An (almost) country practice...

As many of you know, I've just started my general practice rotation, which will be my final rotation as a medical student - if God wills, I'll be having exams after that and graduating at the end of this year! This is just a few short paragraphs I wrote about my first week at the practice, which I hope you find interesting!

I'm doing my rotation down in Mornington, about 50km from the city, a really beautiful area by the beach! The bright sunshine and the lazy pace of this beachside community are both reflected in the sunny, relaxed disposition of the staff at the clinic. Such a refreshing change from the early starts and rush of the city hospitals!

At this clinic, a stone's throw from the neighbouring Bays Hospital, there are six senior GPs and two registrars, four nurses, many friendly faces at the front desk, and many others behind the scenes. They service predominantly an elderly population, mostly of upper class, who come in with all sorts of complaints from the common ear niggle to frustratingly difficult-to-treat generalised pains. I recall a patient, thirty-something male, all neatly outfitted in a business suit, looking like he dropped in on his way to work. He complained of an occasional twinge in the ear. Cursory examination found no source of inflammation or focal lesion, and it was hardly distressing for him. The GP prescribed some drops for the ear, but other than that, the consultation was over within two minutes or so. The patient continued on his way to work. In stark contrast, another patient was a most interesting fifty-something man who looked more like eighty. He had so many medications, and a list of past history that filled the page, the sort of patient you would expect would require, at minimum, low level care. With profound weakness in all four limbs due to severe injury and deformity of his cervical spine, secondary to lesions of neurofibromatosis and steroid-induced osteoporosis (he also had a history of Crohn's disease), it was a wonder he could maintain any degree of independent mobility. But with his scooter and stick, he made his way around Mornington, and gets by with assistance from his daughter at home. The variety certainly keeps one guessing and interested in the job, from both the medical and psychosocial perspectives.

The nurses run the theatre, a small, three-bed room, reminiscent of a rural emergency department. Here, they and the doctors do (and provide me with opportunities to see and do) minor procedures, dressings, triage assessments, administration of injections (e.g. intramuscular, intra-articular) including immunisations, nebulisers and so on. Sometimes, I am allocated the third bed (which is in the room next door) to see patients by myself, which is a helpful exercise. This is also the place to catch up with the up-to-the-minute news of what transpires in the lives of each of the practitioners and their families! One of the doctors' rabbits had a baptism of fire - brought home from the shop, that night it escaped its pen and was mauled by the dogs. Poor rabbit, still battling to survive several days on. Not even the new medical student is exempt from ending up in the gossip channels. Most of them knew my name before I saw them, and rapidly found out about me having been to the same school as many of their children, my upcoming concerts, about my relationship, and about my planned trip to Canada! I think I should be careful what I let out of the bag.

The practice does mostly private billing, but bulk bills certain patients. It is good to see the doctors doing what they can to ensure that patients pay no more than they should, especially with regard to drugs and so on. I've learnt a lot simply through observing their discussions with patients about drug choice. It's easy to forget the financial burden of pharmaceuticals in the clinical setting sometimes.

Women's health day (Tuesday) was difficult for me, as a male medical student, with most of the women opting that I be excluded from their consultation. It's fair enough, of course. I don't plan on being an obstetrician or gynaecologist anyhow, but one of the female doctors with a special interest in women's health was kind enough to give myself and the registrars a tutorial ensuring that our pap smear technique is still competent.

One of the more surprising, but heartwarming, aspects of the practice was home visits (in addition to district nursing). My GP supervisor takes two or three half-days each week to drive around (in his huge four-wheel-drive, but it's necessary for getting around some bits of the region) and call on patients in their houses. He has some regulars, and some who need more intense follow-up at home after a visit to the hospital, or after a disease flare. Patients with mobility problems are given priority. Most home visits are unremarkable medically, mostly a brief "how are things going?", systems review, and filling prescriptions. But when I see these people in their natural habitat, I am provided with a wealth of information beyond what I would get in a consulting room. The fact that their house looks tidy, and doesn't smell, means they are really keeping quite well. And I get to see the luxury of many of the Mornington residents!

Enough babble from me. I never really gave GP much of a thought before. But this rotation, it's really growing on me. It has, in many ways, restored in me a faith in medicine (and the medical system) by showing me a more human side of the profession. I am refreshed to see doctors really connecting with and caring for their patients, and enjoying it too. I am thoroughly looking forward to the remainder of these five weeks!

Imitation of Christ

I discovered this unassuming little book in my local library about a week ago, marked with the appealing and familiar title "The Imitation of Christ", by the saint Thomas à Kempis (1380-1471). So I began reading. What a consuming work! What devotion a man can have to God! Its truth written so simply, yet so passionately, it draws one into intimate understanding of the relationship the author has with Christ, and his amazing joy and longing for the Kingdom of God.

There is one bit I'd like to share, on the nature of God's transforming love.

From "The Imitation of Christ" - Book 3 On Inward Consolation, Chapter 5 On the Wonderful Effect of Divine Love

Love is a mighty power, a great and complete good; Love alone lightens every burden, and makes the rough places smooth. It bears every hardship as though it were nothing, and renders all bitterness sweet and acceptable. The love of Jesus is noble, and inspires us to great deeds; it moves us always to desire perfection. Love aspires to high things, and is held back by nothing base. Love longs to be free, a stranger to every worldly desire, lest its inner vision become dimmed, and lest worldly self-interest hinder it or ill-fortune cast it down. Nothing is sweeter than love, nothing stronger, nothing higher, nothing wider, nothing more pleasant, nothing fuller or better in heaven or earth; for love is born of God (1 John 4:7), and can rest only in God, above all created things.

Love flies, runs, and leaps for joy; it is free and unrestrained. Love gives all for all, resting in One who is highest above all things, from whom every good flows and proceeds. Love does not regard the gifts, but turns to the Giver of all good gifts. Love knows no limits, but ardently transcends all bounds. Love feels no burden, takes no account of toil, attempts things beyond its strength; love sees nothing as impossible, for it feels able to achieve all things. Love therefore does great things; it is strange and effective; while he who lacks love faints and fails.

Love is watchful, and while resting, never sleeps; weary, it is never exhausted; imprisoned, it is never in bonds; alarmed, it is never afraid; like a living flame and a burning torch, it surges upward and surely surmounts every obstacle. Whoever loves God knows well the sound of His voice. A loud cry in the ears of God is that burning love of the soul which exclaims, "My God and my love, You are all mine, and I am yours."

Thanks and praise to our God, who is love! I found a site at which can be found the whole book, for anyone who wants to read bits online.

God bless!

Sickness...

I've caught the bug that's going around, so it seems. Fevers, sweats, cough and yucky mouth, muscle aches and pains, lethargy and weakness. It really only set in today, but I'm feeling a fair bit better through taking some rest and paracetamol. At the moment I'm taking a break from sleeping. ;p

Yay, Sally's back in Melbourne, since about a week and a half ago! It's been a while since last blog. I wonder why my motivation for blogging has dried up over time? I don't seem to be blogging anywhere near as frequently as I used to. But then again, I didn't always use to have such early starts, and I didn't use to have my timesink online game (utopia), so I probably used to have much more time to write!

Anyhow, utopia-wise, the current age is ending, so not spending as much time on it as I did a few weeks ago. We've just come out of hostile relations with another kingdom, and our province was absolutely shafted! We were being singled out as a target, and I made some silly errors of judgment that didn't help. I suppose, given the new ceasefire, we can now concentrate our efforts on destroying the dragon that ravages our kingdom. But for how long? I suppose it'll be over soon. And then we can begin a fresh start. Hopefully next age, we'll be controlling separate provinces within the same kingdom, which will be good for cooperation!

Real-life-wise, am doing my final week of surgical block! I'm with the trauma team, which means I see patients all the time who are not that different to myself (young, fit, healthy, no medical issues), and they come in with some horrific injuries from car and motorcycle accidents. It's a stark reminder just how vulnerable we are, and that anything can happen at any time! People mostly think of broken bones with trauma, but blunt injury to the abdomen caused by deceleration against an improperly worn seatbelt was what led to probably the most striking images I saw in operating theatre. The patient had been complaining of increasing abdominal pain, about a day after the accident. The day before, he'd had an arm fracture reduced and fixed, but the doctors became concerned about peritonitis with the abdominal x-ray showing subdiaphragmatic free gas. So he was taken to theatre for an exploratory laparotomy, and as soon as they opened the belly, there was the most dramatic rush of fluid and bubbles spilling out of the incision, and the nasogastric tube drew back a flood of foul black fluid, decompressing the stomach. Food seems to be a favourite for medical analogies - it was like a boiling pot under high pressure, and suddenly removing the lid, sending bubbles and liquid all over the kitchen floor. Today though, I arranged this guy's discharge from hospital, and he's probably now at home back to most of his daily routine, apart from just a bit of abdominal and arm soreness!

Anyhow, I'll probably be off now. Should get back to sleeping - I hope to be back to full functioning myself quickly. ;p Well, I'll sleep soonish. And sleep in tomorrow. Hopefully, armed with paracetamol, will be back to normal within a few days! Will leave with this passage from Philippians 4, on which we had a sermon on Sunday. When we feel snowed under with many tasks and worries, whether they be within or out of our control, and our troubles seem insurmountable, remember to cast all your anxieties upon Jesus Christ our Saviour, in whom we trust. God bless!

"Rejoice in the Lord always. I will say it again: Rejoice! Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.

"Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. Whatever you have learned or received or heard from me, or seen in me—put it into practice. And the God of peace will be with you.

"I rejoice greatly in the Lord that at last you have renewed your concern for me. Indeed, you have been concerned, but you had no opportunity to show it. I am not saying this because I am in need, for I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through him who gives me strength." - Philippians 4:4-13