in Suva c.2012”

A Purple Patch for a Power Problem

Part of my job as an Anaesthesia Quality and Safety Fellow is to monitor reports made though our Anaesthesia Safety Monitoring Project, which allows staff to report latent safety threats, near-misses, faulty or badly designed equipment and pretty much anything that might pose a threat to patient safety. Below is the text of a “Letter to the Editor” that I wrote explaining how we were able to quickly and cheaply respond to an issue highlighted by one of these reports. The letter was published in the Canadian Journal of Anesthesia, and it can be accessed here (login required) or viewed online here by anyone.

Continue reading “A Purple Patch for a Power Problem”

Vale Professor Geoff Cutfield

I was deeply saddened to hear of the passing of Professor Geoff Cutfield earlier this year. He’s had a lasting impact on me as a doctor, anaesthetist and a  human being. Following his death, people who were unable to make the funeral in New Zealand were given the opportunity to provide something to be read out at the service to help celebrate the phenomenal life he lead. Below is my contribution to that celebration.

Continue reading “Vale Professor Geoff Cutfield”

The (Often Painful) Way of Wisdom

I recently started the fantastic daily devotional book on Proverbs, “The Way of Wisdom”, by Tim & Kathy Keller. It’s full of little nuggets on wisdom and the messy reality of living in a fallen world, but a recent experience with it had quite a big impact on me, and definitely wised me up!

It followed on from the reading nominally set for January 21st, which was about

wisdom com[ing] not through acquisition of knowledge, but through long experience and reflection.

and how we can’t develop good habits, wisdom and resilience overnight if we are suddenly faced with a major crisis. But it was a quote from John Newton that struck me particularly hard.

“The grace of God is as necessary to create a right temper … on the breaking of a china plate as on the death of an only son.”

It helped me to see the role that “trivial evil”, as William Lane Craig refers to it here, can play in helping to shape our character over time, in order to better deal with less trivial evil and suffering. For a long time, similar to Craig, I could see the theoretical possibility for God to act and bring about his purposes through big events where people are forced to ask questions about life, the universe and everything. However I found myself getting quite frustrated, and angry even, when trying to work out why it would be part of God’s good plan to have me stub my toe, or spill my coffee in my lap just after getting dressed for work. But this reading, and the quote from Newton in particular, made me realise that if I couldn’t contain my temper, show self-control, and trust God in these small things, what hope did I have when I was inevitably confronted with the big things!?

So after reading this, I resolved, and asked for God’s help, to do better and trust him when confronted with “trivial evil” and other minor setbacks that I’ve tended to blow out of proportion in the past. Interestingly, I was presented with an opportunity later that day to do just that! I had a meeting at work in the afternoon, but it was only as I approached the hospital that I realised I had timed my arrival to coincide with the overlap between the morning and afternoon nursing shifts. This means the afternoon staff had arrived, but the morning staff were yet to leave, and generally means it’s nigh on impossible to get a park. Going on past experience, it was likely to make me late for my meeting. Usually when this happens, I have a tendency to curse and swear, and drive aggressively looking for any spots that become vacant. The longer it takes to find a park, the angrier I gets, and I often have to park a fair way from my intended destination and then get angrier still on a longer than expected walk, which makes me later still!

But this time, with the lesson from Proverbs, Newton & Keller fresh in my mind I took a deep breath, prayed quietly, & acknowledged that this situation was certainly trivial, didn’t really qualify as evil, and asked for God’s help to remain calm and drive safely while waiting for a spot to become available. Can you imagine my surprise then, when within 30 seconds of entering the carpark, a car pulled out of their spot, and I was able  to calmly make the short walk to my meeting with plenty of time to spare!

It would be easy for non-believers to just pass this off as a coincidence, and praying for parking is often the butt of jokes regarding Christianity. But I didn’t actually pray for a parking spot, and this “coincidence” of God’s small mercies in the face of trivial evil following hot on the heels of what I’d read just that morning provides further evidence to me that God is faithful, and worthy of our trust.

The Problem with Miracle Cancer Cures

Having just started my fifth antibody based medication, this one to try and get on top of my auto-immune colitis, I’m acutely aware of the various tensions, conflicts and ethical dilemmas raised in this article. My melanoma, while not completely gone, has been well controlled by the immunotherapy I received. The main story for me in recent years has been managing the side-effects of the immunotherapy as well as the multiude of medical appointments, blood-tests, scans and so on. But it has taken me from seriously considering palliative care having been given a median survival of 3-4 months, to being back at work part-time some 5 years later. Fortunately, as I am part of clincial trial, combined with Medicare and private health insurance, my out of pocket costs have been manageable. But as these expensive interventions become mainstream, and cancer is increasingly converted from a death sentence into a chronic disease, there will be serious challenges ahead for the health budget, of both governments and individuals.

Opinion | The Problem With Miracle Cancer Cures

Opinion | The Problem With Miracle Cancer Cures

If immunotherapy worked most of the time, this would be an unambiguously happy story. But it doesn’t.

Source: www.nytimes.com/2018/04/19/opinion/sunday/problem-miracle-cancer-cures.html