This is one of those days which make you wish you were less adult and more childlike.
Akin to those days where warranties lapse and everything breaks down.

Where's my reset button?

Things I've thought about lately that are making me rethink my strategy on life-
It's easier not to do the right thing.
Yes, it's true.
Take having the "you're taking too much pain medication" talk.
Patients have spent the past 3-4 weeks taking pretty hard core pain medication after surgery. They have built a tolerance and (some might argue) addiction to pain medication. It's time to wean them off.

It is easier for me to write them a script for their medication and avoid talking to them.

Instead, I spend 15 (often painful) minutes telling them why they should cut down, and attempting to start the opioid weaning process prior to discharge. Rarely I get the "that's cool doctor go ahead" response. A majority of patients are defensive and anxious- "you think i'm a junkie", "You don't believe that i'm in pain", "i've been having this dose and I'm sticking with it!" "Can't you give me more than that doctor??! What am i going to do when they run out?"
It's easier to just do what they want, continue with the routine, not shake the boat.


In my own life, I hope I have learnt from my frustrating times at work, but lately I've noticed the same corroding behaviour influencing my choices. Easier to stay in this simple (yet limitlessly annoying, frustrating and vapid) job. Easier to stay within the same circle of people talking about the same subjects. Easier not to go to the gym! eep!

Time to have that annoying talk with myself..

I haven't read or seen the movie 'How Stella got her groove back' .. But I feel like I need to, or at least, find out how the groove was found. Although if it involves finding some male counterpart soul mate who miraculously loves her for who she is - the end-, then I might just give it a miss.

Despite the rain, the sky intermittenly shines with such drama. This was on the way back from Cockatoo Island last weekend.
P.s. My basil 8 months later- A study of survival of the fittest:
I had about 20 basil sprouts in January, and this has been wittled down to 5. I'm quite proud of how they have grown.

I wonder if they realise they are separated by a thin wall of chipboard??

I am really uneasy with the decision my boss made for a patient today..
1- Because there have been scant medical investigations done prior to diagnosis.
2- Because the patients behaviour was unconductive to more invasive investigation.
3- Because the decision- I feel- has been pushed by nursing staff.
My boss was bullied!!

The scenario was this:
Patient with locally invasive bladder cancer comes in with difficult to control pain. We titrate her pain medication up with morphine. The pain seems to be from her back. We query whether it's due to spinal cord invasion due to her cancer. We get an MRI and that's normal. Meanwhile we start ketamine.
She gets acutely confused, delirious, and aggressive- throwing chairs at staff for example.
We think maybe this confusion might be her drugs- so we wean down her pain relief and stop the ketamine.
Still not better.
We think infection, but no sources found anywhere and she hasn't been feverish.
Meanwhile nursing staff are asking for midazolam to sedate her.
A few days pass. Still no answers for her difficult to manage aggression and confusion.
The nurse manager asks us for a continual infusion of midazolam in order to save money getting a one-on-one nurse for the patient to prevent her from harming herself.
We say we would like to investigate the reason behind her delirium instead of drugging her!
And also there's a known 'paradoxical' effect with benzodiazepines which might provoke aggitation..
The following day, the nurse manager again asks for a continuous infusion of m's idazolam.
It was then that my boss came up with a diagnosis- encephalitis caused by a paraneoplastic syndrome from her cancer.
Conveniently there is no cure- it only gets worse and she is started on a midazolam infusion.


People might think that doctors run the show in hospitals, but like the tooth fairy, it's all a convenient myth.
The real ones in power are nursing staff. And sometimes that's a good thing- when good nurses are around and have sound clinical knowledge coupled with great knowledge of the patient. Sometimes it's bad due to the opposite.
A lot of this isn't particularly interesting, but it's the first time i've actually doubted my bosses decisions! Hmm