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

Am enchanted by the recent cartoons on at the cinema- coraline (although despite recurrent attempts I never made it to that particular movie), Up (Low expectations, but wonderful amimation and brillient storyline), and Ponyo (So innocent and wistful.. A twist on the traditional little mermaid storyline).
All were optimistic, and hopeful.
This tea cup is in a similar theme... from Sweden! A birthday gift from a beautiful friend who is similarly minded about mythical worlds and nostalgia.
Having said that, I'm looking forward to Spike Jonze's Where the Wild Things Are. Although how he extends a 8 sentence picture book into a 1.5 hour movie remains to be seen..

My Sprouting Basil!

Resolutions for when I turn 27 (in a couple of days time):
Learn something new everyday;
Find patience with people and myself;
Complete things you start;
Live healthier.

Kind of typical, but things I should be working on to be happier in myself I guess.

$3000 owed to the tax office?! *cries*

Why do i have to pay back almost a month's salary for tax?

Maybe I should hope to win the lottery for my birthday... Or meet a beneficiary..

Last night shift for the year today!
Wheeeee!!

Thinking about living healthier. Mostly because my dad recently went through a heart attack- the most dreaded of medical afflictions in our population these days. He is only 58, and doesn't smoke, doesn't drink, isn't obese. It's made me realise that we are not invincible, and perhaps this thought marks the transition from youth to adult. Suddenly I realised that life does have an expiry date, that parents cannot look after me forever, and that they too require help.
And now it was time for me to look after my parents. What a role reversal.

So now, i've got a "family history of heart attacks" and cancer. And there is a guilt weighing in my head about regular exercise and decent diet. These things are so essential, but difficult to integrate into my life because of my irregular shift work hours..

But yesterday, the Sydney half marathon was on. We were flooded by young "fit" people in our emergency department. Most were young 30-40 somethings who hadn't trained for the event, and subsequantly had dehydration, loss of consciousness, acute renal failure, and even seizures.

Binge exercise.
Like binge drinking/ Binge partying /Binge smoking- does more harm than people think.

Which got me thinking that I should start exercise, but slowly and in moderation. Just have to find the time to do it.