The wee feeling of the small hours

Being, well, a doctor has its perks and the working hours do not contribute to them. A night with little or no sleep is not unknown to other people, and yet there is something distressingly exhausting about living at the whim of outside pacemakers only. Like now, when I am in the hospital at 6:00, unplugging somebody's nefrostomie tube that just might have waited another day. Oh well.

Anal Zen Master

Part of my workings as a resident include attending formalized and not-so formalized teaching sessions. One of which, lo and behold, just took place and included divers subjects relating to male and female pelvic problems. Urology clinics are regularly consulted by people of either sex with vague abdominal/pelvic/genital complaints that are bothering them very much, yet defy any and all regular attempts of classification. Some urologists call it pelvic pain syndrome, prostatodynia, prostatism, chronic prostatitis, chronic epidymitis, chronic urethritis, and so on and so on. Very difficult (=impossible) to cure, but friendly listening, non-steroids and physiotherapy sometimes do the trick (=alleviate).

Anyway, during that course I followed during the last couple of days a fysiotherapist talked about her experiences with this particular group of patients and how to treat them with her methods....

These methods include a rectal probe that tells the resting tonus (=tension) of the pelvic floor to and how to influence them using progressive relaxation techniques.

As part of the teachings, a patient had the guts to serve as a demo case.

So there we are, a close-knit group of eight doctors and the fysiotherapist, in a congress room in a hotel in Rotterdam, and a dude with a rectal probe (pants on, just some lose wires dangeling from his jeans). Guy lies down and the fysiotherapist gives directions, tighten up, loosen up, do a mid-intensity contraction. He did it all the way he was supposed to. What a body control, the pelvic tension was depictured using biometric graph (ordinate was microvolts, abcisse was time, for the scientifically inclined :)). He was even able to trace simple patterns using biometrics (drawing an elephant's silhouette was certainly possible).

He was the Anal Zen Master

Post-test

The Dutch Urology In-Service exam is behind me. For this year. I could have studied more, that's a truism, but I really could have. Now I have to prepare a presentation on male infertility, out of the book, Campbell's Urology. Urology bible. I keep being distracted by other things (tm), such as this blog and computer games and this cool soundtracksite. My girlfriend Jantina is off for late shifts on the cardiothoracic ward and I am just hanging out by myself. The presentation doesn't progress as it should. Oh well. Today we went for lunch to my future (?) in-laws, more about that some other time. Off to more about the varicocele.

Outlook Fighter

I have been promoted - sort of. Well, my job description has been broadened. Actually, I haven't been promoted at all, it's just that one of my bosses indefintely got rid of one of his jobs by making me do it. So here it goes: Operations need to be planned. Who gets operated on when, especially important in the Dutch managed care system and especially undesirable job to have (patients calling, angrily, why the hell it takes so long before it's their turn). Anyway. My predecessor at this task used Excel to make three to four different lists to allocate time spent in different ORs with different staff and different equipment, and I plan on doing it the better, faster, cleaner, cooler way - with Outlook. Brings me to which: the spreadsheet creation routine of Outlook - brings me to - hours and hours of wasted time, trying to create a spreadsheet that works. Oh well. Back to Excel.....

Clinics of Dwarfs

I am in clinics, catching a moment of respite. Centralizing patients creates something odd - a waiting room full of malformed dwarfs where I, the healthy doctor, am strangely out of place.

Blood on my pants

Today was a good, yet exhausting day. I did five surgical procedures involving lots of blood and even more water - like, 30 liters (yeah, metric) of it per procedure. Most surgeries were pretty difficult and taxed me to the limit. The way it works is that there's this old(er) guy standing behind me (groaning and moaning, generally heckling me), and whenever it is that I either do something really stupid (which hasn't happened lately) or just feel for myself that I've gotten in over my head (which happens regularly), he takes over (since he's been doing this procedures for, what, 20 years). 'This old guy' of course, is my supervisor/mentor/boss. That's the way it goes in post-grad medical education, all this modern talking about how fine scientific medicine has gotten etc., somebody has to teach you the surgical craft.

This is one of the aspects that I like best about my job - I am getting paid to improve. Incredible.

Anyway. I ended the surgeries of today with reasonable success- and a gargatuan stain of someone elses's blood on my pants. More stain than pants. I looked like a butcher.

Which was weird to realize.

The American Telephone

I am a subsriber of Urology Clinics of North America. Very professional journal that I will never ever ever publish in (not that I am much of a publisher, medically speaking). Anyway, the subscription has expired and I get billed for renewal. The Clinics (as it is called by the connoisseur) get delivered quartely (makes four small books annually) and they cost 135 $ per year. Discounted rate. The undiscounted rate was billed, and so I call to enquire about the discount (I am a resident and don't want to pay 270 $ for FOUR magazine, 135 is crazy already, mind u). There I am, calling a person at the other end of the world who answers the phone in the most friendly way imaginable, introducing herself as Nadine and I, intuitively, introduce myself by my first name. Two things now: I like her voice, and recent research has pointed out that a woman's voice truly reflects her sexual attraction. Ahem. Hers is very sensual. Second, a lot can be said against Americans, but oh, it is so very very nice to do business with people who speak with a kind word......

The first set

And there you have it. Which was, incidentally, the end from an ancient rapsong called, ahem, "The Art of Sucking Dick", artist forgotten. Which it might better be, anyway.
This, however, you have. The first of a series of stunning and-not-so stunning tales, medical and otherwise, from my life, that outsiders and healthprofessionals alike could describe as sedantary (is that the word ? I am sitting a lot, that is).

Auscultation marks

I am studying for the Dutch Urology Board Exam. It is due in three weeks, and I already spent a fair amount of time on leisurely reading. Now comes a phase of cramming - reading it over and over again until you can't stomach it any more. However, this gives rise to weird creativity. Some time ago, in an aged lecture-hall in London, GB, a faint student scribbling on the desk read "Hit me with your stethoscope until the auscultation marks bleed".